Dataset Information

Rethinking Primary Care Delivery Models: Can Integrated Primary Care Teams Improve Care Experience?

ABSTRACT:

Background

Integrated Primary Care Teams (IPCTs) have four key characteristics (intensive interdisciplinary practice; advanced nursing practice with an expanded role; group practice; increased proximity and availability) aimed at strengthening primary care in Quebec, Canada. The purpose of this paper is to examine the care experience over time of patients who have an IPCT as their primary source of care.

Methods

We used a quasi-experimental longitudinal design based on a pre-and-post administered survey at a 2-year interval without a control group. We measured patient-reported accessibility, continuity, comprehensiveness, responsiveness and outcomes of care.

Results

Results showed that patients who were newly registered with an IPCT had a significant increase in reported care experience, whereas patients who have been registered with an IPCT for 2 years prior to the first round of data collection had already high reported care experience that was maintained over time. Moreover, linear regression models showed statistically significant different increases in the dimensions of care experience by site and patients' characteristics.

Conclusions

Our results suggest that the IPCT model is tailored to the needs of its target populations, resulting in improved Patient Reported Experience Measures. These results imply that broader implementation of innovative and flexible community-based care models should be considered by policymakers.

SUBMITTER: Duhoux A

PROVIDER: S-EPMC9053536 | biostudies-literature | 2022 Apr-Jun

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Rethinking Primary Care Delivery Models: Can Integrated Primary Care Teams Improve Care Experience?

Duhoux Arnaud A Dufour Émilie É Sasseville Martin M Laroche Dominique D Contandriopoulos Damien D

International journal of integrated care 20220427 2

<h4>Background</h4>Integrated Primary Care Teams (IPCTs) have four key characteristics (intensive interdisciplinary practice; advanced nursing practice with an expanded role; group practice; increased proximity and availability) aimed at strengthening primary care in Quebec, Canada. The purpose of this paper is to examine the care experience over time of patients who have an IPCT as their primary source of care.<h4>Methods</h4>We used a quasi-experimental longitudinal design based on a pre-and-p ...[more]

PMID: 35582500

Similar Datasets

Project description:ObjectiveTo assess whether patient experience is better for patients followed in a primary care team (PCT) than for patients with traditional follow-up in usual care.DesignA cross-sectional survey based on a self-administered questionnaire.SettingPays de la Loire geographical area (located on the French west coast).Patients and methodsPatients over 75 or over 65 years of age with at least one chronic disease were included. A sample of 9900 frail elderly patients was invited to answer a 23-item questionnaire that investigated four dimensions: 'communication and patient-centred care', 'availability and accessibility', 'coordination' and 'caregiver'. Their answers were then analysed depending on whether they were followed in a mature PCT, in an emerging PCT or in usual care. The associations between follow-up in a PCT and patient experience were tested with generalised estimation equation models with a Poisson link function, adjusted for sex, age, educational level and the place of residence (French department).ResultsA total of 4078 responses were received. The result of the assessment for the 'communication and patient-centred care' dimension was improved for the participants in the PCT group for the following items: 'Health professionals were concerned about the impact my health had on my everyday life.' (RR=1.22, 95% CI (1.04; 1.43)), 'I have received help to better adapt my everyday life to my health.' (RR=1.25, 95% CI (1.05; 1.50)), 'I could take part in decisions concerning my health and care.' (RR=1.19, 95% CI (1.01; 1.42)) and 'My consent was requested prior to the transmission of the information between health professionals.' (RR=1.27, 95% CI (1.09; 1.48)). These assessments were not different between the PCT group and usual care group for other dimensions: 'availability and accessibility', 'coordination' and 'caregiver'.ConclusionThis study suggests an improved patient experience in regard to the communication perspective for patients in the PCT group. However, it remains unclear whether interprofessional collaboration (IPC) improves overall patient experience. Additional research could explore aspects of IPC that influence patient experience, providing insights to enhance strategies for improving PCTs.

Project description:BackgroundIntensive primary care (IPC) programs for patients with complex needs do not generate cost savings in most settings. Strengthening existing patient-centered medical homes (PCMH) to address the needs of these patients in primary care is a potential high-value alternative.ObjectivesExplore PCMH team functioning and characteristics that may impact their ability to perform IPC tasks; identify the IPC components that could be incorporated into PCMH teams' workflow; and identify additional resources, trainings, and staff needed to better manage patients with complex needs in primary care.MethodsWe interviewed 44 primary care leaders, PCMH team members (providers, nurses, social workers), and IPC program leaders at 5 VA IPC sites and analyzed a priori themes using a matrix analysis approach.ResultsHigher-functioning PCMH teams were described as already performing most IPC tasks, including panel management and care coordination. All sites reported that PCMH teams had the knowledge and skills to perform IPC tasks, but not with the same intensity as specialized IPC teams. Home visits/assessments and co-attending appointments were perceived as not feasible to perform. Key stakeholders identified 6 categories of supports and capabilities that PCMH teams would need to better manage complex patients, with care coordination/management and fully staffed teams as the most frequently mentioned. Many thought that PCMH teams could make better use of existing VA and non-VA resources, but might need training in identifying and using those resources.ConclusionsPCMH teams can potentially offer certain clinic-based services associated with IPC programs, but tasks that are time intensive or require physical absence from clinic might require collaboration with community service providers and better use of internal and external healthcare system resources. Future studies should explore the feasibility of PCMH adoption of IPC tasks and the impact on patient outcomes.

Project description:BackgroundPrimary care in Canada is the first point of entry for patients needing specialized services, the fundamental source of care for those living with chronic illness, and the main supplier of preventive services. Increased pressures on the system lead to changes such as an increased reliance on interdisciplinary teams, which are advocated to have numerous advantages. The functioning of teams largely depends on inter-professional relationships that can be supported or strained by the financial arrangements within teams. We assess which types of financial environments perpetuate and which reduce the challenge of medical dominance.MethodsUsing qualitative interview data from 19 interdisciplinary teams/networks in three Canadian provinces, as well as related policy documents, we develop a typology of financial environments along two dimensions, financial hierarchy and multiplicity of funding sources. A financial hierarchy is created when the incomes of some providers are a function of the incomes of other providers. A multiplicity of funding sources is created when team funding is provided by several funders and a team faces multiple lines of accountability.ResultsWe argue that medical dominance is perpetuated with higher degrees of financial hierarchy and higher degrees of multiplicity. We show that the financial environments created in the three provinces have not supported a reduction in medical dominance. The longstanding Community Health Centre model, however, displays the least financial hierarchy and the least multiplicity-an environment least fertile for medical dominance.ConclusionsThe functioning of interdisciplinary primary care teams can be negatively affected by the unique positioning of the medical profession. The financial environment created for teams is an important consideration in policy development, as it plays an important role in establishing inter-professional relationships. Policies that reduce financial hierarchies and funding multiplicities are optimal in this regard.

Project description:AimThe aim of the study was to describe practices that support collaboration in interprofessional primary health care teams, and identify performance indicators perceived to measure the impact of this collaboration from the perspective of interprofessional health providers.BackgroundDespite the surge of interprofessional primary health care models implemented across Canada, there is little evidence as to whether or not the intended outcomes of primary health care teams have been achieved. Part of the challenge is determining the most appropriate measures that can demonstrate the value of collaborative care. To date, little remains known about performance measurement from the providers contributing to the collaborative care process in interprofessional primary care teams. Having providers from a range of disciplinary backgrounds assist in the development of performance measures can help identify measures most relevant to demonstrate the value of collaborative care on the intended outcomes of interprofessional primary care models.MethodsA qualitative study; part of a larger mixed methods developmental evaluation to examine performance measurement in interprofessional primary health care teams. A stakeholder workshop was conducted at an annual association meeting of interprofessional primary health care teams in the province of Ontario, Canada. Six questions guided the workshop groups and participant responses were documented on worksheets and flip charts. All responses were collected and entered verbatim into a word document. Qualitative analytic strategies were applied to each question.FindingsA total of 283 primary health care providers from 14 health professions working in interprofessional primary health care teams participated. Top three elements of interprofessional collaboration (total n = 628) were communication (n = 146), co-treatment (n = 112) and patient-based conferences (n = 81). Top three performance indicators currently used to demonstrate the value of interprofessional collaboration (total n = 241) were patient experience (n = 71), patient health status (n = 35) and within team referrals (n = 30).

Project description:AimWe developed a self-report tool to assess patients' experiences with lifestyle services in team-based primary care and pilot tested the questionnaire as part of a lifestyle intervention study to reverse metabolic syndrome.BackgroundOlder client satisfaction questionnaires have been generally inadequate for quality improvement purposes, as they have been focused mainly on interpersonal skills of providers and/or in the context of one disease. New approaches to assessing the patient experience of lifestyle programs in primary care are needed and could inform quality improvement efforts over time.MethodsThe first phase in developing the questionnaire involved a group-administered questionnaire distributed to 38 healthcare providers in five groups to prioritize variables to include in the survey. Concepts were taken from a previous review of available questionnaires assessing primary care services. The draft questionnaire was reviewed by 11 participants from a lifestyle program using think-aloud cognitive interviewing techniques. The modified self-administered questionnaire (paper and online versions) was then pilot tested with 164 recipients of a nutrition and physical activity intervention program.FindingsProviders ranked the top variables to include in the questionnaire as: 'trust,' 'general communication,' 'first-contact accessibility,' 'whole-person care,' and 'respectfulness.' After cognitive interviewing and revisions, 21 multiple choice and two open-ended questions were used for pilot testing. Pilot testing identified additional minor wording changes that were needed for clarity, a decreased number of questions for redundant concepts, and decreased options for ceiling effects, resulting in 20 multiple choice and one open-ended question.ConclusionsThe modified self-administered patient experience questionnaire to assess lifestyle services in primary care has undergone rigorous development. Further validation is needed. The assessment of patient experience of lifestyle programs can be used to supplement other data to assess the overall effectiveness of such programs.

Dataset Information

Rethinking Primary Care Delivery Models: Can Integrated Primary Care Teams Improve Care Experience?

Background

Methods

Results

Conclusions

Publications

Rethinking Primary Care Delivery Models: Can Integrated Primary Care Teams Improve Care Experience?

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets