Background The epidemiological transition calls for redefining the roles of the various professionals involved in primary health care towards greater collaboration. We aimed to identify facilitators of, and barriers to, interprofessional collaboration in primary health care as perceived by the actors involved, other than nurses. Methods Systematic review using synthetic thematic analysis of qualitative research. Articles were retrieved from Medline, Web of science, Psychinfo and The Cochrane library up to July 2013. Quality and relevance of the studies were assessed according to the Dixon-Woods criteria. The following stakeholders were targeted: general practitioners, pharmacists, mental health workers, midwives, physiotherapists, social workers and receptionists. Results Forty-four articles were included. The principal facilitator of interprofessional collaboration in primary care was the different actors’ common interest in collaboration, perceiving opportunities to improve quality of care and to develop new professional fields. The main barriers were the challenges of definition and awareness of one another’s roles and competences, shared information, confidentiality and responsibility, team building and interprofessional training, long-term funding and joint monitoring. Conclusions Interprofessional organization and training based on appropriate models should support collaboration development. The active participation of the patient is required to go beyond professional boundaries and hierarchies. Multidisciplinary research projects are recommended.

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Interprofessional collaboration in primary health care: a review of facilitators and barriers perceived by involved actors

Introduction of the Quality and Outcomes Framework (QOF) with the General Medical Services (GMS) contract in 2004 brought a new dimension to target driven pay in general practice. QOF is a voluntary process for all surgeries in England and was introduced as part of the new GP contract.

The Quality and Outcomes Framework

A structured evidence-based literature review regarding the effectiveness of improvement interventions in clinical handover

Background Deaths are rising fastest among the oldest old but data on their transitions in place of care at the end of life are scarce.

Aim To examine the place of residence or care of ≥85 year-olds less than a year before death, and their place of death, and to map individual changes between the two.

Design of study Population-based cohort study.

Setting Cambridge City over-75s Cohort (CC75C) study, UK.

Method Retrospective analysis of prospective data from males and females aged ≥85 years at death who died within a year of taking part in any CC75C survey ( n = 320); death certificate linkage.

Results Only 7% changed their address in their last year of life, yet 52% died somewhere other than their usual address at the time of death. Over two-thirds were living in the community when interviewed <1 year before death, but less than one-third who had lived at home died there (less than one-fifth in sheltered housing). Care homes were the usual address of most people dying there (77% in residential homes, 87% in nursing homes) but 15% of deaths in acute hospital came from care homes.

Conclusion More than half the study sample of individuals of advanced old age had a change in their place of residence or care in their last year of life. These findings add weight to calls for improved end-of-life care in all settings, regardless of age, to avoid unnecessary transfers. The study data provide a baseline that can help plan and monitor initiatives to promote choice in location of care at the end of life for the very old.

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Place of death for the ‘oldest old’: ≥85-year-olds in the CC75C population-based cohort

Central to establishing continuity of care is the development of a relationship between doctor and patient/caregiver Transfer of information between these parties facilitates the development of continuity in general; and specifically informational continuity of care We conducted a systematic review of published literature to gain a better understanding of the roles that different parties – specifically doctors, patients, family caregivers, and technology – play in establishing and maintaining informational continuity of care within family practice Relevant published articles were sought from five databases Accepted articles were reviewed and appraised in a consistent way Fifty-six articles were retained following title and abstract reviews Of these, 28 were accepted for this review No articles focused explicitly on the roles involved in establishing or maintaining informational continuity of care within family practice Most informational continuity of care literature focused on the transfer of information between settings and not at the first point of contact Numerous roles were, however, were interpreted using the data extracted from reviewed articles Doctors are responsible for record keeping, knowing patients' histories, recalling accumulated knowledge, and maintaining confidentiality Patients are responsible for disclosing personal and health details, transferring information to other practitioners (including new family doctors), and establishing trust Both are responsible for developing a relationship of trust Technology is an important tool of informational continuity of care through holding important information, providing search functions, and providing a space for recorded information There is a significant gap in our knowledge about the roles that family caregivers play The number of roles identified and the interrelationships between them indicates that establishing and maintaining informational continuity of care within family practice is a complex and multifaceted process This synthesis of roles provided serves as an important resource for continuity of care researchers in general, for the development of continuity of care quality indicators, and for the practice of family medicine

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What are the roles involved in establishing and maintaining informational continuity of care within family practice? A systematic review.

Background The transfer of information between general practitioners (GPs) and their out-of-hours providers on vulnerable patient groups is essential to ensure continuity of care. This will be critical when, in 2006, NHS Direct will triage and route all out-of-hours calls. This study investigates the current use of information handover systems for palliative care patients within four out-of-hours co-operatives. Methods Paper records of all 13460 contacts during August 2002 were scrutinized. Using a standardized data extraction form we recorded details on all palliative or terminal contacts, and the existence of information handover. Results Across the four co-operatives, 2.1 per cent of all calls were from palliative care patients; co-operatives held handover information for between one (1.2 per cent) and 13 (32.5 per cent) of these patients. Conclusions The systems in place to alert these co-operatives to the needs of palliative care patients are currently under-utilized. As services move towards an integrated approach, scrutiny of information transfer systems and encouragement of GPs and district nurses to update information, may help to ensure better continuity of care.

Nigel Marshall

Papers

Continuity within primary palliative care: an audit of general practice out-of-hours co-operatives.