Observation of interprofessional collaborative practice in primary care teams: An updated integrative review.

Abstract

Interprofessional collaboration is essential for delivering high-quality patient care. However, the key elements of effective interprofessional collaboration in primary care settings remain obscure. Previous reviews do not provide clarity, relying heavily on studies using self-reported data. In contrast, Direct-Observation-Methods provide valuable insight into how health professionals interact in day-to-day practice, offering an authentic, more accurate and more useful depiction of interprofessional collaboration than self-report. To examine and synthesise the key factors influencing interprofessional collaboration in primary care teams based exclusively on published studies using Direct-Observation-Methods and reporting direct-observation findings. An integrative review using Whittemore and Knafl's (2005) five-stage framework. 8 September 2013-29 October 2024. This follows and updates our previous integrative review of studies using Direct-Observation-Methods published between 1 January 2005 and 7 September 2013. MEDLINE, PsychINFO, Scopus, King's Fund and Informit Health Collection databases, and hand-searching recent review reference lists. Three reviewers screened search output. Fifty-four studies examining elements of interprofessional collaboration incorporating Direct-Observation-Methods were identified. Of these, 19 studies clearly reported direct-observation findings related to factors influencing interprofessional collaboration. Studies had varied aims and methodologies (qualitative, quantitative and mixed methods). The Mixed Method Appraisal Tool assessed methodological quality. Whittemore and Knafl's qualitative synthesis method identified themes across observation-based study findings. Three interrelated themes were identified as key influences on effective interprofessional collaboration in primary care settings: Space Time, and Team Factors. Effective Interpersonal Communication emerged as the central element across these themes. Within this overall finding, the review reveals new insights less evident in our previous review: the importance of cultivating non-hierarchical collaborative team cultures; enhancing opportunities for effective interpersonal communication within formal meetings as well as informally, and the value of training or coaching to build collaborative communication skills. By focusing on directly observed factors influencing interprofessional collaboration in primary care settings, this review offers insights not possible from reviewing self-report data. It shows that a multi-level approach is needed to achieve and sustain effective collaboration and improve patient care. Further studies using Direct-Observation-Methods are needed, including studies on optimising time for collaboration and supporting teams to develop effective interpersonal communication skills. To strengthen future research quality, direct observation data must be collected, analysed and reported with rigour and transparency. This review provides methodological guidance to support such research.