Abstract
Background: Our integrated care organization in Toronto, Ontario, Canada has embarked on a project to reduce inequities in patients accessing interprofessional services in primary care. We serve ~200,000 patients. Currently we are focusing on a limited group of patients with access through two primary care models. Several interventions are planned to resolve these inequities and stakeholders are being engaged to inform, consult, and co-design. This is part of a larger case study.
Aims and Methods: Initial interviews were completed by our research team, employed centrally, to understand “usual care” and to get physicians’ perceptions of patients’ needs and gaps in interprofessional services. Interviews were completed by one researcher using a semi-structured interview guide and recorded. Interviews discussed current data use, referral and collaboration with interprofessional providers, and transitions in care. Recorded interviews were deductively coded by at least two team members. Inductive thematic analysis was done by our senior researcher to identify emergent themes for future use. Emergent themes were discussed with the larger project team.
Results: Because researchers, clinicians, and patients are all involved within the same case, the project aligned with principles of participatory action research though it was not designed as such. In all initial interviews, an outcome was the researcher provided information to the physicians that could be applied immediately, themed “Reciprocity”. Interviews were meant to capture “usual care” and identified gaps that were able to be reconciled immediately. Reciprocity allowed for physicians to see the benefit of the association to the integrated care model in the moment. Shared resources included technical instructions for accessing data from a provincial organization, linkages to a centralized hospital referral service, and information about a rapid access addiction medicine clinic. Reciprocity supported the overall aim of the larger project.
Conclusion: Reciprocity highlighted the organization’s need for better awareness of current services and improve information flow. Researchers in integrated care should capitalize on the opportunities to inform participants about current services and use the interview as an exchange of ideas, this is likely to assist in network building.
Transferability: In early research and building phases with new partners, integrated care organizations who have knowledgeable and experienced researchers about their context could have an advantage. Without this, organizations could consider partnering researchers with operational leads to help contribute to network building.