Gilles Ingrid, Filliettaz Séverine Schusselé, Berchtold Peter, Peytremann-Bridevaux Isabelle
Department of epidemiology and health systems, Centre for primary care and public health, Lausanne University, Lausanne, CH.
Forum Managed Care (FMC), Neuageri, CH.
Int J Integr Care. 2020 Mar 18;20(1):10. doi: 10.5334/ijic.4649.
Interprofessional collaboration (IPC) is a key ingredient of integrated care. Nevertheless, IPC benefits remain unclear and its implementation within integrated care initiatives is not straightforward. In this study, we first explored whether IPC was associated with organisational and patient care improvements in Swiss integrated care initiatives; we then investigated the effect of various barriers faced by these initiatives, on these associations.
Self-reported data from 153 integrated care initiatives included in the Swiss Integrated Care Survey was used. We conducted moderated mediation analyses in which patient care improvements were the outcome, the degree of IPC implementation was the predictor, organisational improvements were the mediator, and professional, patient and financial barriers to integrated care, the moderators.
IPC implementation within integrated care was associated with organisational improvements, which in turn were associated with patient care improvements; this path no longer existed when financial barriers to integrated care were considered.
Organisational improvements should be considered a priority when implementing IPC within integrated care initiatives since patient care improvements due to IPC can be expected mainly when organisational aspects are improved. More importantly, the role of financial barriers should be acknowledged, and actions taken to reduce their impact on integrated care.
跨专业协作(IPC)是综合护理的关键要素。然而,IPC的益处仍不明确,且在综合护理举措中实施IPC并非易事。在本研究中,我们首先探讨了IPC是否与瑞士综合护理举措中的组织改进和患者护理改善相关;然后我们调查了这些举措所面临的各种障碍对这些关联的影响。
使用了瑞士综合护理调查中包含的153项综合护理举措的自我报告数据。我们进行了调节中介分析,其中患者护理改善是结果,IPC实施程度是预测因素,组织改进是中介,而综合护理的专业、患者和财务障碍是调节因素。
综合护理中IPC的实施与组织改进相关,而组织改进又与患者护理改善相关;当考虑综合护理的财务障碍时,这条路径不再存在。
在综合护理举措中实施IPC时,应将组织改进视为优先事项,因为只有在组织方面得到改善时,才有望通过IPC实现患者护理的改善。更重要的是,应认识到财务障碍的作用,并采取行动减少其对综合护理的影响。