Models of multidisciplinary working: international review
An international review by Rossal Research and Consultancy (RRC) of models of multi-disciplinary team working in rural primary care.
Methods
The primary method was a set of structured expert interviews with key informants in selected countries: academics working in rural primary care, rural general practitioners, nurses and physiotherapists, health care planners and policymakers. The review was underpinned by collation and review of relevant documentation provided by participants.
Selected countries had a public funded health service, and a significant rural population.
Informed consent was obtained from participants, data was stored by RRC for the duration of the project. All participants elected to become co-authors on the report. No ethics consent was required for the conduct of the review of current practice rather than research.
Interviews were informed by analysis to ascertain basic health delivery and demographic information. The interviewer collected data on history of primary care, characteristics of service delivery, the scope of activities undertaken , the nature of multi-disciplinary teams and their contractual status, the challenges faced, and barriers overcome, the interactions with other services, education of health care workers, the regulatory and contractual framework, the income stream, and interaction with patients and the local community. Interview questions are shown in Table 1 below:
| Table 1 Interview schedule questions |
|---|
| How do rural patients access services? |
| Is it easy to recruit, and retain the different elements of the MDT? |
| Is the current care model perceived as stable? |
| What is the level of investment in rural primary health care? |
| What contracts are in place for the different elements of the MDT? |
| What is the role of General Practitioners? |
| To what extent is care provided by multi-disciplinary teams? |
| At what level are non-medics working in the system? |
| What is the interaction between health care and social care? |
| What are the perceived benefits and costs of the model of care? |
| Are there differences in the way rural and urban care are provided? |
| Has the model been changed in recent years of are there plans to change it? |
| Are communities involved in the design of health care models? |
At a broad level, interviews investigated the nature of multi-disciplinary teams in rural primary care, seeking evidence that organisational arrangements make a difference to staff, patients, and outcomes, establishing whether services are stable, and investigating the importance of resources, geography, population, and underlying differences in understanding of social contract.
A thematic framework was generated based partly on the research questions and data from the respondents.
In summary, the process of conducting the review took the following steps
- Interviewees recruited (including consent)
- Background material examined
- An interview arranged via the Zoom application
- With permission, interviews were recorded
- Notes were taken during and after the interview
- Audio recordings were listened to after the interview
- Themes were drawn from the data
Contact
Email: Teja.Bapuram@gov.scot
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