Difficulties Encountered in Collaborative Care: Logistics Trumps Desire

Abstract

Introduction: This study examines the development of collaborative relationships between family physicians (FPs) and Anticipatory And Preventative Team Care (APTCare) team members providing care to medically complex patients who have been identified as at-risk for negative health outcomes.Methods: We undertook a qualitative study of a primary health care intervention in a family practice. Interviews were held with FPs and ATPCare intervention nurse practitioners (NPs) and pharmacists. Focus groups were conducted and a survey was administered to participating FPs, NPs, and pharmacists. NPs and pharmacists maintained a log recording their tasks and moments of collaboration.Results: Scheduling demands rendered face-to-face collaboration difficult, leaving the team to rely on technological tools to keep in touch. Limited space meant the APTCare team had to work out of a downstairs office, limiting informal interactions with the practitioners on the main level.Conclusions: We demonstrate that the difficulties inherent in collaborative care are independent of the patient population being cared for. Regardless of the patient population and sector of health care, developing collaborative relationships and learning to work collaboratively is difficult and takes time. What many of these teams need is ongoing support and education about how to make these collaborative care practices work. (J Am Board Fam Med 2012;25:168 -176.)

Collaborative arrangements and privately practising nurse practitioners in Australia: results from a national survey

“…The barriers medical practitioners historically erected to the establishment of NPs, in both private and public practice, are well documented in the international literature. [20][21][22] Notwithstanding this opposition, the need for NPs was recognised by many enlightened medical practitioners, and NP roles are now widely established in the public sector. The clarity of NP roles and scope of practice were the most frequently identified barriers and facilitators to collaborative practice reported in a recent integrative review of NP collaborative practice in primary care in the US, Canada, UK, the Netherlands, Sweden, Ireland and New Zealand.…”

“…A period of 3-6 months has been identified as a sufficient period to build trust and understanding between a NP and collaborating medical practitioner working in the same practice and speciality. 20 The geography of some Australianbased PPNP services means that the NPs work alone and may not have the opportunity to work at the same practice, which may affect the relationship.…”

Collaboration in a primary care setting: strategies for a family nurse practitioner caring for the frail older adult

“…Collaboration can be accomplished ifthere is a common goal and all agree on both the goals and tasks to be completed (Baxter & Markle-Reid, 2009;Chreim et al, 201 0;Emery et al, 2012;Hall, 2005;Legault et al, 2012;Palinkas et al, 2011;Weberg & Weberg, 2014 Legault et al, 2012). The process of how to achieve this common goal is the big challenge for collaborators.…”

“…Political differences and conflicting values (Chreim et al,201 0), inability to compromise (de Stampa et al, 2013;Lapidos & Rothschild, 2004;Legault et al, 2012;Mian et al, 2012), and lack of willingness to share information can also interrupt the collaborative process (EICP, 2005).…”

“…Collaboration cannot be effective without full partnership in decision making between all relevant parties according to Matthews and Brown (2013). Leadership distribution should be shared and rotated depending on the need and expertise, with a focus on facilitating, rather than patemalizing, patient care (Chreim, Williams, Janz, & Dastmalchian, 2010;de Stampa et al, 2013;Legault et al, 2012;Weberg & Weberg, 2014).…”