84 What works and why for interprofessional collaboration in older people’s care integration: realist evidence synthesis

Abstract

Abstract Background Interdisciplinary Community Specialist Teams for older people (CSTs) are a novel innovation in Irish health service delivery and require, over time, a shift in cultures of care to allow for the development of interprofessional collaboration. However, there is limited international guidance on how to foster, enhance and sustain meaningful interprofessional collaboration in the context of interdisciplinary team-based care integration for older people. This realist review presents initial programme theories of what works and why in fostering competencies for interprofessional collaboration in CSTs for older persons. Methods Realist reviews are an interpretive theory-driven approach to evidence synthesis which uses multiple sources of evidence including published peer-reviewed studies, policy documents and grey literature. This evidence is combined with stakeholder theories and explanations of how interventions might work. Four stakeholder cohorts were identified: public and patient representatives of older people and family carers, healthcare professionals who are members of CSTs; team leads responsible for the operational management of CSTs, and healthcare managers responsible for national clinical programme design. Results This synthesis resulted in a series of evidence-based Initial Programme Theories (IPT) in the form of statements that explain the Mechanisms (M) and Resources (R), generated within particular Contexts (C) in response to interprofessional collaboration, that are thought to lead enhanced care Outcomes (O). For example: Where CST members have professional experience in different areas of service delivery (C), they bring to the team pre-existing relationships with other HCPs (R), enabling good cross-sectoral communication and trust (M) leading to enhanced continuity of care (O). Conclusion The IPTs generated from this realist synthesis of international literature support workforce education, development and planning. They also provide healthcare leaders with knowledge of the resources and supports required to harness the benefits of interprofessional collaboration and realise the goals of care integration for older people.