Background
Mature health systems are placing increased emphasis on interdisciplinary teams to deliver primary care [
1,
2]. Interdisciplinary primary care (IDPC) teams consist of healthcare providers from different disciplines working together toward common goals [
2]. This approach is perceived as appropriate to address health needs of populations through the creation of comprehensive care options, increased continuity, and coordination of care [
3‐
7].
The policy maker perspective is captured in Hutchison et al. [
8]. Provinces in Canada have been implementing IDPC teams and “this is an opportune time for within and cross-jurisdictional comparisons” and to “understand the complicating effects of physician remuneration and the variety of organizational forms” (p. 281). Now more than ever do we need a synthesis of the evidence, both to guide future implementations and to improve existing teams [
8].
In addition to decision makers, providers crave evidence. Providers may be reluctant to organize into new teams without evidentiary support [
9]. For example, physicians in Ontario have been seeking evidence regarding the lessons learned and best practices of Ontario’s Family Health Teams [
10]. The Knowledge User Advisory Group associated with this project has identified the question of how best to structure and support IDPC teams as being of utmost importance. This is consistent with findings from a Research Roundtable that was held in October 2014 as a part of a qualitative study of the funding and remuneration structures of IDPC teams in Canada [
11].
The ongoing request for more evidence makes this synthesis of such evidence across Canada and similar health systems timely. Previous evidence syntheses about IDPC teams have looked at specific clinical treatments [
12‐
14] or isolated particular variables with respect to team functioning [
15‐
17]. These reviews have been driven by the quantitative method, which tend to ignore the complexity of context. Their results are of limited usefulness to decision makers. Our study will improve upon existing literature via its comprehensive focus and rigorous inclusion and evaluation of qualitative alongside quantitative evidence [
18]. Our results will explicate what is known about the implications of varied choices in varied contexts.
This knowledge synthesis will deliver a decision support tool to knowledge users, some of whom are members of the Knowledge User Advisory Group working with this research team. The question of how best to structure IDPC teams has been at the forefront of their policy agenda. They have committed to using this tool in policy and planning discussions. The tool will support evidence-based policy development and implementation strategies in the organization of primary care. Well-organized teams improve primary care delivery [
8,
19], and an improved primary care system is shown to positively contribute to improved population health [
20].
This knowledge synthesis builds on three prior projects: (i) a preliminary scoping of relevant literature [
21], (ii) a qualitative study of IDPC teams in Canada [
22], and (iii) a systematic review with narrative synthesis focused on the impact of funding and remuneration on team process. The focused review allowed us to pilot the search and selection approach. The qualitative study and scoping review allowed us to identify relevant team characteristics, categorize them (financial, governance, management), identify measures of team process, and identify relevant health system outcomes [
3‐
7,
23‐
34].
Objectives
The goal of this evidence synthesis is to review the relevant published literature to identify factors that contribute to the effective functioning of IDPC teams and improved health system outcomes. Specific objectives are as follows:
1.
To assess the extent to which team structure contributes to team processes
2.
To assess the extent to which team processes contribute to primary care goals
3.
To assess the extent to which team structure contributes to primary care goals
We will undertake a synthesis of the research evidence to help answer decision makers’ question: “Given my goal and context, how best to structure IDPC teams?”
Based on a scoping review and a qualitative study of IDPC teams in Canada (under review), we define the following indicators to measure the relevant factors:
Team structure: We categorize factors related to team structure into financial structure (funding method for team, remuneration method for providers), governance structure (lines of accountability, type of governance), and management structure (team composition, management of patient acuity, management of team, location, patient rostering, and list size).
Team processes: This includes factors related to the functioning of teams, including the Team Climate Inventory [
24,
35] and the Team Effectiveness Tool [
25].
Primary care goals: These are relevant health system outcomes including patient health or process outcomes specific to selected chronic conditions (described below) and primary care delivery process indicators including access, comprehensiveness, and continuity, or broader measures, such as the primary care assessment tool [
36].
Discussion
Potential challenges and solutions
We anticipate and respond to three challenges in the proposed review. First is the challenge related to the reporting of qualitative research. Due to conventional space constraints imposed by journals, coupled with the lack of standardized reporting requirements, published qualitative studies are often not reported with sufficient breath and detail [
56]. This limits our ability to judge the study’s quality. We will respond to this challenge by contacting study authors where necessary, to retrieve more complete reports on methods used in the qualitative studies.
Second, our proposed study is atypically broad. The breadth is dictated by the needs identified by the Knowledge User Advisory Group. We respond to this challenge by proposing a structured and well-matched process for retrieval, analysis, and synthesis developed specifically to address the diverse nature of research in this area.
Third, the explication of the search process for online non-academic studies presents a challenge. The online environment is less controlled than the academic library database system. We respond to this by creating an audit trail using the customized Grey Matters Tool and creating a tracking system for any digressions.
Potential contribution
The resultant synthesis will be packaged into a web-based decision support tool. The integrated knowledge translation approach in the development of the decision tool will ensure its usability from the point of view of decision makers. We anticipate that the decision tool will be used in public payer health policy discussions focused on the design of policy-controlled elements of IDPC teams.
Acknowledgements
We wish to acknowledge the contributions of Maryna Korchagina, formerly Executive Director with Alberta Health, and Ian Bower, formerly Executive Director with the Nova Scotia Department of Health and Wellness. They had participated as knowledge user partners at the onset of the development of this protocol but have since changed positions.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (
http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (
http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.