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Primary Care Teams are not as Effective as they Could be Because of Three Sets of Barriers

A centerpiece of primary health care reform in the past decade – the development of interprofessional primary care (IPC) teams – is still not working as effectively as it should.

Toronto, October 31, 2012—A centerpiece of primary health care reform in the past decade – the development of interprofessional primary care (IPC) teams – is still not working as effectively as it should.

Barriers, which exist among individual team members, within practices and throughout the primary care system, prevent interprofessional teams from serving their patients most effectively, according to a Conference Board of Canada report and video released today at the Summit on Sustainable Health and Health Care.

This is an image that represents the primary care“Countries with effective primary care systems have more healthy populations and lower health care costs,” said Thy Dinh, Senior Research Associate, Health Economics. “Most provinces have put much effort into building interprofessional primary care teams, and some have been successful in improving clinical outcomes for patients. But most of the current models are still not working optimally.”

“There is a need for better use of information and communication technology, along with improved monitoring and evaluation, and appropriate funding models. And many barriers could be overcome with improved communication, greater levels of trust and the creation of incentives for individuals to work effectively within teams.”

An IPC team is a group of professionals from different disciplines who communicate and work together in a formal arrangement to care for a patient population in a primary care setting. Examples of traditional primary care settings are family physicians’ offices or practices and community health centres.

Individual-level barriers include the lack of clarity in roles and tasks, which inhibits trust. Perceived and projected professional hierarchies – such as the decision-making authority of some team members over others – can compromise the effectiveness of teams.

Practice-level barriers include lack of strong governance and leadership to manage complex practices. Teams struggle to establish the right size of team and obtain the proper mix of skills needed on the team. A lack of physical space and time can limit communication, as does inadequate systems and structures intended to promote communication.

System-level barriers include inadequate education and training in developing or working within collaborative teams. Funding models can also be problematic if the way team members are paid does not promote effective interprofessional collaboration. Most current IPC teams use a blended-payment model of fee-for-service and salary or fee-for-service and capitation and extra financial incentives for physicians, while non-physicians are mostly paid on salary from a variety of sources.

The publications, Current Knowledge About Interprofessional Teams in Canada and Barriers to Successful Interprofessional Teams, are publicly available.

These first two briefings provide an overview of various IPC team models in Canada and barriers to their effectiveness. Future reports will examine the health and economic impacts of optimized IPC teams, and make recommendations for policy changes that can lead to more successful interprofessional collaboration in primary care.

These reports are part of the research program of the Conference Board’s Canadian Alliance for Sustainable Health Care (CASHC). Launched in 2011, CASHC is a five-year Conference Board program of research and dialogue. It will delve deeply into facets of Canada’s health care challenge, including the financial, workplace, and institutional dimensions, in an effort to develop forward-looking qualitative and quantitative analysis and solutions to make the system more sustainable.

View a commentary by Thy Dinh, Senior Research Associate, Health Economics

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