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Enhancing Interdisciplinary Collaboration In Primary Health Care
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Health Promotion And Interdisciplinary Approach
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By Franziska GeeseFranziska Geese SciProfiles Scilit Preprints.org Google Scholar and Kai-Uwe SchmittKai-Uwe Schmitt SciProfiles Scilit Preprints.org Google Scholar *
Submission received: 5 December 2022 / Revised: 16 January 2023 / Accepted: 23 January 2023 / Published: 27 January 2023
The Principles And Framework For Interdisciplinary Collaboration In Primary Health Care
Healthcare professionals often feel challenged by complex patients and their associated care needs during care transitions. Interprofessional collaboration (IPC) is considered an effective approach in such situations. However, a fragmented healthcare system can limit IPC. This study investigated the experiences of Swiss healthcare professionals regarding the transition of complex patient care and the potential of IPC. Experts from the fields of nursing, medicine, psychology, physiotherapy, dietetics and nutrition, social services, occupational therapy and speech therapy are involved. A qualitative design of triangulation between methods was applied, with two focus group discussions and ten individual interviews. The combination of different data collection methods allowed us to explore the complex transition of patient care and to systematically add the perspectives of healthcare professionals from different care settings. Three main themes were identified: (1) Participants described their vision of an ideal complex patient care transition, ie, the status they would like to see implemented; (2) participants reported challenges in transitioning complex patient care as experienced today; and (3) participants suggested ways to improve the transition of complex patient care through IPC. This research highlighted that healthcare professionals consider IPC to be an effective intervention for improving the transition of complex care for patients. It has been shown that the sustainable implementation of IPC in care organizations is currently limited in Switzerland. In the absence of strong and direct promotion of IPC by the health system, professionals in clinical practice can further promote IPC by finding practical solutions to overcome organizational boundaries.
In high-income countries, patient complexity is associated with chronic disease and multi-morbidity in an aging society [1, 2]. Complex patients are characterized by unstable trajectories of their chronic and multiple diseases and the need for timely and effective coordination of care between healthcare workers and healthcare institutions [3]. In order to provide quality care in the context of complex patients, “complexity” must be understood as a comprehensive concept with wide-ranging, interrelated dimensions and different interpretations by healthcare professionals [4]. Different models of complexity, such as the ‘Theoretical Vector Model’ [5] and the ‘Complexity Framework’ [1], have been developed to try to incorporate a patient-centeredness by considering the dynamics of complexity and the interaction between medical and non-medical issues in order to increase the understanding of healthcare professionals on providing services needed for complex patients [6, 7, 8]. Despite this, there is still a lack of shared understanding of ‘complexity’ in health care due to the fluctuating and dynamic state and changes in the disease trajectory [9]. This limited understanding is also reflected in clinical practice when health professionals focus solely on disease, medical therapy, or family socioeconomic status, without considering the interaction of such health determinants, and therefore fail to collaborate [10]. A definition of complexity in the context of dynamically evolving patient needs and demands is needed to enable healthcare professionals to understand this complex environment.
Various approaches have been cited as effective solutions in the context of transitions of care for complex patients between primary care (care provided by a general practitioner, e.g. general practitioner), secondary care (care provided by a specialist such as a cardiologist or oncologist in a general hospital) and tertiary care (care provided by a higher level of specialization, e.g. in a university hospital) [11, 12]. Integrated care models appear promising in terms of improving patient experience and collaboration between healthcare professionals in care organizations and preventing fragmented care by better addressing care demands that arise when transitioning from one setting to another [13, 14]. Providing continuity of care and a constant point of contact as part of an integrated approach seems beneficial when the disease state fluctuates and requires timely coordination of care [15, 16, 17]. However, there is evidence that integrated care programs are mainly implemented regionally and not, for example, as part of a health system strategy [18]. The CHANgE (Clinical practice-oriented Change solutions against Active AND Health AGEing) project, for example, focused on healthy and active aging of people with non-communicable diseases and aimed at identifying barriers that prevent the provision of integrated care. Common barriers were found to be a lack of case managers and care coordinators, a lack of evidence-based guidelines for patients with multiple morbidities, inadequate training of healthcare professionals in complex patient care, and challenges in implementing universal integrated healthcare solutions across Europe [13]. Language barriers have also been shown to have a negative effect; a national cross-sectional study in Switzerland, a multilingual country, pointed out that the exchange of information between health professionals can be hindered by a lack of language skills [19]. Mabire et al., in addition, investigated the benefits of integrated discharge care planning for elderly hospital patients in Switzerland and found that not all patients benefited from the integrated initiative. Here, a risk-stratified approach to the patient population is proposed to identify individuals in need of an integrated nursing intervention [ 20 ].
Effective interprofessional collaboration (IPC) has been understood as another complementary intervention to increase team dynamics and improve the patient’s experience of care [21]. IPC occurs when multiple healthcare professionals from different professional backgrounds provide services working with patients, their families, carers and communities to deliver the highest quality of care in all settings [22]. Several reviews summarizing the latest evidence on the effectiveness of IPC have reported favorable outcomes, such as increased quality of care, better continuity of care, improved patient satisfaction, teamwork and job satisfaction among healthcare professionals [21, 23, 24]. However, variability was found between interprofessional interventions and their outcomes, leading to the assumption that interprofessional interventions were not well conceptualized [21]. Therefore, in order to improve the conceptual framework of IPC, a description of relevant activities related to the fluctuating and dynamic state of complex needs and demands of patients has been added. Activities are defined as: ‘cooperation’, divided into consultative cooperation and collaborative partnership; “coordination”, which is performed as coordinated cooperation, delegated coordination and/or consultative coordination; and ‘networking’ [25]. Schmitz et al. who qualitatively investigated Swiss healthcare professionals’ perspectives on IPC described similar results. The authors distinguished three forms of cooperation (1) coordinative (refers to the interweaving of clearly defined, institutionalized patterns of action and learned professional skills), (2) cocreative (cooperation of different professional and individual skills over relatively long periods of time) and (3) project cooperation which can be placed in the middle of the continuum ranging from coordinative to co-creative cooperation as a form of ad hoc cooperation [26]. For the sustainable implementation of IPC in the healthcare system, the inhibiting factors must be understood. A systematic meta-review by Wei et al. [27] summarized organizational, team, and individual-level influence factors based on studies conducted in 14 countries, excluding Switzerland. The authors reported that outcomes for patients, healthcare professionals, and the organization may be negatively impacted if these influencing factors are not addressed. For example, a shared definition of organizational values and mission, delegated power, and support structures can enhance IPC, while a lack of these factors can reduce IPC. The same applies to factors such as role clarity, conflict management and leadership at the team level, as well as communication, trust and respect at the individual level [27].
Naturopathic Doctors As Part Of The Health Care Team
In summary, the evidence related to the factors influencing IPC is mainly based on various quantitative international studies, while qualitative studies dealing with the perspective of healthcare professionals working in the care of complex patients are lacking. In particular, there is a lack of adequate analyzes for Switzerland. Only one qualitative study was identified that examined the views of IPC healthcare workers in Switzerland [26]. However, this study addresses the general nature and challenges of IPC, but is too unspecific regarding complex patient care. Accordingly, this study aimed to investigate the transition of complex patient care and
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