Do primary care professionals agree about progress with implementation of primary care teams: results from a cross sectional study

Abstract

BackgroundPrimary care is the cornerstone of healthcare reform with policies across jurisdictions promoting interdisciplinary team working. The effective implementation of such health policies requires understanding the perspectives of all actors. However, there is a lack of research about health professionals’ views of this process. This study compares Primary Healthcare Professionals’ perceptions of the effectiveness of the Primary Care Strategy and Primary Care Team (PCT) implementation in Ireland.MethodsDesign and Setting: e-survey of (1) General Practitioners (GPs) associated with a Graduate Medical School (N = 100) and (2) Primary Care Professionals in 3 of 4 Health Service Executive (HSE) regions (N = 2309). After piloting, snowball sampling was used to administer the survey. Descriptive analysis was carried out using SPSS. Ratings across groups were compared using non-parametric tests.ResultsThere were 569 responses. Response rates varied across disciplines (71 % for GPs, 22 % for other Primary Healthcare Professionals (PCPs). Respondents across all disciplines viewed interdisciplinary working as important. Respondents agreed on lack of progress of implementation of formal PCTs (median rating of 2, where 1 is no progress at all and 5 is complete implementation). GPs were more negative about the effectiveness of the Strategy to promote different disciplines to work together (median rating of 2 compared to 3 for clinical therapists and 3.5 for nurses, P = 0.001). Respondents identified resources and GP participation as most important for effective team working. Protected time for meetings and capacity to manage workload for meetings were rated as very important factors for effective team working by GPs, clinical therapists and nurses. A building for co-location of teams was rated as an important factor by nurses and clinical therapists though GPs rated it as less important. Payment to attend meetings and contractual arrangements were considered important factors by GPs but not by nurses or clinical therapists.ConclusionPCPs and GPs agree there is limited PCT implementation. GPs are most negative about this implementation. There is some disagreement about which resources are most important for effective PCT working. These findings provide valuable data for clinicians and policy makers about implementation of interdisciplinary teams in primary care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0541-9) contains supplementary material, which is available to authorized users.

Using Normalization Process Theory in feasibility studies and process evaluations of complex healthcare interventions: a systematic review

“…Thomas et al [ 137 ] Sweden ENPT Healthy lifestyle promotion in primary care – Process evaluation Mixed Retrospective Yes Yes Yes 100. Tierney et al [ 138 ] Ireland NPT Interdisciplinary teams in primary care Systematic review [ 194 – 196 ] Yes Process evaluation Quantitative Prospective Yes Yes No 101. Toye et al [ 139 ] Canada NPT Assessment instrument for homecare Yes Feasibility study Qualitative Prospective Yes Yes Yes 102.…”

“…This study raised important questions about how the interactions between clinicians’ (micro-level) experiences of the workability of complex interventions and meso-level organisational processes through which reflexive monitoring mechanisms play out their effects. Some studies were also explicitly concerned with implementing change in professional roles ( n = 7, 6.5% [ 20 , 54 , 63 , 70 , 94 , 101 , 138 ]). For example, Thomas et al [ 56 , 57 ] showed how changes in roles and workload interacted to promote the routine embedding of an intervention intended to manage incontinence in stroke patients.…”

Healthcare professionals’ perceptions of malnutrition management and oral nutritional supplement prescribing in the community: A qualitative study

“…Primary care team members in Ireland have previously reported valuing the structure and communication channels within their teams [37]. GP participation in primary care teams was considered particularly important for effective teamwork in a study surveying GPs and the wider multi-disciplinary team [38]. Geographical spread and multiple locations can be a barrier to effective communication in primary care [39,40].…”

“…Geographical spread and multiple locations can be a barrier to effective communication in primary care [39,40]. HCPs value co-location to facilitate face-to-face meetings between team members; however, GPs may not rate co-location as highly as other HCPs and in one recent study, GPs placed more emphasis on compensation for attendance at primary care meetings than other HCPs did [38]. It is important to note that GPs in the Irish primary care team system act independently, typically running their own practices as sole traders or partnerships, while the wider multi-disciplinary team members are health service employees.…”

Implementing community participation via interdisciplinary teams in primary care: An Irish case study in practice

“…Despite this, and other interim measures such as the national strategy for service user involvement, involvement of patients and communities in the development and running of PCTs is not routine practice across the country, is hard to achieve, and is generally not regarded by service providers as an important resource for PCTs . Therefore, the aforementioned gaps in international literature are also relevant to the Irish context…”