Saint-Pierre Cecilia, Herskovic Valeria, Sepúlveda Marcos
Department of Computer Science, Pontificia Universidad Católica de Chile, Santiago, Chile.
Fam Pract. 2018 Mar 27;35(2):132-141. doi: 10.1093/fampra/cmx085.
Several studies have discussed the benefits of multidisciplinary collaboration in primary care. However, what remains unclear is how collaboration is undertaken in a multidisciplinary manner in concrete terms.
To identify how multidisciplinary teams in primary care collaborate, in regards to the professionals involved in the teams and the collaborative activities that take place, and determine whether these characteristics and practices are present across disciplines and whether collaboration affects clinical outcomes.
A systematic literature review of past research, using the MEDLINE, ScienceDirect and Web of Science databases.
Four types of team composition were identified: specialized teams, highly multidisciplinary teams, doctor-nurse-pharmacist triad and physician-nurse centred teams. Four types of collaboration within teams were identified: co-located collaboration, non-hierarchical collaboration, collaboration through shared consultations and collaboration via referral and counter-referral. Two combinations were commonly repeated: non-hierarchical collaboration in highly multidisciplinary teams and co-located collaboration in specialist teams. Fifty-two per cent of articles reported positive results when comparing collaboration against the non-collaborative alternative, whereas 16% showed no difference and 32% did not present a comparison.
Overall, collaboration was found to be positive or neutral in every study that compared collaboration with a non-collaborative alternative. A collaboration typology based on objective measures was devised, in contrast to typologies that involve interviews, perception-based questionnaires and other subjective instruments.
多项研究探讨了初级保健中多学科协作的益处。然而，具体而言，协作是如何以多学科方式开展的仍不明确。
确定初级保健中的多学科团队如何协作，涉及团队中的专业人员以及开展的协作活动，并确定这些特征和做法是否跨学科存在，以及协作是否影响临床结果。
使用MEDLINE、ScienceDirect和Web of Science数据库对以往研究进行系统的文献综述。
确定了四种团队组成类型：专业团队、高度多学科团队、医生 - 护士 - 药剂师三人组和以医生 - 护士为中心的团队。确定了团队内的四种协作类型：同地协作、非等级协作、通过共享会诊协作以及通过转诊和反向转诊协作。两种组合经常出现：高度多学科团队中的非等级协作和专业团队中的同地协作。在将协作与非协作替代方案进行比较时，52%的文章报告了积极结果，而16%显示无差异，32%未进行比较。
总体而言，在每项将协作与非协作替代方案进行比较的研究中，协作被发现是积极的或中性的。与涉及访谈、基于感知的问卷和其他主观工具的类型学不同，设计了一种基于客观指标的协作类型学。
