Contextual levers for team-based primary care: lessons from reform interventions in five jurisdictions in three countries

Russell, Grant M, Miller, William L, Gunn, Jane M, Levesque, Jean-Frederic, Harris, Mark F, Hogg, William E, Scott, Cathie M, Advocat, Jenny R, Halma, Lisa, Chase, Sabrina M and Crabtree, Benjamin F 2018, Contextual levers for team-based primary care: lessons from reform interventions in five jurisdictions in three countries, Family practice, vol. 35, no. 3, pp. 276-284, doi: 10.1093/fampra/cmx095.

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Title Contextual levers for team-based primary care: lessons from reform interventions in five jurisdictions in three countries
Author(s) Russell, Grant M
Miller, William L
Gunn, Jane M
Levesque, Jean-Frederic
Harris, Mark F
Hogg, William E
Scott, Cathie M
Advocat, Jenny R
Halma, Lisa
Chase, Sabrina M
Crabtree, Benjamin F
Journal name Family practice
Volume number 35
Issue number 3
Start page 276
End page 284
Total pages 9
Publisher Oxford University Press
Place of publication Oxford, Eng.
Publication date 2018-06
ISSN 0263-2136
Keyword(s) evaluation studies
health care reform
primary health care
qualitative research
Summary Background: Most Western nations have sought primary care (PC) reform due to the rising costs of health care and the need to manage long-term health conditions. A common reform-the introduction of inter-professional teams into traditional PC settings-has been difficult to implement despite financial investment and enthusiasm. Objective: To synthesize findings across five jurisdictions in three countries to identify common contextual factors influencing the successful implementation of teamwork within PC practices. Methods: An international consortium of researchers met via teleconference and regular face-to-face meetings using a Collaborative Reflexive Deliberative Approach to re-analyse and synthesize their published and unpublished data and their own work experience. Studies were evaluated through reflection and facilitated discussion to identify factors associated with successful teamwork implementation. Matrices were used to summarize interpretations from the studies. Results: Seven common levers influence a jurisdiction's ability to implement PC teams. Team-based PC was promoted when funding extended beyond fee-for-service, where care delivery did not require direct physician involvement and where governance was inclusive of non-physician disciplines. Other external drivers included: the health professional organizations' attitude towards team-oriented PC, the degree of external accountability required of practices, and the extent of their links with the community and medical neighbourhood. Programs involving outreach facilitation, leadership training and financial support for team activities had some effect. Conclusion: The combination of physician dominance and physician aligned fee-for-service payment structures provide a profound barrier to implement team-oriented PC. Policy makers should carefully consider the influence of these and our other identified drivers when implementing team-oriented PC.
Language eng
DOI 10.1093/fampra/cmx095
Field of Research 1117 Public Health And Health Services
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©2017, The Authors
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