Perri, Frank ORCID: 0000-0001-6855-7858 (external link) (2024) The Development of an Interprofessional Model for Primary Healthcare Clinics in Australia. PhD thesis, Victoria University.

Abstract

Interprofessional practice (IP) involves health practitioners, the community, and clients working together to achieve a higher quality of healthcare. Research continues to grow, showing that interprofessional practice can be particularly effective in chronic and complex disease management and prevention. In Australia, IP uptake is low, especially in primary healthcare settings (such as general practice medical clinics), yet most healthcare occurs in these settings. This lack of uptake means fewer Australians can access IP, so they miss the potential benefits. While there is extensive literature in some areas of IP, such as how it can be taught, very little literature offers specific guidance on how it can be implemented in primary practice settings. This study had two primary aims. The first primary aim was to investigate the barriers to implementing IP in primary healthcare settings in Australia and to identify potential solutions for those barriers. The second aim was to develop a practice model for implementing IP in primary healthcare settings. This second aim was achieved by integrating the findings regarding the barriers and solutions. This qualitative study consisted of three phases. In Phase One, interviews were undertaken with 20 participants working in primary healthcare settings to explore the barriers preventing IP implementation in primary healthcare. Nine barriers were identified, which included cost, logistics, and a lack of understanding of IP and its principles. In Phase Two, solutions to the barriers were explored. To assist with this, the barriers were categorised using The Centers for Disease Control and Prevention (CDC)’s Social-Ecological Framework (Perkinson et al., 2007). This analysis furthered understanding of the multifaceted nature and the dynamic interrelations between the identified barriers. A critical review of the literature was undertaken to identify evidence-based solutions to the barriers, which took into account the Social-Ecological Framework. A case study was undertaken to further explore possible solutions to two important barriers to IP: cost and logistics. These barriers were found to be impacted by rapidly changing external factors, such as government funding and the rise of advancing technology, such as Artificial Intelligence (AI). The case study findings indicated that AI could potentially address many of the logistical barriers faced in interprofessional implementation and reduce costs. In Phase Three, a model was developed that integrated the study’s findings regarding barriers and potential solutions to facilitate IP implementation in primary healthcare clinics. The conceptualisation of identified barriers and solutions within the CDC’s framework was then integrated with Kotter’s 8-Step Change Model (Kotter, 1996) to develop a model that guides clinics on addressing the barriers to implementation. The model also draws on well-established design principles based on the work of Norman (2002), which emphasises refining implementation rather than simply applying solutions. This approach could allow the model to be more easily adapted to Australia's wide variety of primary healthcare clinics. This study’s findings have both theoretical and clinical implications. This study's theoretical contribution includes the innovative integration of a socio-ecological model with change management principles to develop an IP implementation model. The socio-ecological model provided a framework for conceptualising the barriers to IP and the need for a multi-level approach to address these barriers. The integration of change principles provides further guidance for the effective implementation of IP in primary healthcare settings. On a clinical level, this research gives primary healthcare clinics a model by which they can implement interprofessional practice, ultimately allowing many more Australians to benefit from it by improving the delivery of healthcare.

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