Interprofessional Collaboration and Quality Primary Healthcare

Key Messages

  • There is high-quality evidence supporting positive outcomes for patients/clients, providers and the system in specialized areas such as interprofessional collaboration in mental health care, and chronic disease prevention and management.
  • There are findings in the literature, and in some jurisdictions, which support positive outcomes for patients/clients, providers and the system when interprofessional collaboration (for example, physicians/nurses, physicians/pharmacists, physicians/dietitians in partnerships) is fostered and supported on the basis of servicing geographic populations or population health models. These outcomes include enhanced patient/client self-care, knowledge and outcomes; enhanced provider satisfaction, knowledge, skills and practice behaviors; and system enhancements such as the provision of a broader range of services, better access, shorter wait times and more effective resource utilization.
  • There are findings of cost benefits of interprofessional collaboration in some primary healthcare settings (for example, decreased average provider and patient costs for blood pressure control, and lower readmission rates and costs for team-managed, home-based primary care).
  • Although findings in the literature and in jurisdictions demonstrate the positive outcomes of interprofessional collaboration, they do not identify how variation among interprofessional collaborative models affect outcomes.
  • A variety of processes and tools (including definitions, principles, frameworks, barriers and facilitators) have been developed to support the planning, implementation and evaluation of effective interprofessional collaborative partnerships which can be used for future planning, implementation, evaluation and research.
  • Knowledge transfer from syntheses such as this one is necessary to utilize current studies in future planning, implementation research and evaluation.
  • There is a need for greater regulatory and legislative support to foster and promote the consistency and clarity of interprofessional collaborative partnerships (for example, physician/nurse, physician/pharmacist, physician/dietitian) and scope of practice, as well as the availability of physician (and other professional) remuneration models.
  • There is a need for more rigorous research in order to clarify definitions for interprofessional collaboration (especially clarification of the patient/client and family roles in the process), teams and shared care; to gather higher-quality evidence regarding interprofessional collaboration and outcomes for servicing geographic populations or population health models; and to gather evidence associating variations in models to outcomes.

Executive Summary

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.