Diffusion of a collaborative care model in primary care: a longitudinal qualitative study

Isabelle Vedel, Veronique Ghadi, Matthieu de Stampa, Christelle Routelous (), Howard Bergman, Joel Ankri and Liette Lapointe
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Isabelle Vedel: Lady Davis Institute for Medical Research [Montréal] - McGill University = Université McGill [Montréal, Canada] - Jewish General Hospital
Veronique Ghadi: UVSQ - Université de Versailles Saint-Quentin-en-Yvelines
Matthieu de Stampa: UVSQ - Université de Versailles Saint-Quentin-en-Yvelines
Christelle Routelous: EA MOS - EA Management des Organisations de Santé - EHESP - École des Hautes Études en Santé Publique [EHESP] - PRES Sorbonne Paris Cité, EHESP - École des Hautes Études en Santé Publique [EHESP], IDM - Institut du Management - EHESP - École des Hautes Études en Santé Publique [EHESP]
Joel Ankri: VIMA - Vieillissement et Maladies chroniques : approches épidémiologique et de santé publique - UVSQ - Université de Versailles Saint-Quentin-en-Yvelines - INSERM - Institut National de la Santé et de la Recherche Médicale
Liette Lapointe: Instituto de Matemática y Física - Universidad de Talca - Universidad de Talca

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Abstract: BACKGROUND: Although collaborative team models (CTM) improve care processes and health outcomes, their diffusion poses challenges related to difficulties in securing their adoption by primary care clinicians (PCPs). The objectives of this study are to understand: (1) how the perceived characteristics of a CTM influenced clinicians' decision to adopt -or not- the model; and (2) the model's diffusion process. METHODS: We conducted a longitudinal case study based on the Diffusion of Innovations Theory. First, diffusion curves were developed for all 175 PCPs and 59 nurses practicing in one borough of Paris. Second, semi-structured interviews were conducted with a representative sample of 40 PCPs and 15 nurses to better understand the implementation dynamics. RESULTS: Diffusion curves showed that 3.5 years after the start of the implementation, 100% of nurses and over 80% of PCPs had adopted the CTM. The dynamics of the CTM's diffusion were different between the PCPs and the nurses. The slopes of the two curves are also distinctly different. Among the nurses, the critical mass of adopters was attained faster, since they adopted the CTM earlier and more quickly than the PCPs. Results of the semi-structured interviews showed that these differences in diffusion dynamics were mostly founded in differences between the PCPs' and the nurses' perceptions of the CTM's compatibility with norms, values and practices and its relative advantage (impact on patient management and work practices). Opinion leaders played a key role in the diffusion of the CTM among PCPs. CONCLUSION: CTM diffusion is a social phenomenon that requires a major commitment by clinicians and a willingness to take risks; the role of opinion leaders is key. Paying attention to the notion of a critical mass of adopters is essential to developing implementation strategies that will accelerate the adoption process by clinicians.

Keywords: Health service research; Chronic disease; Collaboration; Primary care; Primary care physician; Nurses; Diffusion of innovation (search for similar items in EconPapers)
Date: 2013
Note: View the original document on HAL open archive server: https://hal.science/hal-01519874v1
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Citations: View citations in EconPapers (1)

Published in BMC Family Practice, 2013, 14, pp.3. ⟨10.1186/1471-2296-14-3⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-01519874

DOI: 10.1186/1471-2296-14-3

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