title: Primary care physicians' perspectives on facilitating older patients' access to community support services: Qualitative case study.
abstract: OBJECTIVE
  To understand how family physicians facilitate older patients' access to community support services (CSSs) and to identify similarities and differences across primary health care (PHC) models.
  
  
  METHODS
  Qualitative, multiple-case study design using semistructured interviews.
  
  
  METHODS
  Four models of PHC delivery, specifically 2 family health teams (FHTs), 4 non-FHTs family health organizations, 4 fee-for-service practices, and 2 community health centres in urban Ontario.
  
  
  METHODS
  Purposeful sampling of 23 family physicians in solo and small and large group practices within the 4 models of PHC.
  
  
  METHODS
  A multiple-case study approach was used. Semistructured interviews were conducted and data were analyzed using within- and cross-case analysis. Case study tactics to ensure study rigour included memos and an audit trail, investigator triangulation, and the use of multiple, rather than single, case studies.
  
  
  RESULTS
  Three main themes were identified: consulting and communicating with the health care team to create linkages; linking patients and families to CSSs; and relying on out-of-date resources and ineffective search strategies for information on CSSs. All participants worked with their team members; however, those in FHTs and community health centres generally had a broader range of health care providers available to assist them. Physicians relied on home-care case managers to help make linkages to CSSs. Physicians recommended the development of an easily searchable, online database containing available CSSs.
  
  
  CONCLUSIONS
  This study shows the importance of interprofessional teamwork in primary care settings to facilitate linkages of older patients to CSSs. The study also provides insight into the strategies physicians use to link older persons to CSSs and their recommendations for change. This understanding can be used to develop resources and approaches to better support physicians in making appropriate linkages to CSSs.
authors.affiliation: Professor in the School of Nursing in the Faculty of Health Sciences and an associate member of the Department of Health, Aging and Society at McMaster University in Hamilton, Ont, and Scientific Director of the Aging, Community and Health Research Unit. ploegj@mcmaster.ca.
authors.forename: Jenny
authors.initials: J
authors.lastname: Ploeg
authors.affiliation: Professor Emeritus in the Department of Health, Aging and Society and the Department of Sociology at McMaster University.
authors.forename: Margaret
authors.initials: M
authors.lastname: Denton
authors.affiliation: Professor Emeritus in the Department of Family Medicine, the Department of Clinical Epidemiology and Biostatistics, and the Centre for Health Economics and Policy Analysis at McMaster University.
authors.forename: Brian
authors.initials: B
authors.lastname: Hutchison
authors.affiliation: Associate Professor of Psychiatry and Behavioural Neurosciences at McMaster University and Director of Research and Evaluation for the Seniors Mental Health Service at St Joseph's Healthcare Hamilton.
authors.forename: Carrie
authors.initials: C
authors.lastname: McAiney
authors.affiliation: Associate Professor in the Department of Family Medicine at McMaster University and a family physician at Stonechurch Family Health Centre.
authors.forename: Ainsley
authors.initials: A
authors.lastname: Moore
authors.affiliation: Professor of Palliative Care in the School of Nursing and Midwifery at Queen's University Belfast in Northern Ireland.
authors.forename: Kevin
authors.initials: K
authors.lastname: Brazil
authors.affiliation: College Professor Emeritus in the Department of Family Relations and Applied Nutrition at the University of Guelph in Ontario.
authors.forename: Joseph
authors.initials: J
authors.lastname: Tindale
authors.affiliation: Master's in Science of Nursing student at McMaster University, a research assistant at the Aging, Community and Health Research Unit at McMaster University, and a registered nurse.
authors.forename: Annie
authors.initials: A
authors.lastname: Lam
mesh_terms: D003153:Community Health Services / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008297:Male; D009864:Ontario; D010348:Patient Care Team / Q000592:standards*; D010821:Physicians, Family / Q000523:psychology*; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D012017:Referral and Consultation / Q000592:standards*