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Abstract
Objective To identify strategies and interventions used to improve interprofessional collaboration and integration (IPCI) in primary care.
Design Scoping review
Data sources Specific Medical Subject Headings terms were used, and a search strategy was developed for PubMed and afterwards adapted to Medline, Eric and Web of Science.
Study selection In the first stage of the selection, two researchers screened the article abstracts to select eligible papers. When decisions conflicted, three other researchers joined the decision-making process. The same strategy was used with full-text screening. Articles were included if they: (1) were in English, (2) described an intervention to improve IPCI in primary care involving at least two different healthcare disciplines, (3) originated from a high-income country, (4) were peer-reviewed and (5) were published between 2001 and 2020.
Data extraction and synthesis From each paper, eligible data were extracted, and the selected papers were analysed inductively. Studying the main focus of the papers, researchers searched for common patterns in answering the research question and exposing research gaps. The identified themes were discussed and adjusted until a consensus was reached among all authors.
Results The literature search yielded a total of 1816 papers. After removing duplicates, screening titles and abstracts, and performing full-text readings, 34 papers were incorporated in this scoping review. The identified strategies and interventions were inductively categorised under five main themes: (1) Acceptance and team readiness towards collaboration, (2) acting as a team and not as an individual; (3) communication strategies and shared decision making, (4) coordination in primary care and (5) integration of caregivers and their skills and competences.
Conclusions We identified a mix of strategies and interventions that can function as ‘building blocks’, for the development of a generic intervention to improve collaboration in different types of primary care settings and organisations.
- PRIMARY CARE
- Organisation of health services
- PUBLIC HEALTH
- Protocols & guidelines
- Quality in health care
Data availability statement
All data relevant to the study are included in the article or uploaded as online supplemental information.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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- PRIMARY CARE
- Organisation of health services
- PUBLIC HEALTH
- Protocols & guidelines
- Quality in health care
STRENGTHS AND LIMITATIONS OF THIS STUDY
The review focuses exclusively on primary care; thus, our findings are not directly transferable to other healthcare levels.
Only articles written in English were included. Therefore, we may have missed valuable literature.
Only studies performed in high-income countries were included in this review; hence, our findings are not directly transferable to other countries because differences in health systems, financing, governance, title protection and culture can pose significant implementation challenges.
The risk of bias to the interpretation of the data was minimised by triangulating researchers from different backgrounds (eg, nurses, pharmacists and a psychologist) throughout the whole review process and conducting the selection of articles with a team of at least two researchers.
We did not limit the search to the collaboration between specific types of caregivers, or in relation to a specific disease, or condition of patients. Therefore, our data and analysis can be used in the context of or added to a broad scope of interprofessional collaboration and integration in primary care.
Introduction
As the world population is ageing, the growing complexity of healthcare and health needs, together with the associated financial challenges1 and the fragmentation of primary care,2–4 are prompting a fundamental rethink of how primary care should be organised and how professionals in different settings should collaborate.5 As approximately one-third of the world population lives with a chronic disease,6 and as primary care is usually the first point of access to the care system, integrated care at that level in which professionals closely collaborate, both interdisciplinary and interprofessional, is unquestionably important in current and future care organisations.
Interprofessional collaboration can be beneficial to achieving a more integrated primary healthcare and should overcome the aforementioned challenges and problems. According to the WHO, interprofessional collaboration occurs when two or more professions work together to achieve common goals.7 Orchard et al8 defined it as involving a partnership between a team of health professionals and a client in a participatory, collaborative and coordinated approach to shared decision-making around health and social issues. As Goodwin et al9 and Lewis et al10 saw an efficient interprofessional collaboration as a prerequisite for integrated care. Edmondson et al11 indicated that psychological safety, defined as a shared belief that the team is safe for interpersonal risk-taking, is a critical factor in understanding teamwork and organisational learning.
Next to health professionals, informal caregivers are involved in interprofessional collaboration.12 According to the WHO,13 informal caregivers should be considered full partners in care and they mostly consist of families and friends of the patient. To measure the collaboration and coordination of these formal and informal caregivers, many questionnaires are available.14 The Assessment of Interprofessional Team Collaboration Scale is an example consisting of the subscales; partnership, cooperation and coordination, and can be deployed in primary healthcare.15
To achieve and maintain interprofessional collaboration in primary care, Bardet et al16 identified the following key elements: trust, interdependence, perceptions and expectations from the other healthcare professionals, their skills, their interest for collaborative practice, their role definition and their communication.17–23 These key elements are also present in the five dimensions of integrated care that Valentijn et al24 25 described in the Rainbow model as follows: system, organisational, professional, clinical, functional and normative integration. Integrated care and quality collaboration between professionals leads to improved access to care,26 better health outcomes27 and enhanced prevention.28 29
Although several literature reviews identified strategies to influence, improve or facilitate interprofessional collaboration, a thorough analysis of the interventions is lacking. Most review papers focused on the collaboration of a single type of caregiver or one specific disease.27 30–38 Therefore, it is difficult to broaden these findings to primary care and chronic conditions in general.
To fill this gap, we performed a scoping review to identify strategies and interventions improving and/or facilitating interprofessional collaboration and integration (IPCI) in primary care. More specifically, we listed and analysed the existing strategies, interventions and their outcomes, without focusing on a specific profession or disease. Based on the definitions of interprofessional collaboration7 8 and integrated care,9 10 24 25 we included papers, thus outlining strategies and interventions working on microlevel, mesolevel and macrolevel. The included papers described organisational, relational and processual factors influenced by these interventions and strategies.
This review was conducted as the first phase of a research project to develop an evidence-based toolkit, guiding health professionals in their transition towards IPCI of different competencies, skills and roles as well as the role of patients and their needs in primary care.
Methods
We conducted a scoping review using the Arksey and O’Malley framework39: (1) identifying the research questions, (2) identifying relevant studies, (3) selecting studies, (4) charting the data and (5) collating, summarising and reporting results. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines and the PRISMA-ScR templates to help conduct the scoping review.40
Step 1: identifying the research questions
An exploratory literature search was performed preliminarily to identifying the research question on IPCI in primary care. Based on this literature search, we developed the following research question: Which strategies and/or interventions improve or facilitate IPCI in primary care? We aimed to search for articles containing generic strategies and methods used in primary care settings, to facilitate IPCI in primary care. Five researchers were involved in identifying this research question for the scoping review.
Step 2: identifying relevant studies: search strategy
We used specific Medical Subject Headings (MeSH) terms and free text terms to design a search strategy around the following key concepts: primary care, healthcare team, integration and interprofessional collaboration. We combined the keywords and MeSH terms presented in box 1 with the Boolean terms ‘OR’, ‘AND’ and ‘NOT’. The search strategy was developed for PubMed and afterwards adapted to Medline, Eric and Web of Science and was performed between March and June 2020. The full search strategy is available in online supplemental material.
Supplemental material
keywords and Medical Subject Headings (MeSH) terms used to identify relevant data.
MeSh/search terms and combinations for PubMed
primary care
primary healthcare
primary health care
1 or 2t or 3 (Title/abstract)
integrative team
integrative teams
collaborative practice
collaborative practices
interdisciplinary team
interdisciplinary teams
multidisciplinary team
multidisciplinary teams
interprofessional team
interprofessional teams
healthcare team
healthcare teams
health care team
health care teams
5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 (title/abstract)
interprofessional collaboration
interprofessional teamwork
interprofessional team work
interdisciplinary collaboration
interdisciplinary teamwork
interdisciplinary team work
multidisciplinary collaboration
20 or 21 or 22 or 23 or 24 or 25 or 26 (All fields)
4 AND 19 AND 27
Step 3: study selection
Articles were included if they: (1) were in English, (2) described an intervention to improve interprofessional collaboration or integration in primary care involving at least two different healthcare disciplines, (3) originated from a high-income country,41 (4) were peer-reviewed and (5) were published between 2001 and 2020. Articles were excluded when: (1) the research methods and findings were not thoroughly described, (2) it concerned opinion papers, (3) the study focused on a single disease or group of patients/clients and (4) when the full text was not available.
We used Rayyan42 to collect and organise eligible articles. In the first stage of the selection, MMS and PvB screened the article abstracts to select eligible papers, according to the inclusion and exclusion criteria, and to eliminate the duplicates. When decisions conflicted, three other researchers (HDL, KDV and KVdB) joined the decision-making process; they were blind to the decisions of the first two reviewers, and each screened a third of the conflicting abstracts. In the second stage of the selection, the initial two reviewers read the full texts of the selected articles. As in the first stage, studies were included or excluded depending on the agreement of both reviewers. When the decisions of the two reviewers conflicted, the other researchers joined the decision-making process and a procedure similar to the one outlined above was followed.
Charting the data
From each paper, eligible data were extracted using a self-developed descriptive template. The following characteristics were recorded: a full reference citation (author, title, journal and publication date); the methodology used to conduct the research; a summary of the intervention or strategy used to facilitate IPCI and the impact on IPCI.
Step 5: collating, summarising and reporting the data
The selected papers were analysed inductively. Studying the main focus of the papers, we searched for common patterns among them, answering the research question and/or exposing research gaps. We, thus, identified themes and subthemes, which were discussed and adjusted until consensus was reached among all authors. Subsequently, all selected papers were coded using the defined themes. Using a tabular overview and summary of the selected literature, the iterative analysis and discussion among the authors were facilitated and allowed the extraction of the interventions and strategies of interest.
Patient and public involvement
This scoping review did not directly involve patients or public.
Results
The literature search yielded a total of 1816 papers, of which 445 duplicates were removed (figure 1). On screening titles and abstracts of the remaining 1371 records, only 100 were eligible given the inclusions criteria outlined above. After further reading, 47 studies, lacking an intervention, were excluded. Finally, 19 more articles were excluded because they did not include strategies or interventions. This resulted in 34 papers describing strategies and interventions to facilitate IPCI in primary care. A Flow diagram on the selection procedure is available in figure 1.
PRISMA flow diagram. *IPCI, interprofessional collaboration or integration. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Findings
Five main themes, essential for IPCI, emerged from our analyses: (1) Acceptance and team readiness towards collaboration (n=21), (2) acting as a team and not as an individual (n=26); (3) communication strategies and shared decision making (n=16), (4) coordination in primary care (n=20) and (5) integration of caregivers and their skills and competences (n=16). An overview of the interventions is presented in table 1, while an overview of the articles sorted in themes is presented in table 2.
An overview of the characteristics of the selected articles
Articles sorted in themes (X=paper included under that theme)
Theme 1: acceptance and team readiness towards collaboration
Twenty-one articles provided strategies to improve the acceptance and team readiness towards collaboration.43–63 Before being able to collaborate, caregivers need to accept working as a team. Team readiness towards collaboration occurs when team members obtain the right mindset to take necessary measures for efficient collaboration. This does not mean that an efficient collaboration has been reached, but both acceptance and team readiness were a prerequisite to achieving it. Acceptance and team readiness of caregivers towards collaboration were strongly influenced by their attitude, awareness, knowledge and understanding, and caregiver satisfaction.
Interventions on changing caregivers’ attitudes towards collaboration seem to facilitate teamwork.64 Workshops and information sessions were organised to make changes in caregivers’ attitudes, in which advantages of teamwork and finding common ground were explained and lectured.44 50 55 56 59–61 63 Basic knowledge about the potential of teamwork was learnt by using logical explanations.44 50 55 56 59–61 63 65 Caregivers to whom the advantages of collaboration were explained were more likely to accept and adopt the principles of interprofessional collaboration. Simple and accessible knowledge transfer seems to be an important characteristic of a successful intervention on the attitude and knowledge of caregivers.43 51 57 59 60
Some articles44 46 49 53 59 63 reported on strategies to increase awareness about collaboration in primary care. Increased awareness resulted in a better acceptance and team readiness towards collaboration. Making caregivers aware of their shortcomings and the need for collaboration with different disciplines seemed an effective way to facilitate interprofessional collaboration. In addition to awareness, potential improvements in care quality,44 47 62 caused by better collaboration, motivate caregivers to change their attitude. Furthermore, some studies45 48 52 54 58 61 62 reported that increased caregiver satisfaction was considered as a facilitator of collaboration between caregivers.
Theme 2: acting as a team and not as an individual
Twenty-six articles provided strategies to act as a team and not as an individual.43 45–48 50 52 54–63 66–74 In some articles,54 55 57 61 62 this was mentioned as collaborative behaviour, which was considered to be a facilitator of teamwork. Moreover, showing mutual respect and trust50 55 59–63 68 70 between caregivers were important facilitators towards collaboration: it improves acting as a team, and it supports a safe team climate. An environment of greater psychological safety improved collaborative behaviour, and in some cases, it replaced working in silos with working as a team.45 48 62 69 71 74
Developing and enhancing a shared vision, shared values and shared goals were mentioned as facilitators towards interprofessional collaboration.43 47 50 61 63 66 This was achieved by a structural inclusion of every team member in the development of the teams’ vision, values and goals.63 By simply writing down these principles, caregivers were more likely to participate in developing shared principles.43 47 Although the development process was not explained in detail, three articles mentioned that once developed, shared vision, goals and values were crucial to maintaining a beneficial collaboration.50 61 63 To establish these shared principles, a patient-centred focus may be an important asset. By prioritising the patient’s needs and preferences, caregivers can find common ground more easily.58–60 63 67 73
Leadership seems of utmost importance to act as a team. Strategies towards collaborative leadership and shared leadership were mentioned in the articles,46 56 59 66–68 70 72 74 and leaders and decision makers should be aware of the potential effects of policy and structural changes on interprofessional teamwork. By using a clear role assignment, caregivers can prevent issues in their collaboration.52 59 61 63 However, in one case,48 a rotational leadership was implemented and suggested, in which there was no permanent leader.
One paper emphasised that awareness of potential unintended negative effects of changes on the functioning of interprofessional teams should be taken into account by decision makers.67
Theme 3: communication strategies and shared decision-making
Sixteen articles provided communication strategies and strategies to facilitate shared decision-making, to improve interprofessional collaboration in primary care.44–47 49–52 58–60 63 66–68 75 These strategies can be further delineated into the following subthemes: (1) knowledge about each other,47 58 59 (2) formal and informal meetings,45 52 59 60 66 67 75 (3) the use of structured guidelines and protocols,46 47 58 60 (4) conflict resolution44 51 59 60 63 67 and (5) relational equality.49 50 63 68
Knowing each other’s professional roles and tasks seems a precondition for teamwork. However, knowing more about each other’s family situation, interests and hobbies was also mentioned to be important to improve the communication and collaboration between caregivers.47 58 59
Both formal45 59 60 67 75 and informal52 60 66 team meetings, mainly happening between caregivers working in the same practice (under one roof),52 were considered as an important communication strategy. Formal meetings were mostly used to share information about patients or clients, distribute tasks and identify and solve problems in the organisation. Planning and structuring a team meeting can increase the efficiency and productivity of these meetings.45 59 60 67 75 Informal meetings were important to know more about each other and facilitated the trust relations between caregivers. Information that could not be shared in the formal meetings often appeared in the informal meetings. Even lunches with team members were used as a communication strategy.52 60 66
Structured guidelines, standardised tools and protocols were used to improve the communication and coordination between caregivers working in primary care. These protocols provided more effective communication and the provision of an evidence-based approach towards collaboration and care delivery. Besides using protocols, workshops were organised to improve communication.46 47 58 60
Making decisions as a team was an indicator of good and effective communication. Shared decision-making was mentioned in nine studies,44 49–51 59 60 63 67 68 and our analysis identified conflict resolution44 51 59 60 63 67 and relational equality49 50 63 68 as key factors to improve shared decision-making.
Theme 4: coordination in primary care
By collaborating with different disciplines and professions, many caregivers were experiencing problems regarding information sharing43 49 54 57 59 61 65 68 71 73 and referring44 45 49 51 55 59 61 65 66 68 between primary healthcare workers. Twenty articles, therefore, provided strategies to improve coordination in order to ameliorate information sharing between caregivers, to facilitate referrals for the patient and to guarantee the continuity of care.43–45 49 51 53–55 59 61 65 66 68–73 75 76 Accordingly, reciprocity and reciprocal interdependence were shown to play a crucial role in the coordination of primary care.55 61
Colocation and the importance of architecture and building characteristics were, in some cases, mentioned as influential factors for collaboration.70 75 76 By optimising the architecture and working under one roof, brief face-to-face interactions may increase. The architecture could be optimised by having shared spaces, thus leading to increased staff proximity or visibility. Especially informal communication was positively affected by the presence of convenient circulatory (eg, foyers and lobbies) and transitional (eg, courtyards, verandas and corridors) spaces.70 75 76 Additionally, weekly or monthly face-to-face meetings were organised to coordinate care. Face-to-face meetings and electronic task queues facilitate information sharing and efficient care coordination for complex patients.75 76
Theme 5: integration of caregivers and their skills and competences
Fifteen papers provided strategies to improve the integration of caregivers and their skills and competences in primary care practices45–48 50 53 56–61 67 70 73 77 and tried to get the most out of every team member’s presence.
For new team members, a successful integration was facilitated by welcoming the newcomers and making them know and understand the vision of the practice. Inclusion of the caregiver required additional proactive efforts regarding communication and coordination among practice members.47 61 In some cases, a personal, one-to-one meeting with the new team member could facilitate problem-solving.47
Eleven papers presented an improved integration of caregivers skills and competences, as a facilitator for task distribution and role clarification.45 46 48 50 56 59–61 67 70 73 Knowing each other’s capabilities, including skills and competences, was very important in this regard.46 48 61 70 In addition, making sure that caregivers not only know each other’s skills and competences but also enable more transparency about their daily needs and preferences were mentioned as facilitators.48 56 59 61 70 Six articles presented strategies to optimise the use of team members’ skills and competences. By acknowledging and affirming their capabilities, integration of skills and competences was facilitated.50 53 58 59 61 77
In one article, researchers indicated that the organisation of team communication-training workshops and implementation of flexible protocols gave practice stakeholders significant discretion to integrate new care team roles to best fit local needs. Furthermore, it improved team communication and functioning because of increased engagement and local leadership facilitation.47
Discussion
This scoping review identified five themes for interventions and strategies aimed at improving and facilitating IPCI in primary care. The first category, which incorporates acceptance and team readiness, was a precondition for enhancing and maintaining efficient interprofessional collaboration. Accepting to collaborate requires a change of attitude, which involves valuing team members and actively soliciting the opinions or receiving feedback from other team members.78 A major barrier to adopting a suitable attitude towards collaboration is the difficulty and complexity of sharing responsibility for patient care within a team.79 80 Making caregivers aware of their shortcomings and the need for collaboration with different disciplines are effective ways to facilitate interprofessional collaboration.44 46 49 53 59 63 In addition, Liedvogel et al.81 demonstrated that experiencing teamwork itself increases the awareness of the advantages, and the importance of collaboration, as well as gives caregivers opportunities to demonstrate their skills and capabilities. In the broader community, increased awareness of the importance of interprofessional collaboration can lead to an improved experience and understanding of the totality of healthcare services.81 Furthermore, according to Lockwood and Maguire,82 it can also help to reduce the sense of isolation experienced by solo medical practitioners.
Second, collaborative behaviour has been described as a facilitator of teamwork.54 55 57 61 62 To enhance and maintain a collaborative behaviour, the development of shared principles (such as shared vision, values and goals) is an important prerequisite.43 47 50 61 63 66 Our review revealed that maintaining a safe team climate in which care professionals feel comfortable is important to act as a team and not as an individual.45 48 62 69 71 74 Although psychological safety is not often mentioned in primary care research,22 Edmondson11 and Kim et al83 had indicated the essential role of a safe workplace environment in enhancing teamwork. Team psychological safety is defined as a shared value; the team is safe for interpersonal risk taking.84 This means that team members feel they will not be punished or humiliated for speaking up with ideas, questions, concerns or mistakes. A team may not be able to collaborate properly if there is a lack of psychological safety; hence, it is assumed that psychological safety is a necessary but insufficient condition for increasing interprofessional collaboration and workplace effectiveness.85
Third, structured guidelines and protocols seem to be beneficial for communication between care professionals, thereby impacting IPCI. Team meetings, especially formal meetings, can be held more efficiently by using protocols, that have positive effects on hierarchy and conflicts resolution between team members.86 Although interventions in our review did not give attention to informal meetings as much as existing literature,87–89 Burm et al87 indicated that, by recognising the importance of informal meetings, care providers are more motivated to organise or participate in informal meetings. These meetings tended to be ad hoc and improvised, and in some cases discussion topics were recorded in notebooks.88 89 The shared decision-making model has been put forward as a guide for discussing and making decisions in the most effective way.90 This model includes three principles: recognising and acknowledging that a decision is required, knowing and understanding the best available evidence, and incorporating the patient’s values and preferences into the decision.91
Fourth, as an element of IPCI, care coordination is of utmost importance for patient safety. The situation-background-assessment-recommendation protocol is an existing method to perform information sharing efficiently and appropriately.92 In addition, Lo et al93 suggested that the protocol may be a cost-effective method for coordinating between general practitioners and nurses.93 To solve problems regarding care coordination, especially after the COVID-19 pandemic, the use of digital healthcare tools was established.94 Fagherazzi et al95 indicated that these digital tools improved triage and risk assessment.
Finally, optimal integration of caregivers skills and competences has been associated with maximalising every team member’s presence and shortening the adaptation process of new team members.96 Family caregivers provide a significant portion of health and support services to individuals with serious illnesses; however, existing literature and healthcare systems have often overlooked them and mostly focused on integrating care professionals.97 98 Friedman and Tong97 suggested using a framework, in which the family caregiver is an indispensable partner of care professionals and patients.
Although all interventions or strategies are useful to a certain point, none is suitable to be used in isolation as a unique solution for IPCI in primary care. However, a mix of the interventions and strategies compiled in this scoping review may be capable of doing so. The consistency, design and order of this mix of interventions and strategies cannot be specified based on the results of this scoping review.
This scoping review has several limitations. The review focuses exclusively on primary care; thus, our findings are not directly transferable to other healthcare levels. Only studies performed in high-income countries were included in this review; hence, our findings are not directly transferable to other countries because differences in health systems, financing, governance, title protection and culture can pose significant implementation challenges. In addition, by including only English-language articles and avoiding the grey literature, we might have missed some relevant papers. It is worthwhile to note, that this scoping review aimed to identify interventions that can improve IPCI in primary care and to list their impact on outcomes related to collaboration and integration. Our review did not report the effectiveness of interventions regarding health outcomes. Contrary to generic interventions focusing on IPCI, interventions focusing on a single disease and improving health outcomes were implemented more successfully and were evaluated in a more sophisticated way, using validated scales.27 99–101
We selected articles based on WHO’s7 and Orchard’s8 definition of interprofessional collaboration. For integrated care, we adopted the definitions of Lewis et al’s10 and Valentijn et al’s25 definitions, which represent a widely accepted consensus. However, there are many other definitions of IPCI care that, if adopted, could affect the inclusion or exclusion of articles.
The literature has established that researchers can influence the interpretation of data. This risk of bias was minimised by triangulating researchers from different backgrounds (eg, nurses, pharmacists and a psychologist) through the whole process and conducting the selection of articles with a team of at least two researchers. This triangulation, intensive cooperation and inductive process increased the credibility and reduced the risk of bias to the interpretation of the data based on preconceived understanding and personal opinions.
A strength of this review is the fact that we did not limit the search to the collaboration between specific types of caregivers, or in relation to a specific disease, or condition of patients. Therefore, our data and analysis can be used in the context of or added to a broad scope of IPCI in primary care. Furthermore, we performed an inductive analysis within a multidisciplinary team of researchers, to expand the analysis and to identify generic strategies and interventions.
Conclusion
This scoping review identified five categories of strategies and interventions to improve or facilitate IPCI in primary care: (1) acceptance and team readiness towards collaboration, (2) acting as a team and not as an individual, (3) communication strategies and shared decision making, (4) coordination in primary care and (5) integration of caregivers and their skills and competences. We did not identify a single strategy or intervention which is broad or generic enough to be used in every type of primary care setting.
We can conclude that a mix of the identified strategies and interventions, which we illustrated as ‘building blocks’, can provide valuable input to develop a generic intervention to be used in different settings and levels of primary healthcare.
Data availability statement
All data relevant to the study are included in the article or uploaded as online supplemental information.
Ethics statements
Patient consent for publication
Acknowledgments
We are grateful for the partnership with the Primary Care Academy (www.academie-eerstelijn.be) and want to thank the King Baudouin Foundation and Fund Daniel De Coninck for the opportunity they offer us for conducting research and have impact on the primary care of Flanders, Belgium. The consortium of the Primary Care Academy consists Lead author: Roy Remmen–roy.remmen@uantwerpen.be—Department of Primary Care and Interdisciplinary Care, Faculty of Medicine and Health Sciences. University of Antwerp. Antwerp. Belgium; Emily Verté—Department of Primary Care and Interdisciplinary Care, Faculty of Medicine and Health Sciences. University of Antwerp. Antwerp. Belgium, Department of Family Medicine and Chronic Care, Faculty of Medicine and Pharmacy. Vrije Universiteit Brussel. Brussel. Belgium; Muhammed Mustafa Sirimsi—Centre for research and innovation in care, Faculty of Medicine and Health Sciences. University of Antwerp. Antwerp. Belgium; Peter Van Bogaert—Workforce Management and Outcomes Research in Care, Faculty of Medicine and Health Sciences. University of Antwerp. Belgium; Hans De Loof—Laboratory of Physio pharmacology, Faculty of Pharmaceutical Biomedical and Veterinary Sciences. University of Antwerp. Belgium; Kris Van den Broeck—Department of Primary Care and Interdisciplinary Care, Faculty of Medicine and Health Sciences. University of Antwerp. Antwerp. Belgium.; Sibyl Anthierens—Department of Primary Care and Interdisciplinary Care, Faculty of Medicine and Health Sciences. University of Antwerp. Antwerp. Belgium; Ine Huybrechts—Department of Primary Care and Interdisciplinary Care, Faculty of Medicine and Health Sciences. University of Antwerp. Antwerp. Belgium.; Peter Raeymaeckers—Department of Sociology, Faculty of Social Sciences, Faculty of Social Sciences. University of Antwerp. Belgium; Veerle Buffel- Department of Sociology; centre for population, family and health, Faculty of Social Sciences. University of Antwerp. Belgium.; Dirk Devroey- Department of Family Medicine and Chronic Care, Faculty of Medicine and Pharmacy. Vrije Universiteit Brussel. Brussel.; Bert Aertgeerts—Academic Centre for General Practice, Faculty of Medicine. KU Leuven. Leuven, Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven. Leuven; Birgitte Schoenmakers—Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven. Leuven. Belgium; Lotte Timmermans—Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven. Leuven. Belgium.; Veerle Foulon—Department of Pharmaceutical and Pharmacological Sciences, Faculty Pharmaceutical Sciences. KU Leuven. Leuven. Belgium.; Anja Declerq—LUCAS-Centre for Care Research and Consultancy, Faculty of Social Sciences. KU Leuven. Leuven. Belgium.; Nick Verhaeghe—Research Group Social and Economic Policy and Social Inclusion, Research Institute for Work and Society. KU Leuven. Belgium.; Dominique Van de Velde Department of Rehabilitation Sciences, Occupational Therapy. Faculty of Medicine and Health Sciences. University of Ghent. Belgium., Department of Occupational Therapy. Artevelde University of Applied Sciences. Ghent. Belgium.; Pauline Boeckxstaens—Department of Public Health and Primary Care, Faculty of Medicine and Health sciences. University of Ghent. Belgium.; An De Sutter -Department of Public Health and Primary Care, Faculty of Medicine and Health sciences. University of Ghent. Belgium.; Patricia De Vriendt—Department of Rehabilitation Sciences, Occupational Therapy. Faculty of Medicine and Health Sciences. University of Ghent. Belgium., Frailty in Ageing (FRIA) Research Group, Department of Gerontology and Mental Health and Wellbeing (MENT) research group, Faculty of Medicine and Pharmacy. Vrije Universiteit. Brussels. Belgium., Department of Occupational Therapy. Artevelde University of Applied Sciences. Ghent. Belgium.; Lies Lahousse—Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University. Ghent. Belgium.; Peter Pype—Department of Public Health and Primary Care, Faculty of Medicine and Health sciences. University of Ghent. Belgium., End-of-Life Care Research Group, Faculty of Medicine and Health Sciences. Vrije Universiteit Brussel and Ghent University. Ghent. Belgium.; Dagje Boeykens- Department of Rehabilitation Sciences, Occupational Therapy. Faculty of Medicine and Health Sciences. University of Ghent. Belgium., Department of Public Health and Primary Care, Faculty of Medicine and Health sciences. University of Ghent. Belgium.; Ann Van Hecke—Department of Public Health and Primary Care, Faculty of Medicine and Health sciences. University of Ghent. Belgium., University Centre of Nursing and Midwifery, Faculty of Medicine and Health Sciences. University of Ghent. Belgium.; Peter Decat—Department of Public Health and Primary Care, Faculty of Medicine and Health sciences. University of Ghent. Belgium.; Rudi Roose—Department of Social Work and Social Pedagogy, Faculty of Psychology and Educational Sciences. University Ghent. Belgium.; Sandra Martin—Expertise Centre Health Innovation. University College Leuven-Limburg. Leuven. Belgium.; Erica Rutten—Expertise Centre Health Innovation. University College Leuven-Limburg. Leuven. Belgium.; Sam Pless—Expertise Centre Health Innovation. University College Leuven-Limburg. Leuven. Belgium.; Vanessa Gauwe—Department of Occupational Therapy. Artevelde University of Applied Sciences. Ghent. Belgium.; Didier Reynaert- E-QUAL, University College of Applied Sciences Ghent. Ghent. Belgium.; Leen Van Landschoot—Department of Nursing, University of Applied Sciences Ghent. Ghent. Belgium.; Maja Lopez Hartmann—Department of Welfare and Health, Karel de Grote University of Applied Sciences and Arts. Antwerp. Belgium.; Tony Claeys- LiveLab, VIVES University of Applied Sciences. Kortrijk. Belgium.; Hilde Vandenhoudt—LiCalab, Thomas University of Applied Sciences. Turnhout. Belgium.; Kristel De Vliegher—Department of Nursing–homecare, White-Yellow Cross. Brussels. Belgium.; Susanne Op de Beeck—Flemish Patient Platform. Heverlee. Belgium. Kristel driessens—Department of Sociology, Faculty of Social Sciences. University of Antwerp. Belgium
References
Supplementary materials
Supplementary Data
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Footnotes
Contributors All listed authors meet authorship criteria and no others meeting the criteria have been omitted. The following role distribution was given to perform the scoping review: (1) development of the research question and establishment of the search strategy: MMS, HDL, KdV, KVdB and PvB, (2) database search: MMS and PvB, (3) record screening: MMS, PvB, HDL, KDV and KVdB performed abstract and full text screenings, (4) data analysis: MMS, HDL, KdV, KVdB and PvB, (5) discussion construction: MMS, HDL, KdV, KVdB, PP, RR and PVB, (6) writing-review and editing: MMS, HDL, KdV, KVdB, PP, RR and PvB. Finally, MMS is the guarantor of this scoping review.
Funding This research was funded by fund Daniël De Coninck, King Baudouin Foundation, Belgium. The funder had no involvement in this study. Grant number: 2019-J5170820-211588.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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