Family physicians partnering for system change: a multiple-case study of Ontario Health Teams in development

BMC Health Services Research

Research

Sophy Chan-Nguyen¹  Colleen Grady¹  Nadia Alam²  David Mathies³ 

[1] Centre for Studies in Primary Care, Department of Medicine, Queen’s University, 220 Bagot Street, K7L 3G2, Kingston, ON, Canada;Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada;Muskoka and Area Ontario Health Team, Muskoka, ON, Canada;

关键词: Primary care;    Integrated care;    Ontario Health Teams;    Family physicians;   

DOI  :  10.1186/s12913-023-10070-0

 received in 2022-11-02, accepted in 2023-09-25,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe Ontario Health Team (OHT) model is a form of integrated care that seeks to provide coordinated delivery of care to communities across Ontario, Canada. Primary care is positioned at the heart of the OHT model, yet physician participation and representation has been severely challenged at planning and governance tables. The purpose of this multiple case study is to examine (1) processes and structures to enable family physician participation in OHTs and (2) describe challenges to family physician participation.MethodsWe chose a qualitative, exploratory multiple-case study approach following Yin’s design and methods. The study took place between June and December 2021.We conducted semi-structured interviews with OHT stakeholders in four communities and carried out an analysis of internal and external documents to contextualize interview findings. Thematic analysis was applied within case and between cases.ResultsFour OHTs participated in this study with thirty-nine participants (17 family physicians; 22 other stakeholders). Over 60 documents were analyzed. Within-case analysis found that structures and processes should be formalized and established to facilitate physician participation. Skepticism, burnout, heavy workload, and the COVID-19 pandemic were challenges to participation. Between-case analysis found that participation varied. Face-to-face communication processes were favoured in all cases and history of collaboration facilitated relationship-building. All cases faced similar challenges to physician participation despite regional differences.ConclusionsThe implementation of OHTs demonstrates that integrated care models can address critical health system issues through a collective approach. Physician participation is vital to the development of an OHT, however, recognition of their challenges (skepticism, burnout, COVID-19 pandemic) to participating must be acknowledged first. To ensure that models like OHTs thrive, physicians must be meaningfully engaged in various aspects and levels of governance and delivery.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

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