Journal of Interprofessional Care最新文献

Interprofessional teams in primary care are vital for enhancing health outcomes, professional satisfaction, and equitable access to health services. However, the longitudinal evolution of high-performing teams remains underexplored, requiring interdisciplinary research. Preliminary mapping and operationalization of key constructs are recommended prior to conducting such research. This article outlines the development of the Optimizing Teams for Interprofessional Care in Primary Health Care (OPTIC-PHC) conceptual framework by a Canadian multidisciplinary research team. The objective of developing this framework is to guide a pan-Canadian longitudinal study on interprofessional primary care team evolution, defining key constructs to streamline research efforts. The participatory, multi-stage group concept mapping exercise involved 14 meetings with 30 researchers and policymakers across six steps: defining the focus questions; brainstorming and identifying concepts; constructing a preliminary map; initial team revision; identifying cross-links and developing the framework; and final framework revision. The framework comprises 19 concepts organized into 6 domains: 1) patient and community partnership and engagement; 2) individual perspectives, values, and beliefs; 3) team structure and organizational factors; 4) team collaboration and communication; 5) aligning with patient and community needs, and 6) external context. These concepts and domains delineate structural elements and processes to study in multidisciplinary longitudinal research to understand what drives IPCTs' evolution to meet patient and community needs over time. It serves as an initial tool for researchers studying IPCTs and teams that aim to advance IPCT models. Engagement of patients and caregivers can help refine the framework, ensuring its relevance and strengthening measurement strategies.

Validating an interprofessional education and collaborative practice (IPECP) curriculum prior to implementation is uncommon. A sound empirical investigation involving external and internal participants considered four criteria: relevance, consistency, practicality, and effectiveness, as part of an educational design research process to assess whether the proposed curriculum content was valid for the South African healthcare higher education context. Participants provided quantitative input on the four criteria on a visual analog scale (0-100) and qualitative comments to suggest improvements to the proposed curriculum. Descriptive statistics and deductive thematic analysis were used for data analysis. The participants lauded the proposed curriculum. Relevance generated strong agreement and consensus (m = 99, IQR = 6.75), with a lower, but still adequate, rating and consensus for practicality (m = 85.5, IQR = 25.75). The consistency and effectiveness, rated across years of study and streams, indicated in ratings and consensus with an increase across years of study from the first to the last year. Of the streams, the proposed Research and Ethics stream appeared to be the most problematic with moderate consensus (m = 90, IQR = 19.75). Curriculum validation before implementation illuminated concerns requiring refinement and strengthening responsive strategies to ensure a tailored implementation of the proposed curriculum.

In shared decision-making (SDM) with families facing complex problems, interprofessional decision-making is an essential part of providing appropriate care yet complicated by the differing perspectives and responsibilities of professionals involved. To strengthen interprofessional decision-making often multidisciplinary teams, such as Specialist Integrated care Teams (SITs), are organized. Since little is known on how interprofessional decision-making is practiced in this setting, this study explores facilitators and barriers of interprofessional decision-making within SITs and with other care services. We gathered perspectives of families, professionals, and organizational managers of SITs by 43 semi-structured interviews and conducted 40 observations of SITs multidisciplinary team meetings. Reflexive Thematic Analysis was applied to analyze the transcripts both deductively and inductively. Four categories of facilitators and barriers for interprofessional decision-making within SITs (on the professional, team, and organizational level) and with other care services were formulated: (1) organizing decision-making, (2) dealing with differing opinions, (3) motivation for interprofessional decision-making, and (4) embedding interprofessional decision-making in SDM with families. In SDM with families facing complex problems, professionals and services need to balance decision-making both in multidisciplinary teams and with other care services, considering a formal organization of decision-making, integrating professional perspectives, and keeping the family in the center of decision-making.

Interprofessional education (IPE) underpins interprofessional collaborative practice (IPCP), which promotes safe and high-quality health care. Whilst IPE is known to improve healthcare student's individual collaborative competencies, less is understood about its impact on qualified health care professionals (HCPs) practice and organizational change. This review critically examines evidence of practice change, identified using Level 3 and Level 4a of Kirkpatrick's Modified Model of Learning, and barriers following IPE interventions. In February 2025 an integrated mixed methods systematic review was conducted following PRISMA guidelines. Six databases (PubMed, ProQuest, EBSCO/MEDLINE, EBSCO/ERIC, EBSCO/CINAHL, and EBSCO/PsycInfo) were searched using predefined criteria. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT), and data synthesized using the Johanna Briggs Institute (JBI) convergent integrated approach. Seventy-one studies were included. Four categories of practice change were identified: (1) improvements to clinical care provision, (2) improvements in team communication, (3) changes in teams and teamwork, and (4) increased professional development including research. The studies quality varied, with 56% meeting at least four out of five MMAT criteria. Studies revealed practice change is mostly self-reported (87%), at single time points (35%), and at an individual level (96%) by HCPs. Nine studies reported barriers in achieving practice changes following IPE. This paper provides evidence to support IPE for qualified HCPs to improve IPCP and the delivery of high quality and safe healthcare. The identified practice changes align with the Interprofessional Education Collaborative (IPEC) and the Canadian Interprofessional Health Collaborative (CIHC) IPCP frameworks. Further research is required focusing on whether changes are sustained long term and if more flexible evaluation methods such as a realist synthesis would be beneficial. This would allow a deeper understanding of practice changes, in particular how team behaviors change, and to explore the influence of healthcare decision makers on IPE and IPCP.

In health and social care, disagreements over referrals involve professionals contesting between them the power to define the situation. An aspect of practice that commonly gives rise to such disagreements is self-neglect because of its high ambiguity for services. Self-neglect therefore provides a useful case to explore how professionals anticipate and respond to interagency barriers to referral when criteria and thresholds are only loosely defined, and collaboration is often ad hoc. To investigate the dynamics of interagency referral for self-neglect, we interviewed 69 practitioners: health and social care professionals; and fire and rescue, environmental health, and housing officers, all of whom regularly respond to both crisis and chronic situations of self-neglect. Dynamics that influence referrers and hinder coordination between interprofessional networks included uncertainties about the right route, perceived barriers to referral acceptance, and feeling unable to refer. These present barriers to the anticipatory labor needed to make interagency referrals land successfully with the receiving agency and may lead to a self-fulfilling cycle that discourages practitioners from thoughtful referral practice. Although referral failures are often treated in research on referral in safeguarding as a technical knowledge-deficit problem, the data show the significance of wider interagency relations, perceptions, and expectations in accounting for the barriers.

Measuring functional status allows clinicians to deliver evidence-based interventions to prevent or delay associated adverse outcomes. Functional status is seldom routinely measured in primary care settings where most older adults receive care. Interprofessional team-based care is increasingly regarded as an important feature of high quality and efficient health care systems. Yet despite growing evidence of the benefits of team-based care, in primary care there are not yet standards for how to operationalize interprofessional practice. In this study we explored interprofessional perspectives on assessing functional status among older adults in team-based VA primary care clinics. We conducted qualitative interviews with 57 primary care team members (nursing staff, primary care providers, and social workers) from six geographically diverse VA medical centers. We drew from implementation science frameworks and sociotechnical theories to ground our thematic analysis in dynamic, real-world contexts. Interviews revealed the view that all primary care team members play a role in measuring and addressing functional status. Participants also described a perceived hierarchy of accuracy of assessment based on role and outlined strategies for validating the accuracy of functional status assessments. These results can inform guidelines for functional status measurement in primary care that improve interprofessional assessment and team-based communication.

Interprofessional Education and Collaborative Practice (IPECP) involves healthcare workers and/or students from at least two professions working alongside patients, to improve the quality of healthcare provided. IPECP implementation in rural areas, however, lags due to limited resources and workforce shortages. This systematic review was undertaken to identify the enablers and barriers to the implementation of IPECP initiatives in rural healthcare settings. The JBI mixed methods review methodology and PRISMA guidelines were followed. Studies included peer-reviewed articles of IPECP initiatives implemented in rural healthcare settings identified in PubMed, Scopus, Embase, and Web of Science, alongside gray literature searches. Following screening, data were extracted and critically appraised using the Mixed Methods Appraisal Tool. Forty-eight papers were included in the final review. Enablers of IPECP in rural settings were student factors, supervisor and clinician factors, and strength of the community. Barriers included funding, resources and time constraints, lack of trained IPECP facilitators, and low prioritization of IPECP initiatives. The identified enablers and barriers of IPECP implementation in rural settings can inform further policy and practice developments. Future researchers could investigate strategies to aid IPECP implementation and use of longitudinal designs to assess their long-term impact.

This systematic review examines the content, structure, and process characteristics of interprofessional case discussions (InCaD) involving nurses in adult acute hospital care. Given the complexity of patient care and the need for enhanced interprofessional collaboration. Drawing on the structuration model of interprofessional collaboration framework, a comprehensive search was conducted in PubMed, CINAHL, Cochrane Library and PsycINFO (last search: December 2024). Studies with any type of multiprofessional case discussion were included if they described nurse´s tasks and roles. It was conducted a Level of Evidence statement. In total 42 out of 4541 studies were included. Eight types of InCaD were identified, including interprofessional bedside rounds (I(B)Rs), interdisciplinary rounds (IDRs), structured interdisciplinary bedside rounds (SIBR), and multidisciplinary team meetings (MDTM). Central contents of InCaD encompass collaborative decision-making, coordination of care, ethical reflection, and the integration of patient and family perspectives. Nurses play a pivotal role in InCaD, fulfilling tasks related to information exchange, ethical reflection, and coordination of care. However, nurses rarely assume leadership roles within InCaD. Our results reveal considerable heterogeneity in InCaD formats, theoretical foundations, and methodological approaches, no meta-analysis was feasible. While InCaD are seen as a valuable tool to improve care outcomes, further research to establish standardized frameworks and best practices is needed. These findings underscore the need for clear guidelines, nurse-led initiatives, and structured implementation strategies to optimize InCaD in clinical practice. The broad definition used may limit coherence and generalizability, and robust evidence on effectiveness remains scarce. This review provides insights for healthcare leaders, nurse educators by highlighting how the heterogeneity of InCaD formats can be harnessed as a flexible toolkit to develop context-sensitive implementation strategies, strengthen interprofessional collaboration, and ensure patient-centered, team-based care across diverse clinical settings.