Community group practices in Canada: Are they ready to reform their practice?

Murray, Suzanne; Silver, Ivan; Dupuis, Martin; Hayes, Sean M.; Davis, Dave

doi:10.1002/chp.160

Cited by 15 publications

(8 citation statements)

References 3 publications

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“…Several barriers to the development of multidisciplinary collaboration have been identified, and the structure of the team, clearly defined roles and knowledge of each other's responsibilities are crucial for the team to function effectively [9,10]. A GP's participation in a multidisciplinary team attending one of his/her patients is regarded as important in providing an appropriate, coordinated service [11].…”

Section: Introductionmentioning

confidence: 99%

Norwegian GPs' participation in multidisciplinary meetings: A register-based study from 2007

Hetlevik

Gjesdal

2010

BMC Health Serv Res

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BackgroundAn increasing number of patients with chronic disorders and a more complex health service demand greater interdisciplinary collaboration in Primary Health Care. The aim of this study was therefore to identify factors related to general practitioners (GPs), their list populations and practice municipalities associated with a high rate of GP participation in multidisciplinary meetings (MDMs).MethodsA national cross-sectional register-based study of Norwegian general practice was conducted, including data on all GPs in the Regular GP Scheme in 2007 (N = 3179). GPs were grouped into quartiles based on the annual number of MDMs per patient on their list, and the groups were compared using one-way analysis of variance. Binary logistic regression was used to analyse associations between high rates of participation and characteristics of the GP, their list population and practice municipality.ResultsOn average, GPs attended 30 MDMs per year. The majority of the meetings concerned patients in the age groups 20-59 years. Psychological disorders were the motivation for 53% of the meetings. In a multivariate logistic regression model, the following characteristics predicted a high rate of MDM attendance: younger age of the GP, with an OR of 1.6 (95% CI 1.2-2.1) for GPs < 45 years, a short patient list, with an OR of 4.9 (3.2-7.5) for list sizes below 800 compared to lists ≥ 1600, higher proportion of psychological diagnosis in consultations (OR3.4 (2.6-4.4)) and a high MDM proportion with elderly patients (OR 4.1 (3.3-5.4)). Practising in municipalities with less than 10,000 inhabitants (OR 3.7 (2.8-4.9)) and a high proportion of disability pensioners (OR 1.6 (1.2-2.2)) or patients receiving social assistance (OR 2.2 (1.7-2.8)) also predicted high rates of meetings.ConclusionsPsychological problems including substance addiction gave grounds for the majority of MDMs. GPs with a high proportion of consultations with such problems also participated more frequently in MDMs. List size was negatively associated with the rate of MDMs, while a more disadvantaged list population was positively associated. Working in smaller organisational units seemed to facilitate cooperation between different professionals. There may be a generation shift towards more frequent participation in interdisciplinary work among younger GPs.

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Section: Introductionmentioning

confidence: 99%

Norwegian GPs' participation in multidisciplinary meetings: A register-based study from 2007

Hetlevik

Gjesdal

2010

BMC Health Serv Res

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“…Murray et al [25] examined the primary care reform in Canada and found that although the health care providers reported themselves ready to make necessary changes and willing to move to interdisciplinary team practices, challenges still impeded that movement. Previous positive experience with partners is a key to motivating clinicians to join partnerships.…”

Section: Discussionmentioning

confidence: 99%

Partnership disengagement from primary community care networks (PCCNs): A qualitative study for a national demonstration project

Liau

Lin

et al. 2010

BMC Health Serv Res

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BackgroundThe Primary Community Care Network (PCCN) Demonstration Project, launched by the Bureau of National Health Insurance (BNHI) in 2003, is still in progress. Partnership structures in PCCNs represent both contractual clinic-to-clinic and clinic-to-hospital member relationships of organizational aspects. The partnership structures are the formal relationships between individuals and the total network. Their organizational design aims to ensure effective communication, coordination, and integration across the total network. Previous studies have focused largely on how contractual integration among the partnerships works and on its effects. Few studies, however, have tried to understand partnership disengagement in PCCNs. This study explores why some partnerships in PCCNs disengage.MethodsThis study used a qualitative methodology with semi-structured questions for in-depth interviews. The semi-structured questions were pre-designed to explore the factors driving partnership disengagement. Thirty-seven clinic members who had withdrawn from their PCCNs were identified from the 2003-2005 Taiwan Primary Community Care Network Lists.ResultsOrganization/participant factors (extra working time spend and facility competency), network factors (partner collaboration), and community factors (health policy design incompatibility, patient-physician relationship, and effectiveness) are reasons for clinic physicians to withdraw or change their partnerships within the PCCNs.ConclusionsTo strengthen partnership relationships, several suggestions are made, including to establish clinic and hospital member relationships, and to reduce administrative work. In addition, both educating the public about the concept of family doctors and ensuring well-organized national health policies could help health care providers improve the integration processes.

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“…Sicotte et al (2002); 14 Rees et al (2005); 15 Murray et al (2008); 16 Sargeant et al (2008); 17 Bateman et al (2003); 18 Hann et al (2007); 19 Orchard et al (2005); 20 Gabhainn et al (2001); 21 Minns Lowe and Bithell (2000); 22 Kharicha et al (2005); 23 Jesson and Wilson (2003); 24 Samuels et al (2008); 25 Galvin et al (1999); 26 West et al (2003); 27 Nolan and Hewison (2008); 28 Lincoln (2006); 29 Stewart (2002); 30 Jansen (2008); 31 Grant et al (2009); 32 Stevenson et al (2001).…”

Section: Iphc Team Sustainability: Existing Empirical and Conceptual mentioning

confidence: 99%

Rural interprofessional primary health care team development and sustainability: establishing a research agenda

McPherson

McGibbon

2010

Primary Health Care

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Primary health care (PHC) plays a pivotal role in health system reform locally and globally. The use of well functioning interprofessional primary health care (IPHC) teams is recognized as a key strategy in widespread health system reform across global, national, and provincial jurisdictions. IPHC teams contribute to the improvement of the health and well being of the population. These teams engage in issues that are a priority for citizens, such as: providing good evidence-based care; supporting the efforts of individuals, families, and communities in leading healthy lives; actively and deliberatively involving citizens in decisions affecting their health and health care system; and addressing the systemic social, economic, and political causes of health disparities, such as poverty, violence, and rural isolation. Many jurisdictions have begun to experiment with and implement major changes in the delivery of PHC. This has required that health care managers and practitioners reconsider the ways in which they have traditionally worked. However, although many innovative PHC services were developed, the notion of how to best develop and sustain the service delivery team itself and within what contexts could have used more deliberate attention. There are no documented best practices for rural IPHC team development and sustainability in the scholarly literature. This paper presents the results of a literature review, including the empirical and conceptual evidence regarding team development, team sustainability, and the role of rural context in IPHC team development. An argument for advancing PHC research that focuses on rural IPHC team development and sustainability is posited.This development discussion informs a new area for research that has evolved from an identified primary health care (PHC) policy and practice gap in Nova Scotia, Canada. In this paper, we present an argument for advancing PHC research that focuses on rural interprofessional primary health care (IPHC) team development and sustainability. This focus is important because of the known role that PHC plays in health system reform locally and globally, and because there are relatively few documented best practices for IPHC team development and sustainability in the scholarly literature. This paper presents the PHC developmental context in Nova Scotia and the results of our literature review, including the Correspondence to:

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Community group practices in Canada: Are they ready to reform their practice?

Cited by 15 publications

References 3 publications

Norwegian GPs' participation in multidisciplinary meetings: A register-based study from 2007

Norwegian GPs' participation in multidisciplinary meetings: A register-based study from 2007

Partnership disengagement from primary community care networks (PCCNs): A qualitative study for a national demonstration project

Rural interprofessional primary health care team development and sustainability: establishing a research agenda

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