Operational area where IPC takes place

This subcategory condenses participants’ elaborations on joint activities. Dietitians, medical training therapists, midwives, nurses, occupational therapists, and psychotherapists viewed preventative measures and patient education offered on an interprofessional basis as important activities in PHC in general and PHCUs specifically. Participants noted that patients better understand the specific operational area of each PG through this preventative work. IPC occurs during preventative work both within and outside the PHCU, including childcare units, private homes and schools. Health care and social experts collaborate to help patients, e.g., in adapting their homes to prevent falls. Nurses considered themselves the lynchpin, especially in disease management programmes, wound management, case and care management and holistic patient care:

‘(…) no matter what the patient’s concerns are, nursing is involved everywhere. (…) [in] case and care management, (…) wound care, (…) coordinating other health care providers, nurses are always in contact with the patient’. ^{Nurse PHCU}

A dietitian explained that the operational area in PHC differs from that in the acute sector, particularly in PHCUs. She noted that each day presents new challenges, with individual counselling and increasing tasks like visiting nursing homes. Unlike hospitals, PHCUs frequently experience interruptions due to team meetings and other organizational activities.

Biomedical scientists mentioned their PG is not yet visible in Austrian PHC, but they are eager to take over quality control responsibilities in PHC and PHCUs, especially in issuing reports and training, e.g., in blood sampling. They suggested the useful concept of a ‘movable lab’, where the laboratory comes to the patient instead of the other way around.

Structural and organizational implementation in PHCUs

This subcategory subsumes participants’ elaborations on particular structural and organizational manifestations in PHCUs that are essential for the implementation of IPC.

Patients’ first contact with a PHCU is typically with an office assistant, who directs them to the general practitioners. The interviewed general practitioners suggest that allowing patients to transition from the office assistant to the nurses for follow-up appointments could enhance regular care for chronically ill patients:

‘For me it is quite clear that there must be medical integration in PHC. (…) But I would like to start a nursing care department, where chronically ill multimorbid patients would have an appointment with a qualified nurse, where it is simply about weight, blood pressure, medication… The patients would have regular appointments and we would be called in, in case of a change or when problems occur’. ^{General practitioner PHCU}

Complex cases are discussed in PHCUs during weekly staff meetings. A coordinator and a joint calendar are of great importance:

‘We have a shared calendar as a PHC network. That means I see the appointments of the others and I can immediately make an appointment for my patient with another specialist, with the patient sitting opposite to me. (…) We have a coordinator who sort of brings us all together’. ^{Psychotherapist PHCU}

Observed benefits of PHCUs for patients

This subcategory encompasses participants’ observations regarding the advantages they perceive in PHCUs for patients.

PHCUs provide access to continuous care from multiple PGs. Many PHCUs offer extended opening hours, ensuring that daily appointment slots are available:

‘(…) if a patient comes on Monday and needs an appointment quickly, then the office assistant finds an available slot. This is not possible in the private practice, with a waiting time of several weeks’. ^{Physiotherapist PHCU}

These observations highlight the perceived advantages of PHCUs from the professionals’ perspective. Disease management programmes, particularly for chronic diseases, are designed with the patient’s needs in mind. Participants emphasized that prevention and health promotion work in PHC and PHCUs enhance patients’ health literacy.

Moreover, easy access to various therapies, swift assistance, and convenient diagnostics and treatment near patients’ homes, even in rural areas, were consistently mentioned as benefits. IPC emerged as a significant theme in this context, with discussions frequently focusing on how IPC contributes to improving patient care and accessibility:

‘(…) there are straightforward access points and you’re really close on a personal level (…) I think that’s such a huge benefit for everyone involved, especially for the patients. (…) that we can simply offer this all in one place’. ^{Psychotherapist PHCU}

Successful IPC

This subcategory sums up participants’ elaborations on factors contributing to a successful IPC in practice.

A beneficial close collaboration between general practitioners, office assistants, and other PGs in PHC settings was reported by the study participants. Consciously positively experienced IPC leads to friction-less and fluent teamwork, as shown in three examples: (1) occupational therapists, physiotherapists and nurses in the context of fall prevention, (2) speech therapists, physiotherapists and dietitians, (3) social workers and nurses in case and care management. A nurse illustrated the advantage of collaborating with social workers: they ‘look at the whole thing from a different perspective. […] But they need us just as much as we need them. It’s a partnership’. ^{Nurse PHCU} .

Overlapping areas can also be organized as a pragmatic division of tasks, e.g., physiotherapists stating that occupational therapy focusses on the upper and physiotherapy on the lower extremities.

In general, overlapping areas of competency between different PGs were experienced positively: ‘There are of course overlapping areas, […] And that’s the exciting thing, that you solve it together’. ^{General practitioner PHCU}

One physiotherapist emphasized the importance of attitudes: ‘We always coordinate when we have patients together […] as long as I engage in interaction, I always receive good collaboration in return’. ^{Physiotherapist PHCU}

Weekly team meetings support a low-threshold, simple and uncomplicated collaboration:

‘For me the main thing is that we simply appreciate each other very much as a team (…). And when (…) there’s a need for a psychotherapist or a dietitian, then we immediately network. We also have a team meeting once a week, where we exchange ideas and discuss patients that we treat together’. ^{Psychotherapist PHCU}

General practitioners are seen as ‘bosses’, nevertheless flat hierarchies can be experienced:

‘There is an incredibly flat hierarchy. It is clear that the doctors are the bosses, but they admit when they don’t know something and ask us to come in with our “occupational therapy – perspective.” Or they go to the dietician and ask for their perspective’. ^{Occupational therapist PHCU}

Challenges in IPC

This subcategory summarizes participants’ views on issues that hinder successful IPC in practice.

Participants noted that role ambiguity in teams can hinder IPC. Biomedical scientists, dietitians, medical training therapists, midwives, occupational therapists, radiographers and speech therapists reported that the other health experts often lack awareness of their roles or do not fully recognize their expertise:

‘It is unfortunately not the case that other health professions fully understand the scope of occupational therapy; for example, many physiotherapists are unaware of it’. ^{Occupational therapist PHCU}

‘I don’t know if this is just the case in my area, but doctors often don’t know what speech therapy entails or when they should refer a patient, or what issues speech therapists actually treat’. ^{Speech therapist PHCU}

Some situations were also mentioned by midwives, physiotherapists and social workers, where IPC is not perceived at eye level:

‘I actually wanted to report that the relationship to other PGs is often something of a double-edged sword. I do indeed experience a hierarchy problem. In other words, doctors always have the last word. (…) It is often the case that social work is regarded as subordinate in the hierarchy. I find that problematic’. ^{Social worker teaching institution}

A shortage of time and unfavourable circumstances for networking or monitoring patients’ therapeutic progress was identified by dietitians, occupational therapists, orthoptists, and speech therapists. This presents a significant challenge for IPC in PHC, particularly in PHCUs.

‘It is usually difficult to talk together. Because it is often the case that when you work your colleague is not there’. ^{Speech therapist PHCU}

Difficulties can arise in overlapping areas, e.g., between medical training therapists and physiotherapists or between midwifery and nurses:

‘I sometimes experience some difficulties with nurses who do breastfeeding and lactation training. They are normally very much appreciated (…) but there are also nurses who are active in the postpartum period. Not just breastfeeding counselling, but simply offering postpartum care. And that is simply a midwife’s job’. ^{Midwife self-employed}

Competences required for IPC

This subcategory aggregates participants’ elaborations on personal competences that are required for IPC.

Participants emphasized the need to understand each PG’s strengths, recognize boundaries, and clarify roles, believing that a strong professional identity enhances IPC, especially in the flat hierarchy of PHC: ‘For me, collaboration only works when I know what the other person can do. And I know where my limits are. That means, whenever I notice that this could also be in the area of the other person, who could support or knows more than me, then I ask for their advice’. ^{Orthoptist self-employed}

Additionally, several other competences emerged as vital for effective IPC. One participant emphasized that ‘coordination is very important; it’s about coordinating with all PGs’. ^{Office assistants PHCU}

Moreover, the ability to communicate effectively within the team is crucial. A participant pointed out that, ‘(…) social communication skills are essential. In a primary care team, everyone must find their place’. ^{Occupational therapist PHCU} This reflects the necessity for team members to understand their own roles and how they interact with one another.

Furthermore, participants stressed the importance of being open to learning from others. One participant articulated that there must be ‘(…) a process within us to learn to let go of certain things and truly utilize the competencies of other PGs’. ^{General practitioner PHCU} This mindset encourages flexibility and the effective use of diverse skills within the team.

Overall, networking abilities and social skills are essential for working in PHC. Participants emphasized the need for flexibility in scheduling common time with colleagues and the willingness to give and receive constructive criticism, highlighting the collaborative spirit in PHC settings.

Previous and present training content

This subcategory includes participants’ insights on past and present training content for IPC, specifically in PHC.

When asked about their preparedness for IPC in PHC, participants had varying responses, even within the same PG. Dietitians, midwives, occupational therapists, and psychotherapists reported minimal preparation during training but gained IPC experience through internships and courses like ‘casework’, where students from all health and social sciences programmes collaborated on cases. Occupational therapists, however, admitted that it ‘made up a very small proportion’. ^{Occupational therapy PHCU}

Summing up, study participants wished for a different and extended preparation for IPC in PHC in the areas of cooperation, communication and interdisciplinary connection:

‘What I think that should be integrated into the training, especially with regard to PHC, is that one learns about interdisciplinary collaboration and, above all, what the other PGs are allowed to do’. ^{Biomedical analytics teaching institution}