Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Doctor of Philosophy

Program

Nursing

Supervisor

Orchard, Carole

Abstract

With current rapid expansions to medical knowledge and technology and rising chronicity of diseases, health care providers are increasingly called upon to work together within interprofessional teams to provide the most comprehensive care to their patients. Interprofessional teams have been depicted as enhancing patient health outcomes and increasing patient satisfaction with care, while decreasing health care spending and wait times for receiving care. However, there is little evidence on how to collaboratively include patients in these teams. The study’s purpose was to construct a framework on the conditions and processes required for patients to assume active participant roles in their care within primary care interprofessional teams. Charmaz’s Constructivist Grounded Theory approach was used. Ten patients and 10 health care providers from two Family Health Teams in Southwestern Ontario, Canada participated in individual semi-structured interviews to learn about their perspectives on patient roles in teams. Data collection and analysis including memoing, coding and constant comparative analysis were used to generate theoretical concepts of the framework. Member-checking interviews occurred to provide final feedback on the framework. The framework entitled: “Patients on Interprofessional Teams in Primary Care: A Framework for Teamwork” presents three main concepts: (1) patient roles; (2) processes; and (3) conditions. The patient roles concept comprises three sub-concepts with each having two categories/descriptors: (1) expert of own health – expressive and advisor; (2) (co)decision-maker – active voice and trusting; and (3) self-manager – advocate and evaluator of care. The processes concept presents five sub-concepts: (1) explain; (2) identify; (3) educate; (4) build; and (5) collaborate. The conditions concept outlines four sub-concepts: (1) flexibility; (2) time; (3) willingness; and (4) readiness. This study presents a comprehensive framework for patient-health care provider interactions within primary care interprofessional teams, including dimensions of and more clarity about three types of roles patients can assume within these teams. This study also offers an understanding of the conditions and processes health care providers adopt in practice towards patient inclusion on these teams. Further research should utilize this framework to continue to build knowledge of patient roles on interprofessional teams within a multitude of health care settings and populations.

Summary for Lay Audience

When health care providers and patients work together as part of interprofessional teams, both groups experience benefits during care delivery. However, we do not have enough information on how patients can be effectively integrated into these teams. The term interprofessional team means a team that is comprised of two or more different health care providers who interact and work together with each other and the patient for more enhanced health outcomes to occur. An example of an interprofessional team is when a nurse, a dietitian, and a physiotherapist work together with and involve the patient in the planning and implementing of patient care. The study purpose was to learn about patients’ and health care providers’ perspectives of roles patients can hold within interprofessional teams in primary care settings, such as a Family Health Team (a clinic in a community setting that includes a team of different health care provider professions who work together to provide care to patients). In addition, the study explored what was needed to be in place for the team for patients to be able to enact such roles. Ten patients and 10 health care providers, from two primary care Family Health Teams in Southwestern Ontario, Canada underwent individual interviews with the study researcher. Additionally, some of these participants took part in a follow-up interview group where they were asked to review the first interview findings to see if they accurately captured participants’ perspectives. This process resulted in construction of a framework on patient roles in teams. Three patient roles were identified: (1) expert of own health; (2) (co)decision-maker; and (3) self-manager. Five processes (steps) were presented that needed to be taken for patients to enact any of these roles: (1) explain; (2) identify; (3) educate; (4) build; and (5) collaborate. Lastly, four conditions (items) were outlined as needing to be in place for these roles to be enacted: (1) flexibility; (2) time; (3) willingness; and (4) readiness. This study has provided an understanding of potential patient roles on interprofessional teams and what is needed to change current practice settings towards patients’ inclusion in their care on such teams.

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