Finding common ground? Evaluating an intervention to improve teamwork among primary health-care professionals

Chan, Bibiana; Perkins, David; Wan, Qing; Zwar, Nicholas; Daniel, Christopher S.; Crookes, Patrick A; Harris, Mark

doi:10.1093/intqhc/mzq057

Cited by 39 publications

(59 citation statements)

References 8 publications

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“…The studies were from 11 countries and most of the studies were conducted in Canada ( n = 17) [45, 51–53, 55, 57, 63, 65, 66, 71, 78–80, 82–84, 87], followed by the USA ( n = 12) [40, 43, 44, 47, 49, 56, 58, 72, 76, 77, 85, 86], the UK ( n = 7) [39, 48, 59, 64, 68, 70, 81], Australia ( n = 4) [42, 73–75], New Zealand ( n = 2) [41, 62], Sweden ( n = 2) [54, 67], France ( n = 1) [50], Spain ( n = 1) [46], Netherlands ( n = 1) [60], Brazil ( n = 1) [61] and Republic of South Africa ( n = 1) [69]. Thirty-two different primary care professionals participated in these studies, with most of the data relating to General Practitioners/Family Physicians (42 papers), nurses (35 papers), pharmacists (14 papers) and administrative staff (11 papers) (Table 3).…”

Section: Resultsmentioning

confidence: 99%

“…Fifteen papers were based on co-located teams [43, 48, 49, 53, 54, 56, 58, 65, 70, 71, 75, 83–85, 87] and 16 were from settings where the team is made up of some co-located professionals who are working with others in different sites [40, 42, 45, 46, 60, 64, 66, 68, 69, 73, 74, 80–82, 86]. Details about the physical infrastructure of the team being studied were not explicit in 18 papers [39, 41, 44, 47, 50–52, 55, 57, 61–63, 67, 72, 76–79].…”

Section: Resultsmentioning

confidence: 99%

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Assessing the facilitators and barriers of interdisciplinary team working in primary care using normalisation process theory: An integrative review

et al. 2017

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BackgroundInterdisciplinary team working is of paramount importance in the reform of primary care in order to provide cost-effective and comprehensive care. However, international research shows that it is not routine practice in many healthcare jurisdictions. It is imperative to understand levers and barriers to the implementation process. This review examines interdisciplinary team working in practice, in primary care, from the perspective of service providers and analyses 1 barriers and facilitators to implementation of interdisciplinary teams in primary care and 2 the main research gaps.Methods and findingsAn integrative review following the PRISMA guidelines was conducted. Following a search of 10 international databases, 8,827 titles were screened for relevance and 49 met the criteria. Quality of evidence was appraised using predetermined criteria. Data were analysed following the principles of framework analysis using Normalisation Process Theory (NPT), which has four constructs: sense making, enrolment, enactment, and appraisal. The literature is dominated by a focus on interdisciplinary working between physicians and nurses. There is a dearth of evidence about all NPT constructs apart from enactment. Physicians play a key role in encouraging the enrolment of others in primary care team working and in enabling effective divisions of labour in the team. The experience of interdisciplinary working emerged as a lever for its implementation, particularly where communication and respect were strong between professionals.ConclusionA key lever for interdisciplinary team working in primary care is to get professionals working together and to learn from each other in practice. However, the evidence base is limited as it does not reflect the experiences of all primary care professionals and it is primarily about the enactment of team working. We need to know much more about the experiences of the full network of primary care professionals regarding all aspects of implementation work.Systematic review registrationInternational Prospective Register of Systematic Reviews PROSPERO 2015: CRD42015019362.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Assessing the facilitators and barriers of interdisciplinary team working in primary care using normalisation process theory: An integrative review

et al. 2017

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“…These findings are consistent with other studies that have documented similar EHR barriers and workarounds in ambulatory care and other clinical settings. [23][24][25][26][27][28][29][30][31][32][33][34] However, the challenges and workarounds described in this article are specific to practices that were new to behavioral health and primary care integration and tested their EHR systems at the same time they worked to refine their care delivery approaches over a 3-year period. These practices' experiences can help shed light on challenges other practices under similar circumstances may also experience when starting the integration journey, and may help more quickly guide them to viable solutions.…”

Section: Discussionmentioning

confidence: 99%

“…We define a workaround as a behavior adopted by a user to overcome a perceived limitation in a technical system. 22 Although not all workarounds are inherently bad, [23][24][25][26][27][28][29][30][31] they point to mismatches between capabilities of existing HIT systems and the clinical tasks practices need to perform.…”

mentioning

confidence: 99%

Electronic Health Record Challenges, Workarounds, and Solutions Observed in Practices Integrating Behavioral Health and Primary Care

Cifuentes

Davis

Fernald

et al. 2015

The Journal of the American Board of Family Medicine

130

132

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Purpose: This article describes the electronic health record (EHR)-related experiences of practices striving to integrate behavioral health and primary care using tailored, evidenced-based strategies from 2012 to 2014; and the challenges, workarounds and initial health information technology (HIT) solutions that emerged during implementation.Methods: This was an observational, cross-case comparative study of 11 diverse practices, including 8 primary care clinics and 3 community mental health centers focused on the implementation of integrated care. Practice characteristics (eg, practice ownership, federal designation, geographic area, provider composition, EHR system, and patient panel characteristics) were collected using a practice information survey and analyzed to report descriptive information. A multidisciplinary team used a grounded theory approach to analyze program documents, field notes from practice observation visits, online diaries, and semistructured interviews.Results: Eight primary care practices used a single EHR and 3 practices used 2 different EHRs, 1 to document behavioral health and 1 to document primary care information. Practices experienced common challenges with their EHRs' capabilities to 1) document and track relevant behavioral health and physical health information, 2) support communication and coordination of care among integrated teams, and 3) exchange information with tablet devices and other EHRs. Practices developed workarounds in response to these challenges: double documentation and duplicate data entry, scanning and transporting documents, reliance on patient or clinician recall for inaccessible EHR information, and use of freestanding tracking systems. As practices gained experience with integration, they began to move beyond workarounds to more permanent HIT solutions ranging in complexity from customized EHR templates, EHR upgrades, and unified EHRs.Conclusion: Integrating behavioral health and primary care further burdens EHRs. Vendors, in cooperation with clinicians, should intentionally design EHR products that support integrated care delivery functions, such as data documentation and reporting to support tracking patients with emotional and behavioral problems over time and settings, integrated teams working from shared care plans, template-driven documentation for common behavioral health conditions such as depression, and improved registry functionality and interoperability. This work will require financial support and cooperative efforts among clinicians, EHR vendors, practice assistance organizations, regulators, standards setters, and workforce educators. (J Am Board Fam Med 2015;28:S63-S72.)

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“…Primary health care provides the means of organising a complete range of care, from home to hospital, investing resources rationally in the different levels of health. NCDs require an integrated care model using multidisciplinary and teamwork approaches in which primary care is on the front line in order to provide optimal care on a basis of adequate public health strategies [64,65].…”

Section: Integrated Care Model For the Control Of Ncdsmentioning

confidence: 99%

Systems Medicine Approaches for the Definition of Complex Phenotypes in Chronic Diseases and Ageing. From Concept to Implementation and Policies

Bousquet¹,

Jørgensen²,

Dauzat³

et al. 2014

CPD

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Finding common ground? Evaluating an intervention to improve teamwork among primary health-care professionals

Abstract: The Team-link intervention improved professional collaboration among GPs, practice staff, AHPs and patients, increasing understanding and trust and enhancing multidisciplinary teamwork for chronic disease care in primary care settings.

Cited by 39 publications

References 8 publications

Assessing the facilitators and barriers of interdisciplinary team working in primary care using normalisation process theory: An integrative review

Assessing the facilitators and barriers of interdisciplinary team working in primary care using normalisation process theory: An integrative review

Electronic Health Record Challenges, Workarounds, and Solutions Observed in Practices Integrating Behavioral Health and Primary Care

Systems Medicine Approaches for the Definition of Complex Phenotypes in Chronic Diseases and Ageing. From Concept to Implementation and Policies

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