Facilitating Implementation of Interprofessional Collaborative Practices Into Primary Care: A Trilogy of Driving Forces.

Celine Bareil, PhD, professor, Department of Management, and Centre for Research on Organizational Transformation, HEC Montreal, Quebec, Canada; Fabie Duhamel, PhD, professor, Faculty of Nursing, Universite de Montreal, Research Team in Primary Care at CSSS Laval; Lyne Lalonde, PhD, professor, Faculty of Pharmacy, Universite de Montreal, Research Team in Primary Care at CSSS Laval, CRCHUM; Johanne Goudreau, PhD, professor, Faculty of Nursing, Universite de Montreal, Research Team in Primary Care at CSSS Laval; Eveline Hudon, MD, clinical associate professor, Faculty of Medicine, Universite de Montreal, Research Team in Primary Care at CSSS Laval, CRCHUM; Marie-Therese Lussier, MD, associate professor, Faculty of Medicine, Universite de Montreal, Research Team in Primary Care at CSSS Laval; Lise Levesque, PhD, researcher, Research Team in Primary Care at CSSS Laval; Sylvie Lessard, research assistant, HEC Montreal; Alain llircotte, MD, family physician, CSSS Laval at the time of the study; Gilles Lalonde, MD, family physician, Medi-Centre Chomedey, LavalEXECUTIVE SUMMARYImplementing interprofessional collaborative practices in primary care is challenging, and research about its facilitating factors remains scarce. The goal of this participatory action research study was to better understand the driving forces during the early stage of the implementation process of a community-driven and patient-focused program in primary care titled "TRANSforming InTerprofessional cardiovascular disease prevention in primary care" (TRANSIT). Eight primary care clinics in Quebec, Canada, agreed to participate by creating and implementing an interprofessional facilitation team (IFT). Sixty-three participants volunteered to be part of an IFT, and 759 patients agreed to participate. We randomized six clinics into a supported facilitation ("supported") group, with an external facilitator (EF) and financial incentives for participants. We assigned two clinics to an unsupported facilitation ("unsupported") group, with no EF or financial incentives. After 3 months, we held one interview for the two EFs. After 6 months, we held eight focus groups with IFT members and another interview with each EF. The analyses revealed three key forces: (1) opportunity for dialogue through the IFT, (2) active role of the EF, and (3) change implementation budgets. Decisionmakers designing implementation plans for interprofessional programs should ensure that these driving forces are activated. Further research should examine how these forces affect interprofessional practices and patient outcomes.For more information about the concepts in this article, contact Dr. Bareil at celine.bareil@hec.ca.INTRODUCTIONImplementation of collaborative, team-based care is a key component of primary care transformation (Murray et al., 2008) and is recommended by the World Health Organization (WHO) to counteract healthcare fragmentation. The WHO's vision of collaborative practice involves multiple health professionals and other workers providing comprehensive health services to, and working with, communities, patients, and families or caregivers to deliver the highest quality of care across settings (WHO, 2010). Enacting this vision implies moving from silos and parallel practices to referral consultations and joint provision of care (Oandasan et al., 2006), which constitutes a cultural shift (WHO, 2010, p. 64).Although the characteristics of interprofessional collaboration have been identified (D'Amour, Goulet, Labadie, Martin-Rodriguez, & Pineault, 2008), more research is needed to identify the forces driving and restraining the implementation of interprofessional collaborative practices in primary care. Known restraining forces include unfavorable clinician perceptions regarding interprofessional practice (Ahmed, et al., 2009), lack of leadership (Drummond, Abbott, Williamson, & Somji, 2012), little clinical team identity, and interprofessional and interpersonal conflicts (Rodriguez & Pozzebon, 2010). …