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Abstract
Objective To assess the degree of collaboration in primary health care organizations between FPs and other health
care professionals; and to identify organizational factors associated with such collaboration.
Setting Primary health care organizations in the Montreal and Monteregie regions of Quebec.
Main outcome measures Degree of collaboration between FPs and other specialists and between FPs and
nonphysician health professionals.
Results Almost half (47.1%) of organizations reported a high degree of collaboration between FPs and other
specialists, but a high degree of collaboration was considerably less common between FPs and nonphysician
professionals (16.5%). Clinic collaboration with a hospital and having more patients with at least 1 chronic disease
were associated with higher FP collaboration with other specialists. The proportion of patients with at least 1 chronic
disease was the only factor associated with collaboration between FPs and nonphysician professionals.
Conclusion There is room for improvement regarding interprofessional collaboration in primary health care,
especially between FPs and nonphysician professionals. Organizations that manage patients with more chronic
diseases collaborate more with both non-FP specialists and nonphysician professionals.
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Recherche Exclusivement sur le web
Résumé
Objectif Vérifier le degré de collaboration entre MF et autres professionnels de la santé dans des organismes
dispensant des soins primaires; et cerner les facteurs organisationnels qui jouent un rôle dans cette collaboration.
Contexte Des organismes dispensant des soins de santé primaires dans les régions de Montréal et de la Montérégie,
au Québec.
Résultats Près de la moitié (47,1 %) des organismes ont répondu qu’il y avait un très bon niveau de collaboration
entre les MF et les autres spécialistes; toutefois, la collaboration entre les MF et les professionnels autres que les
médecins n’atteignait pas souvent un tel niveau (16,5 %). Le fait de collaborer avec un hôpital ou d’avoir plus de
patients souffrant d’au moins une maladie chronique était associé à une meilleure collaboration entre les MF et
les autres spécialistes. C’est seulement lorsqu’il y avait une
forte proportion de patients souffrant d’au moins une maladie
chronique que la collaboration entre MF et professionnels autres Points de repère du rédacteur
que les médecins était meilleure. • Peu d’études empiriques ont porté sur
l’influence des facteurs organisationnels sur
Conclusion Dans les établissements de santé primaire, la la collaboration interprofessionnelle dans les
collaboration interprofessionnelle pourrait certainement être établissements de soins de santé primaires.
meilleure, notamment entre les MF et les professionnels autres Notre étude portait sur le degré de collaboration
que les médecins. Les organismes qui s’occupent de patients interprofessionnelle au sein des organismes de
souffrant de plus de maladies chroniques collaborent mieux avec soins primaires des 2 régions les plus densément
peuplées du Québec.
les spécialistes autres que les MF et les professionnels autres que
les médecins.
• En général, les participants ont rapporté qu’il
y avait une meilleure collaboration entre les MF
et les autres spécialistes qu’entre les MF et les
professionnels de la santé autres que les médecins.
e382 Canadian Family Physician • Le Médecin de famille canadien | Vol 63: september • septembre 2017
What can organizations do to improve family physicians’ interprofessional collaboration? | Research
I
nterprofessional collaboration has been increasingly interprofessional collaboration is essential to identify-
promoted in recent years to optimize the quality of ing targets for improving interprofessional collaboration
health care.1 The Romanow Commission report on the when relevant.20
future of health care highlighted the importance of inter- The objectives of this study were to assess the degree
professional collaboration in the Canadian health system, of collaboration in primary health care organizations
including in primary care.2 In Quebec, recent initiatives between FPs and other health care professionals (non-
for primary health care renewal have translated into the FP specialists and nonphysicians) and identify organiza-
implementation of family medicine groups (FMGs) and tional factors associated with collaboration.
network clinics (NCs).3 Developing interprofessional col-
laboration, notably between FPs and nurses, was viewed
as an essential aspect of these new models of care.4 Methods
Interprofessional collaboration has been described as
a solution to the shortage of human resources, the frac- Study design
tioning of professional fields, and the need to improve This study was part of a larger study that documented
the effectiveness and efficiency of services, and as a way the evolution and performance of primary care orga-
to better respond to patients’ needs, especially those nizational models in Quebec following primary care
with complex or chronic conditions. 5-8 Previous work reform (2005 to 2010), and also examined organiza-
shows that interprofessional collaboration has positive tional and wider contextual factors associated with
effects on worker and patient satisfaction, clinical out- these transformations in primary care.21 Primary care
comes, and quality of care.9-12 Interprofessional collabo- organizations within Quebec’s 2 most densely popu-
ration between FPs and other specialists substantially lated regions, Montreal and Monteregie, were surveyed.
contributes to continuity between primary and specialty Ethical approval was obtained from the research eth-
care.13 Moreover, lack of communication and collabora- ics committee of the Agence de la santé et des services
tion could be associated with patient harm.14,15 sociaux in Montreal and from research ethics commit-
Not surprisingly, interprofessional collaboration has tees in each health and social services centre in the
become a hallmark of the competency profiles of numer- regions under study.
ous professions (eg, physiotherapists, nurses), includ-
ing those of physicians. The 2005 CanMEDS framework Selection of organizations
states that “as collaborators, physicians effectively work The list of primary health care organizations was com-
within a healthcare team to achieve optimal patient piled by using administrative lists of the Ministère de la
care.”16 This health care team includes all professionals Santé et des Services sociaux, the regional Agence de
with whom physicians practise within their own work- la santé et des services sociaux, and the Collège des
places, but also those from other organizations.16 médecins du Québec, and by including other nonlisted
Multiple forces influence the development and imple- organizations identified by participants in the population
mentation of interprofessional collaboration. Several survey, which was part of the larger study. Each orga-
frameworks have been proposed in an attempt to cap- nization was contacted to identify the potential respon-
ture the numerous factors that shape interprofessional dent, an FP or manager.
collaboration and team performance. According to All eligible organizations were sent an invitation to
D’Amour et al,17 there are 3 main categories of deter- participate in the study with a copy of the survey ques-
minants of interprofessional collaboration: interactional tionnaire and consent forms. The questionnaire could
determinants between professionals, organizational also be completed online via LimeSurvey using a unique
determinants, and determinants related to the profes- access code, and in either English or French according
sional system. More specifically, organizational determi- to the respondent’s preference. Up to 3 reminders were
nants include aspects such as organizational structure, sent to nonresponding organizations. Data were col-
technology, size, and human resources.1 Reeves et al18 lected between March 2010 and January 2011.
proposed another framework where relational, pro-
cess, organizational, and contextual factors all influence Survey questionnaire
interprofessional teamwork. Even if there are consider- The questionnaire was adapted from one used in a pre-
able overlapping features and interconnections between vious study.22,23 It covered organizational characteris-
different categories of factors,18 a favourable organiza- tics based on the 4 dimensions of the configurational
tional setting is essential for interprofessional collabo- approach that served as a framework for the study:
ration.19 Nonetheless, most of the published writings organizational vision (ie, goals, values, and orienta-
on factors associated with collaboration have relied tions), resources (ie, availability, quantity, and variety),
on conceptual rather than empirical work.19 Gaining structure (ie, rules of governance, conventions, and pro-
a better understanding of the factors associated with cedures), and practices (ie, mechanisms that support
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Research | What can organizations do to improve family physicians’ interprofessional collaboration?
e384 Canadian Family Physician • Le Médecin de famille canadien | Vol 63: september • septembre 2017
What can organizations do to improve family physicians’ interprofessional collaboration? | Research
Figure 1. Degree of collaboration between FPs and other specialists and nonphysician health professionals
Quite a bit
Somewhat
50
A bit
47.1 46.5 Not at all
45
40
35.4
35
30.6
30
RESPONDENTS, %
25
20
16.5
15
13.3
10
6.4
5 4.3
0
Other specialists Nonphysician health professionals
COLLABORATORS
of patients with chronic diseases (P = .001) were signifi- Collaboration between FPs and other specialists has
cantly associated with a greater degree of collaboration been described as suboptimal in traditional models of con-
between FPs and other specialists. sultation.27 Our results show that there is room for improve-
The model for the degree of collaboration between ment regarding the degree of collaboration between FPs
FPs and nonphysician professionals is presented in and other specialists within primary care organizations in
Table 3. Degree of collaboration with nonphysician pro- Quebec. Almost 50% of organizations reported high collab-
fessionals was significantly associated with the propor- oration, but most stated that FPs collaborated somewhat, a
tion of patients with at least 1 chronic disease within the bit, or not at all. In the 2007 Canadian National Physician
clinic caseload (P = .04). Survey, most FPs reported having had regular collaboration
with other specialists in areas such as pediatrics, psychiatry,
and gynecology.28 Also, we found that a high degree of col-
DISCUSSION laboration was less frequently reported between FPs and
nonphysicians than between FPs and other specialists. In
This study explored the degree of collaboration in pri- the 2007 survey, most physicians stated they had regularly
mary care organizations between FPs and other spe- collaborated in providing patient care with pharmacists
cialists or nonphysician professionals as well as the (73.5%), physiotherapists (67.4%), nurses (56.5%), social
organizational factors associated with collaboration. workers (54.1%), and nutritionists (52.2%).28,29 Proportions
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Research | What can organizations do to improve family physicians’ interprofessional collaboration?
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What can organizations do to improve family physicians’ interprofessional collaboration? | Research
Table 3. Organizational factors associated with a high degree of collaboration between FPs and
nonphysician professionals
Characteristics Odds ratio 95% CI P value
Region of Quebec
• Montreal 1.25 0.69-2.25 .46
• Monteregie* 1
Type of clinic
• New 2.01 0.93-4.33 .08
• Traditional* 1
At least 1 clinic FP also working in an emergency or acute care unit in a hospital
• Yes 1.18 0.60-2.31 .64
• No* 1
Clinic collaboration with a hospital
• Yes 1.25 0.68-2.32 .47
• No* 1
No. of other professionals within clinic building
• ≥ 5 0.96 0.36-2.56 .94
• 3-4 0.84 0.37-1.90 .67
• 1-2 1.58 0.81-3.07 .18
• 0* 1
Proportion of patients with at least 1 chronic condition 1.13 1.00-1.27 .04†
*Reference category.
†
Statistically significant relationship (P < .05).
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Research | What can organizations do to improve family physicians’ interprofessional collaboration?
12. Zwarenstein M, Goldman J, Reeves S. Interprofessional collaboration: effects of 24. Prud’homme A, Pineault R, Couture A, Borgès Da Silva R, Levesque JF, Tousignant
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