The Experience of Interprofessional Collaboration in a Telehealth Context in Primary Care: The Perspective of Patients Living with a Chronic Illness – A Research Protocol

The Experience of Interprofessional Collaboration in a Telehealth Context in Primary Care: The Perspective of Patients Living with a Chronic Illness – A Research Protocol | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Study protocol The Experience of Interprofessional Collaboration in a Telehealth Context in Primary Care: The Perspective of Patients Living with a Chronic Illness – A Research Protocol Monica Mcgraw, Yves Couturier, Isabelle Gaboury, Marie-Dominique Poirier, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4472719/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: The enhancement of primary health care and the prevalence of chronic diseases are key issues worldwide, especially in Canada. As the incidence of chronic illnesses rises, they have emerged as the foremost cause of mortality worldwide. This trend has led to a surge in demand for healthcare services, placing significant pressure on primary care systems. In 2019, with the arrival of the pandemic, the rapid introduction of telehealth emerged as a crucial resource for patients with chronic illnesses, augmenting the role of primary healthcare as their initial point of contact. This resource was implemented with no infrastructure, often without patient support, and left to the discretion of individual professionals. Interprofessional collaboration plays a critical role in optimizing the use of telehealth in managing chronic diseases. Interprofessional teams can provide comprehensive care that addresses the multifaceted needs of patients with chronic illnesses. This approach ensures that patients receive holistic and coordinated care, leading to better health outcomes. Despite its advantages, telehealth can have negative effects if used sub-optimally. Methods/design: To describe the process of interprofessional collaboration in the telehealth context in primary care coming from the perspective of patients living with chronic disease, this qualitative research is based on a constructivist research methodology, where the research team constructs knowledge derived from the interpretation of information obtained during the interviews with participants. To meet the study's objectives, qualitative Journey Mapping data collection will be carried out, following the approach of Trebbel. Individual interviews will be analyzed qualitatively and iteratively. This method is useful for analysis being done by different people from the team, including those with little experience in qualitative analysis. Anticipated benefits: The health and well-being of patients is central to the practice of healthcare professionals in primary care. Patients living with chronic diseases are among the most frequent users of primary care in Canada. The results of this study will support and improve the interprofessional collaboration process in the telehealth context, using a patient-centered approach. Journey mapping will help identify potential facilitating factors for improving primary care in the telehealth context according to the patient's journey. Results will be used to build a practical guide (phase 2) supporting interprofessional collaboration in the primary care telehealth context. Primary health care Interprofessional collaboration chronic disease telehealth patient engagement qualitative method Background Chronic disease is recognized as a long-term, persistent, mostly non-communicable condition requiring ongoing management [1]. In Canada, 44% of adults aged 20 and over live with chronic diseases [2]. This percentage increases significantly with age [2]. Over 4.9 million (73%) Canadians over 65 live with at least one chronic disease. For patients living with chronic diseases, access to primary care is an essential element contributing to their continuity of care and patient engagement [1,3,4]. However, the lack of access to primary care does not promote efficient chronic disease management or active engagement of people living with chronic disease [5,6] and, ultimately, to their health [7,8]. The COVID-19 pandemic has amplified the delay in accessing primary care [9, 10]. Various publications describe patients living with chronic disease as those who consult primary care most frequently [1,11]. These receive regular interprofessional follow up by the primary care nurse, family doctor, pharmacist, social worker, etc.) [12,13]. This interprofessional necessity of chronic disease management and the need to provide optimal professional care implies that each professional involved must apply the recommended interprofessional practice standards [14,15]. Interprofessional collaboration is defined as the process by which professionals from different disciplines develop modalities of practice that provide a coherent, integrated response to the needs of the individual, their loved ones, and the community [14]. The evolving and multidimensional nature of the chronic disease situation creates challenges that can affect the quality of care offered to patients. For example, patients who consult different healthcare professionals must often repeat their medical history due to sub-optimal interprofessional collaboration among team members in the same work environment [6,16,17]. This lack of communication directly affects relational continuity, i.e., the sharing of information from previous events and circumstances, to ensure that care is appropriate to the individual and his or her problem [18]. Patients living with chronic disease may also perceive contradictory recommendations from different professionals, which undermines their potential for self-management [19]. These challenges highlight the importance of establishing clear patient pathways within interprofessional teams, ensuring that information is shared efficiently and that the continuity of care is coordinated effectively, especially in a telehealth context [16,18]. During a well-established interprofessional collaboration, another way to improve the quality of care is to offer care with the support of telehealth to increase access [20,21]. Telehealth is defined as "any interaction between a patient and a healthcare professional that takes place at a distance and uses some form of information or communication technology (i.e., telephone, e-mail, SMS, videoconferencing platform, electronic medical record (EMR)" [22]. In several Canadian provinces, telehealth is being used to better meet patient needs, such as accessibility to care [6,23]. Some studies point out that Canadians want to maintain access to telehealth consultations post-pandemic, mainly because of the time saved on travel and improved access to an appointment [24]. This consultation modality not only increases accessibility but also reduces the costs associated with care for the healthcare system when used optimally and appropriately [25, 26]. For healthcare professionals and the healthcare system, proper use of telehealth facilitates communication between healthcare professionals, which ultimately promotes interprofessional collaboration [4,20,27]. Despite the benefits of telehealth, it can have negative effects on patient health if used suboptimal or inappropriately [19,20], affecting interprofessional collaboration and the quality of patient engagement [24, 28]. The use of telehealth has accelerated in recent years, not only because of the pandemic [29, 30], but also to support access to care in certain more remote regions [31]. The scientific literature affirms that telehealth should continue to exist because of its ability to increase accessibility to care for patients and because of its positive impact on adapting the healthcare system to the demographic transition [6,20,32,33]. Although telehealth offers many advantages and is appreciated by patients and professionals alike [34, 35], some studies point to the importance of further adapting this service modality to the needs of patients living with chronic diseases (ex: video-assisted telehealth for older patients due to digital literacy, patients with technological challenges, etc.). Other studies emphasize that to achieve positive effects for patients, it is essential to support professionals and patients in their appropriation of this intervention modality and to promote the maintenance of interprofessional collaboration despite the remote work/care context [36]. This is because telehealth is often used without a defined framework and left to the discretion of each care setting [6, 17, 36]. Telehealth implemented without a clear framework (i.e., tools, work procedures, etc.) for primary care increases work overload and stress for professionals [13,27,30]. Including the perspective of patients living with chronic diseases remains crucial and essential to guide professionals in keeping telehealth, and interprofessional collaboration responsive to their needs [15,20]. The patient perspective helps improve health outcomes for individuals and increases patient satisfaction, confidence, and engagement in their health [37]. To date, however, the patient perspective of the interprofessional collaboration process, including patient engagement living with chronic disease in a telehealth context is still under-researched [38, 39]. The Montreal Model, the Canadian Institutes of Health Research (CIHR) and Strategy for Patient-Oriented Research (SPOR) also support this approach to integrating patient partners into the research team [40,41,42]. Aim and objectives This study will aim to understand patients' engagement experience in the process of interprofessional collaboration in a primary care telehealth setting, considering patient engagement. To achieve this aim, this research project has three specific objectives: describe the telehealth interprofessional collaboration process in primary care, from the perspective of patients living with chronic disease; identify, in collaboration with patients living with chronic disease, the barriers and facilitators in this process; understand how these patients are engaged in the interprofessional collaboration process in a telehealth context. Conceptual framework Two conceptual frameworks will be used to structure this study. To enrich the understanding of patient engagement regarding the interprofessional collaboration process, the interprofessional collaboration -related domains of the Interprofessional Education for Collaborative Patient-Centred Practice (IECPCP) model will be used for this project [14]. This model of interprofessional collaboration is patient-centred, intending to improve patient outcomes. In this model, the process is divided into four dimensions: 1) governance; 2) rules to structure the team; 3) shared goals and vision; and 4) sense of belonging [14]. To adequately include the dimension of patient-centered care and the importance of patient engagement, the Montreal Model [40] also be used. This model is widely used to support patient engagement throughout the interprofessional collaboration process regarding their health condition, including the management of chronic diseases [40]. The patient's voice is considered on an equal footing with other stakeholders in the primary healthcare team. What's more, the patient can also be accompanied by a care giver to better express his or her experience [40]. Ultimately, this model relies on patients' experiential knowledge, enabling them to make informed decisions and exercise leadership at the same level as healthcare professionals [40]. The direct care delivery section is a logical level of the model that refers to interactions between professionals and patients [40]. It provides an understanding of the level of engagement between professionals and patients at the clinical level. In addition, the telehealth context will be highlighted in the consultation section of the Montreal model, where the patient must have had a telehealth consultation [40]. Finally, the components present in this model will support our understanding of the phenomenon of patient engagement living with chronic diseases in a telehealth context. Methods/design The focus of the study is to better understand patient. This study therefore includes one patient partner in the research team. Meetings were held with the patient partner and the research team to develop the study protocol, interview guide and mapping template. This approach is based on the recommendations of Pomey [40] conceptual framework for patient engagement in research. This qualitative research is based on a constructivist research methodology, where the research team constructs knowledge from the interpretation of information obtained during dialogues with participants [43,44]. To meet the study's objectives, a qualitative Journey Mapping data collection will be carried out, following the approach of Trebbel et al. [45]. This method enables users (in this case, patients living with chronic diseases) to be involved early on and throughout the mapping development process. Pathway mapping in telehealth allows us to delineate the patient journey, detailing their engagement and experiences with telehealth services at the primary care level. This approach helps identify areas for enhancing the quality of patient care. This approach also places the patient at the center of the research to better understand and improve the process of interprofessional collaboration [46]. It also allows us to identify the points of contact between patients and professionals, during the telehealth consultation process (i.e., method of communication; pathway to an appointment; and others) based on patient's expressed or unexpressed needs [45]. This type of approach provides a better understanding of elements starting from service entry, navigation, and ongoing experience, right through to patient discharge from the healthcare system [46]. Study population The target population is all adult patients living with chronic diseases who have consulted virtually a primary care clinic in which different healthcare professionals practice collaboratively (i.e. presence of communication channels, alternating care plan already established). The settings studied for this research will be university primary care clinics such as Family medicine units (U-FMGS). The U-FMGS (i.e., a grouping of family physicians who work together and in close collaboration with other health and social services professionals - Government of Quebec (2023) [47] is the main model of primary care services in Quebec [13,48]. Some FMGs are affiliated with universities and integrate the training of family medicine residents and externs. These primary care clinics are then called U-FMGS. This study will focus on U-FMGS clinics, as many healthcare professionals work in interprofessional teams (i.e. physicians, nurses, social workers, pharmacists, etc.) and practice telehealth. Sampling and recruitment strategy We will use a purposive sampling to provide a diverse description of telehealth interprofessional collaboration experiences in primary care [49,50]. This type of purposive sampling allows the research team to recruit subjects who meet specific inclusion criteria and are representative of the phenomenon under study [50]. We will strategically select research sites and sampling methods based on their perceived richness and utility in providing comprehensive insights into the phenomenon under investigation [51]. The literature also points to other important strengths such as lower cost, convenience, and the fact that it takes less time to undertake [52]. A two-tiered recruitment will be carried out, namely the development of a partnership with U-FMGSs and subsequently the direct recruitment of patients from partner U-FMGSs. This partnership will enable the team to recruit two U-FMGSs. These U-FMGSs will be recruited face-to-face, to enable us to develop a relationship of trust between the research team and the U-FMGS administration from the outset. From the very first meeting, the team will ensure the existence of an interprofessional collaboration process (presence of communication channels, alternating care plans already established) as well as a French- or English-speaking clientele and the presence of telehealth consultations for patients. Once the U-FMGS has been selected, the research team and U-FMGS managers will work together to ensure adequate patient recruitment. Posters will be placed in waiting rooms with information relevant to the study, to solicit participation from the target population. The research team aims to reach at least 30 participants [53]. The final sample will be determined according to data saturation [54, 55]. Guest et al., (2006) define this form of saturation when data tend to be redundant concerning data already collected [55]. This data analysis will be carried out on an ongoing basis throughout the data collection process, to check for redundant information. For example, when the research team begins to hear the same comments repeatedly, using a saturation grid as a method of keeping track of this redundancy. This will enable them to stop collecting data and start analyzing it. As inclusion criteria, adult participants will have to declare that they live with at least two chronic diseases that are recognized by the Public Health Agency of Canada, (2022) and have consulted at least three times in the last year in the participating clinic, having at least one of the three appointments in a telehealth context. Selected patients must have consulted the primary care clinic in connection with their chronic diseases. Recruitment from this population is justified by a higher likelihood of having had interprofessional collaboration experiences in a telehealth setting due to the need to maintain follow-ups in primary care [23,51]. Collecting data We will be collecting data in the format of a journey mapping through a maximum of 90-minute semi-structured interviews describing patient engagement in interprofessional collaboration from the perspective of patients living with chronic diseases [50,56]. These interviews will be conducted in either French or English, depending on patient preference. This type of interview leaves the researcher free to simply ask a question or several questions from a predetermined list, depending on the direction of the dialogue. This type of interview allows the patient's experience to emerge. Due to the geographical distance between the researcher/interviewer researcher and the potential U-FMGSs, for the advantage and flexibility of the patient, the interviews will be conducted using the Microsoft Teams platform [57], to maintain consistency of format between each participant. The semi-structured interview guide will be oriented towards the interprofessional collaboration's experience in the process of patient engagement in the primary care clinic in the last 12 months in a telehealth context and was developed considering both conceptual frameworks [14,40]. We will begin the interview with an initial question: Tell me about your experience with your clinic's team of healthcare professionals during telehealth consultations in the last 12 months. The purpose of this initial question is to activate memories of the past, to enable the start of a conversation that will map the journey of these patients living with chronic disease and their experiences using telehealth [58,59]. The interview guide includes sub-questions to gather information on the patient's journey, as well as facilitators and barriers. The interview questionnaire will be customized as needed to capture the interprofessional collaboration experience of each patient living with chronic diseases in a telehealth context. As soon as consent to this study has been obtained, all recruited participants will be asked to complete a socio-demographic form covering their clinical and professional socio-demographic characteristics as supported by the conceptual frameworks. A logbook will also be used by the first author to record her field notes. Data analysis We will analyze the individual interviews qualitatively and iteratively using this specific method [60]. This method is useful for analysis by different people from interprofessional teams, including those with little experience in qualitative analysis [60]. This method of analysis comprises seven steps: 1) transcription; 2) familiarization with the data; 3) coding; 4) development of the analytical framework; 5) application of the analytical framework; 6) graphical representation of the data; and 7) interpretation of the data. Analysis of this project will be in the form of journey mapping to structure what will be expressed by patients. This analysis will also be carried out jointly with one patient partner, who will contribute to steps 4 and 7 [61]. Coding will be both inductive (based on respondents’ subjective experience) and semi-deductive (guided by the interprofessional collaboration theme domains of the FIPCCP model and the Montreal model) [14, 40, 62]. The first author will do the transcription (taking notes) during the interview process and may validate certain information with the patient during the interview [15, 60]. Next, the first author will ensure that the information is fully transcribed in cartographic format by listening to the interviews (step 1 of Gale et al., 2013). She will be responsible for familiarizing herself with the transcribed data, auditory data, and interview notes (step 2) while entering the information directly into the journey mapping. Mapping is a practical and visual method that can be used to support thinking about continuity of care, reducing waiting times and improving patient safety [45, 63]. The first author will then begin coding the data collected (step 3), thus initiating the mapping synthesis. Once the data has been coded, the research team, together with the patient partner, will meet to verify (co-code) the data (step 4). The research team will then apply the analysis frameworks to the collected and coded data (step 5). Following this analysis and synthesis, the student will produce a meta-synthesis of the graphic representations (journey mapping) of the data (step 6). She will be accompanied by one patient partner, and they will meet to finalize the analysis and interpretation of the data. At this stage, the team and patient partner will verify the data collected with the mapping synthesis. Throughout the analysis, the research team will use the two conceptual frameworks to guide them. In addition, particular attention will be given to equity criteria when analyzing according to the PROGRESS + model [64], but not limited to, since these can influence interprofessional collaboration, the use of technological tools and their functions, and the delivery of telehealth [65]. PROGRESS + is associated with diverse characteristics of the target population, ensuring their representation [64]. These criteria will be considered during the recruitment and at every stage of the project. All barriers and facilitators related to interprofessional collaboration should be retained as information to be analyzed and interpreted to describe the interprofessional collaboration process. The team will ensure that the interview and the information retained focus directly on the experience according to the interprofessional collaboration process and the patient engagement in the telehealth context. Limits and benefits This research possesses several notable strengths. Firstly, it adopts a patient-centred research approach [40] and collaborates with a patient partner, thereby ensuring the inclusion of perspectives and experiences of individuals directly affected by the health condition under investigation. Secondly, the use of journey mapping will offer a comprehensive understanding of the patient journey, particularly emphasizing the patient engagement experience of the interprofessional collaboration process, including its facilitators and barriers. This approach will enhance the knowledge transfer process and has the potential to positively influence primary care practice. Furthermore, this study will contribute to addressing a gap in the current literature concerning the patient perspective on interprofessional collaboration in the context of telehealth. Memory bias represents a significant limitation, as the intervention requires participants to recall information that may span 12 months [66]. However, the implementation of the pathway mapping approach serves as a method [46, 66] to re-engage memories, thereby mitigating this bias [58;59]. Another limitation of this study is that it was carried out only in U-FMGs. These teaching institutions are more supervised at the interprofessional collaboration level [15]. However, the team’s research expertise, having already conducted several qualitative studies with U-FMGs, as well as the approach used, allows us to reduce this bias and truly understand how the U-FMG context will influence the results and transferability. Discussion This study will better support and improve interprofessional collaboration in the context of telehealth using a patient-centred approach. Journey mapping will identify potential facilitating factors for improving primary care in telehealth settings, based on the patient’s pathway. Recommendations will be made to build a practical guide supporting interprofessional collaboration in the primary care telehealth context. Various strategies will be implemented by the research team to promote knowledge transfer and knowledge integration. Declarations Acknowledgements Not applicable Authors’ contributions M.M., M.-E.P., Y.C., I.G. and M.-D.P. are the principal co-investigators of the study and contributed to the study’s design and the protocol’s writing. M.-D.P. is a patient co-leader and contributed to all steps of the study. M.M. drafted the paper. M.-E.P., Y.C., I.G., and M.-D.P. improved and approved the manuscript. All authors reviewed the manuscript. Funding The work was supported by the CRMUS Chair in Optimal Professional Practices in Primary Care and the CHUS Research Centre’s Axe SPOP (research areas in health: populations, organization, practices). Availability of data and materials The datasets used and analyzed during the current study protocol are available from the corresponding author upon reasonable request. Ethics approval Prior to the study, the Ethics Committee at the Centre intégré Universitaire de santé et de services sociaux (CIUSSS) of Saguenay-Lac-Saint-Jean acted as the reviewer and granted ethics approval on May 9 th , 2024 (Project Number 2023-047). The project was also submitted and approved by the Ethics Committee of the Université de Sherbrooke’s Faculty of Education and Social Sciences on December 15, 2023 (Project Number 2023-4057), and the Vitality Health Network on January 13, 2024 (Project Number 101931). Written consent will be obtained for all study participants. At the beginning of each interview, the research team will explain the project, the expected participation, and the associated risks. The interview process and data collection will be explained. There will also be a question period. Following this introduction, written consent will be obtained. All research data will be coded anonymized and stored on a secured server; files will be stored in a password-coded folder on a computer from the CRMUS Chair Research. It is also important to note that our study will comply with ethical considerations, according to the Tri-Council Policy Statement: Research Ethics (2022) [67]. Consent for publication Not applicable Competing interests The authors declare that they have no competing interests. References World Health Organization. Primary Care. https://www.who.int/teams/integrated-health-services/clinical-services-and-systems/primary-care Public Health Agency of Canada. Chronic Diseases. [Internet]. 2022 [cited 2024 Feb 12]. https://www.canada.ca/en/public-health/services/chronic-diseases.html Boivin A, Flora L, Dumez V, L'espérance A, Berkesse A, Gauvin FP. Co-constructing health in partnership with patients and the public: history, approach and impacts of the “Montreal model.” La participation des patients. Paris: Éditions Dalloz, collection Normes Juridiques et Ethique Biomédicale; 2017. p. 11-23. Brodar KE, Hong N, Liddle M, Hernandez L, Waks J, Sanchez J, et al. Transitioning to Telehealth Services in a Pediatric Diabetes Clinic During COVID-19: An Interdisciplinary Quality Improvement Initiative. Journal of Clinical Psychology in Medical Settings. 2021;29:727-738. https://doi.org/10.1007/s10880-021-09830-z Gaboury I, Breton M, Perreault K, Bordeleau F, Descôteaux S, Maillet L, et al. Interprofessional advanced access - a quality improvement protocol for expanding access to primary care services. BMC Health Services Research. 2021;21:1-9. Breton M, Deville-Stoetzel N, Gaboury I, Smithman MA, Kaczorowski J, Lussier MT, et al. Telehealth in Primary Healthcare: A Portrait of its Rapid Implementation during the COVID‑19 Pandemic. Healthcare Policy = Politiques de santé. 2021;17(1):73-90. https://doi.org/10.12927/hcpol.2021.26576 Kiran, T., and O'Brien P. “Challenge of same-day access in primary care.” Canadian family physician Medecin de famille canadien vol. 61,5 (2015): 399-400, 407-9. N.B. Health Council. Access to primary health care. Graphical Summary - Access to Primary Health Care | New Brunswick Health Council (nbhc.ca); 2023. Donnelly C, Ashcroft R, Bobbette N, Mills C, Mofina A, Tran T, et al. Interprofessional primary care during COVID-19: a survey of the provider perspective. BMC Family Practice. 2021;22(1):31-31. https://doi.org/10.1186/s12875-020-01366-9 Manuel V, Bien-Aimé I, Boutot É, Dupuis JB, Johnson C. Timely access to primary care in New Brunswick: Variability across health regions. Canadian Family Physician / Le Médecin de famille canadien. 2023;69(3):e66-e72. https://doi.org/10.46747/cfp.6903e66 Wensing M, Kersnik J. Improving the quality of care for patients with chronic diseases: What research and education in family medicine can contribute. European Journal of General Practice 2012;18(4):238-41. https://doi.org/10.3109/13814788.2012.742059 Fortin M, Hudon C, Haggerty J, Akker Mv, Almirall J. Prevalence estimates of multimorbidity: a comparative study of two sources. BMC Health Services Research. 2010;10:111. https://doi.org/10.1186/1472-6963-10-111 Ministère de la Santé et des Services sociaux du Québec. Trousse portant sur l'identification des personnes à risque de vulnérabilité psychosociale. Gouvernement du Québec. 2020. p. 59. D’amour D, Oandasan I. Interprofessionality as the field of interprofessional practice and interprofessional education: An emerging concept. Journal of Interprofessional Care. 2005;19(sup1):8-20. The College of Family Physicians of Canada. Collaborer pour améliorer les soins : Un guide pratique pour les enseignants et les apprenants en médecine familiale. 2018. Collaborer pour améliorer les soins : Un guide pratique pour les enseignants et les apprenants en médecine familiale (cfpc.ca). Jiang H, Gomes P, Meer DV. Promoting continuity of care in nurse-patient assignment: A multiple objective heuristic algorithm. Decision Support Systems. 2023;167. https://doi.org/10.1016/j.dss.2023.113926 Canadian Medical Association. Continuity of care in the context of primary and episodic care. 2022. Reid R, Haggerty J, Mckendry R. Defusing the Confusion: Concepts and Measures of Continuity of Health Care. Réseau sur les innovations en soins de santé de première ligne et intégrés and Décary S. The impact of COVID-19 on primary care: innovations in research and practice in Quebec. 2020: Webinar August 25, 2020. Janjua S, Carter D, Threapleton CJ, Prigmore S, Disler RT. Telehealth interventions: remote monitoring and consultations for people with chronic obstructive pulmonary disease (COPD). The Cochrane Database of Systematic Reviews. 2021;7(7):CD013196. https://doi.org/10.1002/14651858.CD013196.pub2 Poitras M-E, Poirier MD, Couturier Y, et al. Chronic conditions patient’s perception of post-COVID-19 pandemic teleconsulting continuation in primary care clinics: a qualitative descriptive study. BMJ Open. 2022;12(12):e066871. Published Dec 15 2022. doi:10.1136/bmjopen-2022-066871 Allen M, Aylott M, Loyola M, Moric M, Saffarek L. Nurses: Extending Care through Telehealth. Studies in Health Technology and Informatics. 2015;208:35-39. https://doi.org/10.17265/1548-7709/2015.03.003 Jamieson K, Carvalho C, Macauley K, McMillan S, Shiels J, Sylvestre L, Joshi K, Chakravarthy S. Virtual Care in Canada: Lexicon. Digital Health Canada. 2020. Virtual-Care-National-Lexicon-v-JAN2521.pdf (digitalhealthcanada.com) Breton M, Sullivan EE, Deville-Stoetzel N, McKinstry D, DePuccio M, Sriharan A, et al. Telehealth challenges during COVID-19 as reported by primary healthcare physicians in Quebec and Massachusetts. BMC Family Practice. 2021;22(1):192. https://doi.org/10.1186/s12875-021-01543-4 Lemire F, Sisler J. Integrating virtual care in family practice. Canadian Family Physician. 2020;66(2):151. Peters GM, Kooij L, Lenferink A, van Harten WH, Doggen CJM. The Effect of Telehealth on Hospital Services Use: Systematic Review and Meta-analysis. Journal of Medical Internet Research. 2021;23(9):e25195. https://doi.org/10.2196/25195 Gajarawala SN, Pelkowski JN. Telehealth Benefits and Barriers. The Journal for Nurse Practitioners. 2021;17(2):218-221. Poitras ME, Couturier Y, Beaupré P, Girard A, Aubry F, Vaillancourt VT, et al. Collaborative practice competencies needed for telehealth delivery by health and social care professionals: a scoping review. Journal of Interprofessional Care. 2023:1-15. Hardcastle L, Ogbogu U. Virtual care: Enhancing access or harming care? Healthcare Management Forum. 2020;33(6):288-292. https://doi.org/10.1177/0840470420938818 Chang JE, Lai AY, Gupta A, Nguyen AM, Berry CA, Shelley DR. Rapid Transition to Telehealth and the Digital Divide: Implications for Primary Care Access and Equity in a Post-COVID Era. The Milbank Quarterly. 2021;99(2):340-368. Lieneck C, Garvey J, Collins C, Graham D, Loving C, Pearson R. Rapid Telehealth Implementation during the COVID-19 Global Pandemic: A Rapid Review. Healthcare (Basel, Switzerland). 2020;8(4):517. https://doi.org/10.3390/healthcare8040517 Smith AC, Thomas E, Snoswell CL, et al. Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). J Telemed Telecare . 2020;26(5):309-313. doi:10.1177/1357633X20916567 Falk W. The State of Virtual Care in Canada as of Wave Three of the COVID-19 Pandemic. An Early Diagnostique and Policy Recommendations. 2021;95. Hafner M, Yerushalmi E, Dufresne E, Gkousis E. The potential socio-economic impact of telemedicine in Canada. RAND Health Quarterly. 2021. Agarwal P, Wang R, Meaney C, et al. Sociodemographic differences in patient experience with primary care during COVID-19: results from a cross-sectional survey in Ontario, Canada. BMJ Open. 2022;12(5):e056868. https://doi.org/10.1136/bmjopen-2021-056868 Arnaert A, Girard A, Craciunas S, Shang Z, Ahmad H, Debe Z, et al. Patients’ experiences of telenursing follow-up care after bariatric surgery. Journal of Clinical Nursing. 2022;31(7-8):985-994. https://doi.org/10.1111/jocn.15955 Phimphasone-Brady P, Chiao J, Karamsetti L, Sieja A, Johnson R, Macke L, et al. Clinician and staff perspectives on potential disparities introduced by the rapid implementation of telehealth services during COVID-19: a mixed-methods analysis. Translational Behavioral Medicine. 2021;11(7):1339-1347. https://doi.org/10.1093/tbm/ibab060 Catalyst NEJM. What is Patient-Centered Care? NEJM Catalyst. 2017;3(1). Alami H, Gagnon M, Fortin J. Organizational and systemic conditions at citizen-patient involvement in the development of telehealth in Quebec. Santé Publique. 2019;31:125-135. https://doi.org/10.3917/spub.191.0125 Boivin A, Lehoux P, Lacombe R, Burgers J, Grol R. Involving patients in setting priorities for healthcare improvement: a cluster randomized trial. Implementation Science: IS. 2014;9:24. https://doi.org/10.1186/1748-5908-9-24 Pomey MP, Flora L, Karazivan P, Dumez V, Lebel P, Vanier MC, et al. Le “Montreal model”: enjeux du partenariat relationnel entre patients et professionnels de la santé [The Montreal model: the challenges of a partnership relationship between patients and healthcare professionals]. Santé Publique (Vandœuvre-lès-Nancy, France). 2015;27(1 Suppl):S41-S50. Government of Canada. [Internet]. 2022. Facilitating Research - CIHR (cihr-irsc.gc.ca) Canadian Institutes of Health Research. Strategy for Patient-Oriented Research, Patient Engagement Framework. January 2014. Guba EG, Lincoln YS. Fourth Generation Evaluation. London: Sage; 1989. Guba EG, Lincoln YS. Competing Paradigms in Qualitative Research. In: Denzin N, Lincoln Y, editors. The Landscape of Qualitative Research. London: Sage; 1998. p. 195-220. Trebble TM, Hansi N, Hydes T, Smith MA, Baker M. Process mapping the patient journey: an introduction. BMJ (Clinical research ed.). 2010;341:c4078. https://doi.org/10.1136/bmj.c4078 Davies EL, Bulto LN, Walsh A, Pollock D, Langton VM, Laing RE, et al. Reporting and conducting patient journey mapping research in healthcare: A scoping review. Journal of Advanced Nursing. 2022;79(1):83-100. Government of Quebec. Family medicine group (FMG), University family medicine group (U-FMG) and super-clinic (A/N-FMG). Groupe de médecine de famille (GMF), groupe de médecine de famille universitaire (GMF‑U) et super-clinique (GMF-A et GMF-R). Gouvernement du Québec; 2023. Breton M., et al. "L’implantation du modèle des groupes de médecine de famille au Québec : potentiel et limites pour l’accroissement de la performance des soins de santé primaires." Pratiques et organisation des soins 2. 2011): 101-109. Frey B. The SAGE Encyclopedia of Educational Research, Measurement, and Evaluation Vol. 4. Thousand Oaks, CA: SAGE Publications, Inc.; 2018. doi:10.4135/9781506326139 Fortin M-F, Gagnon J. Fondements et étapes du processus de recherche. Montréal, Québec: Chenelière éducation; 2022. Government of Canada. Canadian Chronic Disease Surveillance System Report: Heart Disease in Canada, 2018. Ottawa: A.d.l.s.p.d. Canada; 2018. Taherdoost H. Sampling Methods in Research Methodology; How to Choose a Sampling Technique for Research (April 10, 2016). https://ssrn.com/abstract=3205035 or http://dx.doi.org/10.2139/ssrn.3205035 Creswell JW, Creswell JD. Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. Sage, Los Angeles; 2018. Saunders B, Sim J, Kingstone T, et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Quality & Quantity. 2018;52(4):1893-1907. doi:10.1007/s11135-017-0574-8 Guest G, Bunce A, Johnson L. How Many Interviews are Enough?: An Experiment with Data Saturation and Variability. Field Methods, 18(1). 2006. 59-82. Wang CC, Geale SK. The power of story: Narrative inquiry as a methodology in nursing research. International Journal of Nursing Sciences. 2015;2(2):195-198. https://doi.org/10.1016/j.ijnss.2015.04.014 Sah LK, Singh DR, Sah RK. Conducting Qualitative Interviews using Virtual Communication Tools amid COVID-19 Pandemic: A Learning Opportunity for Future Research. JNMA: Journal of the Nepal Medical Association. 2020;58(232):1103. https://doi.org/10.31729/jnma.5738 Bearnot B, Mitton JA. “You’re always jumping through hoops”: journey mapping the care experiences of individuals with opioid use disorder-associated endocarditis. Journal of Addiction Medicine. 2020;14(6):494. Kushniruk AW, Borycki EM, Parush A. A case study of patient journey mapping to identify gaps in healthcare: Learning from experience with cancer diagnosis and treatment. Knowledge Management & E-Learning: An International Journal. 2020;12(4):405. Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology. 2013;13:117. https://doi.org/10.1186/1471-2288-13-117 Poitras M-E, Godbout I, T Vaillancourt V, Débarges B, Poirier A, Prévost K, et al. Step-by-step Strategies for an Integrated Patient-Oriented Research: Lessons Learned from a Multicentered Study. Science of Nursing and Health Practices / Science infirmière et pratiques en santé. 2020;3(2):1-9. https://doi.org/10.31770/2561-7516.1068 Bingham AJ, Witkowsky P. Deductive and inductive approaches to qualitative data analysis. In: Vanover C, Mihas P, Saldaña J, editors. Analyzing and interpreting qualitative data: After the interview. SAGE Publications; 2022. p. 133-146. Borycki EM, Kushniruk AW, Wagner E, Kletke R. Patient journey mapping: Integrating digital technologies into the journey. Knowledge Management & E-Learning: An International Journal. 2020;12(4):521-535. https://go.openathens.net/redirector/umoncton.ca?url=https://www.proquest.com/scholarly-journals/patient-journey-mapping-integrating-digital/docview/2509652843/se-2. O’Neill J, Tabish H, Welch V, Petticrew M, Pottie K, Clarke M, et al. Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health. Journal of Clinical Epidemiology. 2014;67(1):56-64. https://doi.org/10.1016/j.jclinepi.2013.08.005 Darrat I, Tam S, Boulis M, Williams AM. Socioeconomic Disparities in Patient Use of Telehealth During the Coronavirus Disease 2019 Surge. JAMA Otolaryngology-Head & Neck Surgery. 2021;147(3):287-295. https://doi.org/10.1001/jamaoto.2020.5161 Carter-Harris L. (2015). An introduction to key event mapping: A primer for nurse researchers. Applied Nursing Research: ANR, 28(2), 83–85. https://doi.org/10.1016/j.apnr.2015.01.003 Government of Canada [Internet]. 2022. TCPS2-2022-Word-dec-19-2022-en_Left alignment_without index_table of contents (clean) (ethics.gc.ca) Additional Declarations No competing interests reported. Supplementary Files SupplementaryfileMcgrawetal.2024.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4472719","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Study protocol","associatedPublications":[],"authors":[{"id":311786617,"identity":"35c7ddfd-95c9-429b-86f4-f35293dc921f","order_by":0,"name":"Monica Mcgraw","email":"","orcid":"","institution":"Université de Sherbrooke","correspondingAuthor":false,"prefix":"","firstName":"Monica","middleName":"","lastName":"Mcgraw","suffix":""},{"id":311786618,"identity":"2b13e088-e567-4d9f-9eef-6d67d7e7a483","order_by":1,"name":"Yves Couturier","email":"","orcid":"","institution":"Université de Sherbrooke","correspondingAuthor":false,"prefix":"","firstName":"Yves","middleName":"","lastName":"Couturier","suffix":""},{"id":311786619,"identity":"0a3b8e97-de18-4314-9029-9594ef7a6fd7","order_by":2,"name":"Isabelle Gaboury","email":"","orcid":"","institution":"Université de Sherbrooke","correspondingAuthor":false,"prefix":"","firstName":"Isabelle","middleName":"","lastName":"Gaboury","suffix":""},{"id":311786620,"identity":"78065784-e0a6-4ddf-99ac-7c9d8a5bdaaa","order_by":3,"name":"Marie-Dominique Poirier","email":"","orcid":"","institution":"CRMUS-Research Chair in Optimal Professional Practices in Primary Care","correspondingAuthor":false,"prefix":"","firstName":"Marie-Dominique","middleName":"","lastName":"Poirier","suffix":""},{"id":311786621,"identity":"aecab7de-857c-45d9-8157-effbc4f9b06f","order_by":4,"name":"Marie-Eve Poitras","email":"data:image/png;base64,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","orcid":"","institution":"Université de Sherbrooke","correspondingAuthor":true,"prefix":"","firstName":"Marie-Eve","middleName":"","lastName":"Poitras","suffix":""}],"badges":[],"createdAt":"2024-05-24 13:21:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4472719/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4472719/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":81705303,"identity":"7b9a7ea1-d3ff-4d2e-81b0-ac46dc3993a2","added_by":"auto","created_at":"2025-04-30 13:23:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":499212,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4472719/v1/b9aa8a70-d8c4-48bd-abe2-6ab2731ae11a.pdf"},{"id":58177895,"identity":"a5a656b6-4587-4d2c-a93b-a9db9d01b03c","added_by":"auto","created_at":"2024-06-12 05:24:23","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":1897353,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryfileMcgrawetal.2024.docx","url":"https://assets-eu.researchsquare.com/files/rs-4472719/v1/178ff2a607bc116487c05016.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Experience of Interprofessional Collaboration in a Telehealth Context in Primary Care: The Perspective of Patients Living with a Chronic Illness – A Research Protocol","fulltext":[{"header":"Background","content":"\u003cp\u003eChronic disease is recognized as a long-term, persistent, mostly non-communicable condition requiring ongoing management [1]. In Canada, 44% of adults aged 20 and over live with chronic diseases [2]. This percentage increases significantly with age [2]. Over 4.9 million (73%) Canadians over 65 live with at least one chronic disease. For patients living with chronic diseases, access to primary care is an essential element contributing to their continuity of care and patient engagement [1,3,4]. However, the lack of access to primary care does not promote efficient chronic disease management or active engagement of people living with chronic disease [5,6] and, ultimately, to their health [7,8]. The COVID-19 pandemic has amplified the delay in accessing primary care [9, 10].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVarious publications describe patients living with chronic disease as those who consult primary care most frequently [1,11]. These receive regular interprofessional follow up by the primary care nurse, family doctor, pharmacist, social worker, etc.) [12,13]. This interprofessional necessity of chronic disease management and the need to provide optimal professional care implies that each professional involved must apply the recommended interprofessional practice standards [14,15]. Interprofessional collaboration is defined as the process by which professionals from different disciplines develop modalities of practice that provide a coherent, integrated response to the needs of the individual, their loved ones, and the community\u0026nbsp;[14].\u003c/p\u003e\n\u003cp\u003eThe\u0026nbsp;evolving and multidimensional nature of the chronic disease situation creates challenges that can affect the quality of care offered to patients. For example, patients who consult different healthcare professionals must often repeat their medical history due to sub-optimal interprofessional collaboration among team members in the same work environment [6,16,17]. This lack of communication directly affects relational continuity, i.e., the sharing of information from previous events and circumstances, to ensure that care is appropriate to the individual and his or her problem [18]. Patients living with chronic disease may also perceive contradictory recommendations from different professionals, which undermines their potential for self-management\u0026nbsp;[19].\u0026nbsp;These challenges highlight the importance of establishing clear patient pathways within interprofessional teams, ensuring that information is shared efficiently and that the continuity of care is coordinated effectively, especially in a telehealth context\u0026nbsp;[16,18].\u0026nbsp;During a well-established interprofessional collaboration, another way to improve the quality of care is to offer care with the support of telehealth to increase access\u0026nbsp;[20,21]. Telehealth is defined as \u0026quot;any interaction between a patient and a healthcare professional that takes place at a distance and uses some form of information or communication technology (i.e., telephone, e-mail, SMS, videoconferencing platform, electronic medical record (EMR)\u0026quot; [22].\u0026nbsp;In several Canadian provinces, telehealth is being used to better meet patient needs, such as accessibility to care [6,23]. Some studies point out that Canadians want to maintain access to telehealth consultations post-pandemic, mainly because of the time saved on travel and improved access to an appointment [24].\u0026nbsp;This consultation modality not only increases accessibility but also reduces the costs associated with care for the healthcare system when used optimally and appropriately [25, 26].\u0026nbsp;For healthcare professionals and the healthcare system, proper use of telehealth facilitates communication between healthcare professionals, which ultimately promotes interprofessional collaboration [4,20,27]. Despite the benefits of telehealth, it can have negative effects on patient health if used suboptimal or inappropriately [19,20], affecting interprofessional collaboration and the quality of patient engagement [24, 28].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe use of telehealth has accelerated in recent years, not only because of the pandemic [29, 30], but also to support access to care in certain more remote regions [31]. The scientific literature affirms that telehealth should continue to exist because of its ability to increase accessibility to care for patients and because of its positive impact on adapting the healthcare system to the demographic transition [6,20,32,33]. Although telehealth offers many advantages and is appreciated by patients and professionals alike [34, 35], some studies point to the importance of further adapting this service modality to the needs of patients living with chronic diseases (ex: video-assisted telehealth for older patients due to digital literacy, patients with technological challenges, etc.). Other studies emphasize that to achieve positive effects for patients, it is essential to support professionals and patients in their appropriation of this intervention modality and to promote the maintenance of interprofessional collaboration despite the remote work/care context [36]. This is because telehealth is often used without a defined framework and left to the discretion of each care setting [6, 17, 36]. Telehealth implemented without a clear framework (i.e., tools, work procedures, etc.) for primary care increases work overload and stress for professionals [13,27,30]. Including the perspective of patients living with chronic diseases remains crucial and essential to guide professionals in keeping telehealth, and interprofessional collaboration responsive to their needs [15,20]. The patient perspective helps improve health outcomes for individuals and increases patient satisfaction, confidence, and engagement in their health [37]. To date, however, the patient perspective of the interprofessional collaboration process, including patient engagement living with chronic disease in a telehealth context is still under-researched [38, 39]. The Montreal Model, the Canadian Institutes of Health Research (CIHR) and Strategy for Patient-Oriented Research (SPOR) also support this approach to integrating patient partners into the research team [40,41,42]. \u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eAim and objectives \u003c/h3\u003e\n\u003cp\u003eThis study will aim to understand patients\u0026apos; engagement experience in the process of interprofessional collaboration in a primary care telehealth setting, considering patient engagement. To achieve this aim, this research project has three specific objectives:\u0026nbsp;\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003edescribe the telehealth\u0026nbsp;interprofessional collaboration\u0026nbsp;process in primary care, from the perspective of patients living with chronic disease;\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eidentify, in collaboration with patients living with chronic disease, the barriers and facilitators in this process;\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eunderstand how these patients are engaged in the interprofessional collaboration process in a telehealth context.\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Conceptual framework","content":"\u003cp\u003eTwo conceptual frameworks will be used to structure this study. To enrich the understanding of patient engagement regarding the interprofessional collaboration process, the interprofessional collaboration -related domains of the Interprofessional Education for Collaborative Patient-Centred Practice (IECPCP) model will be used for this project [14]. This model of interprofessional collaboration is patient-centred, intending to improve patient outcomes. In this model, the process is divided into four dimensions: 1) governance; 2) rules to structure the team; 3) shared goals and vision; and 4) sense of belonging [14].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo adequately include the dimension of patient-centered care and the importance of patient engagement, the Montreal Model [40] also be used. This model is widely used to support patient engagement throughout the interprofessional collaboration process regarding their health condition, including the management of chronic diseases [40]. The patient\u0026apos;s voice is considered on an equal footing with other stakeholders in the primary healthcare team. What\u0026apos;s more, the patient can also be accompanied by a care giver to better express his or her experience [40]. Ultimately, this model relies on patients\u0026apos; experiential knowledge, enabling them to make informed decisions and exercise leadership at the same level as healthcare professionals [40]. The direct care delivery section is a logical level of the model that refers to interactions between professionals and patients [40]. It provides an understanding of the level of engagement between professionals and patients at the clinical level. In addition, the telehealth context will be highlighted in the consultation section of the Montreal model, where the patient must have had a telehealth consultation [40]. Finally, the components present in this model will support our understanding of the phenomenon of patient engagement living with chronic diseases in a telehealth context.\u003c/p\u003e"},{"header":"Methods/design","content":"\u003cp\u003eThe focus of the study is to better understand patient. This study therefore includes one patient partner in the research team. Meetings were held with the patient partner and the research team to develop the study protocol, interview guide and mapping template. This approach is based on the recommendations of Pomey\u0026nbsp;[40]\u0026nbsp;conceptual framework for patient engagement in research.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis qualitative research is based on a constructivist research methodology, where the research team constructs knowledge from the interpretation of information obtained during dialogues with participants [43,44]. To meet the study\u0026apos;s objectives, a qualitative Journey Mapping data collection will be carried out, following the approach of Trebbel et al. \u0026nbsp;[45]. This method enables users (in this case, patients living with chronic diseases) to be involved early on and throughout the mapping development process. Pathway mapping in telehealth allows us to delineate the patient journey, detailing their engagement and experiences with telehealth services at the primary care level. This approach helps identify areas for enhancing the quality of patient care. This approach also places the patient at the center of the research to better understand and improve the process of interprofessional collaboration [46]. It also allows us to identify the points of contact between patients and professionals, during the telehealth consultation process (i.e., method of communication; pathway to an appointment; and others) based on patient\u0026apos;s expressed or unexpressed needs [45]. This type of approach provides a better understanding of elements starting from service entry, navigation, and ongoing experience, right through to patient discharge from the healthcare system [46].\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eStudy population\u003c/h2\u003e\n\u003cp\u003eThe target population is all adult patients living with chronic diseases who have consulted virtually a primary care clinic in which different healthcare professionals practice collaboratively (i.e. presence of communication channels, alternating care plan already established).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe settings studied for this research will be university primary care clinics such as Family medicine units (U-FMGS). The U-FMGS (i.e., a grouping of family physicians who work together and in close collaboration with other health and social services professionals - Government of Quebec (2023) [47] is the main model of primary care services in Quebec [13,48]. Some FMGs are affiliated with universities and integrate the training of family medicine residents and externs. These primary care clinics are then called U-FMGS. This study will focus on U-FMGS clinics, as many healthcare professionals work in interprofessional teams (i.e. physicians, nurses, social workers, pharmacists, etc.) and practice telehealth.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eSampling and recruitment strategy\u003c/h2\u003e\n\u003cp\u003eWe will use a purposive sampling to provide a diverse description of telehealth\u0026nbsp;interprofessional collaboration\u0026nbsp;experiences in primary care [49,50].\u0026nbsp;This type of purposive sampling allows the research team to recruit subjects who meet specific inclusion criteria and are representative of the phenomenon under study [50]. We will strategically select research sites and sampling methods based on their perceived richness and utility in providing comprehensive insights into the phenomenon under investigation [51]. The literature also points to other important strengths such as lower cost, convenience, and the fact that it takes less time to undertake [52].\u0026nbsp;A two-tiered recruitment will be carried out, namely the development of a partnership with U-FMGSs and subsequently the direct recruitment of patients from partner U-FMGSs. This partnership will enable the team to recruit two U-FMGSs. These U-FMGSs will be recruited face-to-face, to enable us to develop a relationship of trust between the research team and the U-FMGS administration from the outset. From the very first meeting, the team will ensure the existence of an\u0026nbsp;interprofessional collaboration\u0026nbsp;process (presence of communication channels, alternating care plans already established) as well as a French- or English-speaking clientele and the presence of telehealth consultations for patients. Once the U-FMGS has been selected, the research team and U-FMGS managers will work together to ensure adequate patient recruitment. Posters will be placed in waiting rooms with information relevant to the study, to solicit participation from the target population. The research team aims to reach at least 30 participants [53]. The final sample will be determined according to data saturation [54, 55]. Guest et al., (2006) define this form of saturation when data tend to be redundant concerning data already collected\u0026nbsp;[55]. This data analysis will be carried out on an ongoing basis throughout the data collection process, to check for redundant information. For example, when the research team begins to hear the same comments repeatedly, using a saturation grid as a method of keeping track of this redundancy. This will enable them to stop collecting data and start analyzing it.\u003c/p\u003e\n\u003cp\u003eAs inclusion criteria, adult participants will have to declare that\u0026nbsp;they live with at least two chronic diseases that are recognized by the Public Health Agency of Canada, (2022) and have consulted at least three times in the last year in the participating clinic, having at least one of the three appointments in a telehealth context. Selected patients must have consulted the primary care clinic in connection with their chronic diseases. Recruitment from this population is justified by a higher likelihood of having had\u0026nbsp;interprofessional collaboration experiences in a telehealth setting due to the need to maintain follow-ups in primary care [23,51].\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eCollecting data\u003c/h2\u003e\n\u003cp\u003eWe will be collecting data in the format of a journey mapping through a maximum of 90-minute semi-structured interviews describing patient engagement in interprofessional collaboration from the perspective of patients living with chronic diseases [50,56]. \u0026nbsp;These interviews will be conducted in either French or English, depending on patient preference. This type of interview leaves the researcher free to simply ask a question or several questions from a predetermined list, depending on the direction of the dialogue. This type of interview allows the patient\u0026apos;s experience to emerge. Due to the geographical distance between the researcher/interviewer researcher and the potential U-FMGSs, for the advantage and flexibility of the patient, the interviews will be conducted using the Microsoft Teams platform [57], to maintain consistency of format between each participant.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe semi-structured interview guide will be oriented towards the interprofessional collaboration\u0026apos;s experience in the process of patient engagement in the primary care clinic in the last 12 months in a telehealth context and was developed considering both conceptual frameworks [14,40]. We will begin the interview with an initial question: \u003cem\u003eTell me about your experience with your clinic\u0026apos;s team of healthcare professionals during telehealth consultations\u0026nbsp;\u003c/em\u003e\u003cem\u003ein the\u0026nbsp;\u003c/em\u003e\u003cem\u003elast 12 months.\u0026nbsp;\u003c/em\u003eThe purpose of this initial question is to activate memories of the past, to enable the start of a conversation that will map the journey of these patients living with chronic disease and their experiences using telehealth [58,59]. The interview guide includes sub-questions to gather information on the patient\u0026apos;s journey, as well as facilitators and barriers. The interview questionnaire will be customized as needed to capture the interprofessional collaboration experience of each patient living with chronic diseases in a telehealth context.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs soon as consent to this study has been obtained, all recruited participants will be asked to complete a socio-demographic form covering their clinical and professional socio-demographic characteristics as supported by the conceptual frameworks. A logbook will also be used by the first author to record her field notes. \u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eData analysis\u003c/h2\u003e\n\u003cp\u003eWe will analyze the individual interviews qualitatively and iteratively using this specific method\u0026nbsp;[60]. This method is useful for analysis by different people from interprofessional teams, including those with little experience in qualitative analysis\u0026nbsp;[60]. This method of analysis comprises seven steps: 1) transcription; 2) familiarization with the data; 3) coding; 4) development of the analytical framework; 5) application of the analytical framework; 6) graphical representation of the data; and 7) interpretation of the data. Analysis of this project will be in the form of journey mapping to structure what will be expressed by patients. This analysis will also be carried out jointly with one patient partner, who will contribute to steps 4 and 7\u0026nbsp;[61]. Coding will be both inductive (based on respondents\u0026rsquo; subjective experience) and semi-deductive (guided by the\u0026nbsp;interprofessional collaboration\u0026nbsp;theme domains of the FIPCCP model and the Montreal model)\u0026nbsp;[14, 40, 62].\u003c/p\u003e\n\u003cp\u003eThe first author will do the transcription (taking notes) during the interview process and may validate certain information with the patient during the interview [15, 60]. Next, the first author will ensure that the information is fully transcribed in cartographic format by listening to the interviews (step 1 of Gale et al., 2013). She will be responsible for familiarizing herself with the transcribed data, auditory data, and interview notes (step\u0026nbsp;2) while entering the information directly into the journey mapping. Mapping is a practical and visual method that can be used to support thinking about continuity of care, reducing waiting times and improving patient safety [45, 63].\u003c/p\u003e\n\u003cp\u003eThe first author will then begin coding the data collected (step 3), thus initiating the mapping synthesis. Once the data has been coded, the research team, together with the patient partner, will meet to verify (co-code) the data (step 4). The research team will then apply the analysis frameworks to the collected and coded data (step 5). Following this analysis and synthesis, the student will produce a meta-synthesis of the graphic representations (journey mapping) of the data (step 6). She will be accompanied by one patient partner, and they will meet to finalize the analysis and interpretation of the data. At this stage, the team and patient partner will verify the data collected with the mapping synthesis. Throughout the analysis, the research team will use the two conceptual frameworks to guide them. In addition, particular attention will be given to equity criteria when analyzing according to the PROGRESS + model [64], but not limited to, since these can influence interprofessional collaboration, the use of technological tools and their functions, and the delivery of telehealth [65]. PROGRESS + is associated with diverse characteristics of the target population, ensuring their representation [64]. These criteria will be considered during the recruitment and at every stage of the project.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll barriers and facilitators related to interprofessional collaboration should be retained as information to be analyzed and interpreted to describe the interprofessional collaboration process. The team will ensure that the interview and the information retained focus directly on the experience according to the interprofessional collaboration process and the patient engagement in the telehealth context.\u003c/p\u003e\n\u003ch2\u003eLimits and benefits\u003c/h2\u003e\n\u003cp\u003eThis research possesses several notable strengths. Firstly, it adopts a patient-centred research approach [40] and collaborates with a patient partner, thereby ensuring the inclusion of perspectives and experiences of individuals directly affected by the health condition under investigation. Secondly, the use of journey mapping will offer a comprehensive understanding of the patient journey, particularly emphasizing the patient engagement experience of the interprofessional collaboration process, including its facilitators and barriers. This approach will enhance the knowledge transfer process and has the potential to positively influence primary care practice. Furthermore, this study will contribute to addressing a gap in the current literature concerning the patient perspective on interprofessional collaboration in the context of telehealth.\u003c/p\u003e\n\u003cp\u003eMemory bias represents a significant limitation, as the intervention requires participants to recall information that may span 12 months [66]. However, the implementation of the pathway mapping approach serves as a method [46, 66] to re-engage memories, thereby mitigating this bias [58;59]. Another limitation of this study is that it was carried out only in U-FMGs. These teaching institutions are more supervised at the interprofessional collaboration level [15]. However, the team\u0026rsquo;s research expertise, having already conducted several qualitative studies with U-FMGs, as well as the approach used, allows us to reduce this bias and truly understand how the U-FMG context will influence the results and transferability. \u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study will better support and improve interprofessional collaboration in the context of telehealth using a patient-centred approach. Journey mapping will identify potential facilitating factors for improving primary care in telehealth settings, based on the patient\u0026rsquo;s pathway. Recommendations will be made to build a practical guide supporting interprofessional collaboration in the primary care telehealth context. Various strategies will be implemented by the research team to promote knowledge transfer and knowledge integration.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAuthors\u0026rsquo; contributions\u003c/h2\u003e\n\u003cp\u003eM.M., M.-E.P., Y.C., I.G. and M.-D.P. are the principal co-investigators of the study and contributed to the study\u0026rsquo;s design and the protocol\u0026rsquo;s writing. M.-D.P. is a patient co-leader and contributed to all steps of the study. M.M. drafted the paper. M.-E.P., Y.C., I.G., and M.-D.P. improved and approved the manuscript.\u0026nbsp;All authors reviewed the manuscript.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThe work was supported by the CRMUS Chair in Optimal Professional Practices in Primary Care and the CHUS Research Centre\u0026rsquo;s Axe SPOP (research areas in health: populations, organization, practices).\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eThe datasets used and analyzed during the current study protocol are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003ch2\u003eEthics approval\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003ePrior to the study, the Ethics Committee at the Centre int\u0026eacute;gr\u0026eacute; Universitaire de sant\u0026eacute; et de services sociaux (CIUSSS) of Saguenay-Lac-Saint-Jean acted as the reviewer and granted ethics approval on May 9\u003csup\u003eth\u003c/sup\u003e, 2024 (Project Number 2023-047). The project was also submitted and approved by the Ethics Committee of the Universit\u0026eacute; de Sherbrooke\u0026rsquo;s Faculty of Education and Social Sciences on December 15, 2023 (Project Number 2023-4057), and the Vitality Health Network on January 13, 2024 (Project Number 101931). Written consent will be obtained for all study participants. At the beginning of each interview, the research team will explain the project, the expected participation, and the associated risks. The interview process and data collection will be explained. There will also be a question period. Following this introduction, written consent will be obtained. All research data will be coded anonymized and stored on a secured server; files will be stored in a password-coded folder on a computer from the CRMUS Chair Research. It is also important to note that our study will comply with ethical considerations, according to the Tri-Council Policy Statement: Research Ethics (2022) [67].\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWorld Health Organization. Primary Care. https://www.who.int/teams/integrated-health-services/clinical-services-and-systems/primary-care\u003c/li\u003e\n \u003cli\u003ePublic Health Agency of Canada. Chronic Diseases. [Internet]. 2022 [cited 2024 Feb 12]. https://www.canada.ca/en/public-health/services/chronic-diseases.html\u003c/li\u003e\n \u003cli\u003eBoivin A, Flora L, Dumez V, L\u0026apos;esp\u0026eacute;rance A, Berkesse A, Gauvin FP. Co-constructing health in partnership with patients and the public: history, approach and impacts of the \u0026ldquo;Montreal model.\u0026rdquo; La participation des patients. Paris: \u0026Eacute;ditions Dalloz, collection Normes Juridiques et Ethique Biom\u0026eacute;dicale; 2017. p. 11-23.\u003c/li\u003e\n \u003cli\u003eBrodar KE, Hong N, Liddle M, Hernandez L, Waks J, Sanchez J, et al. Transitioning to Telehealth Services in a Pediatric Diabetes Clinic During COVID-19: An Interdisciplinary Quality Improvement Initiative. Journal of Clinical Psychology in Medical Settings. 2021;29:727-738. https://doi.org/10.1007/s10880-021-09830-z\u003c/li\u003e\n \u003cli\u003eGaboury I, Breton M, Perreault K, Bordeleau F, Desc\u0026ocirc;teaux S, Maillet L, et al. Interprofessional advanced access - a quality improvement protocol for expanding access to primary care services. BMC Health Services Research. 2021;21:1-9.\u003c/li\u003e\n \u003cli\u003eBreton M, Deville-Stoetzel N, Gaboury I, Smithman MA, Kaczorowski J, Lussier MT, et al. Telehealth in Primary Healthcare: A Portrait of its Rapid Implementation during the COVID‑19 Pandemic. Healthcare Policy = Politiques de sant\u0026eacute;. 2021;17(1):73-90. https://doi.org/10.12927/hcpol.2021.26576\u003c/li\u003e\n \u003cli\u003eKiran, T., and O\u0026apos;Brien P. \u0026ldquo;Challenge of same-day access in primary care.\u0026rdquo; \u003cem\u003eCanadian family physician Medecin de famille canadien\u003c/em\u003e vol. 61,5 (2015): 399-400, 407-9.\u003c/li\u003e\n \u003cli\u003eN.B. Health Council. Access to primary health care. Graphical Summary - Access to Primary Health Care | New Brunswick Health Council (nbhc.ca); 2023.\u003c/li\u003e\n \u003cli\u003eDonnelly C, Ashcroft R, Bobbette N, Mills C, Mofina A, Tran T, et al. Interprofessional primary care during COVID-19: a survey of the provider perspective. BMC Family Practice. 2021;22(1):31-31. https://doi.org/10.1186/s12875-020-01366-9\u003c/li\u003e\n \u003cli\u003eManuel V, Bien-Aim\u0026eacute; I, Boutot \u0026Eacute;, Dupuis JB, Johnson C. Timely access to primary care in New Brunswick: Variability across health regions. Canadian Family Physician / Le M\u0026eacute;decin de famille canadien. 2023;69(3):e66-e72. https://doi.org/10.46747/cfp.6903e66\u003c/li\u003e\n \u003cli\u003eWensing M, Kersnik J. Improving the quality of care for patients with chronic diseases: What research and education in family medicine can contribute. European Journal of General Practice 2012;18(4):238-41. https://doi.org/10.3109/13814788.2012.742059\u003c/li\u003e\n \u003cli\u003eFortin M, Hudon C, Haggerty J, Akker Mv, Almirall J. Prevalence estimates of multimorbidity: a comparative study of two sources. BMC Health Services Research. 2010;10:111. https://doi.org/10.1186/1472-6963-10-111\u003c/li\u003e\n \u003cli\u003eMinist\u0026egrave;re de la Sant\u0026eacute; et des Services sociaux du Qu\u0026eacute;bec. Trousse portant sur l\u0026apos;identification des personnes \u0026agrave; risque de vuln\u0026eacute;rabilit\u0026eacute; psychosociale. Gouvernement du Qu\u0026eacute;bec. 2020. p. 59.\u003c/li\u003e\n \u003cli\u003eD\u0026rsquo;amour D, Oandasan I. Interprofessionality as the field of interprofessional practice and interprofessional education: An emerging concept. Journal of Interprofessional Care. 2005;19(sup1):8-20.\u003c/li\u003e\n \u003cli\u003eThe College of Family Physicians of Canada. Collaborer pour am\u0026eacute;liorer les soins : Un guide pratique pour les enseignants et les apprenants en m\u0026eacute;decine familiale. 2018. Collaborer pour am\u0026eacute;liorer les soins : Un guide pratique pour les enseignants et les apprenants en m\u0026eacute;decine familiale (cfpc.ca).\u003c/li\u003e\n \u003cli\u003eJiang H, Gomes P, Meer DV. Promoting continuity of care in nurse-patient assignment: A multiple objective heuristic algorithm. Decision Support Systems. 2023;167. https://doi.org/10.1016/j.dss.2023.113926\u003c/li\u003e\n \u003cli\u003eCanadian Medical Association. Continuity of care in the context of primary and episodic care. 2022.\u003c/li\u003e\n \u003cli\u003eReid R, Haggerty J, Mckendry R. Defusing the Confusion: Concepts and Measures of Continuity of Health Care. R\u0026eacute;seau sur les innovations en soins de sant\u0026eacute; de premi\u0026egrave;re ligne et int\u0026eacute;gr\u0026eacute;s and D\u0026eacute;cary S. The impact of COVID-19 on primary care: innovations in research and practice in Quebec. 2020: Webinar August 25, 2020.\u003c/li\u003e\n \u003cli\u003eJanjua S, Carter D, Threapleton CJ, Prigmore S, Disler RT. Telehealth interventions: remote monitoring and consultations for people with chronic obstructive pulmonary disease (COPD). The Cochrane Database of Systematic Reviews. 2021;7(7):CD013196. https://doi.org/10.1002/14651858.CD013196.pub2\u003c/li\u003e\n \u003cli\u003ePoitras M-E, Poirier MD, Couturier Y, et al. Chronic conditions patient\u0026rsquo;s perception of post-COVID-19 pandemic teleconsulting continuation in primary care clinics: a qualitative descriptive study. BMJ Open. 2022;12(12):e066871. Published Dec 15 2022. doi:10.1136/bmjopen-2022-066871\u003c/li\u003e\n \u003cli\u003eAllen M, Aylott M, Loyola M, Moric M, Saffarek L. Nurses: Extending Care through Telehealth. Studies in Health Technology and Informatics. 2015;208:35-39. https://doi.org/10.17265/1548-7709/2015.03.003\u003c/li\u003e\n \u003cli\u003eJamieson K, Carvalho C, Macauley K, McMillan S, Shiels J, Sylvestre L, Joshi K, Chakravarthy S. Virtual Care in Canada: Lexicon. Digital Health Canada. 2020. Virtual-Care-National-Lexicon-v-JAN2521.pdf (digitalhealthcanada.com)\u003c/li\u003e\n \u003cli\u003eBreton M, Sullivan EE, Deville-Stoetzel N, McKinstry D, DePuccio M, Sriharan A, et al. Telehealth challenges during COVID-19 as reported by primary healthcare physicians in Quebec and Massachusetts. BMC Family Practice. 2021;22(1):192. https://doi.org/10.1186/s12875-021-01543-4\u003c/li\u003e\n \u003cli\u003eLemire F, Sisler J. Integrating virtual care in family practice. Canadian Family Physician. 2020;66(2):151.\u003c/li\u003e\n \u003cli\u003ePeters GM, Kooij L, Lenferink A, van Harten WH, Doggen CJM. The Effect of Telehealth on Hospital Services Use: Systematic Review and Meta-analysis. Journal of Medical Internet Research. 2021;23(9):e25195. https://doi.org/10.2196/25195\u003c/li\u003e\n \u003cli\u003eGajarawala SN, Pelkowski JN. Telehealth Benefits and Barriers. The Journal for Nurse Practitioners. 2021;17(2):218-221.\u003c/li\u003e\n \u003cli\u003ePoitras ME, Couturier Y, Beaupr\u0026eacute; P, Girard A, Aubry F, Vaillancourt VT, et al. Collaborative practice competencies needed for telehealth delivery by health and social care professionals: a scoping review. Journal of Interprofessional Care. 2023:1-15.\u003c/li\u003e\n \u003cli\u003eHardcastle L, Ogbogu U. Virtual care: Enhancing access or harming care? Healthcare Management Forum. 2020;33(6):288-292. https://doi.org/10.1177/0840470420938818\u003c/li\u003e\n \u003cli\u003eChang JE, Lai AY, Gupta A, Nguyen AM, Berry CA, Shelley DR. Rapid Transition to Telehealth and the Digital Divide: Implications for Primary Care Access and Equity in a Post-COVID Era. The Milbank Quarterly. 2021;99(2):340-368.\u003c/li\u003e\n \u003cli\u003eLieneck C, Garvey J, Collins C, Graham D, Loving C, Pearson R. Rapid Telehealth Implementation during the COVID-19 Global Pandemic: A Rapid Review. Healthcare (Basel, Switzerland). 2020;8(4):517. https://doi.org/10.3390/healthcare8040517\u003c/li\u003e\n \u003cli\u003eSmith AC, Thomas E, Snoswell CL, et al. Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). \u003cem\u003eJ Telemed Telecare\u003c/em\u003e. 2020;26(5):309-313. doi:10.1177/1357633X20916567\u003c/li\u003e\n \u003cli\u003eFalk W. The State of Virtual Care in Canada as of Wave Three of the COVID-19 Pandemic. An Early Diagnostique and Policy Recommendations. 2021;95.\u003c/li\u003e\n \u003cli\u003eHafner M, Yerushalmi E, Dufresne E, Gkousis E. The potential socio-economic impact of telemedicine in Canada. RAND Health Quarterly. 2021.\u003c/li\u003e\n \u003cli\u003eAgarwal P, Wang R, Meaney C, et al. Sociodemographic differences in patient experience with primary care during COVID-19: results from a cross-sectional survey in Ontario, Canada. BMJ Open. 2022;12(5):e056868. https://doi.org/10.1136/bmjopen-2021-056868\u003c/li\u003e\n \u003cli\u003eArnaert A, Girard A, Craciunas S, Shang Z, Ahmad H, Debe Z, et al. Patients\u0026rsquo; experiences of telenursing follow-up care after bariatric surgery. Journal of Clinical Nursing. 2022;31(7-8):985-994. https://doi.org/10.1111/jocn.15955\u003c/li\u003e\n \u003cli\u003ePhimphasone-Brady P, Chiao J, Karamsetti L, Sieja A, Johnson R, Macke L, et al. Clinician and staff perspectives on potential disparities introduced by the rapid implementation of telehealth services during COVID-19: a mixed-methods analysis. Translational Behavioral Medicine. 2021;11(7):1339-1347. https://doi.org/10.1093/tbm/ibab060\u003c/li\u003e\n \u003cli\u003eCatalyst NEJM. What is Patient-Centered Care? NEJM Catalyst. 2017;3(1).\u003c/li\u003e\n \u003cli\u003eAlami H, Gagnon M, Fortin J. Organizational and systemic conditions at citizen-patient involvement in the development of telehealth in Quebec. Sant\u0026eacute; Publique. 2019;31:125-135. https://doi.org/10.3917/spub.191.0125\u003c/li\u003e\n \u003cli\u003eBoivin A, Lehoux P, Lacombe R, Burgers J, Grol R. Involving patients in setting priorities for healthcare improvement: a cluster randomized trial. Implementation Science: IS. 2014;9:24. https://doi.org/10.1186/1748-5908-9-24\u003c/li\u003e\n \u003cli\u003ePomey MP, Flora L, Karazivan P, Dumez V, Lebel P, Vanier MC, et al. Le \u0026ldquo;Montreal model\u0026rdquo;: enjeux du partenariat relationnel entre patients et professionnels de la sant\u0026eacute; [The Montreal model: the challenges of a partnership relationship between patients and healthcare professionals]. Sant\u0026eacute; Publique (Vand\u0026oelig;uvre-l\u0026egrave;s-Nancy, France). 2015;27(1 Suppl):S41-S50.\u003c/li\u003e\n \u003cli\u003eGovernment of Canada. [Internet]. 2022. Facilitating Research - CIHR (cihr-irsc.gc.ca)\u003c/li\u003e\n \u003cli\u003eCanadian Institutes of Health Research. Strategy for Patient-Oriented Research, Patient Engagement Framework. January 2014.\u003c/li\u003e\n \u003cli\u003eGuba EG, Lincoln YS. Fourth Generation Evaluation. London: Sage; 1989.\u003c/li\u003e\n \u003cli\u003eGuba EG, Lincoln YS. Competing Paradigms in Qualitative Research. In: Denzin N, Lincoln Y, editors. The Landscape of Qualitative Research. London: Sage; 1998. p. 195-220.\u003c/li\u003e\n \u003cli\u003eTrebble TM, Hansi N, Hydes T, Smith MA, Baker M. Process mapping the patient journey: an introduction. BMJ (Clinical research ed.). 2010;341:c4078. https://doi.org/10.1136/bmj.c4078\u003c/li\u003e\n \u003cli\u003eDavies EL, Bulto LN, Walsh A, Pollock D, Langton VM, Laing RE, et al. Reporting and conducting patient journey mapping research in healthcare: A scoping review. Journal of Advanced Nursing. 2022;79(1):83-100.\u003c/li\u003e\n \u003cli\u003eGovernment of Quebec. Family medicine group (FMG), University family medicine group (U-FMG) and super-clinic (A/N-FMG). Groupe de m\u0026eacute;decine de famille (GMF), groupe de m\u0026eacute;decine de famille universitaire (GMF‑U) et super-clinique (GMF-A et GMF-R). Gouvernement du Qu\u0026eacute;bec; 2023.\u003c/li\u003e\n \u003cli\u003eBreton M., et al. \u0026quot;L\u0026rsquo;implantation du mod\u0026egrave;le des groupes de m\u0026eacute;decine de famille au Qu\u0026eacute;bec : potentiel et limites pour l\u0026rsquo;accroissement de la performance des soins de sant\u0026eacute; primaires.\u0026quot; Pratiques et organisation des soins 2. 2011): 101-109.\u003c/li\u003e\n \u003cli\u003eFrey B. \u003cem\u003eThe SAGE Encyclopedia of Educational Research, Measurement, and Evaluation\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eVol. 4. Thousand Oaks, CA: SAGE Publications, Inc.; 2018. doi:10.4135/9781506326139\u003c/li\u003e\n \u003cli\u003eFortin M-F, Gagnon J. Fondements et \u0026eacute;tapes du processus de recherche. Montr\u0026eacute;al, Qu\u0026eacute;bec: Cheneli\u0026egrave;re \u0026eacute;ducation; 2022.\u003c/li\u003e\n \u003cli\u003eGovernment of Canada. Canadian Chronic Disease Surveillance System Report: Heart Disease in Canada, 2018. Ottawa: A.d.l.s.p.d. Canada; 2018.\u003c/li\u003e\n \u003cli\u003eTaherdoost H. Sampling Methods in Research Methodology; How to Choose a Sampling Technique for Research (April 10, 2016). https://ssrn.com/abstract=3205035 or http://dx.doi.org/10.2139/ssrn.3205035\u003c/li\u003e\n \u003cli\u003eCreswell JW, Creswell JD. Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. Sage, Los Angeles; 2018.\u003c/li\u003e\n \u003cli\u003eSaunders B, Sim J, Kingstone T, et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Quality \u0026amp; Quantity. 2018;52(4):1893-1907. doi:10.1007/s11135-017-0574-8\u003c/li\u003e\n \u003cli\u003eGuest G, Bunce A, Johnson L. How Many Interviews are Enough?: An Experiment with Data Saturation and Variability. Field Methods, 18(1). 2006. 59-82.\u003c/li\u003e\n \u003cli\u003eWang CC, Geale SK. The power of story: Narrative inquiry as a methodology in nursing research. International Journal of Nursing Sciences. 2015;2(2):195-198. https://doi.org/10.1016/j.ijnss.2015.04.014\u003c/li\u003e\n \u003cli\u003eSah LK, Singh DR, Sah RK. Conducting Qualitative Interviews using Virtual Communication Tools amid COVID-19 Pandemic: A Learning Opportunity for Future Research. JNMA: Journal of the Nepal Medical Association. 2020;58(232):1103. https://doi.org/10.31729/jnma.5738\u003c/li\u003e\n \u003cli\u003eBearnot B, Mitton JA. \u0026ldquo;You\u0026rsquo;re always jumping through hoops\u0026rdquo;: journey mapping the care experiences of individuals with opioid use disorder-associated endocarditis. Journal of Addiction Medicine. 2020;14(6):494.\u003c/li\u003e\n \u003cli\u003eKushniruk AW, Borycki EM, Parush A. A case study of patient journey mapping to identify gaps in healthcare: Learning from experience with cancer diagnosis and treatment. Knowledge Management \u0026amp; E-Learning: An International Journal. 2020;12(4):405.\u003c/li\u003e\n \u003cli\u003eGale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology. 2013;13:117. https://doi.org/10.1186/1471-2288-13-117\u003c/li\u003e\n \u003cli\u003ePoitras M-E, Godbout I, T Vaillancourt V, D\u0026eacute;barges B, Poirier A, Pr\u0026eacute;vost K, et al. Step-by-step Strategies for an Integrated Patient-Oriented Research: Lessons Learned from a Multicentered Study. Science of Nursing and Health Practices / Science infirmi\u0026egrave;re et pratiques en sant\u0026eacute;. 2020;3(2):1-9. https://doi.org/10.31770/2561-7516.1068\u003c/li\u003e\n \u003cli\u003eBingham AJ, Witkowsky P. Deductive and inductive approaches to qualitative data analysis. In: Vanover C, Mihas P, Salda\u0026ntilde;a J, editors. Analyzing and interpreting qualitative data: After the interview. SAGE Publications; 2022. p. 133-146.\u003c/li\u003e\n \u003cli\u003eBorycki EM, Kushniruk AW, Wagner E, Kletke R. Patient journey mapping: Integrating digital technologies into the journey. Knowledge Management \u0026amp; E-Learning: An International Journal. 2020;12(4):521-535. https://go.openathens.net/redirector/umoncton.ca?url=https://www.proquest.com/scholarly-journals/patient-journey-mapping-integrating-digital/docview/2509652843/se-2.\u003c/li\u003e\n \u003cli\u003eO\u0026rsquo;Neill J, Tabish H, Welch V, Petticrew M, Pottie K, Clarke M, et al. Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health. Journal of Clinical Epidemiology. 2014;67(1):56-64. https://doi.org/10.1016/j.jclinepi.2013.08.005\u003c/li\u003e\n \u003cli\u003eDarrat I, Tam S, Boulis M, Williams AM. Socioeconomic Disparities in Patient Use of Telehealth During the Coronavirus Disease 2019 Surge. JAMA Otolaryngology-Head \u0026amp; Neck Surgery. 2021;147(3):287-295. https://doi.org/10.1001/jamaoto.2020.5161\u003c/li\u003e\n \u003cli\u003eCarter-Harris L. (2015). An introduction to key event mapping: A primer for nurse researchers. Applied Nursing Research: ANR, 28(2), 83\u0026ndash;85. https://doi.org/10.1016/j.apnr.2015.01.003\u003c/li\u003e\n \u003cli\u003eGovernment of Canada [Internet]. 2022. TCPS2-2022-Word-dec-19-2022-en_Left alignment_without index_table of contents (clean) (ethics.gc.ca)\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Primary health care, Interprofessional collaboration, chronic disease, telehealth, patient engagement, qualitative method","lastPublishedDoi":"10.21203/rs.3.rs-4472719/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4472719/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThe enhancement of primary health care and the prevalence of chronic diseases are key issues worldwide, especially in Canada. As the incidence of chronic illnesses rises, they have emerged as the foremost cause of mortality worldwide. This trend has led to a surge in demand for healthcare services, placing significant pressure on primary care systems. In 2019, with the arrival of the pandemic, the rapid introduction of telehealth emerged as a crucial resource for patients with chronic illnesses, augmenting the role of primary healthcare as their initial point of contact. This resource was implemented with no infrastructure, often without patient support, and left to the discretion of individual professionals. Interprofessional collaboration plays a critical role in optimizing the use of telehealth in managing chronic diseases. Interprofessional teams can provide comprehensive care that addresses the multifaceted needs of patients with chronic illnesses. This approach ensures that patients receive holistic and coordinated care, leading to better health outcomes. Despite its advantages, telehealth can have negative effects if used sub-optimally.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods/design: \u003c/strong\u003eTo describe the process of interprofessional collaboration in the telehealth context in primary care coming from the perspective of patients living with chronic disease, this qualitative research is based on a constructivist research methodology, where the research team constructs knowledge derived from the interpretation of information obtained during the interviews with participants. To meet the study's objectives, qualitative Journey Mapping data collection will be carried out, following the approach of Trebbel. Individual interviews will be analyzed qualitatively and iteratively. This method is useful for analysis being done by different people from the team, including those with little experience in qualitative analysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnticipated benefits: \u003c/strong\u003eThe health and well-being of patients is central to the practice of healthcare professionals in primary care. Patients living with chronic diseases are among the most frequent users of primary care in Canada. The results of this study will support and improve the interprofessional collaboration process in the telehealth context, using a patient-centered approach. Journey mapping will help identify potential facilitating factors for improving primary care in the telehealth context according to the patient's journey. Results will be used to build a practical guide (phase 2) supporting interprofessional collaboration in the primary care telehealth context.\u003c/p\u003e","manuscriptTitle":"The Experience of Interprofessional Collaboration in a Telehealth Context in Primary Care: The Perspective of Patients Living with a Chronic Illness – A Research Protocol","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-12 05:24:18","doi":"10.21203/rs.3.rs-4472719/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"012af1b2-d51d-4ac7-b550-01afae4b09fb","owner":[],"postedDate":"June 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-30T13:23:39+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-12 05:24:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4472719","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4472719","identity":"rs-4472719","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}