title: Communities of clinical practice in action: Doing whatever it takes.
abstract: Burgeoning numbers of patients with long-term conditions requiring complex care have placed pressures on healthcare systems around the world. In New Zealand, complex patients are increasingly being managed within the community. The Community of Clinical Practice concept identifies the network of carers around an individual patient whose central participants share a common purpose of increasing that patient's well-being. We conducted a focused ethnography of nine communities of clinical practice in one general practice setting using participant observation and interviews, and examined the patients' medical records. Data were analysed using a template organising style. Communities of clinical practice were interprofessional and included informal supports, services and non-professionals. These communities of clinical practice mediate practice, utilising informal networks to cut across boundaries, bureaucracy, mandated clinical pathways and professional jurisdictions to achieve optimum patient-centred care. Communities of clinical practice's repertoires are characterised by care and are driven by the moral imperative to care. They do 'whatever it takes', although there is a cost to this form of care. Well-functioning communities of clinical practice use patient's well-being as a guiding light and, by sharing a vision of care through trusting and respectful relationships, avoid fragmentation of care. The Community of Clinical Practice (CoCP) model is particularly useful in accounting for the 'messiness' of community-based care.
authors.forename: Jessica
authors.initials: J
authors.lastname: Young
authors.forename: Chrystal
authors.initials: C
authors.lastname: Jaye
authors.forename: Tony
authors.initials: T
authors.lastname: Egan
authors.affiliation: University of Otago, New Zealand.
authors.forename: Martyn
authors.initials: M
authors.lastname: Williamson
authors.affiliation: Otago Polytechnic, New Zealand.
authors.forename: Anna
authors.initials: A
authors.lastname: Askerud
authors.affiliation: University of Otago, New Zealand; Mornington Health Centre, New Zealand.
authors.forename: Peter
authors.initials: P
authors.lastname: Radue
authors.affiliation: Mornington Health Centre, New Zealand.
authors.forename: Maree
authors.initials: M
authors.lastname: Penese
mesh_terms: D000884:Anthropology, Cultural; D002908:Chronic Disease; D003153:Community Health Services; D003695:Delivery of Health Care / Q000379:methods*; D006801:Humans; D009520:New Zealand; D018802:Patient-Centered Care; D011320:Primary Health Care / Q000379:methods; D036301:Qualitative Research
keywords: chronic illness; community care; long-term conditions; primary care; shared care; social networks