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Table 5 Selected quotes: Primary Care Physicians’ and Nurses’ perceptions about the Collaborative Team Model

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

 

Primary Care Physicians (PCP)

Nurses (N)

Common perceptions among PCPs and Nurses

Observability

Positive opinion (early adopter, early majority)

Positive opinion (early adopter, early majority)

Eg. I talked about [the CTM] a bit with one of my colleagues who has a practice much like mine, and we agreed that it could help us. PCP, early majority

Eg. We talked about [the CTM], and everyone thought that it’s a good thing. N, early adopter

Negative opinion (late majority, laggards)

Negative opinion (late majority, laggards)

Eg. We don’t hear much that is good about the networks that have been implemented. The reports aren’t very good. PCP, late adopter

Eg. My colleague will tell you exactly the same thing; (these models) are taking our jobs. N, laggard

Trialability

Positive opinion (early adopter, early majority)

Positive opinion (early adopter, early majority)

Eg. I had to invest a bit of time finding [the CTM]. I tested it when I had a chance, and I found it very good. PCP, early majority

Eg. I tried [the CTM] once just to see, and it was great. So I hope it will continue. N, early majority

Negative opinion (late majority, laggards)

Negative opinion (late majority, laggards)

Eg. I proposed a patient, but I guess they didn’t quite meet their criteria… So I didn’t continue; I waited. PCP, late majority

Eg. We don’t even work the same way, we don’t have the same approach to work or availability. The first time, they said I’d find all the information there, but when I went, I saw all the faults in the system. So I said no. N, laggard

Simplicity

Positive opinion (early adopter, early majority)

Positive opinion (early adopter, early majority)

Eg. It’s going well. When I call, I get a quick callback if I need [the CTM]. Right there I have my solution, right away. PCP, early adopter

Eg. [the CTM] really works very simply, (…) it’s highly available, and very responsive. It’s really easy. N, early adopter

Negative opinion (late majority, laggards)

Negative opinion (late majority, laggards)

Eg. It isn’t easy to change your practices. When we learned how to work on our own, it didn’t come easily. PCP, late adopter

Eg. It’s very unclear how it works: a [CTM] can mean anything. N, late adopter

Different perceptions among PCPs and Nurses

Compatibility

Positive opinion but caution (early adopter, early majority)

Strong positive opinion

Eg. To the extent that everyone knows their place and helps each other out, that we don’t start seeing encroachment by other specialists or anything like that, then [the CTM] may be a good experience. PCP, early adopter

Eg. They’re people with know-how, who don’t take over, who in fact try to respect people in their practices, to express themselves very diplomatically. N, early majority

Strong negative opinion (late majority, laggards)

Mild negative opinion (late majority, laggards)

Eg. If the case manager centralizes the information, that makes me uncomfortable. Medical information can only move from one physician to another with the patient’s agreement. PCP, laggard

Eg. I know that nowadays the style is to produce a lot of paper… We preferred spending our time with the person rather than on doing paperwork. N, laggard

Eg. I imagine that they’re going to impose constraints that don’t fit our practices… We don’t work the same way. So I can’t see how we can develop closer ties. PCP, laggard

Eg. There are patients that I haven’t seen since. In particular, there’s a woman with dementia. She was being followed by [geriatrician], she didn’t have other needs than to see [geriatrician]. PCP, late majority

Eg. When I learn that a patient I’m following has been asked to take a certain test and I learn it from a member of his family, I’ve got problems with that… PCP, laggard

Eg. We’ve known our patients for years, and in a few days they’ll change the patient’s treatment without telling us. PCP, laggard

Relative advantage

Mild positive opinion (early adopter, early majority)

Strong positive opinion (early adopter, early majority)

Eg. When it comes to community-based care for dependent elderly patients, it may help. PCP, early adopter

Eg. Patient monitoring is shared. This is a great help for community-based providers, especially because it’s a multidisciplinary team that can answer quite a lot of questions. N, early majority

 

Eg. Until now, we’ve had a relationship with the attending physician of a subordinate to a higher hierarchical level. Now we have the impression that the relationship isn’t vertical, rather, it’s become more horizontal. N, early adopter

 

Eg. As soon as there was a problem, we had to bother the general practitioner, who is already “overbooked.” But now I feel extremely safe, knowing that there are [geriatricians] above me, people whom I can ask for advice. I find this really incredible. N, early majority

Strong negative opinion (late majority, laggards).

Mild negative opinion (late majority, laggards)

 

Eg. For me, [the CTM] has nothing to offer. We did just fine without it. PCP, laggard

Eg. Who works 7 days a week? It’s the nurses, not the case managers. So I’m against imposing this person [case manager]. N, laggard