Abstract
Background: Older adults experiences multiple health difficulties and often require complex care. Several healthcare professionals in primary care such as general practitioners, nurses and paramedics are involved in their care. To coordinate complex care, case meetings between these healthcare professionals are held, so called interprofessional team meetings (ITM). However, it is a challenge to sustainably hold these meetings due to several factors such as lack of time, frequently changes in team members, shortage in healthcare professionals.
Objective: This study aims to gain insights into the ‘foundation’ of sustainability of ITM between relevant healthcare professionals to strengthen the perceived health of vulnerable older adults living at home.
Method: A participatory action research design is being used. This includes continuous stakeholder participation, such as patient participation and co-creation teams within the phases of the study.
The project consists of five phases. The first phase contained the inventory of the self-reported health of older adults by performing semi-structured interviews (n=44) and measuring work pleasure through the Team Climate Inventory (n=50). The second phase included the inventory of the functioning of the ITM, facilitators and barriers and sustainability needs. Data was gathered by observation of the ITMs (n=7), and by focus group interviews (n=7).
This data will be used in the third phase to develop and prioritize individual tailored sustainable strategies per ITMs. In the fourth phase these strategies will be implemented by co-teams. The last phase includes the follow-up measures which are done in the first phase. In addition, the developed strategies for sustainability are evaluated by focus group interviews.
Results: Phase one and two are completed. The findings of the interviews with older adults about self-reported health were categorized in to the domains of positive health such as quality of life, social participation, and physical environment. In general older adults expressed the importance of maintaining social and community participation and gratitude that care can take place in their homes. In the Team Climate Inventory, the ITMs achieved an average score of 157.7 out of a total score of 220.
During ITM observations quite some differences were observed between team members, processes and content of the ITMs. In three ITMs only the general practitioners, practice nurses and nurses participated in the ITM. Only one ITM had participation of paramedics. Patient participation was not provided in any of the observed ITMs.
Through the focus group interviews the members of the ITMs reported barriers and needs for sustainability of their ITMs such as pragmatic factors like setting up an agenda, missing a shared IT-system to report the outcomes of the ITMs and a standardized method of discussing the care of the patient. Frequent changes of team members lead to inconstant collaboration and made it difficult to include paramedics and other relevant professionals into the ITMs.
Conclusion: These preliminary results show the diversity of ITMs in primary care. This proves that one-size-fits-all approaches will not reach the goal of sustainable ITMs. There is a need for tailored interventions in each ITM.