Patients’ perceptions of team-based care in family practice: access, benefits and team roles
Olga Szafran 1 , Sandra L. Kennett 2 , Neil R. Bell 3 , Lee Green 41 Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
2 Edmonton Oliver Primary Care Network, Family Medicine Clinic, Misericordia Community Hospital, Edmonton, Alberta, Canada; Currently: Primary Care, Health Canada, Edmonton, Alberta, Canada
3 Department of Family Medicine, University of Alberta Family Medicine Clinic, Misericordia Community Hospital, Edmonton, Alberta, Canada
4 Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
Correspondence to: Olga Szafran, Department of Family Medicine, 6–10 University Terrace, University of Alberta, Edmonton, Alberta T6G 2T4, Canada. Email: olga.szafran@ualberta.ca
Journal of Primary Health Care 10(3) 248-257 https://doi.org/10.1071/HC18018
Published: 4 October 2018
Journal Compilation © Royal New Zealand College of General Practitioners 2018.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
INTRODUCTION: The increasing complexity of health care and escalating prevalence of multiple chronic conditions have driven interprofessional team-based care in family practice. Most published studies examine team-based care from the perspective of health professionals. The purpose of this study was to examine patients’ perceptions of team-based care in family practice.
METHODS: This was a waiting room survey conducted in five family medicine academic teaching clinics in Edmonton, Alberta, Canada. Patients aged ≥18 years were invited to participate in a survey addressing patient access to team-based care, perceived benefits, preferred health professional and team member roles.
RESULTS: Of the 44.3% (565/1274) of respondents, 41.8% (231/552) reported receiving care from a team of health professionals, primarily for chronic disease management or pharmacy consultations. While there was a consistent pattern of patient perception that many aspects of care did not worsen with team-based care, improvements in knowledge of their medical condition (67.4%); the care received (65.0%); access to care (51.1%); ability to self-care (48.9%) and maintain their independence (43.7%); and overall health (51.1%) were reported. Some patients felt that team-based care reduced emergency visits (34.6%) and hospitalisations (29.9%), and 44.1% of patients felt that they had an active role on the team and made decisions about their care together with health professionals.
CONCLUSION: Patients perceive that team-based care in family practice has improved their knowledge and access to care, overall health and avoided some emergency department visits and hospital admissions. The findings support the continued development of team-based care in family practice.
KEYWORDS: Family practice; primary health care; patient care team; patient-centred care; patient participation; Canada
References
[1] World Health Organization. Framework for action on interprofessional education & collaborative practice. Geneva, Switzerland: WHO Press; 2010. [cited 2018 February 6]. Available from: http://www.who.int/hrh/resources/framework_action/en/[2] The College of Family Physicians of Canada. A vision for Canada: the Patient’s Medical Home. Position Paper. Mississauga, Ontario, Canada: The College of Family Physicians of Canada; 2011. [cited 2018 February 5]. Available from: http://www.cfpc.ca/A_Vision_for_Canada/
[3] Naylor MD, Coburn KD, Kurtzman ET, et al. Inter-professional team-based primary care for chronically ill adults: state of the science. Unpublished white paper presented at the ABIM Foundation meeting to Advance Team-Based Care for the Chronically Ill in Ambulatory Settings. Philadelphia, PA; 2010. [cited 2018 February 8]. Available from: https://www.nationalahec.org/pdfs/vsrt-team-based-care-principles-values.pdf
[4] Brown J. Patient-Centred Collaborative Practice. Ottawa: Health Canada; 2004.
[5] Bissell P, May CR, Noyce PR. From compliance to concordance: barriers to accomplishing a reframed model of health care interactions. Soc Sci Med. 2004; 58 851–62.
| From compliance to concordance: barriers to accomplishing a reframed model of health care interactions.Crossref | GoogleScholarGoogle Scholar |
[6] Katon WJ, Lin EHB, Von Korff M, et al. Collaborative care for patients with depression and chronic illnesses. N Engl J Med. 2010; 363 2611–20.
| Collaborative care for patients with depression and chronic illnesses.Crossref | GoogleScholarGoogle Scholar |
[7] Davies HTO, Nutley S, Mannion R. Organizational culture and quality of health care. Qual Health Care. 2000; 9 111–9.
| Organizational culture and quality of health care.Crossref | GoogleScholarGoogle Scholar |
[8] Crawford MJ, Rutter D, Manley C, et al. Systematic review of involving patients in the planning and development of health care. BMJ. 2002; 325 1263
| Systematic review of involving patients in the planning and development of health care.Crossref | GoogleScholarGoogle Scholar |
[9] Hogg C. Patients, Power and Politics – From Patients to Citizens. London: Sage Publications; 1999.
[10] Taylor KI, Oberle KM, Crutcher RA, Norton PG. Promoting health in type 2 diabetes: nurse-physician collaboration in primary care. Biol Res Nurs. 2005; 6 207–15.
| Promoting health in type 2 diabetes: nurse-physician collaboration in primary care.Crossref | GoogleScholarGoogle Scholar |
[11] Reeves S, Pelone F, Harrison R, et al. Interprofessional collaboration to improve professional practice and health care outcomes. Cochrane Database Syst Rev, 2017; CD000072
| Interprofessional collaboration to improve professional practice and health care outcomes.Crossref | GoogleScholarGoogle Scholar |
[12] Barrett J, Curran V, Glynn L, Godwin M. CHSRF Synthesis: Interprofessional Collaboration and Quality Primary Healthcare. Ottawa, Ontario: Canadian Health Services research Foundation; 2007. [cited 2018 February 6]. Available from: http://www.cfhi-fcass.ca/Migrated/PDF/SynthesisReport_E_FINAL.pdf
[13] Harris MF, Advocat J, Crabtree BF, et al. Interprofessional teamwork innovations for primary health care practices and practitioners: evidence from a comparison of reform in three countries. J Multidiscip Healthc. 2016; 9 35–46.
| Interprofessional teamwork innovations for primary health care practices and practitioners: evidence from a comparison of reform in three countries.Crossref | GoogleScholarGoogle Scholar |
[14] Jaruseviciene L, Liseckiene I, Valius L, et al. Teamwork in primary care: perspectives of general practitioners and community nurses in Lithuania. BMC Fam Pract. 2013; 14 118
| Teamwork in primary care: perspectives of general practitioners and community nurses in Lithuania.Crossref | GoogleScholarGoogle Scholar |
[15] Welp A, Meier LL, Manser T. The interplay between teamwork, clinicians’ emotional exhaustion, and clinician-rated patient safety: a longitudinal study. Crit Care. 2016; 20 110
| The interplay between teamwork, clinicians’ emotional exhaustion, and clinician-rated patient safety: a longitudinal study.Crossref | GoogleScholarGoogle Scholar |
[16] Litaker D, Mion LC, Planavsky L, et al. Physician-nurse practitioner teams in chronic disease management: the impact on costs, clinical effectiveness, and patients’ perceptions of care. J Interprof Care. 2003; 17 223–37.
| Physician-nurse practitioner teams in chronic disease management: the impact on costs, clinical effectiveness, and patients’ perceptions of care.Crossref | GoogleScholarGoogle Scholar |
[17] Schadewaldt V, McInnes E, Hiller JE, Gardner A. Views and experiences of nurse practitioners and medical practitioners with collaborative practice in primary health care - an integrative review. BMC Fam Pract. 2013; 14 132
| Views and experiences of nurse practitioners and medical practitioners with collaborative practice in primary health care - an integrative review.Crossref | GoogleScholarGoogle Scholar |
[18] Pullon S, McKinlay E, Stubbe M, Todd L, Badenhorst C. Patients’ and health professionals’ perceptions of teamwork in primary care. J Prim Health Care. 2011; 3 128–35.
[19] Infante FA, Proudfoot JG, Powell Davies G, et al. How people with chronic illnesses view their care in general practice: a qualitative study. Med J Aust. 2004; 181 70–3.
[20] van Dongen JJJ, de Wit M, Smeets HWH, et al. “They are talking about me, but not with me”: a focus group study to explore the patient perspective on interprofessional team meetings in primary care. Patient. 2017; 10 429–38.
| “They are talking about me, but not with me”: a focus group study to explore the patient perspective on interprofessional team meetings in primary care.Crossref | GoogleScholarGoogle Scholar |
[21] Cheong LH, Armour CL, Bosnic-Anticevich SZ. Primary health care teams and the patient perspective: a social network analysis. Res Social Adm Pharm. 2013; 9 741–57.
| Primary health care teams and the patient perspective: a social network analysis.Crossref | GoogleScholarGoogle Scholar |
[22] Karazivan P, Dumez V, Flora L, et al. The patient-as-partner approach in health care: a conceptual framework for a necessary transition. Acad Med. 2015; 90 437–41.
| The patient-as-partner approach in health care: a conceptual framework for a necessary transition.Crossref | GoogleScholarGoogle Scholar |
[23] Alberta Health, Government of Alberta (1995–2016). Primary care networks. Edmonton, Alberta, Canada: Government of Alberta. [cited 2018 February 5]. Available from: http://www.health.alberta.ca/services/primary-care-networks.html
[24] Van Berckelaer A, DiRocco D, Ferguson M, et al. Building a patient-centered medical home: obtaining the patient’s voice. J Am Board Fam Med. 2012; 25 192–8.
| Building a patient-centered medical home: obtaining the patient’s voice.Crossref | GoogleScholarGoogle Scholar |
[25] McAlister FA, Bakal JA, Green L, et al. The effect of provider affiliation with a primary care network on emergency department visits and hospital admissions. CMAJ. 2018; 190 E276–84.
| The effect of provider affiliation with a primary care network on emergency department visits and hospital admissions.Crossref | GoogleScholarGoogle Scholar |
[26] Carroll JC, Talbot Y, Permaul J, et al. Academic family health teams. Part 2: patient perceptions of access. Can Fam Physician. 2016; 62 e31–9.
[27] Tinelli M, Bond D, Blenkinsopp A, et al. Community pharmacy medicines management evaluation team. Patient evaluation of a community pharmacy medications management service. Ann Pharmacother. 2007; 41 1962–70.
| Community pharmacy medicines management evaluation team. Patient evaluation of a community pharmacy medications management service.Crossref | GoogleScholarGoogle Scholar |
[28] Leach B, Gradison M, Morgan P, et al. Patient preference in primary care provider type. Healthc (Amst). 2018; 6 13–16.
| Patient preference in primary care provider type.Crossref | GoogleScholarGoogle Scholar |
[29] Szafran O, Torti JMI, Kennett SL, Bell NR. Family physicians’ perspectives on interprofessional teamwork: findings from a qualitative study. J Interprof Care. 2018; 32 169–77.
| Family physicians’ perspectives on interprofessional teamwork: findings from a qualitative study.Crossref | GoogleScholarGoogle Scholar |
[30] Al Sayah F, Szafran O, Robertson S, et al. Nursing perspectives on factors influencing interdisciplinary teamwork in the Canadian primary care setting. J Clin Nurs. 2014; 23 2968–79.
| Nursing perspectives on factors influencing interdisciplinary teamwork in the Canadian primary care setting.Crossref | GoogleScholarGoogle Scholar |
[31] Freund T, Everett C, Griffiths P, et al. Skill mix, roles and remuneration in the primary care workforce: who are the healthcare professionals in the primary care teams across the world? Int J Nurs Stud. 2015; 52 727–43.
| Skill mix, roles and remuneration in the primary care workforce: who are the healthcare professionals in the primary care teams across the world?Crossref | GoogleScholarGoogle Scholar |
[32] Supper I, Catala O, Lustman M, et al. Interprofessional collaboration in primary health care: a review of facilitators and barriers perceived by involved actors. J Public Health (Oxf). 2015; 37 716–27.
[33] Martin DR, O’Brien JL, Heyworth JA, Mayer NR. The collaborative healthcare team: tensive issues warranting ongoing consideration. J Am Acad Nurse Pract. 2005; 17 325–30.
| The collaborative healthcare team: tensive issues warranting ongoing consideration.Crossref | GoogleScholarGoogle Scholar |
[34] O’Daniel M, Rosenstein AH. Professional communication and team collaboration. In: Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Hughes RG, editor. Rockville, MD, USA: Agency for Healthcare Research and Quality, US Department of Health and Human Resources; April 2008. [cited 2018 February 5]. Available from: https://archive.ahrq.gov/professionals/clinicians-providers/resources/nursing/resources/nurseshdbk/nurseshdbk.pdf
[35] Christensen C, Larson JR. Collaborative medical decision making. Med Decis Making. 1993; 13 339–46.
| Collaborative medical decision making.Crossref | GoogleScholarGoogle Scholar |
[36] Canadian Medical Association. Health Care Transformation in Canada. Ottawa, Ontario: Canadian Medical Association; 2010. [cited 2018 February 8]. Available from: http://policybase.cma.ca/dbtw-wpd/PolicyPDF/PD10-05.PDF
[37] Hewitt G, Sims S, Greenwood N, et al. Interprofessional teamwork in stroke care: is it visible or important to patients and carers? J Interprof Care. 2015; 29 331–9.
| Interprofessional teamwork in stroke care: is it visible or important to patients and carers?Crossref | GoogleScholarGoogle Scholar |
