Addressing uncertainty : contributions of knowing patients and team members to negotiating team-based primary care

The interprofessional team-based primary care model currently being implemented in northern British Columbia represents a significant shift in primary care delivery. The purpose of this study is to examine how patients feel known in the context of an interprofessional primary care team that is not co-located, and to illuminate how practices of connection between patients, providers, and team members can influence how care is negotiated within the team. Through methods of observation and interviews, data were collected then analyzed interpretively. The findings of this study highlight practices within patient-provider encounters that contribute to patients feeling known and maintain therapeutic relationship. The way in which primary care providers know patients influences decision-making about which patients need team-based care, and when. The relationship between primary care providers and team members is also influential in deciding who needs team-based care, yet existing relationships can be disrupted by the degree of uncertainty that occurs alongside major shifts in primary care delivery. Team-based primary care is negotiated through practices of connection and genuine conversation. These practices and conversations influence the timing of team involvement, the information that is shared, and the type of care that is provided. Implications of these findings can support efforts to increase relationship-based care for patients and improve understanding about what patients value in receiving team-based care. Engaging in practices of connection and genuine conversation helps relieve uncertainty, whether at a team or patient level, and re-aligns the core attributes of primary care as central to delivering high quality team-based care.