Abstract
Background: Industrialized countries are facing pressure to address the complexity of populations who experience high needs with significant costs to the health system. Interprofessional team-based care (TBC) is an essential component of integrated care strategies to respond to these complex needs. However, TBC models operate within complex policy environments that can facilitate or constrain their activities. The main goal of this project is to develop deeper insights on the manner in which system-level policies contributed in shaping TBC in three Canadian provinces - Ontario (ON), British Columbia (BC) and Nova Scotia (NS).
Approach: This research consisted of an analysis of provincial policy documents (3 ON, 7 BC and 4 NS). Data was extracted using an innovative framework, based on a concept mapping exercise completed by the research team. Qualitative description and matrix comparative analysis for similarities and differences were used for data analysis.
Results: Across the provinces, government investments encouraged the development of various models of TBC models (physician clinics, interprofessional team clinics, nurse practitioner led clinics, Community Health Centers). Government support was often tied to changes in the operations of TBC models such as increasing the number of services or extending opening hours. To enhance TBC, some policies expanded the roles and competencies of allied health professionals or shifted services from hospital to community settings. Patient engagement and participation in policy development and implementation was more salient in BC policies than ON.
Implications: Provincial policymakers play a key role in creating the conditions in which TBC models are created and operate. This policy analysis highlights successful strategies that can contribute to improving the development and operations of TBC. These findings can inform the development of public polices and avenues for adopting practices so as to foster TBC in Canada.