Reviewing Interprofessional Collaboration and Funding Models in Primary and Allied Health Care

A review in the Journal of Interprofessional Care explores the challenges of integrated health care and interprofessional collaboration in primary and allied health care, highlighting the need for new funding models to promote greater teamwork and coordination among health care professionals.

Interprofessional collaboration in health care involves multiple health professions working together to deliver comprehensive and person-centered care. These collaborations connect different levels of the health care system, from tertiary to primary care. Well-managed, collaborative health care systems lead to more effective resource utilization and improved satisfaction among clinicians and consumers. Despite the benefits, implementing interprofessional collaboration in primary health care settings is still challenging. 

The scoping review followed Joanna Briggs Institute (JBI) methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, with a protocol paper outlining key definitions, search strategy, eligibility criteria, and data extraction protocols. A literature search was conducted using various databases and grey literature sources, focusing on health care collaboration and funding models from 2011 to 2021. Eligibility criteria included interprofessional collaboration, discipline recognition, and primary health care practice. Data extraction and synthesis involved a narrative synthesis approach and critical appraisal. Quality assessment was conducted to address heterogeneity, with papers categorized based on methodological quality and level of evidence.

A total of 8122 articles were identified in the literature search. After screening based on title and abstract, 688 articles progressed to full-text screening, and 63 papers met the inclusion criteria and were included in the review. 

Primary health care professionals such as doctors and nurses were prominently discussed in the included papers. Interprofessional collaboration types, roles, and responsibilities were summarized based on the Rainbow Model of Integrated Care. Most papers focused on organizational-level integration and discussed functional and normative connections. Health care funding characteristics, including models, levels, and principles, were also mapped based on World Health Organization (WHO) guidelines. Public funding models and payments per unit of service were commonly discussed in the included papers.

Papers with lower evidence levels were recommended for further research or raising awareness rather than immediate practice changes. Collaboration in health care was often described as multidisciplinary, interdisciplinary, or transdisciplinary, each with unique collaborative roles and responsibilities. Confusion remained regarding distinctions between interprofessional and interdisciplinary collaborations in the literature, leading to potential misinterpretations in health care settings.

Health care integration at the system level focused on shared rules, responsibilities, and funding, with discussions on insurance policies and health care team composition. Organization-level integration highlighted the need for consistent funding to enable collaboration and shared care between organizations. Professional-level integration involved meso-level partnerships between health care professionals within and between organizations. Collaboration was influenced by funding access and remuneration equality, impacting the success of integration efforts in health care.

“The key findings suggested that most primary and allied healthcare services were operating under fee-for-service (FFS) funding arrangements. However, it also found that funding services under FFS arrangements may discourage the provision of collaborative, coordinated, and complex care, as the additional time and financial costs of providing these services are rarely accounted for under these arrangements,” researchers said. “Collaborative roles and responsibilities were found to be more likely to involve parallel care arrangements that retain traditional, siloed, and hierarchical structures between disciplines or professions where doctors and physicians have higher authority, power, and responsibility than their nursing and allied health colleagues. These gatekeeper roles, whether assigned to or assumed by doctors and physicians, also appear to perpetuate funding discrepancies, contributing to workload, remuneration, and job satisfaction inequalities. To better offset these imbalances, future research is needed to explore how blended funding models can facilitate greater interprofessional collaboration and service integration among primary and allied healthcare professions.” 

Reference
Archer J, Rogalsky J, Guerra E, Brown T, Robinson L. The impact of healthcare funding on interprofessional collaboration and integrated service delivery in primary and allied healthcare: a scoping review. J Interprof Care. Published online January 28, 2025. doi:10.1080/13561820.2025.2452958