Multi-professional collaboration in primary care: A scoping review of Norwegian experiences

Abstract

Introduction: Multi-professional team-based care is recognised as essential for effective and person-centred health care. However, this practice approach is new to Norwegian primary care and the amount of research describing this field of topic is uncertain. The aim of this scoping review was to describe facilitators, barriers and perceived benefits of multi-professional collaboration among general practitioners GPs and other health care professionals’ HCPs in Norwegian primary care. Description of policy context and objective: Yet, Norwegian primary care is mostly uniprofessional and primary care teams are soon to be introduced. We performed systematic searches in specialist and Scandinavian databases. English or Norwegian studies published after 2000 were included. Of the 707 citations retrieved, nineteen studies were considered eligible for inclusion. The results rest on a descriptive summary and a content analysis. In favour of study validity, four stakeholders with extensive clinical or administrative experience from primary care were asked to assess and comment on the results. Target population: GPs involved in multi-professional chronic care in primary care. Highlights: This is the first review exploring Norwegian general practitioners’ experiences of multi-professional collaboration in primary care. We could not find any study describing multi-professional team-based care in general practice and none of the studies included patient-reported outcomes. The results show that care services lack conformity, experienced local managers and formalised national procedures which support necessary financial and cultural changes enabling collaboration between providers and organisations. Quality improvement in general practice was successful when all staff participated and the process was managed by the municipality. Finally, our results indicate that professional seniority, mutual trust, competence in team work and the use of e-messages may facilitate multi-professional collaboration. Comments: on transferability The lessons learnt from this review strongly resemblance those of international studies pertaining to financial and organizational barriers, professional cultures and lack of integrated data and information systems. This review adds to the evidence that team-based competencies will have to be improved as an essential tool for constructing a more effective and person-centred health care delivery system. Conclusion: This review brings new information about the scarcity of studies about experiences and organisation of multi-professional collaboration in Norwegian general practice and primary care. There is an urgent need for research on how professionals in different health and social institutions may integrate their services, improve communication and share responsibilities in the best interests of the patient. This requires policy development entailing new infrastructure and incentives that promote participation from general practitioners, education of professionals in team-based care and research which includes patients’ perspectives.