Funding models and medical dominance in interdisciplinary primary care teams: qualitative evidence from three Canadian provinces

Wranik, Wiesława Dominika; Haydt, Susan

doi:10.1186/s12960-018-0299-3

Cited by 12 publications

(21 citation statements)

References 64 publications

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“…These examples may indicate a mismatch in the perceptions of health between patients and clinicians during the consultation. One influencing factor may be patient/clinician power imbalance, whereby the health professional was perceived to hold power within the consultation 26–28 . A perceived superiority of clinicians in the eyes of patients can impact their willingness to share their opinions, 34 and engage in consultation because they trusted that the clinician knew best 35 .…”

Section: Discussionmentioning

confidence: 99%

Patient views on asthma diagnosis and how a clinical decision support system could help: A qualitative study

Canny

Donaghy

Murray

et al. 2022

Health Expectations

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IntroductionMaking a diagnosis of asthma can be challenging for clinicians and patients. A clinical decision support system (CDSS) for use in primary care including a patient-facing mode, could change how information is shared between patients and healthcare professionals, and improve the diagnostic process. MethodsParticipants diagnosed with asthma within the last five years were recruited from general practices across four UK regions. In-depth interviews were used to explore patient experiences relating to their asthma diagnosis, and to understand how a CDSS could be used to improve the diagnostic process for patients. Interviews were audio recorded, transcribed verbatim and analysed using a thematic approach. Results17 participants (12 female) undertook interviews, including 14 individuals and 3 parents of children with asthma. Being diagnosed with asthma was generally considered an uncertain process.Participants felt a lack of consultation time and poor communication affected their understanding of asthma and what to expect. Had the nature of asthma and steps required to make a diagnosis been explained more clearly, patients felt their understanding and engagement in asthma self-management could have been improved. Participants considered that a CDSS could provide resources to support the diagnostic process, prompt dialogue, aid understanding and support shared decision making. ConclusionUndergoing an asthma diagnosis was uncertain for patients if their ideas and concerns were not addressed by clinicians and was influenced by a lack of consultation time and limitations in communication. An asthma diagnosis CDSS could provide structure and an interface to prompt dialogue, provide visuals about asthma to aid understanding, and encourage patient involvement. Patient and public contributionPre-specified semi-structured interview topic guides (young person and adult versions) were developed by the research team and piloted with members of the Asthma UK Centre for Applied Research Patient and Public Involvement (PPI) group. Findings were regularly discussed within the research group and with PPI colleagues to aid interpretation of data.

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Section: Discussionmentioning

confidence: 99%

Patient views on asthma diagnosis and how a clinical decision support system could help: A qualitative study

Canny

Donaghy

Murray

et al. 2022

Health Expectations

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“…The funding of primary healthcare teams is a vital, but largely understudied issue (Wranik & Haydt, 2018; Wranik et al, 2017). While previous studies recognize that team funding and the degree to which non‐physician workforce remuneration is derived from physician activity influence team functioning, ours is among the first to describe how funding has a direct impact on the contributions of FPN.…”

Section: Discussionmentioning

confidence: 99%

A qualitative study exploring the influence of clinic funding on the integration of family practice nurses in Newfoundland and Labrador

et al. 2020

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Aim This study explores the contributions of family practice nurses in primary care across Newfoundland and Labrador funded by fee‐for‐service and alternate payment plans to examine the influence of funding arrangements on nursing roles/activities. Design A qualitative descriptive design was employed. Methods Semi‐structured telephone interviews were conducted between March‐July 2018 with physicians and Registered Nurses working in primary care settings in Newfoundland and Labrador. Interviews were transcribed verbatim, and a content analysis approach was used to identify recurring themes. Results Clinic funding was instrumental in the integration of family practice nurses into primary care settings and influenced roles/activities. In fee‐for‐service practices, nurses work with physicians and focus on one‐on‐one patient care in office‐based settings, whereas nurses in alternate payment plans practices work more independently, in a wider range of settings and with emphasis on both individual and group‐based encounters. Compared with alternate payment plans practices, fee‐for‐service practices tend to be more restrictive due to physician billing requirements.

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“…20 Medical dominance in healthcare is still structurally embedded, meaning that regulatory, economic and institutional factors enhance the medical logic in multidisciplinary collaboration. 21 This medical dominance is also reflected in the clinical evidence-based guidelines, which do seldom take into account any emotional, individual, exceptional, sociocultural and other "immeasurable" criteria. 22 If a MDC team needs to function effectively, shared goals and values are essential.…”

Section: Discussionmentioning

confidence: 99%

Physicians’ attitudes and perspectives regarding the uptake of psychosocial aspects and/or patient preferences during multidisciplinary team meetings in oncology

Baes

Horlait

Dhaene³

et al. 2020

International Journal of Care Coordination

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Introduction Coordinating cancer care is challenging because of its complexity. To partly encounter this complexity, multidisciplinary team meetings (MDTMs) were implemented to evaluate diagnosis, discuss treatment options and collectively decide upon the most optimal patient care and treatment plan. In cancer trajectories, medical professionals have a coordinating role and final decision responsibility. As a consequence patient-centred non-biomedical information are easily overlooked during discussions in MDTMs. This study aims to uncover physicians’ perceived barriers regarding the uptake of psychosocial aspects and/or patient preferences in the cancer treatment decision-making process during Multidisciplinary Oncology Consultations (MOCs), a specific type of MDTM in Belgium. Methods Between March 2019 and May 2019 semi-structured interviews were conducted with twenty medical professionals specialized in oncology. Grounded theory principles were used to detect and classify perceived barriers and patterns emerging regarding the uptake of psychosocial information in the cancer treatment decision-making process. Results Although physicians showed an open attitude towards taking into account psychosocial aspects and patient preferences in treatment decisions, the majority of respondents is not convinced the MOC is the best place to discuss these aspects. Physicians reported organisational, work process, and health system related barriers. Discussion The MOC emerges as a medicalized form of team discussion that, in its current form, does not reach its objective of truly integrated multidisciplinarity as cancer care is demanding. The working practices of the MOC can be optimized to evolve towards a truly interdisciplinary approach.

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Funding models and medical dominance in interdisciplinary primary care teams: qualitative evidence from three Canadian provinces

Cited by 12 publications

References 64 publications

Patient views on asthma diagnosis and how a clinical decision support system could help: A qualitative study

Patient views on asthma diagnosis and how a clinical decision support system could help: A qualitative study

A qualitative study exploring the influence of clinic funding on the integration of family practice nurses in Newfoundland and Labrador

Physicians’ attitudes and perspectives regarding the uptake of psychosocial aspects and/or patient preferences during multidisciplinary team meetings in oncology

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