title: Difficulties encountered in collaborative care: logistics trumps desire.
abstract: BACKGROUND
  This study examines the development of collaborative relationships between family physicians (FPs) and Anticipatory And Preventative Team Care (APTCare) team members providing care to medically complex patients who have been identified as at-risk for negative health outcomes.
  
  
  METHODS
  We undertook a qualitative study of a primary health care intervention in a family practice. Interviews were held with FPs and ATPCare intervention nurse practitioners (NPs) and pharmacists. Focus groups were conducted and a survey was administered to participating FPs, NPs, and pharmacists. NPs and pharmacists maintained a log recording their tasks and moments of collaboration.
  
  
  RESULTS
  Scheduling demands rendered face-to-face collaboration difficult, leaving the team to rely on technological tools to keep in touch. Limited space meant the APTCare team had to work out of a downstairs office, limiting informal interactions with the practitioners on the main level.
  
  
  CONCLUSIONS
  We demonstrate that the difficulties inherent in collaborative care are independent of the patient population being cared for. Regardless of the patient population and sector of health care, developing collaborative relationships and learning to work collaboratively is difficult and takes time. What many of these teams need is ongoing support and education about how to make these collaborative care practices work.
authors.affiliation: Ontario Primary Health Care Nurse Practitioner Program, University of Ottawa, Ottawa ON, Canada. flegault@uottawa.ca
authors.forename: Frances
authors.initials: F
authors.lastname: Legault
authors.forename: Jennie
authors.initials: J
authors.lastname: Humbert
authors.forename: Stephanie
authors.initials: S
authors.lastname: Amos
authors.forename: William
authors.initials: W
authors.lastname: Hogg
authors.forename: Natalie
authors.initials: N
authors.lastname: Ward
authors.forename: Simone
authors.initials: S
authors.lastname: Dahrouge
authors.forename: Laura
authors.initials: L
authors.lastname: Ziebell
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D003142:Communication; D003299:Cooperative Behavior; D003695:Delivery of Health Care / Q000458:organization & administration; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D017144:Focus Groups; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D009864:Ontario; D009934:Organization and Administration; D010348:Patient Care Team / Q000458:organization & administration*; D010595:Pharmacists; D010819:Physician's Role; D011314:Preventive Health Services / Q000458:organization & administration*