Faculty of Graduate and Post-Doctoral Studies, Université Laval , Québec, Canada.
VITAM: Centre de Recherche en Santé Durable, Québec, Québec, Canada.
BMC Health Serv Res. 2024 Aug 5;24(1):890. doi: 10.1186/s12913-024-11291-7.
In Canada, primary care reforms led to the implementation of various team-based care models to improve access and provide more comprehensive care for patients. Despite these advances, ongoing challenges remain. The aim of this scoping review is to explore current understanding of the functioning of these care models as well as the contexts in which they have emerged and their impact on the population, providers and healthcare costs.
The Medline and CINAHL databases were consulted. To be included, team-based care models had to be co-located, involve a family physician, specify the other professionals included, and provide information about their organization, their relevance and their impact within a primary care context. Models based on inter-professional intervention programs were excluded. The organization and coordination of services, the emerging contexts and the impact on the population, providers and healthcare costs were analysed.
A total of 5952 studies were screened after removing duplicates; 15 articles were selected for final analysis. There was considerable variation in the information available as well as the terms used to describe the models. They are operationalized in various ways, generally consistent with the Patient's Medical Home vision. Except for nurses, the inclusion of other types of professionals is variable and tends to be associated with the specific nature of the services offered. The models primarily focus on individuals with mental health conditions and chronic diseases. They appear to generally satisfy the expectations of the overarching framework of a high-performing team-based primary care model at patient and provider levels. However, economic factors are seldom integrated in their evaluations.
The studies rarely provide an overarching view that permits an understanding of the specific contexts, service organization, their impacts, and the broader context of implementation, making it difficult to establish universal guidelines for the operationalization of effective models. Negotiating the inherent complexity associated with implementing models requires a collaborative approach between various stakeholders, including patients, to tailor the models to the specific needs and characteristics of populations in given areas, and reflection about the professionals to be included in delivering these services.
在加拿大，初级保健改革导致实施了各种基于团队的护理模式，以改善患者的获得途径并提供更全面的护理。尽管取得了这些进展，但仍存在持续的挑战。本范围综述的目的是探讨这些护理模式的运作情况以及它们出现的背景，以及它们对人群、提供者和医疗保健成本的影响。
检索了 Medline 和 CINAHL 数据库。要包括在内，团队护理模式必须是共同定位的，涉及家庭医生，指定包括的其他专业人员，并提供有关其组织、相关性及其在初级保健背景下的影响的信息。排除基于跨专业干预计划的模式。分析了服务的组织和协调、新兴背景以及对人群、提供者和医疗保健成本的影响。
在去除重复项后，共筛选了 5952 项研究；选择了 15 篇文章进行最终分析。可用信息以及用于描述模型的术语存在很大差异。它们以各种方式运作，通常与患者医疗之家的愿景一致。除了护士之外，其他类型专业人员的纳入情况各不相同，而且往往与所提供服务的特定性质有关。这些模式主要针对患有心理健康和慢性疾病的个体。它们似乎普遍满足高绩效团队为基础的初级保健模式在患者和提供者层面的总体预期。然而，经济因素很少被纳入其评估中。
这些研究很少提供全面的观点，使人们能够理解特定背景、服务组织、其影响以及实施的更广泛背景，从而难以为有效模式的运作制定普遍的指导方针。在实施模型方面，需要各种利益相关者之间的协作方法，包括患者，根据特定地区人群的具体需求和特点调整模型，并对要纳入提供这些服务的专业人员进行反思。
