The synthesis “Interprofessional Collaboration and Quality Primary Healthcare” provides a systematic review of peer-reviewed literature regarding outcomes of interprofessional collaboration in primary healthcare, a Canadian environmental scan to obtain stakeholder feedback and incorporates findings from initiatives and projects that involved primary healthcare provision.
Within Canada, it is widely recognized that a strong primary healthcare system is needed to
address the challenges of an aging population, and to meet the needs of the increasing
number of people who experience chronic disease, complex morbidity and/or functional
disability. In spite of a variety of national and provincial supports for primary health care
since 2000, the adoption of a team-based, interprofessional collaborative model of care and
delivery remains in its infancy.
This synthesis was initiated to help the Canadian Health Services Research Foundation and
the Health Council of Canada gain a better understanding of the evidence surrounding
interprofessional collaboration in Canadian primary healthcare, and the potential benefits for
patients and healthcare providers. It focuses on existing evaluations of interprofessional
collaboration initiatives in the literature and projects funded through the Primary Health
Care Transition Fund. The synthesis report incorporates:
- findings from initiatives or projects that involved primary healthcare provision;
- a systematic review of peer-reviewed literature regarding outcomes of interprofessional
collaboration in primary healthcare; and
- a Canadian environmental scan to obtain stakeholder feedback.
The process used to assess the quality of initiatives and projects included:
- examination of the qualitative and quantitative characteristics of the study design, and
the nature of the health services intervention;
- rating of the study design characteristics based on level of evidence criteria; and
- grading of each study by an expert in primary healthcare research.
The synthesis review suggests positive provider, system and patient outcomes as a result of
enhanced interprofessional collaboration (see Appendix I for a table of the included reviews;
other included reviews will be available on the Ontario Ministry of Health and Long-Term
Care web site in the spring of 2008). This finding is particularly pronounced for chronic-disease
or special-needs populations. A large number of the reports uncovered in the grey literature
provide useful information on the definitions, principles, frameworks, barriers and facilitators
of collaboration. Strategies are identified to address the challenges associated with collaboration.
The necessity for clarification of professional legislation and regulation in facilitating
collaboration is also recognized.
Both the excluded literature and feedback through the environmental scan echo the evidence
regarding the determinants of effective collaboration and the outcome measures associated
with it. A number of evaluation and research processes were identified that have been
utilized successfully for planning, implementing and evaluating collaborative practice.
Researchers, managers, policy makers and clinicians should work together to create, share
and use all forms of evidence to support and evaluate interprofessional collaboration, using
baseline information that has already been identified.
Using the Joint Evaluation Team framework classification as a guide, a review of the quality
of evidence across the peer-reviewed and grey literature, as well as the environmental scan,
identified commonalities in these areas:
- There was modification in patient/client and provider attitudes and perception of
interprofessional collaborative practice at all levels of evidence for the included
peer-reviewed and grey literature, and the scan confirmed changes in patient/client
and provider perception or attitudes toward the value of teams.
- There was change in organizational interprofessional practice across all included peerreviewed
and grey literature reflecting high- and moderate-quality evidence, and the
environmental scan confirmed increased use of the team approach in patient/client care
across different jurisdictions in Canada.
- There were identified benefits to patients/clients across all review areas, reflecting highand
moderate-quality evidence, and the environmental scan confirmed increases in
client satisfaction with care, and increases in access to service across Canadian jurisdictions.
Based on the review of peer-reviewed and grey literature, and the environmental scan, there
is increasing good evidence (high or moderate grade), with large quantities of low- and very
low-level evidence, that:
- healthcare providers working in an interprofessional collaborative manner are more
satisfied and have a more positive experience, when compared to primary healthcare
providers working in a uni-professional model (single practitioner providing client care
and accessing other services for the client through a referral system);
- primary healthcare providers who experience working in an interprofessional
collaborative manner develop a positive perception of working collaboratively
with other professionals;
- primary healthcare providers who work in an interprofessional collaborative manner
develop enhanced knowledge and skills;
- primary healthcare providers working in a uni-professional model have different practice
behaviors (for example, referral patterns, follow-up, preventive care) than those working
in an interprofessional collaborative manner;
- interprofessional collaboration models can provide a broader range of services, more
efficient resource utilization, better access to services, shorter wait times, better
coordination of care, and more comprehensive care, compared to a uni-professional
model of primary healthcare delivery;
- patients/clients expressed more satisfaction and identified a more positive experience
with interprofessional collaboration, when compared to patients/clients cared for by
primary healthcare providers working in a uni-professional model;
- patients/clients receiving services from primary healthcare providers through an
interprofessional collaborative approach develop enhanced self-care and health
condition knowledge and skills;
- patients/clients receiving health services through an interprofessional collaborative
approach report different health practices (for example, improved self-care, lifestyle and
preventive service access) compared to patients/clients receiving health services from a
primary healthcare provider working in a uni-professional model; and
- interprofessional collaborative models can provide better health outcomes for
patients/clients (for example, blood pressure control, diabetes control, health status,
quality of life), when compared to a uni-professional model of primary healthcare delivery.