Interprofessional collaboration in primary health care: a review of facilitators and barriers perceived by involved actors.

BACKGROUND: The epidemiological transition calls for redefining the roles of the various professionals involved in primary health care towards greater collaboration. We aimed to identify facilitators of, and barriers to, interprofessional collaboration in primary health care as perceived by the actors involved, other than nurses. METHODS: Systematic review using synthetic thematic analysis of qualitative research. Articles were retrieved from Medline, Web of science, Psychinfo and The Cochrane library up to July 2013. Quality and relevance of the studies were assessed according to the Dixon-Woods criteria. The following stakeholders were targeted: general practitioners, pharmacists, mental health workers, midwives, physiotherapists, social workers and receptionists. RESULTS: Forty-four articles were included. The principal facilitator of interprofessional collaboration in primary care was the different actors' common interest in collaboration, perceiving opportunities to improve quality of care and to develop new professional fields. The main barriers were the challenges of definition and awareness of one another's roles and competences, shared information, confidentiality and responsibility, team building and interprofessional training, long-term funding and joint monitoring. CONCLUSIONS: Interprofessional organization and training based on appropriate models should support collaboration development. The active participation of the patient is required to go beyond professional boundaries and hierarchies. Multidisciplinary research projects are recommended.

[Linking: relationships between health professionals in the informal health networks]. / Créer des liens : les relations soignants-soignants dans les réseaux de soins informels.

BACKGROUND: During the last years, the french health system has been developing formal health networks. So, it was necessary to study informal health networks as <> networks. More precisely, we studied the nature of relationships between various stakeholders around general practionners wich are commonly considering as the <> stakeholder of the health system private sector. METHODS: Fieldwork (ethnography based on direct observations and interviews) was conducted between October 2002 and april 2004, in the South-East of France. Ten monographs of general practioner's offices were achieved in a rural area; then, we achieved fieldwork of the informal health networks identified. RESULTS: There is a cultural frame wich is common to all private professionals. This frame includes a triple ideal (teamwork built up the hospital model, independance, and an relational approach with patients). This frame does not square with the real practices. In fact, regulation mechanisms preserve the balance of relashionships between professionnal groups, by restricting/promoting exchanges and complex alliance strategies. These mecanisms include: (1) a few professionnal's rule as disponibility (to the patients and to the professionnals), as communication about patient, as patient's reference, as obligation to communicate between professionals; (2) some constraints such as territory superposition and competition with other professional groups; (3) some needs for: rileiving (of emotions and worries connected to work), sharing (decisions, responsabilities), of delegation (medical treatment, practices), protection against social and legal risk through the creation of trust relationships. These trust relationships are based on several logics (affinity, solidarity, similarity). The study shows the major place of the patient who is often the main organizer of his network, and even though he makes an important structuring work between medical staff, and an information transfer (on his diagnosis, on his treatment, and << on >> professionals). The patient's role of <> is underestimated. CONCLUSION: The results show that in studied informal networks, professionnals do not have a transversal view of the patient's care management. This is due to the lack of knowledge of each health agent about the work of others, to the symbolic compartmentalization between professional groups, and because the difficulties encountered (i.e. burden work).