Multidisciplinary integration in the context of integrated care: results from the North West London Integrated Care Pilot

Authors:
HARRIS Matthew, et al
Journal article citation:
International Journal of Integrated Care, 13(4), 2013, Online only
Publisher:
International Foundation for Integrated Care

Background: In the context of integrated care, Multidisciplinary Group meetings involve participants from diverse professional groups and organisations and are potential vehicles to advance efficiency improvements within the local health economy. This study aims to characterise the communication within Multidisciplinary Group meetings measuring the extent to which participants integrate and whether this integration leads to improved working. Methods: Four Multidisciplinary Group meetings are selected and a content analysis of audio-recorded and transcribed Case Discussions are carried out. Two coders independently coded utterances according to their ‘integrative intensity’ which was defined against three a-priori independent domains - the Level (i.e. Individual, Collective and Systems); the Valence (Problem, Information and Solution); the Focus (Concrete and Abstract). Inter- and intra-rater reliability was tested with Kappa scores on one randomly selected Case Discussion. Standardised weighted mean integration scores were calculated for Case Discussions across utterance deciles, indicating how integrative intensity changed during the conversations. Results: Twenty-three Case Discussions in four different Multidisciplinary Groups were transcribed and coded. Inter- and intra-rater reliability was good as shown by the Prevalence and Bias-Adjusted Kappa Scores for one randomly selected Case Discussion. There were differences in the proportion of utterances per participant type (Consultant 14.6%; presenting general practitioner 38.75%; Chair 7.8%; non-presenting general practitioner 2.25%; Allied Health Professional 4.8% - District Nurses, Community Matrons and Social Workers). Utterances were predominantly coded at low levels of integrative intensity; however, there was a gradual increase in integrative intensity during the Case Discussions. Based on the analysis of the minutes and action points arising from the Case Discussions, this improved integration did not translate into actions moving forward. Interpretation: The Multidisciplinary Groups were characterised as having consultative characteristics with some trend towards collaboration, but that best resemble Community-Based Ward Rounds. Although integration scores do increase from the beginning to the end of the Case Discussions, this does not tend to translate into actions for the groups to take forward. The role of the Chair and the improved participation of non-presenting general practitioners and Allied Health Professionals seems important, particularly as the latter contribute well to higher integrative scores. Traditional communication patterns of medical dominance seem to be being perpetuated in the Multidisciplinary Groups. This suggests that more could be done to sensitise participants to the value of full participation from all the members of the group. The authors suggest that the method developed could be used for ongoing and future evaluations of integrated care projects. (Edited publisher abstract)

Subject terms:
multidisciplinary services, teams, interprofessional relations, communication, decision making, health care, integrated services, multidisciplinary teams;
Content type:
research
Location(s):
England
Links:
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ISSN online:
1568-4156

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