Integrated care teams in primary care improve clinical outcomes and care processes in patients with non-communicable diseases

Qualitative study on the perceived enablers and barriers to interprofessional education in primary care in Singapore

BACKGROUND

There is a need to strengthen interprofessional collaborative practice (IPCP) through interprofessional education (IPE) to improve patient outcomes. To contextualise IPE in primary care, there is a need to understand the factors associated with IPE. This study aims to identify the perceived enablers and barriers of IPE, taking diabetes care as an example, among practising professionals, educators, and institution leaders in primary care.

METHODS

A qualitative study was conducted in primary care clinics in Singapore. The maximum variation purposive sampling approach was employed and a total of 20 participants were recruited, comprising of 14 healthcare professionals (HCPs), 3 educators, and 3 leaders. Basic demographics data were collected followed by individual semi-structured interviews using a topic guide. Conceptual framework by D'amour and Oandasan was adopted as the underpinning framework to evaluate factors associated to micro (learners and educators), meso (instituitions) and macro (policy and professional bodies) level. Thematic analysis method was adopted for data analysis.

RESULTS

Ten themes were identified in this study. For HCPs at the micro level, the themes illustrated interprofessional interactions influenced by learning and work environments, and receptiveness towards IPE shaped by HCPs' attitudes. Additionally, interprofessional collaboration was enhanced through increased interprofessional knowledgeability and overcoming interprofessional hierarchy, while effective communication was fostered by establishing trust, respect, and overcoming psychological barriers. For educators at the micro level, the key themes included the attitudes of educators and the importance of professional development, as well as curriculum development. At the meso level, institutions focused on themes such as resource allocation, system changes, and outcome measurements in the implementation of the IPE programme, along with leadership support for IPE. At the macro level, the emphases were on the roles of policymakers in funding and defining national strategy, as well as the roles of professional bodies in providing educational resources.

CONCLUSIONS

This study demonstrated the complexity and interrelation of the factors associated with IPE in primary care. A multi-pronged approach needs to be adopted to address all the barriers in the future implementation of the IPE model in primary care and to design an IPE curriculum that integrates well with clinical practice.

CLINICAL TRIAL NUMBER

Not Applicable.

Primary health care in Austria: qualitative analysis of requirements and challenges in interprofessional collaboration from the perspective of health care and social professionals

BACKGROUND

Primary health care (PHC) delivered in Austria's newly established primary health care units (PHCU) is based on interprofessional collaboration (IPC) between health care and social professionals.

AIM

This study aims to explore the requirements and challenges in IPC in Austrian PHCUs from the perspective of health care and social professionals.

METHODS

15 semi-standardized, online, mono-professional focus group interviews were conducted with a total of 58 professionals with the following backgrounds: biomedical sciences, dietetics, medical training therapy, medicine, midwifery, nursing, occupational therapy, office assistance, orthoptics, pharmacy, physiotherapy, psychotherapy, radiography, social work, and speech therapy. The participants were representatives from PHC practice (especially PHCUs), respective educational institutions, and professional organizations. The data were inductively analysed using qualitative content analysis according to Mayring.

FINDINGS

The analysis displayed two main fields discussed by the participants, the setting for IPC and the professional relationships. The content analysis revealed three and four topics, respectively, within the main discussion fields. Within the setting for IPC, these topics were elaborated on (1) the operational area where IPC takes place in PHC, (2) the structural and organizational premises for this cooperation in PHCUs, and (3) the observed benefits of PHCUs for patients. Regarding the professional relationships, these topics were discoursed: (1) successful IPC, (2) challenges in IPC, (3) competencies required for IPC, and (4) previous and present corresponding training content.

CONCLUSION

Austrian health care and social professionals aim to get more involved in PHC in general and PHCUs specifically. They see opportunities and also challenges for their professional groups. Specific training is desired focusing on the unique requirements of Austrian PHCUs and equipping the workforce for the intensive, necessary, and beneficial collaboration between multiple professional groups in the increasingly important setting.

Self-Efficacy in Patients With Hypertension and Their Perceived Usage of Patient Portals

INTRODUCTION

Self-efficacy in individuals optimizes their hypertension management. Electronic patient portals are being increasingly used to support chronic disease management, as they raise the health literacy of patients and enable them in self-management. However, the association between the use of patient portals and self-efficacy in hypertension management remains unclear. The study aimed to determine the association between self-efficacy among patients with hypertension who are managed in primary care and their demographic characteristics and usage patterns of patient portals.

METHOD

A cross-sectional survey was conducted at a public primary care clinic in urban Singapore. Multi-ethnic adult patients with hypertension were invited to participate in a self-administered electronic questionnaire. Chi-square test was performed for bivariate analysis; adjusted logistic regression models were used for factors with P value <.1.

RESULTS

A total of 310 patients (66.8% Chinese, 55.5% males, mean age of 63.1 years) completed the survey. Patient portal users had higher self-efficacy scores than non-users (mean score=63 vs 60, maximum = 80, P = .011). The factors associated with increased patient portal access included younger age <65 years (absolute odds ratio [AOR] = 2.634, 95%CI = 1.432-4.847; P = .002), monthly income >$5000 (AOR = 2.324, 95%CI = 1.104-4.892; P = .026), and post-secondary education level (AOR = 3.128, 95%CI = 1.675-5.839; P < .001). Most patients (93.1%) used the portal to check medical appointments but only1.3% of them used it to record home blood pressure measurements (HBPM).

CONCLUSIONS

Patient portal usage was associated with higher self-efficacy scores in patients with hypertension. These users were younger, more educated, and earned more than the non-users, but only 1.3% of them used it for HBPM documentation.