Interprofessional collaboration in general practice

Interprofessional collaborative practice involves two or more healthcare providers from different disciplines working with patients, their families, carers, and communities to provide comprehensive care.¹ General practice provides holistic, person-centred care to individuals and communities throughout all stages of life.² It is responsible for delivering an expansive range of medical and other healthcare services, including disease diagnosis, disease management, preventive care, and health promotion.³ An integral part of this work involves coordinating patient care with health and social care providers, such as nurses, allied health professionals, aged care providers, care workers, and other community service providers, in primary and other healthcare settings, as part of interprofessional teams to ensure that patient care needs are met appropriately and comprehensively.⁴

However, the healthcare system is experiencing considerable strain, with an ageing population and increasing incidence of chronic illnesses contributing to greater demand for healthcare services.⁵ In 2022, the Australian Burden of Disease study reported that lifespans are increasing; however, there has been minimal change in the proportion of life spent in complete health.⁶ Approximately half of the Australian population is estimated to be living with a chronic illness and 20% living with two or more chronic illnesses; these illnesses have effects on quality of life, with health as well as social and economic implications.⁷ A projected shortfall of between 3100 and 10,600 general practitioners by 2031–2032⁸ and 21,765 primary care nurses by 2035⁹ presents further workforce challenges.¹⁰ Interprofessional collaborative practice has the potential to address these challenges by broadening the skill sets involved with patient care and enhancing health service delivery.¹

The Australian Government, through Medicare, the national health insurance scheme, provides rebates for medical and allied health consultations as part of chronic care planning in partnership with the patient’s usual general practitioner.¹¹ Patients perceived the incorporation of allied health professionals improves their knowledge of chronic illness and care processes.¹² Interprofessional care has been shown to increase patient satisfaction, staff satisfaction, and team function.^13–16 Reviews on interprofessional disease management programs have shown improvements in health outcomes, including all-cause mortality, disease-related hospitalisations, and all-cause hospitalisations, as well as cost-effectiveness.^17,18 In 2022, a meta-analysis revealed that interprofessional learning among healthcare teams was associated with a 28% (95% confidence interval [CI], 40–14%; P < 0.0003) reduction in patient mortality and a 23% (95% CI, 33–12%; P < 0.0001) reduction in adverse outcomes.¹⁹

Interprofessional collaboration in general practice not only provides a holistic healthcare experience for the patient, it can also assist in moderating demand on the healthcare sector by preventing or decreasing the need for secondary and tertiary services through better patient health outcomes.²⁰ Well-developed primary healthcare structures often result in lower costs to a healthcare system, and interprofessional approaches have shown potential to generate cost reductions.^13,17 For care providers in general practice, improved contact between the disciplines that make up the team can enhance professional development, with advantages for all stakeholders.²¹ Workload, stress, and time pressure have been reported by primary care providers as concerning issues.⁵ Interprofessional collaboration may also provide much-needed assistance to workload management.²²

There are several considerations for optimising interprofessional collaboration in general practice and harnessing the potential benefits. Rather than viewing interprofessional collaboration as a transfer of service, interprofessional teams in general practice should be viewed as a way towards comprehensive, well-communicated, longitudinal care.²⁰ Australians who saw multiple healthcare providers reported interprofessional collaboration as an issue, with some patients believing it was rarely achieved in general practice.²³ Interprofessional collaboration in general practice must be aligned with the patient’s goals.^22,24,25 For this integrated approach to occur, healthcare providers within interprofessional teams across primary and other healthcare settings need to partner with patients, their families, and carers, as well as each other. An integrated approach to care requires an enabling environment to coordinate these services, as endorsed by the World Health Organization Global Framework on People Centred Health Services.²⁶ Communication and shared decision-making with the patient and the interprofessional team members may be facilitated by real-time accessible clinical information systems.^26,27 Patients in general practice are open to using telehealth services post-pandemic for healthcare needs.²⁸ Interprofessional collaboration needs to be supported by appropriate funding and practice-level arrangements.²⁹

Workforce development enhancements are needed to establish a steady stream of healthcare providers who are motivated to build a career in general practice. To enable interprofessional collaboration and coordinate services together with patients, carers, and other sectors, healthcare providers need to be trained in how to do this, with opportunities to work within these sectors and together with other members of the interprofessional team.³⁰ However, training curriculums often do not promote experience in primary and community care settings, with students and post-graduate trainees spending more time training in other clinical environments.³¹ For example, most medical students spend more time training in tertiary care settings than primary care settings.

Recommendations

The following recommendations are made:

Funding should incentivise value. To sustain a healthy population, system-wide transformations are needed. Through improvements to policy, education, training, and practice, interprofessional collaboration in general practice can be successful.