Implementation of interprofessional team-based care: A cross-case analysis

ABSTRACT

Two out of five Canadians have at least one chronic disease and four out of five are at risk of developing a chronic disease. Successful disease management relies on interprofessional team-based approaches, yet lack of purposeful cultivation and patient engagement has led to systematic inefficiencies. Two primary care teams in Southwestern Ontario implementing interprofessional chronic care programs for patients with chronic obstructive pulmonary disease were compared. A mixed-methods cross-case analysis was conducted including interviews, focus groups, observations and document analysis. Cases (n = 2) were chosen based on intrinsic and unique value. Participants (n = 46) were sampled using a combination of purposive and multi-level sampling. Data was analyzed using an iterative process; inductive coding was used to gain a sense of context followed by a deductive cross-case analysis to compare and contrast themes across sites. Kompier’s five-step framework was used to assess factors contributing to successful implementation and to provide insight into interactions between teams, providers and patients. Both cases satisfied all five factors (systemic and gradual approach, identification of risk factors, theory-driven, participatory approach and sustained committed support). However, one case was more successful at fully implementing their model, attributed to a flexible implementation, plans to mitigate risks, theory use, a supportive team and continued buy-in from leadership. By better understanding key facilitators and barriers, we can support the implementation of chronic disease management programs, foster sustainability of high-performing interprofessional teams, and engage patients in the development and maintenance of team-based chronic disease management.

KEYWORDS:

• Team-based care
• interprofessional teams
• chronic disease
• disease management
• chronic obstructive pulmonary disease (COPD)

Acknowledgments

We thank all of our participants and the study sites for the insight they provided, which greatly assisted in our research.

Statement of interests

The authors have no conflicts of interest to declare.

Additional information

Notes on contributors

Shannon L Sibbald

Shannon L Sibbald - Dr. Sibbald is an assistant professor at Western University in Ontario, Canada. Her research interests include interdisciplinary health and health systems research, implementation science, and interprofessional teams.

Bianca R Ziegler

Bianca R Ziegler - Bianca holds a Master's of Science and Bachelor of Health Sciences from Western University and is currently a medical student at McMaster University, her research interests include interprofessional care, women's health, and global health.

Rachelle Maskell

Rachelle Maskell - Rachelle holds a Master's of Science from Western University, her research interests include program evaluation, implementation science, and quantitative/qualitative research methodologies.

Karen Schouten

Karen Schouten - Karen holds a Master's of Science from Western University, her research interests include interprofessional teams and team-based care.