Department of Family Medicine and Primary Healthcare (Boeckxstaens), Ghent University, Ghent, Belgium; Centre for Studies in Family Medicine (Brown, Reichert, Stewart), Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Medicine (Smith), Toronto East Health Network, Michael Garron Hospital, Toronto, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.
CMAJ Open. 2020 Apr 6;8(2):E251-E256. doi: 10.9778/cmajo.20190222. Print 2020 Apr-Jun.
Patients with multimorbidity often require services across different health care settings, yet team processes among settings are rarely implemented. We explored perceptions of specialists and family physicians collaborating in a telemedicine interprofessional consultation for patients with multimorbidity to better understand the value of bringing physicians together across the boundaries of health care settings.
This was a descriptive qualitative, interview-based study. Physicians who had previously participated in the Telemedicine Interprofessional Model of Practice for Aging and Complex Treatments (Telemedicine IMPACT Plus [TIP] Program) were invited to participate and asked to describe their experience of being a member of the program. Interviews were conducted from March to May 2016. We conducted an iterative and interpretive process using both individual and team analysis to identify themes.
There were 15 participants, 9 specialists and 6 family physicians. Three themes emerged in the analysis: creating new perspectives on care for patients with multimorbidity by sharing knowledge, skills and attitudes; the shift from a consultant model to an interprofessional team model (allowing a window into the community, extending discussions beyond the medical model and focusing on the patient's health in context); and opportunities for learners, including learning about interprofessional collaboration and gaining exposure to a real-world model for caring for people with multimorbidity in outpatient settings.
Family physicians and specialists participating in a TIP Program believed the program improved their knowledge and skills, while also serving as an effective care delivery strategy. The findings also support that learners require more exposure to nontraditional consultant models in order to care for patients with multimorbidity effectively.
患有多种疾病的患者通常需要在不同的医疗保健环境中获得服务，但各环境之间的团队流程很少实施。我们探讨了专家和家庭医生在远程医疗跨专业咨询中合作治疗多种疾病患者的看法，以更好地理解将医生跨越医疗保健环境界限聚集在一起的价值。
这是一项描述性的定性、基于访谈的研究。之前参加过远程医疗多专业老龄化和复杂治疗模式（远程医疗 IMPACT Plus [TIP] 计划）的医生被邀请参加，并被要求描述他们作为该计划成员的经验。访谈于 2016 年 3 月至 5 月进行。我们使用个体和团队分析进行了迭代和解释性过程，以确定主题。
共有 15 名参与者，其中 9 名是专家，6 名是家庭医生。分析中出现了三个主题：通过分享知识、技能和态度，为患有多种疾病的患者创造新的护理视角；从顾问模式向跨专业团队模式转变（允许了解社区，超越医学模式进行讨论，并关注患者在背景下的健康）；以及学习者的机会，包括学习跨专业合作，并接触到在门诊环境中为患有多种疾病的人提供护理的真实世界模式。
参与 TIP 计划的家庭医生和专家认为该计划提高了他们的知识和技能，同时也是一种有效的护理提供策略。研究结果还支持学习者需要更多接触非传统顾问模式，以便有效地为患有多种疾病的患者提供护理。
