Centre for Studies in Primary Care, Department of Medicine, Queen's University, 220 Bagot Street, Kingston, ON, K7L 3G2, Canada.
Muskoka and Area Ontario Health Team, Muskoka, ON, Canada.
BMC Health Serv Res. 2023 Oct 17;23(1):1113. doi: 10.1186/s12913-023-10070-0.
The 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.
We 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.
Four 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.
The 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.
安大略省健康团队（OHT）模式是一种整合护理形式，旨在为加拿大安大略省的各个社区提供协调的护理服务。初级保健是 OHT 模式的核心，但医生的参与和代表在规划和治理层面上一直受到严重挑战。本多项案例研究旨在考察（1）使家庭医生能够参与 OHT 的流程和结构，以及（2）描述家庭医生参与所面临的挑战。
我们采用了 Yin 的设计和方法的定性、探索性多项案例研究方法。该研究于 2021 年 6 月至 12 月进行。我们对四个社区的 OHT 利益相关者进行了半结构化访谈，并对内部和外部文件进行了分析，以将访谈结果置于背景之中。主题分析应用于案例内和案例间。
本研究有四个 OHT 参与，共有 39 名参与者（17 名家庭医生；22 名其他利益相关者）。分析了 60 多份文件。案例内分析发现，应正式制定和建立结构和流程，以促进医生的参与。参与面临的挑战包括怀疑、倦怠、工作量大以及 COVID-19 大流行。案例间分析发现，参与情况各不相同。所有案例都青睐面对面的沟通流程，并且合作历史有助于建立关系。尽管存在地区差异，但所有案例都面临着类似的医生参与挑战。
OHT 的实施表明，通过集体方法，整合护理模式可以解决关键的卫生系统问题。医生的参与对于 OHT 的发展至关重要，但是首先必须认识到他们参与所面临的挑战（怀疑、倦怠、COVID-19 大流行）。为了确保像 OHT 这样的模式蓬勃发展，医生必须在各个方面和治理及提供服务的各级层面上得到有意义的参与。
