Interprofessional teamwork in comprehensive primary healthcare services: Findings from a mixed methods study

Abstract

This article draws on data from a 5-year project that examined the effectiveness of Comprehensive primary healthcare (CPHC) in local communities. A hallmark of CPHC services is interprofessional teamwork. Drawing from this study, our article presents factors that enabled, or hindered, healthcare teams working interprofessionally in Australian primary healthcare (PHC) services. The article reports on the experiences of teams working in six Australian PHC services (four managed by state governments, one non-government sexual health organisation, and one Aboriginal community-controlled health service) during a time of significant health sector restructure. Findings are drawn from two key methods: an online survey of practitioners and managers (n = 154), and interviews with managers and practitioners (n = 60) from the six study sites. The majority of survey respondents worked with other health professionals in their service to provide interprofessional care to clients. Processes included formal team meetings, case conferencing, referring clients to other health professionals if needed, informal communication with other health professionals about clients, and team-based delivery of care. A range of interrelated factors affected interprofessional work at the services, from contextual, organisational, processual, and relational domains. Funding cuts and policy changes that saw a reorientation and re-medicalisation of South Australian services undermined interprofessional work, while a shared CPHC culture and commitment among some staff was helpful in resisting some of these effects. The co-location of services was a factor in PHC teams working interprofessionally and not only enabled some PHC teams to work more interprofessionally but also created barriers to interprofessional teamwork through disruption resulting from restructuring of services. Our study indicates the importance of decision makers taking into account the potential effects of policy and structural changes on interprofessional teamwork. Decision makers should strive to minimise unintended negative effects of changes on the functioning of interprofessional teams.

The impact of interprofessional practice models on health service inequity: an integrative systematic review

“…Practice elements were reviewed in relation to the contextual, organisational, process and relational domains. Themes similar to that of Reeves et al's (2016) interprofessional practice model of interprofessional teamwork were identified (Reeves et al , 2016; Bentley et al , 2018), rather than as part of a wider model of care.…”

“…The social justice focus of Aboriginal health services in Australia may be contributing to the success of the interprofessional practice model. Bentley et al (2018) researched comprehensive interprofessional health care teams within PHC services in Australia and found that the success of interprofessional teams within Aboriginal health services was attributable to the success of the Aboriginal health worker role within the team.…”

“…PC is often considered a medical intervention, based on illness and diagnosis, whereas PHC is a broader concept (Ashcroft, 2015). PHC was introduced as a concept of care more than three decades ago and has re-emerged through the WHO as a comprehensive and integrated model of practice that is person-centred and interprofessional (Bentley et al , 2018; WHO, 2010). There is a global trend to prioritise the delivery of PHC from interdisciplinary teams (Haydt, 2018).…”

Why Community Health Systems Have Not Flourished in High Income Countries: What the Australian Experience Tells Us

“…Staff reported generally much less hierarchical dynamics than would be typical in other health services such as hospitals, and enacted a range of strategies to provide holistic, coordinated care to clients, including joint appointments, case conferencing, and team planning for clients. 35 This allowed, for example, a client with diabetes to see a dietitian, exercise physiologist, diabetes nurse educator, and podiatrist at the one service, to support many different aspects of their management of their diabetes. This provided a more whole-ofperson approach to care than can be achieved in more selective primary medical care services.…”

Educating Children in Our Care

“…Within the health services literature, there are four key domains that are integral to IPC; contextual, organizational, professional practice, and relational (Bentley et al, 2018). We used the Bentley model and had educators and social workers apply it to their professional settings.…”