Rural interprofessional primary health care team development and sustainability: establishing a research agenda

Abstract

Primary health care (PHC) plays a pivotal role in health system reform locally and globally. The use of well functioning interprofessional primary health care (IPHC) teams is recognized as a key strategy in widespread health system reform across global, national, and provincial jurisdictions. IPHC teams contribute to the improvement of the health and well being of the population. These teams engage in issues that are a priority for citizens, such as: providing good evidence-based care; supporting the efforts of individuals, families, and communities in leading healthy lives; actively and deliberatively involving citizens in decisions affecting their health and health care system; and addressing the systemic social, economic, and political causes of health disparities, such as poverty, violence, and rural isolation. Many jurisdictions have begun to experiment with and implement major changes in the delivery of PHC. This has required that health care managers and practitioners reconsider the ways in which they have traditionally worked. However, although many innovative PHC services were developed, the notion of how to best develop and sustain the service delivery team itself and within what contexts could have used more deliberate attention. There are no documented best practices for rural IPHC team development and sustainability in the scholarly literature. This paper presents the results of a literature review, including the empirical and conceptual evidence regarding team development, team sustainability, and the role of rural context in IPHC team development. An argument for advancing PHC research that focuses on rural IPHC team development and sustainability is posited.This development discussion informs a new area for research that has evolved from an identified primary health care (PHC) policy and practice gap in Nova Scotia, Canada. In this paper, we present an argument for advancing PHC research that focuses on rural interprofessional primary health care (IPHC) team development and sustainability. This focus is important because of the known role that PHC plays in health system reform locally and globally, and because there are relatively few documented best practices for IPHC team development and sustainability in the scholarly literature. This paper presents the PHC developmental context in Nova Scotia and the results of our literature review, including the Correspondence to:

Observation of interprofessional collaborative practice in primary care teams: An integrative literature review

“…Earlier reviews have also more generally identified the need to consider contextual determinants (McCallin, 2001), and a range of systemic, organisational (top down) and individual (bottom up) factors (Lemieux-Charles and McGuire, 2006;San Martín-Rodríguez et al, 2005), especially in primary care settings (Bé langer and Rodrí-guez, 2008;McPherson and McGibbon, 2010;Xyrichis and Lowton, 2008).…”

“…Reviews pertaining specifically to primary care teams include those conducted by Bé langer and Rodríguez (2008), Dinh (2012), McPherson and McGibbon (2010), Ruddy (2005) and Xyrichis and Lowton (2008). All conclude that interprofessional collaboration is complex.…”

“…All conclude that interprofessional collaboration is complex. Systemic and organisational factors appear as important as more individual interactional factors (McPherson and McGibbon, 2010). As Xyrichis and Lowton noted in 2008; ''whilst much attention has been given in exploring teams' internal processes, less thought is given to exploring how the wider organisations support and promote their teams'' (p.150).…”

“…Given the well identified need in previous reviews (McPherson and McGibbon, 2010;Xyrichis and Lowton, 2008), to consider processes, structures and organisational support, we were particularly interested in studies where such elements were robustly identified and verified (e.g. linked to specific processes and/or outcomes) in the primary care setting.…”

Ontario primary care reform and quality improvement activities: an environmental scan

“…Nevertheless, there are also many unknowns in terms of how to shift the QI culture within PHC service organizations at all levels while also shifting the way that practitioners, managers and funders have traditionally worked [15,28,50]. Thus, efforts to advance QI-PHC should carefully consider that QI is but one aspect of the health system and culture that is being shifted as many other features are concurrently being changed.…”