How health professionals conceive and construct interprofessional practice in rural settings : A qualitative study
- Authors: Parker, Vicki , McNeil, Karen , Higgins, Isabel , Mitchell, Rebecca , Paliadelis, Penny , Giles, Michelle , Parmenter, Glenda
- Date: 2013
- Type: Text , Journal article
- Relation: BMC Health Services Research Vol. 13, no. 500 (2013), p.1-11
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- Description: Background Although interprofessional practice (IPP) offers the potential to enhance rural health services and provide support to rural clinicians, IPP may itself be problematic due to workforce limitations and service fragmentation. Differing socioeconomic and geographic characteristics of rural communities means that the way that IPP occurs in rural contexts will necessarily differ from that occurring in metropolitan contexts. The aim of this study was to investigate the factors contributing to effective IPP in rural contexts, to examine how IPP happens and to identify barriers and enablers. Methods Using Realistic Evaluation as a framework, semi-structured interviews were conducted with health professionals in a range of rural healthcare contexts in NSW, Australia. Independent thematic analysis was undertaken by individual research team members, which was then integrated through consensus to achieve a qualitative description of rural IPP practice. Results There was clear evidence of diversity and complexity associated with IPP in the rural settings that was supported by descriptions of collaborative integrated practice. There were instances where IPP doesn’t and could happen. There were a number of characteristics identified that significantly impacted on IPP including the presence of a shared philosophical position and valuing of IPP and recognition of the benefits, funding to support IPP, pivotal roles, proximity and workforce resources. Conclusions The nature of IPP in rural contexts is diverse and determined by a number of critical factors. This study goes some of the way towards unravelling the complexity of IPP in rural contexts, highlighting the strong motivating factors that drive IPP. However, it has also identified significant structural and relational barriers related to workload, workforce, entrenched hierarchies and ways of working and service fragmentation. Further research is required to explicate the mechanisms that drive successful IPP across a range of diverse rural contexts in order to inform the implementation of robust flexible strategies that will support sustainable models of rural IPP.
Negotiating Intersections: Inter-Professional Practice in Rural Health Care Contexts
- Authors: Parker, Vicki , Mitchell, Rebecca , McNeil, Karen , Ahrens, Yvonne , Higgins, Isabel , Parmenter, Glenda , Paliadelis, Penny , Giles, Michelle
- Date: 2012
- Type: Text , Conference paper
- Relation: International Journal of Qualitative Methods Vol. 11, p. 750-751
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- Description: Health care in most contexts depends on teams of professionals with diverse skills working together synergistically to achieve optimal outcomes for patients and their families. The way is which interprofessional practice occurs in rural healthcare varies from that which occurs in metropolitan areas. This variation reflects the social, economic and geographic characteristics of rural communities. Further, rural workforce challenges and lack of access to resources and services are compounded by the difficulties associated with the intersection of speciality driven metropolitan models and the generalist models of care that are a feature of rural health care. This study’s aim was to examine how IPP happens in rural contexts, and to identify barriers, enablers and existing and potential models of IPP. Interviews were conducted with health professionals (nurses, doctors and allied health) in a range of rural healthcare contexts (Hospitals, GP practices, Multi-Purpose Services and Community centres) in NSW, Australia. Interview data were supplemented with document review and review of communication systems. Findings suggest that the nature of IPP in rural contexts is diverse and determined by a number of critical factors including rurality, connection to community, availability of staff, funding programs and specific interests and skills of staff. Rural IPP is characterised by a small numbers of professionals across few professions, focus on generalist practice and informal communication systems. IPP is growing in response to changes in government funding models and policy and through the establishment or strengthening of pivotal co-ordinating roles, with a clear mandate to involve other professionals and patients in decision making.
Effective interprofessional collaboration in rural contexts : A research protocol
- Authors: Mitchell, Rebecca , Paliadelis, Penny , McNeil, Karen , Parker, Vicki , Giles, Michelle , Higgins, Isabel , Parmenter, Glenda , Ahrens, Yvonne
- Date: 2013
- Type: Text , Journal article
- Relation: Journal of Advanced Nursing Vol. 69, no. 10 (2013), p. 2317-2326
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- Description: Abstract AIM: To describe the research protocol that will be used to investigate factors contributing to effective interprofessional practice in a rural context in Australia. BACKGROUND: Interprofessional practice is a key strategy for overcoming rural health challenges; however, our knowledge of interprofessional initiatives and consequences in rural areas is limited. DESIGN: A modified realistic evaluation approach will be used to explore the structures, systems, and social processes contributing to effective interprofessional outcomes. This 'context-mechanism-outcome' approach provides a useful framework for identifying why and how interprofessional practice works in rural contexts. METHOD: Initial propositions regarding the factors that explain effective collaborative practice will be generated through interviews with lead clinicians, policy-makers, and clinician managers. Clinician interviews, document analysis, and multi-participant focus groups will be used as evidence to support, refine, or redevelop the initial propositions. This will allow the development of a model of rural interprofessional practice that will explain how and why collaborative approaches work in rural environments. This study is funded by an Institute of Rural Clinical Services and Teaching grant (January 2010). DISCUSSION: Rural healthcare challenges are well documented; however, studies investigating the nature of interprofessional practice in rural contexts are not common. Rural contexts also present research design, particularly data collection, challenges. This proposed research is one of the first to identify the factors that facilitate or constrain effective interprofessional work in rural settings. This is particularly important, given the continuing workforce shortages and maldistribution and poorer health outcomes in rural communities globally.