What are the facilitators and barriers to interdisciplinary team working processes in formal, statutory primary care teams?

Problem

Interdisciplinary team working is of paramount importance for the reform of primary care in order to provide cost effective and comprehensive care for patients and professional satisfaction for service providers. However, there are problems embedding and sustaining interdisciplinary team working as a routine way of working in many heatlhcare jurisdictions. Little is known about the factors that promote and inhibit teamworking in practice. It is imperative to address this gap in knowledge in order to understand how these act as levers and barriers to its normalisation.

Approach

An integrative review following PRISMA guidelines was conducted. Searches of ten international databases were conducted by two reviewers. 8,827 titles were screened for relevance and the inclusion criteria. The research team divided into pairs to screen titles and abstracts for potentially relevant studies. Quantitative, qualitative and mixed methods empirical papers, that provided data about at least two members of an interdisciplinary formal statutory team for the general population in primary care, were included. The quality of evidence, in the included papers, was appraised using standardised tools: SIGN and a tool adapted from Noyes and Popay. Data were analysed following the principles of a deductive Framework Analysis using Normalisation Process Theory (NPT). NPT describes four constructs known to impact on implementation processes: sense making, enrolment, enactment, and appraisal. These four constructs informed the approach to data extraction, analysis and synthesis of findings.

Findings

55 papers were included from 11 countries and provided data about 34 different primary care professionals. A dearth exists of literature about sense-making work regarding interdisciplinary team working. Our findings suggest that this is regarded by primary care professionals as different to routine practice and a way of working that has potential for improving patient care. ‘Top down’ policy imperatives and/or local champions who had the ability to inspire and organise others were key levers for enrolement. Whilst there was evidence of successful enactment of interdisciplinary team working, such as good collaboration with a clear focus on patient outcomes, there were two identified barriers: funding models that do not acknowledge or reward team working and a lack of knowledge and confidence in the skills of other health care professionals. There was a lack of literature relating to the appraisal of interdisciplinary team working and how it could be reconfigured to improve its sustainability.

Consequences

This review has (1) identified gaps in knowledge relating to sense-making and appraisal work among primary care professionals and this needs to be addressed in future research and (2) highlighted that the vision for interdisciplinary team working needs to be backed by a funding model that enables team working and (3) there is much to be done to improve primary care professionals’ knowledge of and trust in each other’s work.