An introduction (comprising background and problem statement) Tuscany is one of the few Italian Regions that have already implemented extensively the organisational model of Primary Care Centres (PCCs), based on the co-location of General Practitioners within the same structure with nurses, specialists, social workers and administrative staff and other primary and secondary care services. While co-location of professionals is a key factor for integrated care (Holtom, 2001; Hubbard, Themessl-Huber, 2005; Hudson, 2006; WHO, 2008), it is not considered sufficient per se to ensure inter-professional collaboration (Imison et al., 2008; Lawn et al., 2014). Integration can be assured when in the co-located services there is a multi-disciplinary team collaborating to share information on patients and define jointly their care pathways (Blount, 2003; Suter et al. 2009; Collins et al., 2010). The aim of the study was to analyse how the organisational, professional and clinical integration, in particular the collaboration between professionals of different disciplines, is characterised within PCCs. Theory/Methods Three cases studies of PCCs in Tuscany Region were carried out, considering the results of a precedent study (Bonciani et al., 2015). Data collection was made through a web survey involving 107 professionals. Social Network Analysis (SNA) was applied in order to analyse patterns of connections/relationships (ties) among professionals (node) working within the three PCCs (network) (Wasserman, Faust, 1994; Mascia et al., 2009; Scott, Carrington, 2011; Borgatti et al., 2013). The analysis included visual representation of the networks diagrams, analysis of the structure and organisation of nodes, calculation of key network measures and possible associations among them. Results The response rate of professionals to SNA questionnaire differs among the three PCCs and it gives indirectly a proxy measure of the different level of professional involvement in PCC activities. Network structures concerning organisational, professional and clinical integration have different shape and characteristics in the three PCCs. Informal interactions on organisational issues are always more dense than discussions on the same topics during periodic formal meetings. The sharing of electronic data involves the overall networks within the three PCCs, but it is characterised mainly as mono-professional, that is among professionals with the same profile or mono-services, that is among professional working within the same service. There are different extents of clinical integration among all professionals working in the three PCCs. In all PCCs the core nodes of the clinical integration are GPs and nurses, while specialists and social workers are differently involved in the patient care management. Discussions This study highlights some potentialities and limits of the actual inter-professional collaboration in PCCs. Organisational coordination take advantages from informal interactions, while formal meetings are not involving all professionals within PCCs. Functional integration, based on sharing electronic patient data, is quite spread although it is more clustered by different disciplines and services. Clinical integration is quite strong between GPs and nurses. The involvement of social workers in patient care pathway should be improved. Sometimes specialists still remain as a separate subgroup within the general network of professionals, both as informal relationships and professional relationships. Conclusions (comprising key findings) This study gives an innovative perspective on the inter-professional integration within PCCs and provide suggestions supporting decision makers and health services managers to improve organisational, functional and clinical integration. Lessons learned The success in implementing the organisational model of PCCs for a better quality of care will depend significantly on their real capacity to promote inter-professional collaboration among the professionals working in these structures. Formalisation of multidisciplinary teams, with defined role and responsibilities, inter-professional and team building training, strengthening of a common information system with PCCs may contribute to improve integration in PCCs. Limitations The presence of non-respondents, without any imputation of missing data neither their removal, might have conditioned an under-representation of existing relationships among professionals working in these structure. Since data on relationships among professionals were collected through questionnaire, some professionals could not answer exhaustively because of privacy reasons, although the closed-ended question format reduce greatly the risk of recall bias. Suggestions for future research SNA could be applied also in investigating the characteristics of singles nodes within the network (in terms of their position and relationships with the other nodes) and to correlate these measures with the individual perceptions of the Primary Care Centres results.
|Titolo:||Co-location of multi-disciplinary professionals within Primary Care Centres in Italy: how do they collaborate? An insight on three cases studies from Tuscany Region through Social Network Analysis|
|Autori interni:||BONCIANI, MANILA|
|Data di pubblicazione:||2016|
|Appare nelle tipologie:||4.1 Contributo Atti Congressi/Articoli in extenso|