The Contexts and Resources that Support Effective Interprofessional Collaboration in Community Care for Older People: A Realist Synthesis

Background Interprofessional collaboration (IPC) is widely accepted as important to enable quality, safe care integration for older people. There is limited understanding of how IPC can be fostered, enhanced, or sustained within the various contexts of team-based care integration for older people. This review describes the contextual factors and resources that support IPC in interdisciplinary community care teams for older people. Methods A five-step process guided the realist synthesis. This involved exploratory scoping (steps 1-2) including a cross-sectional descriptive survey of members of the 30 specialist community teams for older people in Ireland (n=65). Four stakeholder workshops with operational leads, healthcare professionals, policymakers, older people and caregivers (n=25); a systematic evidence retrieval and synthesis phase (40 academic and 5 grey literatures included) (steps 3-4) and finally the development of programme theories via expert advisory panel (n=10) (steps 5). Results We generated 14 initial programme theories from the exploratory scoping phase, and these were refined into 7 programme theories following realist evidence synthesis. The programme theories describe the contexts and resources required to enable IPC within community care teams for older people under the following headings: 1. Professional identity and role awareness; 2. Information sharing and communication across boundaries of care; 3. Enabling Effective Operational and Clinical Governance; 4. Developing team competence in IPC; 5. Meaningful inclusion of older people and caregivers; 6. Monitoring and reviewing team performance for quality improvement and system development. 7. Capacity development and workforce planning. Conclusion The exploratory stakeholder process with local experts, including older people and caregivers, added a rich contextual depth to this realist review. The seven areas of programme theory convey the complex multifaceted contexts and resources that enable IPC in care integration for older people. Work has commenced to test these theories across four interdisciplinary community specialist teams for older people in Ireland.