Research Center of Autonomy and Participation for Persons with a Chronic Illness, Zuyd University of Applied Sciences, Heerlen, The Netherlands.
J Multidiscip Healthc. 2013 Apr 17;6:139-47. doi: 10.2147/JMDH.S42594. Print 2013.
This study investigated the improvement of interprofessional practice in primary care by performing the first three steps of the implementation model described by Grol et al. This article describes the targets for improvement in a setting for children with complex care needs (step 1), the identification of barriers and facilitators influencing interprofessional practice (step 2), and the development of a tailored interprofessional process model (step 3).
In step 2, thirteen qualitative semistructured interviews were held with several stakeholders, including parents of children, an occupational therapist, a speech and language therapist, a physical therapist, the manager of the team, two general practitioners, a psychologist, and a primary school teacher. The data were analyzed using directed content analysis and using the domains of the Chronic Care Model as a framework. In step 3, a project group was formed to develop helpful strategies, including the development of an interprofessional process through process mapping.
In step 2, it was found that the most important barriers to implementing interprofessional practice related to the lack of structure in the care process. A process model for interprofessional primary care was developed for the target group.
The lack of a shared view of what is involved in the process of interprofessional practice was the most important barrier to its successful implementation. It is suggested that the tailored process developed, supported with the appropriate tools, may provide both professional staff and their clients, in this setting but also in other areas of primary care, with insight to the care process and a clear representation of "who should do what, when, and how."
本研究通过执行 Grol 等人描述的实施模型的前三步，探讨了在初级保健中改善跨专业实践的方法。本文描述了在有复杂护理需求的儿童环境中（第 1 步）需要改进的目标、识别影响跨专业实践的障碍和促进因素（第 2 步），以及制定量身定制的跨专业流程模型（第 3 步）。
在第 2 步中，与多个利益相关者（包括儿童的父母、职业治疗师、言语和语言治疗师、物理治疗师、团队经理、两名全科医生、心理学家和小学教师）进行了 13 次半结构化访谈。使用定向内容分析对数据进行分析，并使用慢性病护理模型的领域作为框架。在第 3 步中，成立了一个项目小组来制定有益的策略，包括通过流程映射制定跨专业流程。
在第 2 步中，发现实施跨专业实践的最重要障碍是护理过程缺乏结构。为目标群体制定了跨专业初级保健的流程模型。
缺乏对跨专业实践过程的共同理解是其成功实施的最大障碍。建议，为特定环境中的专业人员及其客户（也包括初级保健的其他领域）量身定制的流程，并辅以适当的工具，可能提供对护理过程的深入了解，并清楚地表示“谁应该在何时、何地以及如何做什么”。
