Evaluation of Team-Based Care Implementation in Primary Health Care Services in Saudi Arabia

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Abstract
Introduction: Saudi Ministry of Health (MOH) is starting to transfer the delivery of primary health care (PHC) services from solo practice to team-based care (TBC) model. It is an important to understand factors that affect the integration of this new model of care in the early stage of implementation process to ensure adequate incorporation of this new intervention into the routine work in PHC centers. Normalization process theory (NPT) is a method that helps evaluate the integration of new interventions. Therefore, this study aimed to explain the integration of TBC model in PHC services and investigate the barriers that may hinder the implementation of this model through using NPT. Methods: A cross-sectional study was conducted in PHC centers of Saudi MOH 7 months after the implementation of TBC model. A systematic random sample technique was used to select participants from all Saudi regions. A NPT questionnaire was sent online to the participants to collect data. Results: The study revealed that cognitive participation construct represented the highest score (4.06 ± 0.74) followed by coherence (3.78 ± 0.87) and reflexive monitoring (3.75 ± 0.79) constructs. Collective action construct represented the lowest integration score (3.48 ± 0.68). Gender, years of work experience, and duration of applying TBC model were not significant factors affecting the mean integration scores of the four constructs of NPT. Conclusion: The study recorded good integration scores of the included health staff to TBC model. However, the study demonstrated some barriers that may hinder the implementation progress of the model including inadequate staff training, insufficient resources, and lack of feedback reports. Other recorded barriers are the staff perception that TBC model affects the nature of their work and disrupts the working relationship. Sufficient resources, adequate staff training with close supervision, and providing them with feedback reports regularly are recommended to support and improve the implementation of the TBC model in PHC services.

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