Examining Interprofessional teams structures and processes in the implementation of a primary care intervention (Health TAPESTRY) for older adults using normalization process theory

Abstract

Background: Many countries are engaged in primary care reforms to support older adults who are living longer in the community. Health Teams Advancing Patient Experience: Strengthening Quality [Health TAPESTRY] is a primary care intervention aimed at supporting older adults that involves trained volunteers, interprofessional teams, technology, and system navigation. This paper examines implementation of Health TAPESTRY in relation to interprofessional teamwork including volunteers. Methods: This study applied Normalization Process Theory (NPT) and used a descriptive qualitative approach [1] embedded in a mixed-methods, pragmatic randomized controlled trial. It was situated in two primary care practice sites in a large urban setting in Ontario, Canada. Focus groups and interviews were conducted with primary care providers, clinical managers, administrative assistants, volunteers, and a volunteer coordinator. Data was collected at 4 months (June-July 2015) and 12 months (February-March 2016) after intervention start-up. Patients were interviewed at the end of the six-month intervention. Field notes were taken at weekly huddle meetings. Results: Overall, 84 participants were included in 17 focus groups and 13 interviews; 24 field notes were collected. Themes were organized under four NPT constructs of implementation: 1) Coherence-(making sense/understanding of the program's purpose/value) generating comprehensive assessments of older adults; strengthening health promotion, disease prevention, and self-management; enhancing patient-focused care; strengthening interprofessional care delivery; improving coordination of health and community services. 2) Cognitive Participation-(enrolment/buy-in) tackling new ways of working; attaining role clarity. 3) Collective Action-(enactment/operationalizing) changing team processes; reconfiguring resources. 4) Reflective Monitoring-(appraisal) improving teamwork and collaboration; reconfiguring roles and processes.

Experiences of integrating community volunteers as extensions of the primary care team to help support older adults at home: a qualitative study

“…Weekly interprofessional primary care "huddles" (a small team of 6 to 8 staff) triaged reports, coordinated further care, and planned next steps. A rich description of team functioning is described in another paper [42].…”

“…A major strength of the research design was the inclusion of multiple different stakeholder voices including the volunteers themselves, clients, health care providers, and the volunteer coordinator, fostering transferability. Findings from qualitative data on other aspects of Health TAPESTRY beyond the volunteer component, including client experiences and the functioning of the interprofessional primary care team, has been published elsewhere [42,56].…”

A Web-Based Social Network Tool (GENIE) for Supporting Self-management Among High Users of the Health Care System: Feasibility and Usability Study

“…Health TAPESTRY is a multicomponent primary care intervention that centers on supporting older adults’ life and health goals [ 34 , 35 ]. The Health TAPESTRY program components include (1) trained volunteers visiting in pairs to collect health information using web-based surveys related to health risks and life goals [ 36 ], (2) care coordination by an interprofessional primary care team, (3) the use of technology to share health information between volunteers and primary care providers, and (4) support for system navigation [ 37 ]. Trained community volunteers implemented the GENIE tool, in addition to the Health TAPESTRY surveys.…”

Evaluating Implementation Contexts, Mechanisms, and Outcomes: A Normalization Process Theory Coding Manual for Qualitative Research and Instrument Development

“…Huddles were viewed as worth creating and maintaining, both for interprofessional team and patient bene ts. Participants identi ed that the majority of patients were satis ed with the interprofessional approach to primary care' [53].…”

“…Participants identi ed that the majority of patients were satis ed with the interprofessional approach to primary care' [53]. 'The respondents offered several explanations for resistance or lack of engagement: some staff felt that health promotion activities overstretched users' resources and thus had a negative impact on their quality of life; others argued that health promotion activities did not respect personal preferences of users and staff (…) One of the important implementation ideas (…) was the concept of staff being role models for health promotion.…”