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The role of the general practitioner in multidisciplinary teams: a qualitative study in elderly care

机译：全科医生在多学科团队中的作用：老年护理中的定性研究

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Background : In the western world, a growing number of the older people live at home. In the Netherlands, GPs are expected to play a pivotal role in the organization of integrated care for this patient group. However, little is known about how GPs can play this role best. Our aim for this study was to unravel how GPs can play a successful role in elderly care, in particular in multidisciplinary teams, and to define key concepts for success. Methods : A mixed qualitative research model in four multidisciplinary teams for elderly care in the Netherlands was used. With these four teams, consisting of 46 health care and social service professionals, we carried out two rounds of focus-group interviews. Moreover, we performed semi-structured interviews with four GPs. We analysed data using a hybrid inductive/deductive thematic analysis. Results : According to the health care and social service professionals in our study, the role of GPs in multidisciplinary teams for elderly care was characterized by the ability to ‘see the bigger picture’. We identified five key activities that constitute a successful GP role: networking, facilitating, team building, integrating care elements, and showing leadership. Practice setting and phase of multidisciplinary team development influenced the way in which GPs fulfilled their roles. According to team members, GPs were the central professionals in care services for older people. The opinions of GPs about their own roles were diverse. Discussion : In the opinions of health care and social professionals in our study, GPs should not be hesitant to take the initiative to organize multidisciplinary teams for the care of older people with complex needs. In position papers, physicians are urged to reform health care to more sustainable systems. Some advocate that GPs should take the lead in reforming primary care. Limitations of this study are the nature and size of our sample and the local setting. GPs’ key concepts for multidisciplinary elderly care teams will probably be relevant for countries where the GP has a similar pivotal position as in the Netherlands, such as in Scandinavian countries, the United Kingdom, and Canada. Our findings will gain strength by studying successful multidisciplinary teams in other western countries. Conclusions : GPs took an important role in successful care settings for older people. Five key concepts seemed to be important for best practices in care for frail older people. Team members from primary care and social services indicated that GPs had an indispensable role in such teams. It would be advantageous for GPs to be aware of this attributed role. Attention to leadership competencies and to the diversity of roles in multidisciplinary teams in GP training programmes seems useful. The challenge is to convince GPs to take a lead, also when they are not inclined to take this role in organizing multidisciplinary teams for older people.
机译：背景：在西方世界，越来越多的老年人住在家里。在荷兰，全科医生有望在该患者群体的综合护理组织中发挥关键作用。但是，对于GP如何发挥最佳作用知之甚少。我们这项研究的目的是揭示全科医生如何在老年人护理中，特别是在多学科团队中发挥成功的作用，并定义成功的关键概念。方法：在荷兰的四个老年人护理多学科团队中使用了混合定性研究模型。在这四个由46位医疗保健和社会服务专业人员组成的团队中，我们进行了两轮焦点小组访谈。此外，我们对四个GP进行了半结构化访谈。我们使用混合归纳/演绎主题分析来分析数据。结果：根据我们研究中的卫生保健和社会服务专业人员的意见，全科医生在跨学科的老年人护理团队中的作用以“看到更大的图景”为特征。我们确定了构成GP成功角色的五项关键活动：联网，促进，团队建设，整合护理要素以及展现领导才能。跨学科团队发展的实践背景和阶段影响了GP履行职责的方式。据团队成员称，全科医生是老年人护理服务的主要专业人员。 GP对自己的角色的看法是多种多样的。讨论：根据我们研究中的医疗保健和社会专业人员的观点，全科医生应毫不犹豫地主动组织多学科团队来照顾有复杂需求的老年人。在立场文件中，敦促医生将医疗保健改革为更具可持续性的系统。一些人主张全科医生应带头改革初级保健。这项研究的局限性在于我们样本的性质和大小以及当地环境。全科医生针对多学科老年护理团队的关键概念可能与全科医生在荷兰具有举足轻重地位的国家有关，例如在斯堪的纳维亚国家，英国和加拿大。通过研究其他西方国家成功的多学科团队，我们的发现将得到加强。结论：全科医生在成功的老年人护理环境中发挥了重要作用。五个关键概念对于照顾年老体弱的老年人的最佳实践来说似乎很重要。来自初级保健和社会服务的团队成员表示，GP在此类团队中起着不可或缺的作用。 GP意识到这一归属角色将是有利的。在GP培训计划中，注意领导能力和多学科团队中角色的多样性似乎很有用。面临的挑战是说服全科医生在不愿为老年人组织多学科团队时发挥领导作用。

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