Research on the harmonious driving mechanism of doctors′ collaboration willingness and behavior in the tiered diagnosis and treatment system / 中华医院管理杂志

Objective:To explore the driving mechanisms of doctors′ collaborative willingness and behavior in the tiered diagnosis and treatment system, in order to provide reference for promoting the construction of the tiered diagnosis and treatment system.Methods:Based on the harmonious management theory, a theoretical framework for the driving mechanisms of doctors′ collaborative behavior in the tiered diagnosis and treatment system was developed. Through random sampling, a questionnaire survey was conducted among doctors from 40 medical institutions in five prefecture-level cities in Zhejiang province between April and May 2022. The t-test, variance analysis, and non-parametric tests were employed to analyze the differences in collaborative willingness and behavior among doctors based on various demographic characteristics. The structural equation model and stratified linear regression were used to assess the impact of collaborative factors (professional environment and work expectations) and harmonious factors (perception of policy support and perception of management mechanism) on doctors′ collaboration willingness and behavior. Results:A total of 1 959 doctors participated in the survey. Doctors′ collaborative behavior scored 2.13±1.12, indicating a slightly below-average level, whereas their willingness to collaborate scored 3.88±0.79, falling between neutral and somewhat willing. Significant differences in collaborative behavior scores were observed based on the medical institution′s ranking, age, years of experience, monthly average income, and professional titles ( P<0.05). Both collaborative and harmonious factors directly influenced the doctors′ willingness to collaborate, with standardized path coefficients of 0.428 and 0.139, respectively. Similarly, these factors directly impacted their collaborative behavior, with standardized path coefficients of 0.104 and 0.366. The perceptions of policy support and management mechanisms demonstrated a significant positive moderating effect on the relationship between doctors′ collaborative willingness and behavior, with effect values of 0.047 and 0.043 respectively ( P<0.05). Conclusions:The collaborative and harmonious elements serve as positive drivers for collaboration among doctors in the tiered diagnosis and treatment system at both the cognitive and behavioral levels. Enhancing and optimizing policy support and management mechanisms can facilitate the transition from intention to actual collaborative actions among doctors from different levels of medical institutions.

A comunicação na perspectiva dialógica da prática interprofissional colaborativa em saúde na Atenção Primária à Saúde / Communication in the dialogical perspective of collaborative interprofessional practice in Primary Health Care

O objetivo deste estudo foi analisar a comunicação enquanto domínio da prática interprofissional colaborativa em Saúde no processo de trabalho das equipes da Atenção Primária à Saúde. Trata-se de um estudo com abordagem qualitativa, de caráter descritivo e interpretativo, cujos dados constituem um recorte de dissertação de mestrado, realizado em Unidades Básicas de Saúde (UBS) de um município do noroeste do estado do Paraná, Brasil, com 84 profissionais de equipes da Atenção Primária à Saúde (APS). Os dados foram coletados por grupos focais, organizados pela classificação hierárquica descendente do software IRaMuTeQ®, submetidos à análise lexical e discutidos pela Teoria da Ação Dialógica. Levantaram-se cinco classes de léxicos que, quando agrupados, revelaram como ocorre a comunicação entre as equipes da Atenção Primária à Saúde. A comunicação, de caráter interprofissional e colaborativo, ainda é um desafio para as equipes de saúde conduzirem um processo de trabalho compartilhado, dialógico e transformador.(AU)

El objetivo de este estudio fue analizar la comunicación como dominio de la práctica interprofesional colaborativa en salud en el proceso de trabajo de los equipos de la Atención Primaria de la Salud. Se trató de un estudio con abordaje cualitativo, de carácter descriptivo e interpretativo, cuyos datos constituyen un recorte de disertación de maestría, realizado en Unidades Básicas de Salud (UBS) de un municipio del noroeste del Estado de Paraná, Brasil, con 84 profesionales de equipos de la Atención Primaria de la Salud (APS). Los datos fueron colectados po grupos focales, organizados por la clasificación jerárquica descendiente del software IRaMuTeQ®, sometidos a análisis de léxico y discutidos por la Teoría de la acción Dialógica. Se estudiaron cinco clases de léxicos que, cuando agrupados, revelaron como se realiza la comunicación entre los equipos de la Atención Primaria de la Salud. la comunicación de carácter interprofesional y colaborativo todavía es un desafío para que los equipos de salud realicen un proceso de trabajo compartido, diálógico y transformador.(AU)

The objective of this study was to analyze communication as a collaborative interprofessional health practice domain in the workflow of primary healthcare teams. It was a qualitative study with a descriptive and interpretative approach, and its data constitute part of a master's thesis. It was conducted in in Primay Health Care Units (UBS) of a Brazilian city in the northwestern part of the state of Paraná, with 84 professionals of primary healthcare teams. Data was collected by focus groups and organized in hierarchical descending order using software IRaMuTeQ®. They were submitted to lexical analysis and discussed based on the Theory of Dialogic Action. Five lexical classes were obtained. When grouped together, they revealed how communication among primary healthcare teams occurs. Collaborative interprofessional communication is still a challenge for health teams when leading a joint transformative and dialogical work process.(AU)

Prática interprofissional colaborativa no serviço de emergência: atribuições privativas e compartilhadas dos fisioterapeutas / Collaborative interprofessional practice in emergency services: specific and shared functions of physiotherapists

Resumo Consideradas a dinamicidade e complexidade dos serviços de emergência, bem como a recomendação de prática colaborativa interprofissional em saúde, este estudo foi desenvolvido para identificar as atribuições específicas e as compartilhadas dos fisioterapeutas que atuam nas equipes desses serviços. Foi realizada análise documental, para mapeamento das ações, e técnica Delphi, para consenso. Foram identificadas 26 atribuições, sendo cinco privativas do fisioterapeuta, 12 compartilhadas com médicos e enfermeiros e nove sem consenso. Isso mostra, de um lado, a ampliação do escopo de prática das profissões e a constituição de atribuições comuns entre os três profissionais, em especial entre fisioterapeutas e médicos. Por outro lado, também mostra que existem potenciais conflitos pela indefinição de um terço de atribuições. Há flexibilidade das fronteiras profissionais, o que pode contribuir para abordagem integral das necessidades dos pacientes e efetivo trabalho em equipe colaborativo.(AU)

Resumen Considerando el dinamismo y la complejidad de los servicios de emergencia, así como la recomendación de práctica colaborativa interprofesional en salud, se desarrolló este estudio para identificar las atribuciones específicas y compartidas de los fisioterapeutas que actúan en los equipos de estos servicios. Se realizó análisis documental para el mapeo de las acciones y la técnica Delphi para consenso. Se identificaron 26 atribuciones, siendo cinco de ellas específicas del fisioterapeuta, 12 compartidas con médicos y enfermeros y nueve sin consenso. Eso muestra, por un lado, la ampliación del alcance de práctica de las profesiones y la constitución de atribuciones comunes entre los tres profesionales, en especial entre fisioterapeutas y médicos. Por el otro, hay potenciales conflictos debido a la indefinición de un tercio de las atribuciones. Hay flexibilidad de las fronteras profesionales, lo que puede contribuir para un abordaje integral de las necesidades de los pacientes y el efectivo trabajo en equipo colaborativo.(AU)

Abstract Considering the dynamic and complex characteristic of emergency services, as well as the recommended collaborative interprofessional health practice, this study aims at identifying specific and shared functions of physiotherapists who work in this environment. A documentation analysis was used to map actions, and Delphi technique was carried out for consensus purposes. Twenty-six functions were identified: five of them were specific to physiotherapists, twelve were shared with doctors and nurses, and nine showed no consensus. On the one hand, this shows an expansion of the professions' scope of practice and constitution of common functions among all three professionals, particularly between physiotherapists and doctors. On the other hand, there are potential conflicts due to lack of a definition of one third of the functions. Professional boundaries are flexible, which can contribute to a comprehensive approach of the patients' needs and to effective collaborative teamwork.(AU)