Knowledge flow and exchange in interdisciplinary primary health care teams (PHCTs): an exploratory study

The purpose of the study is to explore the role of the nurse practitioner (NP) in facilitating knowledge exchange within multidisciplinary primary healthcare teams. The rationale for the study is that most knowledge transfer and exchange literature is from a single profession perspective; yet, an increasing number of healthcare practitioners work in the context of multidisciplinary teams. There is little research examining the mechanisms by which knowledge crosses professional and disciplinary boundaries. The study's data source is a survey administered to NPs in urban, rural, and remote primary healthcare teams in Saskatchewan. The mapping techniques of social network analysis are applied to the survey data. The study's conclusions concern the structure of the intrateam knowledge-exchange behaviors and, in particular, the role of the NP as knowledge boundary spanner. The study hypothesizes that the hallmark of well-functioning multidisciplinary teams is the effective intrateam knowledge exchange and that Saskatchewan's new NPs bring a "boundary-spanning" capacity to the knowledge exchange of the province's multidisciplinary primary healthcare teams. The study fills this gap in the conceptual and empirical research within the evolving context of the reorganization of primary health care.

Empirical research on multi-disciplinary health care teams has yet to explore the development of mutual understanding between team members in the course of their collective clinical decision-making. This paper addresses this gap in the literature directly by examining changes in mutual understanding and the extent to which its facilitation is shared by individual members of multi-disciplinary health care teams. A Habermasian theoretical framework is used to operationalize mutual understanding. Social network analysis is used to analyze survey data on team-based clinical decision-making collected from multi-disciplinary health care teams in a Canadian province. The results of the study indicate that mutual understanding between team members ebbs and flows over the course of their collective clinical decisions. Further, as the extent of mutual understanding within the team increases, its facilitation becomes more equally shared among team members. The paper closes by specifying a practical outcome of the future work: a typology of clinical decisions that health care teams are able to use as an evaluation tool to assess how effectively they are making collective clinical decisions. As an evaluation tool, the typology would foster open and deliberative discussion, enable critical self-reflection, and thereby further enhancing mutual understanding within the teams.

Primary health care (PHC) teams contributed to all phases of the COVID-19 vaccination distribution. However, there has been criticism for not fully utilizing the expertise and infrastructure of PHC teams for vaccination distribution. Our study sought to understand the role PHC teams had in the distribution of the COVID-19 vaccine in Ontario, Canada. The key objective informing this study was to explore the experiences and perspectives of interprofessional PHC teams in the distribution of COVID-19 vaccination across Ontario. A qualitative approach was used for this study, which involved 39 participants from the six health regions of the province. Eight focus groups were conducted with a range of interprofessional healthcare providers, administrators, and staff working in PHC teams across Ontario. The sample reflected a diverse range of clinical, administrative, and leadership roles in PHC. Focus groups were audio-recorded and transcribed, while transcriptions were then analyzed using thematic analysis. We identified the following four themes in the data: i) PHC teams know their patients; ii) mobilizing team capacity for vaccination, iii) intersectoral collaborations, and iv) operational challenges. PHC teams were an instrumental component in supporting COVID-19 vaccinations in Ontario. The involvement of PHC in future vaccination efforts is key but requires additional resourcing and inclusion of PHC in decision-making. This will ensure provider well-being and maintain collaborations established during COVID-19 vaccination.

The international literature suggests a number of benefits related to integrating physiotherapists into primary health care (PHC) teams. Considering the mandate of PHC teams in Canada, emphasizing healthy living and chronic disease management, a broad range of providers, inclusive of physiotherapists is required. However, physiotherapists are only sparsely integrated into these teams. This study explores the perspectives of “core” PHC team members, family physicians and nurse practitioners, regarding the integration of physiotherapists within Ontario (Canada) PHC teams. Twenty individual semi-structured in-depth interviews were conducted, transcribed verbatim, and then analyzed following an iterative process drawing from an interpretive phenomenological approach. Five key themes emerged which highlighted “how physiotherapists could and do contribute as team members within PHC teams particularly related to musculoskeletal health and chronic disease management”. The perceived value of physiotherapists within Ontario, Canada PHC teams was a unanimous sentiment particularly in terms of musculoskeletal health, chronic disease management and maximizing health human resources efficiency to ensure the right care, is delivered by the right practitioner, at the right time.

BackgroundResearch consistently demonstrates the importance of effective team work for improving the quality of health care. We conducted a baseline measure of primary health care (PHC) team effectiveness and overall PHC performance at a primary care facility.AimTo improve PHC team effectiveness and ultimately the quality and user experience of primary care at a community health centre (CHC).SettingDu Noon CHC in the southern and western substructure of the Cape Town Metro district services (MDHS).MethodsA cross-sectional study using a combination of the Nominal Group Technique (NGT) consensus method and the South African Primary Care Assessment Tool (ZA PCAT) to assess PHC team effectiveness and PHC organisation and performance.ResultsThe ZA PCAT was administered to 110 CHC users (patients) and 12 providers (doctors and clinical nurse practitioners). Data from 20 PHC team members showed they perceived their team as well functioning (70% agreement on a 7-item PHC team assessment tool incorporated into the ZA PCAT). The NGT method achieved participant (20) consensus on communication and leadership as the main challenges to effective team functioning and on ideas to overcome the challenges. The ZA PCAT user data showed 18.2% of users rated first contact access as acceptable to good; 47.3% of users rated ongoing care as acceptable to good. Provider data showed that 33% of providers rated first contact access as acceptable to good; 25% of providers rated ongoing care as acceptable to good. First contact access received the lowest acceptable to good score (18.2%) and comprehensiveness (services available) the highest score (88.2%) from users. For the providers, the lowest acceptable to good score was for ongoing care (25%) and the highest acceptable to good score was for primary health care team availability (100%). The ZA PCAT total primary scores were good (above 60%) for both users and providers but moderately higher for the providers.ConclusionKnowledge of how teams perceive their effectiveness can motivate them to generate ideas for improving performance. There were discrepancies between providers’ assessment of team functioning using the ZA PCAT measure and the NGT method results. The ZA PCAT also showed differences between providers’ and users’ perceptions of PHC performance – consistent with the findings of the multi-CHC Western Cape ZA PCAT study. These findings should encourage and support CHC and district level staff in their efforts to improve the quality and user experience of primary care, as well as PHC team performance.

Pharmacist's identity development within multidisciplinary primary health care teams in Ontario; qualitative results from the IMPACT (†) project

The objective of this research was to explore the extent of teamworking in primary health care in the UK and compare primary health care teams with other multidisciplinary teams on fundamental critieria of team functioning. A survey was conducted, using a validated questionnaire which measures four aspects of team climate: participation, shared objectives, task orientation and support for innovation. Sixty-eight primary health care teams participated in the questionnaire survey, with additional comparison data from: 24 oil company teams; 27 NHS management teams; 20 community mental health teams; 40 social services teams. The total number of respondents across three samples was 1,555. Main outcome measures were levels of team participation, support for innovation, task orientation and clarity of, and commitment to, team objectives. Primary health care teams scored significantly lower than other teams in the sample on all team functioning factors except task orientation. It is concluded that a restructuring of the organization of primary health care is required if primary health care teams are to develop clear shared objectives to facilitate the coordinated approach to the delivery of care, long urged by practitioners and policy makers.

IntroductionImproving health services integration through primary health care (PHC) teams for patients with chronic conditions is essential to address their complex health needs and facilitate better health outcomes. The objective of this study was to explore if and how patients, family members, and caregivers were engaged or wanted to be engaged in developing, implementing and evaluating health policies related to PHC teams. This patient‐oriented research was carried out in three provinces across Canada: British Columbia, Alberta and Ontario.MethodsA total of 29 semi‐structured interviews with patients were conducted across the three provinces and data were analysed using thematic analysis.ResultsThree key themes were identified: motivation for policy engagement, experiences with policy engagement and barriers to engagement in policy. The majority of participants in the study wanted to be engaged in policy processes and advocate for integrated care through PHC teams. Barriers to patient engagement in policy, such as lack of opportunities for engagement, power imbalances, tokenism, lack of accessibility of engagement opportunities and experiences of racism and discrimination were also identified.ConclusionThis study increases the understanding of patient, family member, and caregiver engagement in policy related to PHC team integration and the barriers that currently exist in this engagement process. This information can be used to guide decision‐makers on how to improve the delivery of integrated health services through PHC teams and enhance patient, family member, and caregiver engagement in PHC policy.Patient or Public ContributionWe would like to acknowledge the contributions of our patient partners, Brenda Jagroop and Judy Birdsell, who assisted with developing and pilot testing the interview guide. Judy Birdsell also assisted with the preparation of this manuscript. This study also engaged patients, family members, and caregivers to share their experiences with engagement in PHC policy.

The links between deprivation, poverty and ill health are well known, but many people with significant health problems do not claim welfare benefits to which they are entitled. Accessing advice within primary health care may be one way of tackling this problem. The aim of this development project was to develop and evaluate over a 3-year period a welfare rights advice and information service that would not only complement the work of the primary health care team, but also target those patients who were most in need. The service was developed using an action research approach. Three models were used with different primary health care teams. The evaluation consisted of both qualitative and quantitative elements. The qualitative study used semi-structured one-to-one interviews with 11 patients who consented to be contacted, two Citizens' Advice Bureau workers and 26 primary health care team members from 10 general practices in Gateshead covering a wide range of practices and patients (approximately 73 000) from all socio-economic groups, and additional focus group interviews with three further primary health care teams. Quantitative data were collected by the Citizens' Advice Bureau on 683 patients and benefits received. A welfare rights service with an attached Citizens' Advice Bureau worker was seen as beneficial by the primary health care team. The work of the primary health care team was complemented by the CAB worker's additional expertise. Many patients entitled to benefits who would not otherwise have sought advice from a Citizens' Advice Bureau worker were referred by primary health care team members. It was found that targeting people unable to access the surgery reached those most in need in the project group. For those referred, a cumulative total of £1 641 865 was gained during the lifetime of the project. Many patients were referred and as a result received benefits. Optimum use of the service was achieved by restricting the service to the housebound. The use of a dedicated telephone line appeared to maximize the use of the workers' time, and also made few demands on the time of the primary health care team.

This paper presents and critically evaluates data on the long-term impact of brief training for the primary health care team in facilitating smoking behav iour change with patients. Semi-structured interviews were carried out with one third ( n = 23) of training participants one year after taking part in a brief, one-day workshop to enhance the abilities of the primary care team in facilitating smoking behaviour change. The impact of brief training for the primary care team is premised on the health professionals' acceptance of the content and relevance of the training, the enhancement of professional self- efficacy, their definition of their role in health promotion work, their own smoking status, and their readiness to change clinical practice/behaviour. It is also dependent on professionals' capacity to refrain from using ineffective methods which may cancel out the benefits gained by learning and using more effective strategies. Future training workshops or courses for primary health care professionals in health promotion work should be tailored to individual participants' needs as their readiness to change clinical practice must be acknowledged rather than using a global approach which can result in a diluted impact.

Low- and middle-income countries are experiencing serious shortages in meeting health workforce requirements for universal health coverage. We examine how national-level policies can address these deficiencies and support the development of an appropriately skilled health workforce in line with population needs. We discuss three innovative, government-led solutions that are designed to align health workforce training with the demands of universal health coverage. Specifically, we discuss two initiatives to train and retain doctors in rural areas of Thailand, the large-scale training of community health workers within multidisciplinary primary health care teams in Brazil, and the introduction of a postgraduate diploma program in primary care for nurses in India. Several positive outcomes have been associated with these initiatives, including improvements in the rural retention of doctors in Thailand and reductions in infant and child mortality rates in Brazil. However, further research is needed to assess the impact of such initiatives on the long-term retention of workers-particularly doctors-and the adequacy of the training offered to lower-skilled workers to effectively plug medical personnel gaps. Systematic monitoring of program affordability and cost-effectiveness over time must be prioritized, alongside efforts to disseminate lessons learned.

PurposeA sound, scientific base of high quality research is needed to inform service planning and decision making and enable improved policy and practice. However, some areas of health practice, particularly many of the allied health areas, are generally considered to have a low evidence base. In order to successfully build research capacity in allied health, a clearer understanding is required of what assists and encourages research as well as the barriers and challenges.Participants and methodsThis study used written surveys to collect data relating to motivators, enablers, and barriers to research capacity building. Respondents were asked to answer questions relating to them as individuals and other questions relating to their team. Allied health professionals were recruited from multidisciplinary primary health care teams in Queensland Health. Eighty-five participants from ten healthcare teams completed a written version of the research capacity and culture survey.ResultsThe results of this study indicate that individual allied health professionals are more likely to report being motivated to do research by intrinsic factors such as a strong interest in research. Barriers they identified to research are more likely to be extrinsic factors such as workload and lack of time. Allied health professionals identified some additional factors that impact on their research capacity than those reported in the literature, such as a desire to keep at the “cutting edge” and a lack of exposure to research. Some of the factors influencing individuals to do research were different to those influencing teams. These results are discussed with reference to organizational behavior and theories of motivation.ConclusionSupporting already motivated allied health professional individuals and teams to conduct research by increased skills training, infrastructure, and quarantined time is likely to produce better outcomes for research capacity building investment.

Introduction: Senior urology physicians represent a heterogeneous group covering various clinical priorities and career objectives. No reliable data on gender-specific variations among senior urology physicians are available concerning professional and personal aspects. Methods: The objective of this study was to analyze professional perspectives, professional and personal settings, and individual career goals. A Web-based survey containing 55 items was designed which was available for senior physicians at German urologic centers between February and April 2019. Gender-specific differences were evaluated using bootstrap-adjusted multivariate logistic regression models. Results: One hundred and ninety-two surveys were evaluable including 29 female senior physicians (15.1%). Ninety-five percent would choose urology again as their field of specialization – with no significant gender-specific difference. 81.2% of participants rate the position of senior physician as a desirable career goal (comparing sexes: p = 0.220). Based on multivariate models, male participants self-assessed themselves significantly more frequently autonomously safe performing laparoscopic, open, and endourologic surgery. Male senior physicians declared 7 times more often to run for the position of head of department/full professor. Conclusion: This first study on professional and personal aspects among senior urology physicians demonstrates gender-specific variations concerning self-assessment of surgical expertise and future career goals. The creation of well-orchestrated human resources development strategies especially adapted to the needs of female urologists seems advisable.

BackgroundFamily practice registered nurses co-managing patient care as healthcare professionals in interdisciplinary primary care teams have been shown to improve access, continuity of care, patient satisfaction, and clinical outcomes for patients with chronic diseases while being cost-effective. Currently, however, it is unclear how different funding models support or hinder the integration of family practice nurses into existing primary health care systems and interdisciplinary practices. This has resulted in the underutilisation of family practice nurses in contributing to high-quality patient care.MethodsThis mixed-methods project is comprised of three studies: (1) a funding model analysis; (2) case studies; and (3) an online survey with family practice nurses. The funding model analysis will employ policy scans to identify, describe, and compare the various funding models used in Canada to integrate family practice nurses in primary care. Case studies involving qualitative interviews with clinic teams (family practice nurses, physicians, and administrators) and family practice nurse activity logs will explore the variation of nursing professional practice, training, skill set, and team functioning in British Columbia, Nova Scotia, Ontario, and Quebec. Interview transcripts will be analysed thematically and comparisons will be made across funding models. Activity log responses will be analysed to represent nurses’ time spent on independent, dependent, interdependent, or non-nursing work in each funding model. Finally, a cross-sectional online survey of family practice nurses in Canada will examine the relationships between funding models, nursing professional practice, training, skill set, team functioning, and patient care co-management in primary care. We will employ bivariate tests and multivariable regression to examine these relationships in the survey results.DiscussionThis project aims to address a gap in the literature on funding models for family practice nurses. In particular, findings will support provincial and territorial governments in structuring funding models that optimise the roles of family practice nurses while establishing evidence about the benefits of interdisciplinary team-based care. Overall, the findings may contribute to the integration and optimisation of family practice nursing within primary health care, to the benefit of patients, primary healthcare providers, and health care systems nationally.

Poland, like many other former eastern bloc countries, inherited a health system dominated by narrow medical specialties, a large number of hospital beds and relatively weak primary health care (PHC). Since early 1990s, efforts have been made to strengthen the role of PHC, starting with the introduction of specialization training in family medicine. With privatization of PHC practices the standard of PHC care has improved. However, national audits have repeatedly found PHC to still be inadequate, with the key weaknesses including shortages of family medicine specialists, insufficient provision of preventive services, and limited use of diagnostics, which led to inappropriate referrals and long waiting times for specialist consultations. Between mid-2018 and the end of 2021, a new model of PHC organization was piloted in around 40 PHC practices across Poland that met the model's requirements. The pilot, supported by the World Bank, put much emphasis on health promotion and disease prevention by including health educators and dieticians in PHC teams and by introducing periodic check-ups. It also aimed to reduce referrals to specialist care by allowing PHC doctors to order extensive diagnostic and laboratory tests and, if needed, consult with a range of cooperating specialists. It also sought to increase the role of PHC doctors in the management of chronic conditions by introducing disease management programmes (DMPs) for 11 most prevalent conditions. PHC teams were made responsible for coordinating patients’ care pathways, including post-hospital treatment, and a new role of care coordinator was introduced to that end. After the pilot was concluded, all PHC practices were mandated to hire care coordinators. Implementation of other solutions tested in the pilot remains uncertain, mainly due to the lack of financial and human resources, and the dominance of small PHC practices that struggle to meet the ambitious requirements set out in the new model.