Interprofessional teamwork in comprehensive primary healthcare services: Findings from a mixed methods study
Interprofessional teamwork in comprehensive primary healthcare services: Findings from a mixed methods study
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DOI：
10.1080/13561820.2017.1401986
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发表时间：
2018-01-01
影响因子：
2.7
通讯作者：
Javanparast, Sara
中科院分区：
文献类型：
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作者：
Bentley, Michael;Freeman, Toby;Javanparast, Sara
本文借鉴了一个为期 5 年的项目的数据，该项目检查了当地社区综合初级卫生保健 (CPHC) 的有效性。 CPHC 服务的一个特点是跨专业团队合作。根据这项研究，我们的文章提出了促进或阻碍医疗团队在澳大利亚初级医疗保健 (PHC) 服务中进行跨专业工作的因素。本文报道了在卫生部门重大重组期间，澳大利亚六项初级卫生保健服务机构（四项由州政府管理、一项非政府性健康组织和一项原住民社区控制的卫生服务机构）工作的团队的经验。研究结果来自两种主要方法：对从业者和管理者的在线调查（n=154），以及对六个研究地点的管理者和从业者的访谈（n=60）。大多数受访者与其他医疗专业人员合作，为客户提供跨专业护理。流程包括正式的团队会议、病例会议、在需要时将客户转介给其他卫生专业人员、与其他卫生专业人员就客户进行非正式沟通以及基于团队的护理服务。一系列相互关联的因素影响着服务领域的跨专业工作，包括背景、组织、流程和关系领域。资金削减和政策变化导致南澳大利亚服务的重新定位和重新医疗化，破坏了跨专业工作，而一些员工共同的 CPHC 文化和承诺有助于抵御其中一些影响。服务的同一地点是初级卫生保健团队跨专业工作的一个因素，不仅使一些初级卫生保健团队能够更加跨专业地工作，而且由于服务重组造成的中断，也为跨专业团队合作造成了障碍。我们的研究表明决策者考虑政策和结构变化对跨专业团队合作的潜在影响的重要性。决策者应努力尽量减少变革对跨专业团队运作的意外负面影响。
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.