Table 4 Facilitators ( +) and barriers (-) to the first steps of the CMI implementation – Contexts of the clinics
Themes | Case | |||||
|---|---|---|---|---|---|---|
A | B | C | D | E | F | |
Roles and interprofessional collaboration | ( +) Formal collaborative approach ( +) NCM autonomy and leadership ( +) Informal connections among providers | ( +) Formal collaborative approach ( +) NCM autonomy and leadership | ( +) Formal collaborative approach ( +) Informal connections among providers | ( +) Formal collaborative approach | ( +) Excellent communication within the clinic staff ( +) Informal connections among providers (-) Difficulty contacting specialist physicians | ( +) Formal collaborative approach and team meetings where clinic providers discuss complex patients (-) Few psychosocial resources within the clinic |
Organizational collaboration | ( ±) Positive relationships with many different organizations, but lack of collaboration with some (-) Increasing reduction in services offered from other organizations | ( ±) Positive relationships with many different organizations, but lack of collaboration with some (-) Long delay before the take-over of patient care from other organizations | ( ±) Positive relationships with many different organizations, but lack of collaboration with some particularly mental health (-) Challenges accessing some community resources available to clinic | ( ±) Positive relationships with many different organizations, but lack of collaboration with some, particularly mental health (-) Lack of access to resources | ( ±) Positive relationships with many different organizations, but lack of collaboration with some, particularly mental health ( +) Access to various services in close proximity (-) Inability to share records with external departments | ( +) External organizations help to overcome the lack of psychosocial resources (-) Lack of collaboration with some organizations (-) No simple stream-lined process for connecting to community supports |
Access to patient health information | ( ±) Affiliation to regional health centre gives easier access to EMR, but access is still limited (-) Regulations surrounding confidentiality may interfere with the exchange of information among providers | (-) Lack of access to EMR and limited information sharing (-) Regulations surrounding confidentiality may interfere with the exchange of information among providers | (-) Lack of access to EMR | ( ±) Systems and tools exist for specific medical information sharing, but more tools are needed (-) Systems are not used by all providers | ( +) Ability to share records between departments ( ±) Systems and tools exist for specific medical information sharing, but more tools are needed (-) Regulations surrounding confidentiality may interfere with the exchange of information between providers | ( +) Systems and tools exist for specific medical information sharing (-) Communication from referrals not consistent |
Patient-centered care | ( +) Patient centeredness around building a strategy together (-) Goals of care not always discussed with patients | (-) Need for more training in patient self-management support for NCMs | ( +) Patient centeredness around building a strategy together ( +) Having patients self-identify which services or providers they need | ( +) Patient centeredness around building a strategy together ( +) Empowering patients to self-manage | ( +) Access to translation services (-) Literacy and language constraints | ( +) Establishing trusting relationship with patients and staying in touch regularly ( +) Empowering patients to self-manage |