Facilitating Integration Through Team-Based Primary Healthcare: A Cross-Case Policy Analysis of Four Canadian Provinces

Lukey, Alexandra; Johnston, Sharon; Montesanti, Stephanie; Donnelly, Catherine; Wankah, Paul; Bréton, Mylaine; Gaboury, Isabelle; Parniak, Simone; Pritchard, Caille; Berg, Shannon; Maiwald, Karin; Mallinson, Sara; Green, Lee A.; Oelke, Nelly D.

doi:10.5334/ijic.5680

Cited by 13 publications

(18 citation statements)

References 30 publications

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“…Having the educators co-located with the primary care providers enhanced the communication and collaboration among the providers, promoting the exchange of knowledge to facilitate the implementation process [ 50 , 51 ]. Interprofessional teams that are able to work together in one location have been seen to optimize role clarification and support integrated health services [ 52 ]. Furthermore, the function of provider empowerment evolved during the course of implementation; as providers became more aware of their roles, their empowerment enabled increased patient recruitment and ease of program delivery coupled with integration within the existing workflow of the clinic [ 53 , 54 ].…”

Section: Discussionmentioning

confidence: 99%

“…As a result, our study did not explore, nor do we believe it was impacted by the pandemic. The pandemic has shifted how healthcare operates; this may change the focus from co-location to collaboration in regards to integrated team-based care [ 52 ]. Further research is needed to understand how the pandemic has impacted the progressive implementation of BCC and other integrated, team-based models for chronic disease management.…”

Section: Limitationsmentioning

confidence: 99%

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A framework to support the progressive implementation of integrated team-based care for the management of COPD: a collective case study

Sibbald

Misra

daSilva

et al. 2022

BMC Health Serv Res

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Background In Canada, there is widespread agreement about the need for integrated models of team-based care. However, there is less agreement on how to support the scale-up and spread of successful models, and there is limited empirical evidence to support this process in chronic disease management. We studied the supporting and mitigating factors required to successfully implement and scale-up an integrated model of team-based care in primary care. Methods We conducted a collective case study using multiple methods of data collection including interviews, document analysis, living documents, and a focus group. Our study explored a team-based model of care for chronic obstructive pulmonary disease (COPD) known as Best Care COPD (BCC) that has been implemented in primary care settings across Southwestern Ontario. BCC is a quality improvement initiative that was developed to enhance the quality of care for patients with COPD. Participants included healthcare providers involved in the delivery of the BCC program. Results We identified several mechanisms influencing the scale-up and spread of BCC and categorized them as Foundational (e.g., evidence-based program, readiness to implement, peer-led implementation team), Transformative (adaptive process, empowerment and collaboration, embedded evaluation), and Enabling Mechanisms (provider training, administrative support, role clarity, patient outcomes). Based on these results, we developed a framework to inform the progressive implementation of integrated, team-based care for chronic disease management. Our framework builds off our empirical work and is framed by local contextual factors. Conclusions This study explores the implementation and spread of integrated team-based care in a primary care setting. Despite the study’s focus on COPD, we believe the findings can be applied in other chronic disease contexts. We provide a framework to support the progressive implementation of integrated team-based care for chronic disease management.

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Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

A framework to support the progressive implementation of integrated team-based care for the management of COPD: a collective case study

Sibbald

Misra

daSilva

et al. 2022

BMC Health Serv Res

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“…There are currently 41 PCNs serving 3.8 million patients in AB 12 . In 2018, PCNs were also introduced in BC with the goal of increasing patients' access to primary care providers 9 by utilizing interprofessional team‐based care 13 . In contrast, Ontario Health Teams (OHTs) were established in 2019 and are integrated care delivery systems utilized to deliver primary care services in ON 14 .…”

Section: Introductionmentioning

confidence: 99%

“… 7 , 8 In addition, the evidence in the literature is more focused on patient engagement at the individual care planning level rather than policy levels. 8 A cross‐case PHC policy analysis conducted by Lukey et al 9 found that although PHC policies in British Columbia (BC), Alberta (AB), Ontario (ON) and Quebec (QC) have some focus on patient engagement in policy; overall, there is little focus on this topic with no clear information on patient engagement in policy development, implementation and evaluation. Therefore, further research in this area is required to gather evidence on patient engagement in policy processes.…”

Section: Introductionmentioning

confidence: 99%

Patient, family member and caregiver engagement in shaping policy for primary health care teams in three Canadian Provinces

Hirschkorn

Rai

Parniak

et al. 2022

Health Expectations

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Introduction: Improving 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.Methods: A total of 29 semi-structured interviews with patients were conducted across the three provinces and data were analysed using thematic analysis.Results: Three 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. Conclusion:This 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

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“…The recent policy papers in IJIC about the last decade of integrated care in 19 countries including Belgium, Italy, the UK, Switzerland, Canada, the USA and so on, describe examples of these long term efforts. Yet, these policy experiences are often characterized by temporary impulses for ‘quick fixes’ rather than addressing broad spectrum interventions on mixed levels (local, regional, national) and, potentially as a result, in general have achieved mixed results [ 2 3 4 5 6 ]. Schroeder and Cutler recently highlighted the complexity of financial reforms needed to incentivize integrated care [ 7 ].…”

mentioning

confidence: 99%

Slowing Down to Accelerate: The Innovation of the Fundamentals of Integrated Care Governance

Minkman¹

2022

International Journal of Integrated Care

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Facilitating Integration Through Team-Based Primary Healthcare: A Cross-Case Policy Analysis of Four Canadian Provinces

Cited by 13 publications

References 30 publications

A framework to support the progressive implementation of integrated team-based care for the management of COPD: a collective case study

A framework to support the progressive implementation of integrated team-based care for the management of COPD: a collective case study

Patient, family member and caregiver engagement in shaping policy for primary health care teams in three Canadian Provinces

Slowing Down to Accelerate: The Innovation of the Fundamentals of Integrated Care Governance

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