Primary care multidisciplinary teams in practice: a qualitative study.

BACKGROUND: Current recommendations for strengthening the US healthcare system consider restructuring primary care into multidisciplinary teams as vital to improving quality and efficiency. Yet, approaches to the selection of team designs remain unclear. This project describes current primary care team designs, primary care professionals' perceptions of ideal team designs, and perceived facilitating factors and barriers to implementing ideal team-based care. METHODS: Qualitative study of 44 health care professionals at 6 primary care practices in North Carolina using focus group discussions and surveys. Data was analyzed using framework content analysis. RESULTS: Practices used a variety of multidisciplinary team designs with the specific design being influenced by the social and policy context in which practices were embedded. Practices overwhelmingly located barriers to adopting ideal multidisciplinary teams as being outside of their individual practices and outside of their control. Participants viewed internal organizational contexts as the major facilitators of multidisciplinary primary care teams. The majority of practices described their ideal team design as including a social worker to meet the needs of socially complex patients. CONCLUSIONS: Primary care multidisciplinary team designs vary across practices, shaped in part by contextual factors perceived as barriers outside of the practices' control. Facilitating factors within practices provide a culture of support to team members, but they are insufficient to overcome the perceived barriers. The common desire to add social workers to care teams reflects practices' struggles to meet the complex demands of patients and external agencies. Government or organizational policies should avoid one-size-fits-all approaches to multidisciplinary care teams, and instead allow primary care practices to adapt to their specific contextual circumstances.American Academy of Family Physicians Foundation’s Joint Grant Award Program [#G1401JG

Describing knowledge encounters in healthcare: a mixed studies systematic review and development of a classification

This review was self-funded

Effective health care teams: A model of six characteristics developed from shared perceptions

Abstract This study into understanding health care teams began with listening to participants' teamwork experiences. It unfolded through a dialectic of iterations, analyses and critique towards a simplified model comprising six key characteristics of effective teams. Using the complementary theoretical perspectives of personal construct theory and inductive theory building, three research methods were used to collect a range of participant perspectives. A purposive sample of 39 strategic informants participated in repertory grid interviews and clarification questionnaires. A further 202 health care practitioners completed a purpose designed Teamwork in Healthcare Inventory. All responses were transformed through three iterations of interactive data collection, analysis, reflection and interpretation. Unstructured participant perspectives were qualitatively categorised and analysed into hierarchies to determine comparative contributions to effective teamwork. Complex inter-relationships between conceptual categories were investigated to identify four interdependent emerging themes. Finally, a dynamic model of teamwork in health care organisations emerged that has functional utility for health care practitioners. This Healthy Teams Model can be utilised in conjunction with a Reflective Analysis and Team Building Guide to facilitate team members to critically evaluate and enhance their team functioning

"Drink plenty of fluids": a systematic review of evidence for this recommendation in acute respiratory infections

Doctors often recommend drinking extra fluids to patients with respiratory infections. Theoretical benefits for this advice are replacing insensible fluid losses from fever and respiratory tract evaporation, correcting dehydration from reduced intake, and reducing the viscosity of mucus. To many this advice is self evident and justified on the basis that even if the benefit is uncertain, or at best small, at least it is harmless

"Drink plenty of fluids": Authors' reply

We carefully worded our systematic review: there is no direct empirical evidence to support or refute the advice; we ask only that more research is undertaken, and that in the meantime we exercise caution with the age old advice. That the press has run away with a slightly different, sensationalised, slant probably will surprise few, and outrage fewer. But let us look deeper at the indirect evidence. Although an observational study of children with infections of the upper respiratory tract with respiratory syncytial virus showed no increase in secretions of antidiuretic hormone, two case reports describe children with only infections of the upper respiratory tract with hyponatraemia and seizures-one a bottle-fed 10 week old child with a mild cold who was given water and herbal teas over three days; the other a 5 week old with upper respiratory symptoms, conjunctivitis, and poor feeding for two days. In infections of the lower respiratory tract, observational studies show that increased secretion of antidiuretic hormone occurs in bronchiolitis, where it is the norm, not just very ill patients with pneumonia. It is becoming standard management to advise careful monitoring and restriction of fluid intake with bronchiolitis. Would it be responsible to continue to advise the wholesale overhydration of children with acute respiratory infections, even in the absence of empirical data