Doing primary care integration: a qualitative study of meso-level collaborative practices.
Collaboration
Integration
Meso-level
Primary care
Primary health care
Qualitative study
Journal
BMC primary care
ISSN: 2731-4553
Titre abrégé: BMC Prim Care
Pays: England
ID NLM: 9918300889006676
Informations de publication
Date de publication:
17 07 2023
17 07 2023
Historique:
received:
28
01
2023
accepted:
04
07
2023
medline:
19
7
2023
pubmed:
18
7
2023
entrez:
17
7
2023
Statut:
epublish
Résumé
The integration of Primary Care (PC) into broader health systems has been a goal in jurisdictions around the world. Efforts to achieve integration at the meso-level have drawn particular attention, but there are few actionable recommendations for how to enact a 'pro-integration culture' amongst government and PC governance bodies. This paper describes pragmatic integration activity undertaken by meso-level participants in Alberta, Canada, and suggests ways this activity may be generalizable to other health systems. 11 semi-structured interviews with nine key informants from meso-level organizations were selected from a larger qualitative study examining healthcare policy development and implementation during the COVID-19 pandemic. Selected interviews focused on participants' experiences and efforts to 'do' integration as they responded to Alberta's first wave of the Omicron variant in September 2021. An interpretive descriptive approach was used to identify repeating cycles in the integration context, and pragmatic integration activities. As Omicron arrived in Alberta, integration and relations between meso-level PC and central health system participants were tense, but efforts to improve the situation were successfully made. In this context of cycling relationships, staffing changes made in reaction to exogenous shocks and political pressures were clear influences on integration. However, participants also engaged in specific behaviours that advanced a pro-integration culture. They did so by: signaling value through staffing and resource choices; speaking and enacting personal and group commitments to collaboration; persevering; and practicing bi-directional communication through formal and informal channels. Achieving PC integration involves not just the reactive work of responding to exogenous factors, but also the proactive work of enacting cultural, relationship, and communication behaviors. These behaviors may support integration regardless of the shocks, staff turnover, and relational freeze-thaw cycles experienced by any health system.
Sections du résumé
BACKGROUND
The integration of Primary Care (PC) into broader health systems has been a goal in jurisdictions around the world. Efforts to achieve integration at the meso-level have drawn particular attention, but there are few actionable recommendations for how to enact a 'pro-integration culture' amongst government and PC governance bodies. This paper describes pragmatic integration activity undertaken by meso-level participants in Alberta, Canada, and suggests ways this activity may be generalizable to other health systems.
METHODS
11 semi-structured interviews with nine key informants from meso-level organizations were selected from a larger qualitative study examining healthcare policy development and implementation during the COVID-19 pandemic. Selected interviews focused on participants' experiences and efforts to 'do' integration as they responded to Alberta's first wave of the Omicron variant in September 2021. An interpretive descriptive approach was used to identify repeating cycles in the integration context, and pragmatic integration activities.
RESULTS
As Omicron arrived in Alberta, integration and relations between meso-level PC and central health system participants were tense, but efforts to improve the situation were successfully made. In this context of cycling relationships, staffing changes made in reaction to exogenous shocks and political pressures were clear influences on integration. However, participants also engaged in specific behaviours that advanced a pro-integration culture. They did so by: signaling value through staffing and resource choices; speaking and enacting personal and group commitments to collaboration; persevering; and practicing bi-directional communication through formal and informal channels.
CONCLUSIONS
Achieving PC integration involves not just the reactive work of responding to exogenous factors, but also the proactive work of enacting cultural, relationship, and communication behaviors. These behaviors may support integration regardless of the shocks, staff turnover, and relational freeze-thaw cycles experienced by any health system.
Identifiants
pubmed: 37460971
doi: 10.1186/s12875-023-02104-7
pii: 10.1186/s12875-023-02104-7
pmc: PMC10353261
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
149Subventions
Organisme : CIHR
ID : 2020-02-18
Pays : Canada
Informations de copyright
© 2023. The Author(s).
Références
Milbank Q. 2020 Jun;98(2):446-492
pubmed: 32436330
BMJ Simul Technol Enhanc Learn. 2021 Jul;7(6):487-493
pubmed: 34422296
BMC Fam Pract. 2020 Dec 5;21(1):258
pubmed: 33278880
Am J Infect Control. 2022 Aug;50(8):885-889
pubmed: 35908827
Lancet. 2018 Apr 28;391(10131):1718-1735
pubmed: 29483027
Prim Health Care Res Dev. 2012 Oct;13(4):327-46
pubmed: 22353204
J Adv Nurs. 2016 Feb;72(2):451-60
pubmed: 26412414
Healthc Q. 2009;13 Spec No:6-15
pubmed: 20057243
BMC Health Serv Res. 2017 Dec 01;17(1):796
pubmed: 29191182
BMJ. 2018 Nov 28;363:k4907
pubmed: 30487286
Int J Integr Care. 2013 Mar 22;13:e010
pubmed: 23687482
J Gen Intern Med. 2010 Jun;25(6):625-9
pubmed: 20467912
Sociol Health Illn. 2016 Feb;38(2):216-32
pubmed: 26537016
Qual Quant. 2018;52(4):1893-1907
pubmed: 29937585
Res Nurs Health. 1997 Apr;20(2):169-77
pubmed: 9100747
BMJ Open. 2013 Aug 19;3(8):e003217
pubmed: 23959754
Int J Integr Care. 2011 Jan;11 Spec Ed:e004
pubmed: 21677842
Health Res Policy Syst. 2019 Nov 27;17(1):94
pubmed: 31775772
Healthc Pap. 1999 Winter;1(1):5-21
pubmed: 12606855
Can Fam Physician. 2021 Feb;67(2):88-91
pubmed: 33608356
Int J Qual Health Care. 2017 Jun 01;29(3):327-334
pubmed: 28430963
Qual Health Res. 2009 Sep;19(9):1284-92
pubmed: 19690208
Ann Fam Med. 2013 May-Jun;11 Suppl 1:S1-5
pubmed: 23690378
Ann Fam Med. 2014 Mar-Apr;12(2):166-71
pubmed: 24615313
Int J Integr Care. 2019 Dec 20;19(4):10
pubmed: 31871439
BMC Fam Pract. 2016 Jul 20;17:83
pubmed: 27440181
Front Public Health. 2021 Jul 06;9:680316
pubmed: 34295871
BMJ Glob Health. 2020 Jul;5(7):
pubmed: 32718949
Health Aff (Millwood). 2013 Apr;32(4):695-703
pubmed: 23569049
PLoS One. 2017 Jul 26;12(7):e0181689
pubmed: 28746358
Healthc Policy. 2021 Nov;17(2):38-53
pubmed: 34895409
Am Psychol. 2020 Jul-Aug;75(5):668-682
pubmed: 31393143
N Engl J Med. 2003 Aug 21;349(8):768-75
pubmed: 12930930
Qual Health Res. 2016 Nov;26(13):1753-1760
pubmed: 26613970
Int J Health Plann Manage. 2006 Jan-Mar;21(1):75-88
pubmed: 16604850
Int J Integr Care. 2014 Jul 21;14:e024
pubmed: 25114665