Background
Methods
Design
Search method
Inclusion criteria
Study selection
Data extraction
Methodological quality
Synthesis
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• Unequivocal (findings accompanied by an illustration beyond reasonable doubt and therefore not open to challenge).
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• Equivocal (findings accompanied by an illustration lacking clear association with it and therefore open to challenge).
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• Unsupported (the data do not support findings).
Confidence in the synthesized findings
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1. Is there congruity between the research methodology and the research question or objectives?
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2. Is there congruity between the research methodology and the methods used to collect data?
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3. Is there congruity between the research methodology and the representation and analysis of data?
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4. Is there a statement locating the researcher culturally or theoretically?
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5. Is the researcher’s influence on the research, and vice-versa, addressed?
Results
Study selection
Study characteristics and influencing factors of interprofessional collaboration
Author (year); country | Aim | Participants (n) | Setting | Design and data collection | Method of analysis | Influencing factors regarding interprofessional collaboration |
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Baxter et al. (2009); Canada [23] | To describe the experiences of five different health care professionals as they participated in an interprofessional team approach to care for the frail older adult living at home and at risk of falling | Registered Nurse (2) Physiotherapist (2) Occupational Therapist (2) Nutritionist/Dietician (1) Case Manager (2) | Community Care Access Center | Exploratory descriptive qualitative design using focus groups | Thematic analysis | Understanding roles and responsibilities Feeling free to address issues Developing personal relationships Communication Working towards a common goal Gathering and sharing information Organizational support |
Middlebrook et al. (2012); Australia [59] | To investigate the processes involved for private occupational therapists (OTs) and physiotherapists (PTs) to implement Medicare items from the Enhanced Primary Care (EPC) program within their practice, for the purpose of falls prevention interventions for older people | Occupational Therapist (4) Physical Therapist (4) | Service providers within the EPC program across the Sydney area and the Hunter region | Qualitative design with a grounded theory approach using semi-structured interviews | Grounded theory | Communication The importance of a collaborative approach Excessive paperwork and interprofessional reports Inadequacy of fee’s |
Amacher et al. (2016); Switzerland [60] | To explore the perceived benefits and barriers of an evidence-based, home-based pilot FPP among the involved seniors, general practitioners (GPs), home care nurses (HCNs) and physiotherapists (PTs), in order to develop tailored implementation strategies | General practitioners (4) Home care nurses (4) Physiotherapists (4) | Service providers in urban and rural regions providing care to community-dwelling older adults | Mixed-method design using semi-structured interviews and questionnaires | Deductive content analysis | Doubts about the role of health care providers Overlapping skills Unclear reports and unsatisfactory information flows Invest in interprofessional aim |
Liddle et al. (2018); Australia [61] | To explore how AHPs were making fall prevention practice routine in primary care and the factors that influenced their fall prevention practice | Physiotherapist (6) Occupational therapist (4) Exercise physiologist (2) Podiatrist (3) | Primary care settings | Explorative qualitative approach using in-depth interviews | Thematic analysis | Role clarity Overlapping skills and experiences Value of an interprofessional approach Communication should not be limited Receiving information Funding system |
Killingback et al. (2021); United Kingdom [62] | To explore the views of healthcare practitioners involved in falls prevention in understanding how they support older people in self-managing falls and the potential for a transition pathway from NHS-exercise based falls interventions to community-run exercise programs | Physiotherapist (3) Rehabilitation assistant (3) Nurse (2) | An organization which is commissioned to provide falls rehabilitation in the North East of England | Explorative qualitative approach using semi-structured interviews | Inductive thematic analysis | Exchanging knowledge and expertise through discussions Weekly meetings to discuss patients Appreciation of the diversity of disciplines |
Methodological quality
Synthesized findings
Author (year) | Findings | Categories | 1. Barriers to communication | 2. Facilitators to communication | 3. Understanding roles | 4. Overlapping skills | 5. Barrier to information sharing | 6. Facilitators to information sharing | 7. Work environment | 8. Reimbursement | 9. Working with a clear aim | 10. Value of teamwork |
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Understanding Roles (UE) | x | |||||||||||
Understanding own and team members’ responsibilities (US) | x | |||||||||||
Feeling free to address issues (US) | x | |||||||||||
Developing personal relationships (US) | x | |||||||||||
Way of communication (face to face, e-mail, telephone calls) (UE) | x | |||||||||||
Communication was enhanced through teamwork (E) | x | |||||||||||
Finding time to communicate (UE) | x | |||||||||||
Working together towards a goal (US) | x | |||||||||||
Gathering information together (UE) | x | |||||||||||
Sharing information together (UE) | x | |||||||||||
Organizational support (UE) | x | |||||||||||
Limited verbal communication (UE) | x | |||||||||||
Understanding importance of collaborative approach (E) | x | |||||||||||
Understanding roles (US) | x | |||||||||||
Paperwork was excessive (UE) | x | |||||||||||
Interprofessional reports (E) | x | |||||||||||
Inadequacy of fee’s (UE) | x | |||||||||||
Doubts about role in multidisciplinary approach (E) | x | |||||||||||
Overlapping skills (UE) | x | |||||||||||
Receiving unclear reports (UE) | x | |||||||||||
Lack of clarity regarding the aim of FPI (US) | x | |||||||||||
Unsatisfactory information flow (US) | x | |||||||||||
Role clarity (UE) | x | |||||||||||
Overlap in skills and experience across disciplines (UE) | x | |||||||||||
Value of other professionals’ addition (UE) | x | |||||||||||
Communication was limited (E) | x | |||||||||||
Receiving information about clients (US) | x | |||||||||||
Reimbursed for fall prevention (UE) | x | |||||||||||
Exchanging knowledge and expertise through discussions (UE) | x | |||||||||||
Weekly meetings to discuss patients (UE) | x | |||||||||||
Appreciation diversity of disciplines (US) | x |
Categories | Synthesized findings | Quote’s |
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1. Barriers to communication | Communication | “If I’ve been seeing somebody for a couple of weeks… I’m struggling with how to get the patient to progress…then I’ll bring that patient to the meeting and say, ‘Does anybody suggest anything? Am I missing something?’So, it’s quite nice to talk it through with people, there might be something really simple and obvious, there’s a wealth of knowledge and expertise.” [62] “It was really difficult for us to keep up with talking about each and every one of them [clients] every month.” [23] |
2. Facilitators to communication | ||
3. Understanding roles | Role clarity | “Consultingin general is very important to us HCNs. We always per-form a medical diagnostic screening and look also forthese things. (…) … and consulting (regarding facility).(We say):“You have this carpet”, then we solve this(problem)or search for solutions. Also the risk of fallingin the shower.” [60] |
4. Overlapping skills | What I am enjoying about this group is that I am learning about all the different disciplines. I didn’t know a lot about the public health nursing so it was really good to learn about the different roles, and more specifically to clients in what they do so it is really positive for the community. And then physio, OT, and nutrition when they collaborate together. I learn more about what they actually do, especially with their different testings.” [23] | |
5. Barriers to information sharing | Information sharing | “With this particular gentleman, he does not want all these questions. I mean for all four of us to be asking him questions, so we talked last week maybe just having one or two of us to ask or maybe just one of us having to ask those questions.” [23] “It was put about that GPs are informed, but however, our GPs did not really have a clue. (…) But the project flyer (previously mentioned) was helpful then.” [60] |
6. Facilitators to information sharing | ||
7. Work environment | Organization | “Our professional leaders are at least always sort of checking in with us to make sure everything is going okay and we have any issues that need to be taken to the working committee. Very supportive. The pressure of seeing our regular caseload but recognize too that we’ve got to see our new clients and it takes a period of time so they know when to back off with some of the pressure.” [23] “I still haven’t quite got my head around how it all works, the intricacies of all these new systems they have in place.” [61] |
8. Reimbursement | ||
9. Working with a clear aim | Interprofessional aim | “…it’s mostly physios who send people through because they know that these people need to be motivated in another way and just giving them exercises is not enough. They need to get them to think through the issues … so they send them to me, and then they get to … consolidate what the physios been doing.” [61] |
10. Value of teamwork |
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Synthesized finding 1: Communication
“It was really difficult for us to keep up with talking about each and every one of them [clients] every month.” [23].
“If I’ve been seeing somebody for a couple of weeks… I’m struggling with how to get the patient to progress…then I’ll bring that patient to the meeting (…) there’s a wealth of knowledge and expertise.” [62].
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Synthesized finding 2: Role clarity
“What I am enjoying about this group is that I am learning about all the different disciplines (…) And then physio, OT, and nutrition when they collaborate together. I learn more about what they actually do, especially with their different testings.” [23].
“Consulting in general is very important to us HCNs. We always perform a medical diagnostic screening and look also for these things. (…) … and consulting (regarding facility). (We say): “You have this carpet”, then we solve this(problem) or search for solutions.” [60].
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Synthesized finding 3: Information sharing
“It was put about that GPs are informed, but however, our GPs did not really have a clue.” [60].
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Synthesized finding 4: Organization
“Our professional leaders are at least always sort of checking in with us to make sure everything is going okay and we have any issues that need to be taken to the working committee. Very supportive.” [23].
“I still haven’t quite got my head around how it all works, the intricacies of all these new systems they have in place.” [61].
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Synthesized finding 5: Interprofessional aim
“…it’s mostly physios who send people through because they know that these people need to be motivated in another way and just giving them exercises is not enough.” [61].
Confidence levels of synthesized findings
Synthesized finding | Dependability | Credibility | Confidence level |
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Communication | Downgrade -1a | Downgrade -1b | Low |
Role clarity | Downgrade -1a | Downgrade -3d | Extremely low |
Information sharing | Downgrade -1a | Downgrade -3d | Extremely low |
Organization | Downgrade -1a | Downgrade -2c | Extremely low |
Interprofessional aim | Downgrade -1a | Downgrade -3d | Extremely low |