Skip to main content
Top
Published in: BMC Health Services Research 1/2013

Open Access 01-12-2013 | Research article

How health professionals conceive and construct interprofessional practice in rural settings: a qualitative study

Authors: Vicki Parker, Karen McNeil, Isabel Higgins, Rebecca Mitchell, Penelope Paliadelis, Michelle Giles, Glenda Parmenter

Published in: BMC Health Services Research | Issue 1/2013

Login to get access

Abstract

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.
Literature
1.
go back to reference Dayrit MM, Dolea C, Braichet JM: One piece of the puzzle to solve the human resources for health crisis. Bull World Health Organ. 2010, 88: 322-A-10.2471/BLT.10.078485.CrossRefPubMedCentral Dayrit MM, Dolea C, Braichet JM: One piece of the puzzle to solve the human resources for health crisis. Bull World Health Organ. 2010, 88: 322-A-10.2471/BLT.10.078485.CrossRefPubMedCentral
2.
go back to reference Merwin E, Hinton I, Dembling B, Stern S: Shortages of rural mental health professionals. Arch Psychiatr Nurs. 2003, 17: 42-51. 10.1053/apnu.2003.1.CrossRefPubMed Merwin E, Hinton I, Dembling B, Stern S: Shortages of rural mental health professionals. Arch Psychiatr Nurs. 2003, 17: 42-51. 10.1053/apnu.2003.1.CrossRefPubMed
3.
go back to reference Dussault G, Franceschini M: Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce. Hum Resour Health. 2006, 4: 12-10.1186/1478-4491-4-12.CrossRefPubMedPubMedCentral Dussault G, Franceschini M: Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce. Hum Resour Health. 2006, 4: 12-10.1186/1478-4491-4-12.CrossRefPubMedPubMedCentral
4.
go back to reference Bourke L, Humphreys JS, Wakerman J, Taylor J: Charting the future course of rural health and remote health in Australia: Why we need theory. Aust J Rural Health. 2010, 18: 54-58. 10.1111/j.1440-1584.2010.01125.x.CrossRefPubMed Bourke L, Humphreys JS, Wakerman J, Taylor J: Charting the future course of rural health and remote health in Australia: Why we need theory. Aust J Rural Health. 2010, 18: 54-58. 10.1111/j.1440-1584.2010.01125.x.CrossRefPubMed
5.
go back to reference Jackson CL, Marley JE: A tale of two cities: academic service, research, teaching and community practice partnerships delivering for disadvantaged Australian communities. Med J Aust. 2007, 187: 84-87.PubMed Jackson CL, Marley JE: A tale of two cities: academic service, research, teaching and community practice partnerships delivering for disadvantaged Australian communities. Med J Aust. 2007, 187: 84-87.PubMed
7.
go back to reference Paliadelis P, Parmenter G, Parker V, Giles M, Higgins I: The challenges confronting clinicians in rural acute care settings: a participatory research project. Rural Remote Health. 2012, 12: 2-Article no.2017 (online). Retrieved March 2013 at http//:www.rrh.org.au Paliadelis P, Parmenter G, Parker V, Giles M, Higgins I: The challenges confronting clinicians in rural acute care settings: a participatory research project. Rural Remote Health. 2012, 12: 2-Article no.2017 (online). Retrieved March 2013 at http/​/​:​www.​rrh.​org.​au
8.
go back to reference Bourke L, Sheridan C, Russell U, Jones G, DeWitt D, Liaw S-T: Developing a conceptual understanding of rural health practice. Aust J Rural Health. 2004, 12: 181-186. 10.1111/j.1440-1854.2004.00601.x.CrossRefPubMed Bourke L, Sheridan C, Russell U, Jones G, DeWitt D, Liaw S-T: Developing a conceptual understanding of rural health practice. Aust J Rural Health. 2004, 12: 181-186. 10.1111/j.1440-1854.2004.00601.x.CrossRefPubMed
13.
go back to reference Jensen GM, Royeen CB: Improved rural access to care: dimensions of best practice. J Interprof Care. 2002, 16: 117-128. 10.1080/13561820220124139.CrossRefPubMed Jensen GM, Royeen CB: Improved rural access to care: dimensions of best practice. J Interprof Care. 2002, 16: 117-128. 10.1080/13561820220124139.CrossRefPubMed
14.
go back to reference Leathard A: Interprofessional Collaboration: From Policy to Practice in Health and Social Care. 2003, Brunner-Routledge: HoveCrossRef Leathard A: Interprofessional Collaboration: From Policy to Practice in Health and Social Care. 2003, Brunner-Routledge: HoveCrossRef
15.
go back to reference Sharpe D, Curran V: Professional Socialisation and Interprofessional Education. Professional Socialisation and Interprofessional Education. Edited by: Kitto S, Chesters J, Thistelthwaite J, Reeves S. 2011, New York: Nova Science Publishers Inc, 69-85. Sharpe D, Curran V: Professional Socialisation and Interprofessional Education. Professional Socialisation and Interprofessional Education. Edited by: Kitto S, Chesters J, Thistelthwaite J, Reeves S. 2011, New York: Nova Science Publishers Inc, 69-85.
16.
go back to reference Reeves S, Rice K, Conn LG, Miller K-L, Kenaszchuk C, Zwarenstein M: Interprofessional interaction, negotiation and non-negotiation on general internal medicine wards. J Interprof Care. 2009, 23: 633-645. 10.3109/13561820902886295.CrossRefPubMed Reeves S, Rice K, Conn LG, Miller K-L, Kenaszchuk C, Zwarenstein M: Interprofessional interaction, negotiation and non-negotiation on general internal medicine wards. J Interprof Care. 2009, 23: 633-645. 10.3109/13561820902886295.CrossRefPubMed
17.
go back to reference Caldwell K, Atwal A: The problems of interprofessional health care practice in the hospital setting. Br J Nurs. 2003, 12: 1212-1218.CrossRefPubMed Caldwell K, Atwal A: The problems of interprofessional health care practice in the hospital setting. Br J Nurs. 2003, 12: 1212-1218.CrossRefPubMed
18.
go back to reference Thornicroft G, Tansella M: Co-ordinating primary care with community mental health services. 1999, London: Routledge Thornicroft G, Tansella M: Co-ordinating primary care with community mental health services. 1999, London: Routledge
19.
go back to reference Blount A: Integrated primary care: The future of medical and mental health collaboration. 2000, London: Norton and Co Blount A: Integrated primary care: The future of medical and mental health collaboration. 2000, London: Norton and Co
20.
go back to reference Schofield D, Fuller J, Wagner S, Friis L, Tyrell B: Multidisciplinary management of complex care. Aust J Rural Health. 2009, 17: 45-48. 10.1111/j.1440-1584.2008.01036.x.CrossRefPubMed Schofield D, Fuller J, Wagner S, Friis L, Tyrell B: Multidisciplinary management of complex care. Aust J Rural Health. 2009, 17: 45-48. 10.1111/j.1440-1584.2008.01036.x.CrossRefPubMed
21.
go back to reference Goss PW, Paterson MA, Renalson J: A ‘radical’ new rural model for pediatric diabetes care. Pediatr Diabetes. 2010, 11: 296-304.CrossRefPubMed Goss PW, Paterson MA, Renalson J: A ‘radical’ new rural model for pediatric diabetes care. Pediatr Diabetes. 2010, 11: 296-304.CrossRefPubMed
22.
go back to reference Brems C, Johnson M, Warner T, Roberts L: Barriers to healthcare as reported by rural and urban interprofessional providers. J Interprof Care. 2006, 20: 105-118. 10.1080/13561820600622208.CrossRefPubMed Brems C, Johnson M, Warner T, Roberts L: Barriers to healthcare as reported by rural and urban interprofessional providers. J Interprof Care. 2006, 20: 105-118. 10.1080/13561820600622208.CrossRefPubMed
23.
go back to reference Bourke L, Coffin J, Taylor J, Fuller J: Editorial: Rural Health in Australia. Rural Society. 2010, 20: 2-9.CrossRef Bourke L, Coffin J, Taylor J, Fuller J: Editorial: Rural Health in Australia. Rural Society. 2010, 20: 2-9.CrossRef
26.
go back to reference Pawson R, Tilley N: Realistic evaluation. 1997, London: Sage Publications Pawson R, Tilley N: Realistic evaluation. 1997, London: Sage Publications
27.
go back to reference Mitchell R, Paliadelis P, McNeil K, Parker V, Giles M, Higgins I, Parmenter G, Ahrens Y: Effective interprofessional collaboration in rural contexts: a research protocol. J Adv Nurs. 2013, 69: 2317-2326. 10.1111/jan.12083.CrossRefPubMed Mitchell R, Paliadelis P, McNeil K, Parker V, Giles M, Higgins I, Parmenter G, Ahrens Y: Effective interprofessional collaboration in rural contexts: a research protocol. J Adv Nurs. 2013, 69: 2317-2326. 10.1111/jan.12083.CrossRefPubMed
28.
go back to reference Shenton AK: Strategies for ensuring trustworthiness in qualitative research projects. Educ Inf. 2004, 22: 63-75. Shenton AK: Strategies for ensuring trustworthiness in qualitative research projects. Educ Inf. 2004, 22: 63-75.
29.
go back to reference D'Amour D, Ferrada Videla M, San Martin Rodriguez L, Beaulieu MD: The conceptual basis for interprofessional collaboration: Core concepts and theoretical frameworks. J Interprof Care. 2005, 19: 116-131. 10.1080/13561820500082529.CrossRefPubMed D'Amour D, Ferrada Videla M, San Martin Rodriguez L, Beaulieu MD: The conceptual basis for interprofessional collaboration: Core concepts and theoretical frameworks. J Interprof Care. 2005, 19: 116-131. 10.1080/13561820500082529.CrossRefPubMed
30.
go back to reference Hegney D, McCarthy A: Job Satisfaction and Nurses in Rural Australia. J Nurs Adm. 2000, 30: 347-350. 10.1097/00005110-200007000-00007.CrossRefPubMed Hegney D, McCarthy A: Job Satisfaction and Nurses in Rural Australia. J Nurs Adm. 2000, 30: 347-350. 10.1097/00005110-200007000-00007.CrossRefPubMed
32.
go back to reference Gittell JH: Coordinating Mechanisms in Care Provider Groups: Relational Coordination as a Mediator and Input Uncertainty as a Moderator of Performance Effects. Manage Sci. 2002, 48: 1408-1426. 10.1287/mnsc.48.11.1408.268.CrossRef Gittell JH: Coordinating Mechanisms in Care Provider Groups: Relational Coordination as a Mediator and Input Uncertainty as a Moderator of Performance Effects. Manage Sci. 2002, 48: 1408-1426. 10.1287/mnsc.48.11.1408.268.CrossRef
33.
go back to reference Laurence C, Beilby J, Campbell S, Campbell J, Ponte L, Woodward G: Process for improving the integration of care across the primary and acute care settings in rural South Australia: Asthma as a case study. Aust J Rural Health. 2004, 12: 264-268. 10.1111/j.1440-1854.2004.00618.x.CrossRefPubMed Laurence C, Beilby J, Campbell S, Campbell J, Ponte L, Woodward G: Process for improving the integration of care across the primary and acute care settings in rural South Australia: Asthma as a case study. Aust J Rural Health. 2004, 12: 264-268. 10.1111/j.1440-1854.2004.00618.x.CrossRefPubMed
34.
go back to reference May J, Cooper R, Magin P, Critchley A: Integrated Models or Mayhem?: Lessons Learnt from Three Integrated Primary Health Care Entities in Regional New South Wales. Aust Health Rev. 2008, 32: 595-604. 10.1071/AH080595.CrossRefPubMed May J, Cooper R, Magin P, Critchley A: Integrated Models or Mayhem?: Lessons Learnt from Three Integrated Primary Health Care Entities in Regional New South Wales. Aust Health Rev. 2008, 32: 595-604. 10.1071/AH080595.CrossRefPubMed
35.
go back to reference Lockhart C: Collaboration and referral practices of general practitioners and community mental health workers in rural and remote Australia. Aust J Rural Health. 2006, 14: 29-32. 10.1111/j.1440-1584.2006.00746.x.CrossRefPubMed Lockhart C: Collaboration and referral practices of general practitioners and community mental health workers in rural and remote Australia. Aust J Rural Health. 2006, 14: 29-32. 10.1111/j.1440-1584.2006.00746.x.CrossRefPubMed
36.
go back to reference McDonald J, Jayasuriya R, Harris M: The influence of power dynamics and trust on multidisciplinary collaboration: a qualitative case study of type 2 diabetes mellitus. BMC Health Serv Res. 2012, 12: 63-10.1186/1472-6963-12-63.CrossRefPubMedPubMedCentral McDonald J, Jayasuriya R, Harris M: The influence of power dynamics and trust on multidisciplinary collaboration: a qualitative case study of type 2 diabetes mellitus. BMC Health Serv Res. 2012, 12: 63-10.1186/1472-6963-12-63.CrossRefPubMedPubMedCentral
37.
go back to reference Battersby MW, Harvey P, Mills PD, Kalucy E, Pols RG, Frith PA, McDonald P, Esterman A, Tsourtos G, Donato R, et al: SA HealthPlus: A Controlled Trial of a Statewide Application of a Generic Model of Chronic Illness Care. Milbank Q. 2007, 85: 37-67. 10.1111/j.1468-0009.2007.00476.x.CrossRefPubMedPubMedCentral Battersby MW, Harvey P, Mills PD, Kalucy E, Pols RG, Frith PA, McDonald P, Esterman A, Tsourtos G, Donato R, et al: SA HealthPlus: A Controlled Trial of a Statewide Application of a Generic Model of Chronic Illness Care. Milbank Q. 2007, 85: 37-67. 10.1111/j.1468-0009.2007.00476.x.CrossRefPubMedPubMedCentral
38.
go back to reference Wiese M, Jolley G, Baum F, Freeman T, Kidd M: Australia's systems of primary healthcare: The need for improved coordination and implications for Medicare Locals. Aust Fam Physician. 2011, 40: 995-999.PubMed Wiese M, Jolley G, Baum F, Freeman T, Kidd M: Australia's systems of primary healthcare: The need for improved coordination and implications for Medicare Locals. Aust Fam Physician. 2011, 40: 995-999.PubMed
40.
go back to reference Taylor J, Blue I, Misan G: Approach to Sustainable Primary Health Care Service Delivery for Rural and Remote South Australia. Aust J Rural Health. 2001, 9: 304-310. 10.1046/j.1038-5282.2001.00387.x.CrossRefPubMed Taylor J, Blue I, Misan G: Approach to Sustainable Primary Health Care Service Delivery for Rural and Remote South Australia. Aust J Rural Health. 2001, 9: 304-310. 10.1046/j.1038-5282.2001.00387.x.CrossRefPubMed
41.
go back to reference Kelley ML: Developing Rural Communities' Capacity for Palliative Care: a Conceptual Model. J Palliat Care. 2007, 23: 143-153.PubMed Kelley ML: Developing Rural Communities' Capacity for Palliative Care: a Conceptual Model. J Palliat Care. 2007, 23: 143-153.PubMed
43.
go back to reference Bourke L, Humphreys JS, Wakerman J, Taylor J: From ‘problem-describing’ to ‘problem-solving’: Challenging the ‘deficit’ view of remote and rural health. Aust J Rural Health. 2010, 18: 205-209. 10.1111/j.1440-1584.2010.01155.x.CrossRefPubMed Bourke L, Humphreys JS, Wakerman J, Taylor J: From ‘problem-describing’ to ‘problem-solving’: Challenging the ‘deficit’ view of remote and rural health. Aust J Rural Health. 2010, 18: 205-209. 10.1111/j.1440-1584.2010.01155.x.CrossRefPubMed
45.
go back to reference Gittell J: High performance healthcare. 2009, New York, NY: McGraw Hill Gittell J: High performance healthcare. 2009, New York, NY: McGraw Hill
Metadata
Title
How health professionals conceive and construct interprofessional practice in rural settings: a qualitative study
Authors
Vicki Parker
Karen McNeil
Isabel Higgins
Rebecca Mitchell
Penelope Paliadelis
Michelle Giles
Glenda Parmenter
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2013
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-13-500

Other articles of this Issue 1/2013

BMC Health Services Research 1/2013 Go to the issue