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UBC Theses and Dissertations

Bridging silos : increasing collaborative teamwork between family physicians and home health staff Berg, Shannon


Family physicians (FPs) and home health staff (HHS – home care nurses, case managers, occupational and physiotherapists, and nutritionists) share complex acute and chronically ill patients, but experience significant barriers to collaborative care. This study employed a mixed methodology design to assess the effectiveness of use by FPs and HHS of a structured communication process (pre-scheduled, secure audio-conferencing) about patients they shared, involving all HHS staff and a convenience sample of 22 FPs providing service in one geographic area of a large multi-cultural Canadian city. Following a three-month baseline measurement period, FPs were randomized to an intervention or usual communication group, and the intervention was applied for eight months. Outcome measures included number of shared patients; total number of contacts about shared patients; changes in perception of quality of collaboration; and qualitative experience of using the intervention. Primary data sources included extracts and chart reviews from the HHS electronic clinical documentation system; pre- and post-study administration of a published survey designed to measure perception of collaboration for FPs and home care staff ; and post-study semi-structured interviews and focus groups. Non-parametric statistical procedures and mixed effects Poisson regression for longitudinal count data were used for quantitative data, and thematic content analysis for qualitative data. Results from quantitative and qualitative analysis were considered overall to generate insights into how to further collaborative care planning between FPs and HHS. The average number of shared patients per FP per month did not change, but a statistically significant increase was observed in the average number of contacts per shared patient between FPs and HHS for both study groups in the intervention phase. FPs and HHS agreed that the conferences were beneficial for patients, and both gained a better understanding of each others’ services and work processes. Both FPs and HHS provided evidence that structural barriers greatly impede collaboration between primary and community care. Use of audio-conferencing may have provided a proactive, efficient method of communication that avoided the need for subsequent back-and-forth clarification. Limitations included the small sample size of FPs and short timeline of the intervention period given the magnitude of the change expected.

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