Communication and Interprofessional Collaboration in Primary Care: From Ideal to Reality in Practice

Extending Integration: Interventions Supporting Communication and Collaboration Between Patients with Neurological Diseases, Their Informal Caregivers and Healthcare Staff - a Scoping Review

Introduction

Addressing challenges due to demographic changes and the quest for improved value in healthcare requires an extended integrated approach to care that fosters collaboration between all stakeholders, especially within collaboration supporting cognitively impaired patients. The aim is to review existing studies on interventions to improve communication and collaboration between such patients, their caregivers and healthcare staff.

Methods

Following PRISMA guidelines, we systematically searched electronic databases Medline (OVID), CINAHL (Ebsco), and Web of Science (Clarivate) for peer-reviewed literature [2010-2020] focusing on intervention studies. Papers were excluded if not assessing the impact of interventions or only presenting a study protocol.

Results

Twelve studies explored diverse approaches to social support, all with the aim of improving communication and collaboration among stakeholders, and identified three intervention types: supporting empowerment, promoting collaborative disease management, and coping, and enhancing communication and relationships.

Discussion

The interventions employed various approaches and assessed a range of outcomes, demonstrating the benefits of enhancing communication and collaboration among stakeholders. Yet only a few studies included the full triad of partners in care.

Conclusion

There is still much to be done to achieve the extended integration of care services and support that will benefit from patient and caregiver involvement.

Negotiating care in organizational borderlands: a grounded theory of inter-organizational collaboration in coordination of care

BACKGROUND

Although coordination of care and integrated care models aim to enhance patient satisfaction and perceived care quality, evidence regarding their practical implementation remains scarce. Understanding the nuances of collaboration across care providers to achieve effective coordination of care is imperative for seamless care integration. The aim of this study was to construct a grounded theory of how inter-organizational collaboration is performed to support coordination of care for patients with complex care needs.

METHODS

A qualitative design with a constructivist grounded theory approach was applied. In total, 86 participants with diverse backgrounds were recruited across multiple care settings, including hospitals, ambulance services, primary care centers, municipal home healthcare and home care services. The grounded theory was developed iteratively, based on a combination of observations and interviews, and using constant comparative analysis.

RESULTS

Coordination of care, a complex process that occurs across interconnected healthcare organizations, is manifested as "Negotiating care in organizational borderlands." Care coordination evolves through a spectrum of inter-organizational collaboration, ranging from "Dividing care by disease-specific expertise" to "Establishing paths for collaboration" and ultimately "Co-constructing a comprehensive whole." These categories highlight the challenges of coordinating care across both professional and organizational boundaries. In the multifaceted healthcare landscape, effective care coordination occurs when healthcare professionals actively bridge the divides, leveraging their collective expertise. Importantly, organizational boundaries may serve a purpose and should not be dissolved to facilitate effective care coordination.

CONCLUSIONS

The key to effective care coordination lies in robust inter-organizational collaboration. Even when patients receive integrated care, healthcare professionals may have fragmented roles. This research emphasizes the importance of clearly defined lines of accountability, reinforcing mutual responsibility and facilitating bridging of professional and organizational boundaries. Healthcare professionals and policymakers can use these insights to effectively utilize inter-organizational collaboration in supporting care coordination for patients with complex care needs.

Using digital communication tools to improve interprofessional collaboration and satisfaction in a student-run free clinic

BACKGROUND

Interprofessional collaboration can improve the quality of care in complex health conditions often seen in underserved populations. Communication is key to effective collaboration, and digital communication tools can enhance information sharing, collaboration, and satisfaction between professionals, especially when teams are distanced.

LOCAL PROBLEM

In a semirural student-run free clinic that provides care to uninsured and underinsured patients with multifaceted health issues, there is a gap in communication and collaboration across interprofessional teams because of the frequent rotation of various staff, part-time hours, and electronic health record (EHR) function and interoperability limitations.

METHODS

The aim of this nurse practitioner-led quality improvement project was to determine whether implementing digital communication tools could enhance communication and improve provider collaboration and satisfaction during clinical decision-making among the several interprofessional teams at the student-run free clinic.

INTERVENTIONS

Digital communication tools were implemented in a two-part intervention: (1) virtual case conferences to discuss patient care plans and (2) an EHR-linked tool to document the care plans.

RESULTS

Survey evaluation across six virtual case conferences found above-average ratings for collaboration, satisfaction, and usability of the EHR-linked tool. There was a 15.78% improvement in global collaboration from the first to third conference, with a sustained improvement of 11.49%. Satisfaction improved by 4.62% from the first to the fourth conference.

CONCLUSION

Digital communication tools can facilitate efficient communication and collaboration among staff while providing a more streamlined approach to patient care. These technologies can be useful in similar settings, especially when teams are distanced.

A Social Capital Perspective on Social-Medical Collaboration in Community End-of-Life Care in Hong Kong

Recent developments in Hong Kong end-of-life (EOL) care have shifted some caring work for dying people and their families to cross-disciplinary collaboration in community settings. Social-medical collaboration becomes especially important. This study aims to use social capital as an analytical lens to examine the processes and mechanisms of social-medical collaboration in EOL care and elucidate practice implications for engaging in the care of dying people and their families. Qualitative data were collected using in-depth interviews. Three major conceptual categories were generated through grounded theory methodology. They are (a) establishing trust through keeping clear and simple boundaries, (b) cultivating mutuality in the multi-disciplinary meeting, and (c) fostering social-medical collaboration in EOL care. Each new stage is based on the social capital accumulated in the previous one through the social interactions between professionals. Such theorization also provides insights into how to achieve effective social-medical collaboration in this context.

Team Care for the Care Team: A Scoping Review of the Relational Dimensions of Collaboration in Healthcare Contexts

Examining team care for the care team, this scoping literature review highlights the relational and compassionate dimensions of collaboration and teamwork that can alleviate healthcare worker suffering and promote well-being in challenging contexts of care. Its goal is to provide greater conceptual clarity about team care and examine the contextual dimensions regarding the needs and facilitators of team care. Analysis of the 48 retained texts identified three broad types of communicative practice that constitute team care: sharing; supporting; and leading with compassion. The environmental conditions facilitating team care included a caring team culture and specific and accessible organizational supports. These results are crystallized into a conceptual model of team care that situates team care within a system of team and organizational needs and anticipated outcomes. Gaps in the literature are noted and avenues for future research are suggested.

Factors identified as barriers or facilitators to EMR/EHR based interprofessional primary care: a scoping review

As interprofessional collaboration (IPC) in primary care receives increasing attention, the role of electronic medical and health record (EMR/EHR) systems in supporting IPC is important to consider. A scoping review was conducted to synthesize the current literature on the barriers and facilitators of EMR/EHRs to interprofessional primary care. Four online databases (OVID Medline, EBSCO CINAHL, OVID EMBASE, and OVID PsycINFO) were searched without date restrictions. Twelve studies were included in the review. Of six facilitator and barrier themes identified, the key facilitator was teamwork support and a significant barrier was data management. Other important barriers included usability related mainly to interoperability, and practice support primarily in terms of patient care. Additional themes were organization attributes and user features. Although EMR/EHR systems facilitated teamwork support, there is potential for team features to be strengthened further. Persistent barriers may be partly addressed by advances in software design, particularly if interprofessional perspectives are included. Organizations and teams might also consider strategies for working with existing EMR/EHR systems, for instance by developing guidelines for interprofessional use. Further research concerning the use of electronic records in interprofessional contexts is needed to support IPC in primary care.

Continuity and care coordination of primary health care: a scoping review

BACKGROUND

Healthcare coordination and continuity of care conceptualize all care providers and organizations involved in health care to ensure the right care at the right time. However, systematic evidence synthesis is lacking in the care coordination of health services. This scoping review synthesizes evidence on different levels of care coordination of primary health care (PHC) and primary care.

METHODS

We conducted a scoping review of published evidence on healthcare coordination. PubMed, Scopus, Embase, CINAHL, Cochrane, PsycINFO, Web of Science and Google Scholar were searched until 30 November 2022 for studies that describe care coordination/continuity of care in PHC and primary care. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines to select studies. We analysed data using a thematic analysis approach and explained themes adopting a multilevel (individual, organizational, and system) analytical framework.

RESULTS

A total of 56 studies were included in the review. Most studies were from upper-middle-income or high-income countries, primarily focusing on continuity/care coordination in primary care. Ten themes were identified in care coordination in PHC/primary care. Four themes under care coordination at the individual level were the continuity of services, linkage at different stages of health conditions (from health promotion to rehabilitation), health care from a life-course (conception to elderly), and care coordination of health services at places (family to hospitals). Five themes under organizational level care coordination included interprofessional, multidisciplinary services, community collaboration, integrated care, and information in care coordination. Finally, a theme under system-level care coordination was related to service management involving multisectoral coordination within and beyond health systems.

CONCLUSIONS

Continuity and coordination of care involve healthcare provisions from family to health facility throughout the life-course to provide a range of services. Several issues could influence multilevel care coordination, including at the individual (services or users), organizational (providers), and system (departments and sectors) levels. Health systems should focus on care coordination, ensuring types of care per the healthcare needs at different stages of health conditions by a multidisciplinary team. Coordinating multiple technical and supporting stakeholders and sectors within and beyond health sector is also vital for the continuity of care especially in resource-limited health systems and settings.

When Bothering is Part of Professional Practice: Interprofessional Collaboration and Institutional Influences in Primary Care

In Western healthcare systems, increasing numbers of nurse practitioners are practicing in primary care organizations, and their integration onto interprofessional teams can be somewhat bumpy. In this article, we rely on the institutional theory of organizational communication to investigate the situated communication challenges faced by NPs as they integrate onto primary health care teams (RQ1), and how these local challenges manifested institutional features (RQ2). We analyze interview data from NPs, their physician partners, clinical nurses, and a network administrator for NPs at five family medicine clinics in Quebec, Canada. We found three main challenges to IP communication between NPs and physicians, namely a lack of time, the professional necessity of bothering, and talking to - and like - a doctor. We present the solutions that participants found to overcome or workaround these challenges. We also interpreted the institutional features that inflected - or "moored" - the situated communication practices and challenges reported by our participants to better understand how the local experience of IP communication is shaped by broader institutional forces.

Facilitators and Barriers to the Implementation of BETTER WISE, a Chronic Disease and Prevention Intervention in Canada: A Qualitative Study

The aim of the BETTER WISE intervention is to address cancer and chronic disease prevention and screening (CCDPS) and lifestyle risks in patients aged 40-65. The purpose of this qualitative study is to better understand facilitators and barriers to the implementation of the intervention. Patients were invited for a 1-h visit with a prevention practitioner (PP), a member of a primary care team, with specific skills in prevention, screening, and cancer survivorship. We collected and analyzed data from 48 key informant interviews and 17 focus groups conducted with 132 primary care providers and from 585 patient feedback forms. We analyzed all qualitative data using a constant comparative method informed by grounded theory and then employed the Consolidated Framework for Implementation Research (CFIR) in a second round of coding. The following key elements were identified: (1) Intervention characteristics-relative advantage and adaptability; (2) Outer setting-PPs compensating for increased patient needs and decreased resources; (3) Characteristics of individuals-PPs (patients and physicians described PPs as compassionate, knowledgeable, and helpful); (4) Inner setting-network and communication (collaboration and support in teams or lack thereof); and (5) Process-executing the implementation (pandemic-related issues hindered execution, but PPs adapted to challenges). This study identified key elements that facilitated or hindered the implementation of BETTER WISE. Despite the interruption caused by the COVID-19 pandemic, the BETTER WISE intervention continued, driven by the PPs and their strong relationships with their patients, other primary care providers, and the BETTER WISE team.

The effect of COVID-19 patient care and emergency response interprofessional training on COVID-19 knowledge, perception, behavior and readiness for care

BACKGROUND

During the COVID-19 pandemic, the need for Interprofessional Education (IPE) and collaborative practices have gained even more importance.

OBJECTIVE

The aim of this study is to evaluate the impact of IPE on COVID-19 on students' knowledge, perceptions, behaviors and readiness for care regarding COVID-19.

METHOD

The study followed a single-group pre-/post-test semi-experimental research design. The sample consisted of 435 students studying Elderly Care/Home Patient Care/First and Emergency Aid programs. The students' perception of interdisciplinary education was evaluated at the beginning of the study.

RESULTS

The students were given an online COVID-19 Patient Care and Emergency Response IPE that lasted five hours and was split into two parts. The perception of interdisciplinary education was significantly higher among female students and first and emergency students before receiving IPE. Before and after IPE, the knowledge level scores of the students who did not receive IPE were found to be higher than those who did. After the training, the students' knowledge levels, readiness for care and their perceptions of control towards the COVID-19 pandemic increased statistically significantly (p < 0.001).

CONCLUSION

The students' knowledge levels and perceptions of control surrounding the pandemic may grow as a result of the IPE given about COVID-19 during the pandemic, when IPE became more important, and students may feel more prepared to care.

An ethnographic discourse approach to explore GP-counsellor communication in primary health care settings in Hong Kong

This study aims to explore the nature of GP-counsellor interaction during discussions of patients' mental health issues in primary care services. An ethnographic discourse analysis of audio-recorded GP-counsellor conversations and the participating counsellor's reflective accounts. Two participating GPs and one counsellor were recruited from a private medical clinic in Hong Kong. The GPs and the counsellor mainly discussed their patients' issues in terms of medication management, the counsellor's case conceptualization, the case management, knowledge transfer and acknowledging the partnership. During case discussions, both the GPs and the counsellor used a range of interactional strategies to clarify a patient's condition and treatment plans for mutual understanding. The GPs and the counsellor co-construct an insider discourse that covers a greater diversity of topics, including both medical and non-medical concerns. The research findings have implications for theory and practice, including the potential of ethnographic discourse analysis in understanding the features of participants' behavior and evaluating the effectiveness of communication in a particular setting, as well as the importance of exploring professionalized discourse during GP-counsellor communication in developing training programs aimed at enhancing staff awareness of effective IPC communication.

Scoping review to identify strategies and interventions improving interprofessional collaboration and integration in primary care

OBJECTIVE

To identify strategies and interventions used to improve interprofessional collaboration and integration (IPCI) in primary care.

DESIGN

Scoping review DATA SOURCES: Specific Medical Subject Headings terms were used, and a search strategy was developed for PubMed and afterwards adapted to Medline, Eric and Web of Science.

STUDY SELECTION

In the first stage of the selection, two researchers screened the article abstracts to select eligible papers. When decisions conflicted, three other researchers joined the decision-making process. The same strategy was used with full-text screening. Articles were included if they: (1) were in English, (2) described an intervention to improve IPCI in primary care involving at least two different healthcare disciplines, (3) originated from a high-income country, (4) were peer-reviewed and (5) were published between 2001 and 2020.

DATA EXTRACTION AND SYNTHESIS

From each paper, eligible data were extracted, and the selected papers were analysed inductively. Studying the main focus of the papers, researchers searched for common patterns in answering the research question and exposing research gaps. The identified themes were discussed and adjusted until a consensus was reached among all authors.

RESULTS

The literature search yielded a total of 1816 papers. After removing duplicates, screening titles and abstracts, and performing full-text readings, 34 papers were incorporated in this scoping review. The identified strategies and interventions were inductively categorised under five main themes: (1) Acceptance and team readiness towards collaboration, (2) acting as a team and not as an individual; (3) communication strategies and shared decision making, (4) coordination in primary care and (5) integration of caregivers and their skills and competences.

CONCLUSIONS

We identified a mix of strategies and interventions that can function as 'building blocks', for the development of a generic intervention to improve collaboration in different types of primary care settings and organisations.

Mental Healthcare Providers Understanding and Experiences of Palliative Care: A Qualitative Analysis

Objective: To understand the experiences and perceptions of mental health providers about palliative care. Background: Little attention is paid to the experience of people with chronic persistent mental illness (CPMI) and life-threatening diseases and how their dying experience might differ from those without a CPMI. Methods: Interpretive description informed the project. Sixteen mental health care providers were interviewed using a semi-structured interview template. The interviews were recorded, transcribed, and analyzed using a reflexive, inductive-deductive thematic approach, guided by Braun & Clarke's framework for thematic analysis. Results: Four themes were identified from the data: intersectionality, limited collaboration, misconceptions about palliative care, and relationships. Mental health providers identified gaps in their knowledge of palliative care practices along with their knowledge of death and dying.

Heart Failure: An Underappreciated Complication of Diabetes. A Consensus Report of the American Diabetes Association

Heart failure (HF) has been recognized as a common complication of diabetes, with a prevalence of up to 22% in individuals with diabetes and increasing incidence rates. Data also suggest that HF may develop in individuals with diabetes even in the absence of hypertension, coronary heart disease, or valvular heart disease and, as such, represents a major cardiovascular complication in this vulnerable population; HF may also be the first presentation of cardiovascular disease in many individuals with diabetes. Given that during the past decade, the prevalence of diabetes (particularly type 2 diabetes) has risen by 30% globally (with prevalence expected to increase further), the burden of HF on the health care system will continue to rise. The scope of this American Diabetes Association consensus report with designated representation from the American College of Cardiology is to provide clear guidance to practitioners on the best approaches for screening and diagnosing HF in individuals with diabetes or prediabetes, with the goal to ensure access to optimal, evidence-based management for all and to mitigate the risks of serious complications, leveraging prior policy statements by the American College of Cardiology and American Heart Association.

The essential role of nurses in supporting physical examination in telemedicine: Insights from an interaction analysis of postsurgical consultations in orthopedics

Telemedicine changes clinical practice and introduces new ways of distributing tasks between physicians and nurses, and particularly the delegation of sensory assessments during remote physical examinations. As nurses become more involved in patient assessment and clinical decision-making, the quality of physician-nurse collaboration has been recognized as essential to ensure quality patient care. However, few studies have examined physician-nurse interactions during teleconsultations. This article presents the results of an empirical study of nurse-physician communication during remote physical examinations. In partnership with a university-affiliated hospital in Ontario, Canada, we observed and recorded 10 simulated postsurgical consultations in orthopedics (involving a physician, a patient, and an on-site nurse) and conducted auto-confrontation interviews with physicians. The results of the thematic analysis of the interviews informed the selection of consultation sequences for in-depth interaction analysis. The findings demonstrate the nurse's essential role during remote physical examinations and reveal specific practices accomplished by the nurse to ensure successful nurse-physician collaboration. The interview data shows how physicians view the nurse's role and contributions. The findings contribute to our understanding of the collaborative nature of sensory assessments during remote physical examinations in telemedicine and can inform the development of training programs for professionals focusing on communication skills. Implications for clinical practice are discussed.

Multiprofessional family health residency as a setting for education and interprofessional practices

OBJECTIVE

to know the experiences lived during the residency by graduates of a Multiprofessional Residency Program in Family Health that could contribute to the development of Interprofessional Education and/or Collaborative Practice.

METHOD

a qualitative study with residents who entered a Multiprofessional Residency Program of a Brazilian public university in 2017, a period in which the theme of interprofessionality was implemented in the activities of the residency. Data was collected using an electronic form built from the theoretical framework of interprofessional education. Content analysis was used to process the data.

RESULTS

nine residents participated, distributed among the professions of Physical Education, Nursing, Nutrition, Dentistry, Psychology and Social Work, five of whom were female and with a mean age of 28.4. Two categories emerged: the Residency as a setting for learning from the other, and the Residency as a setting for understanding the role of the other. Interprofessional education and practice provided opportunities for the development of collaborative skills, enhancing teamwork and interprofessional work.

CONCLUSION

the multiprofessional logic was evidenced in the resident's practice; and the gradual insertion of activities such as case discussions, shared services and inter-sectoral actions aligned with the theoretical-methodological framework of interprofessionality favored an approach to interprofessional work.

General Practitioners' Experiences During the First Phase of the COVID-19 Pandemic in Italy: A Critical Incident Technique Study

Since February 2020, when coronavirus disease began to spread in Italy, general practitioners (GPs) were called to manage a growing number of health situations. The challenges experienced by Italian GPs remained unrevealed. This study aimed at exploring Italian GPs' care experiences and practices associated with critical incidents during the first wave of the pandemic. A qualitative study design involving the critical incident technique through an online survey was applied. Sociodemographic data and open-ended responses were collected. While participants' characteristics were analyzed through descriptive statistics, qualitative data were thematically analyzed employing the framework method. 149 GPs responded to the survey and 99 participants completed the survey (dropout rate = 33%). Eight themes emerged indicating factors related to the organization of the healthcare system and factors related to the clinical management of patients, that were perceived as impacting on the GPs' care provision. The analysis revealed difficulties in communicating with other local services. This, together with the lack of coordination among services, was reported as a major challenge. Primary care was perceived as having been undervalued and criticalities in the organization of GP courses, led in a bureaucratic fashion, posed at risk some trainees to be infected. The digital technologies adopted for remote patient consultations were seen as useful tools for daily practice helping the GPs to stay emotionally connected with their patients. Besides, the improvement in the GP–patient relationship in terms of solidarity between patients and doctors and compliance to rules, had a positive impact. Moreover, many respondents addressed the importance of professional collaboration and teamwork, in terms of both support in practical issues (to find PPE, diagnostics and guidelines) and emotional support. At the same time, the lack of resources (e.g., PPE, swabs) and of specific guidelines and protocols impacted on the care provision. Our findings suggest that GPs in Italy are at risk of being left behind within the epidemic management. Communication and coordination among services are essential and should be substantially improved, and primary care research should be initiated to collect the context-specific evidence necessary to enhance the system's preparedness to public health emergencies and the quality of primary care services.

The negotiation of sharing leadership in the context of professional hierarchy: Interactions on interprofessional teams

While there is growing recognition of leadership as a collective phenomenon, the question of how leadership is shared in the context of hierarchical asymmetry has been neglected in the collective leadership literature. Our article addresses this gap by examining how sharing leadership is negotiated in team interactions that are steeped in asymmetry deriving from the professional hierarchy. Adopting a leadership-in-interaction approach, we draw on fine-grained analysis of observed interactions on interprofessional teams from two health care organizations to compare the discursive strategies used by professionals in a superior hierarchical position to the ones used by those in inferior positions to share leadership. These strategies are organized into a matrix of interactional moves that resist or enact the professional hierarchy. Empirical vignettes are provided to demonstrate how sharing leadership and hierarchical leadership can be co-present and even intertwined in an interaction. We show that leadership is shared (or not) as a result of how the professional hierarchy gets negotiated in interactions. More specifically, we conclude that the sharing of leadership in this context tends to occur prior to decision making, especially around problem formulation, if the interactional climate allows. Furthermore, it requires concrete effort: Those in superior positions of influence mindfully relax the hierarchy whereas those in inferior positions create moments of sharing leadership through resistance and struggle.