Managing complex primary care situations: For what, with whom, in what context and how have interprofessional care teams added value?

Background: In a fragmented health system such as Switzerland’s, enhancing care integration through coordinated interprofessional and interinstitutional teams offer an effective solution to address complex primary care situations.

Approach: Conducted in Geneva, Switzerland, the PRISM project aims to implement interprofessional and interinstitutional teamwork to address complex care situations.

To overcome challenges posed by Switzerland’s fragmented system, the intervention uses a systemic change management approach, including bottom-up as well as top-down approaches. This includes support for teams’ attitudes and practices (micro), support for institutions (meso), the development of communication tools, and the identification of funding for coordination (macro).

This intervention was evaluated with a realist method, which enabled patients, informal caregivers and professionals to share their answers to the following questions: For what, with whom, in what context and how is an interprofessional care team an added value?

Results: 27 primary health care teams participated in this evaluation. Analyses show that the actors highlighted significant added values when working as a team – with specific collaborative process – to manage complex situations.

Added values include:

a) patient’s health measures, such as improvements or acceptance of health decline,

b) patient’s and/or informal caregiver’s experience, such as increased serenity, reduced stress linked to acute episodes,

c) professionals’ experience, such as enhanced trust, communication, recognition, and mutual support between actors.

Implications: Managing complex situations through coordinated interprofessional and interinstitutional care teams could enhance the sustainability of healthcare systems, by improving the experience of professionals, patients and informal caregivers involved, even when health declines. This model is being disseminated, with special efforts to address potential barriers.