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Community-based participatory action research: transforming multidisciplinary practice in primary health care

DOI: 10.1590/S1020-49892007000200007

Keywords: health services research, primary health care, interprofessional relations, patient care team, health care reform, canada.

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objectives: health care systems throughout the world are in the process of restructuring and reforming their health service delivery systems, reorienting themselves to a primary health care (phc) model that uses multidisciplinary practice (mdp) teams to provide a range of coordinated, integrated services. this study explores the challenges of putting the mdp approach into practice in one community in a city in canada. methods: the data we analyzed were derived from a community-based participatory action research (cbpar) project, conducted in 2004, that was used to enhance collaborative mdp in a phc center serving a residential and small-business community of 11 000 within a medium-sized city of approximately 300 000 people in canada. cbpar is a planned, systematic approach to issues relevant to the community of interest, requires community involvement, has a problem-solving focus, is directed at societal change, and makes a lasting contribution to the community. we drew from one aspect of this complex, multiyear project aimed at transforming the rhetoric advocating phc reform into actual sustainable practices. the community studied was diverse with respect to age, socioeconomics, and lifestyle. its interdisciplinary team serves approximately 3 000 patients annually, 30% of whom are 65 years or older. this phc center's multidisciplinary, integrated approach to care makes it a member of a very distinct minority within the larger primary care system in canada. results: analysis of practice in phc revealed entrenched and unconscious ideas of the limitations and boundaries of practice. in the rhetoric of phc, mdp was lauded by many. in practice, however, collaborative, multidisciplinary team approaches to care were difficult to achieve. conclusions: the successful implementation of an mdp approach to phc requires moving away from physician-driven care. this can only be achieved once there is a change in the underlying structures, values, power relations, and roles define


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