Abstract
Background: In Canada, a large proportion of health service utilization and death is accounted for by Chronic Obstructive Pulmonary Disease (COPD), a complex chronic disease that is often under-diagnosed and under-treated. The literature identifies that appropriate and beneficial care for patients with COPD includes the use of integrated team-based models of care. While using this model of care is widely supported, there is a gap in evidence on how to support the sustainability of these programs in primary care, post-implementation. The Best Care COPD (BCC) Program has been implemented across Southwestern Ontario, Canada and has been successful in delivering integrated team-based care with a focus on improving patient outcomes, as well as patient and provider satisfaction.
Approach: This research study aims to explore the sustainability of an integrated team-based care program, known as BCC. Through this, we will gain a better understanding of the factors that affect and what mechanisms enable sustainability in an integrated team-based care program. A collective case study approach guided by a constructivist paradigm was used to focus on sites in which the BCC program has been implemented for one year or more (post-initial implementation). We used the Program Sustainability Assessment Tool (PSAT) to better understand adaptations that were made over the course of implementation and the way in which these interact to impact sustainability of the BCC program. Additionally, we conducted 2 semi-structured interviews with respiratory therapists, primary care providers, executive leadership, and BCC program leaders. We conducted four focus groups with respiratory therapists (n=20) to gain an understanding of the team dynamic within an integrated team-based model and gain knowledge on the collective experience on adaptation and sustainability of BCC. Moreover, we conducted document analysis to broaden the knowledge base regarding the sustainability of chronic disease management programs.
Results: Preliminary findings indicate strategic planning, strong stakeholder partnerships, along with funding stability are necessary factors to support the sustainability of the BCC program within the context of primary care. Furthermore, mechanisms such as program fidelity, establishing collaborative empowerment and practice-based evidence are mechanisms that enabled the BCC program within the context of primary care.
Implications: The findings of this study will provide a clearer understanding of strategies to support sustainability for integrated team-based care. Currently, sustainability is recognized as a challenge in translational research; this study can be used as a base for improving implementation processes within integrated team-based models of care ultimately to ensure high quality and sustainable patient care. Future research will include a deeper exploration of patient perspectives on the importance of sustaining integrated team-based care programs as well as implications for scale and spread.