Ambulance clinicians' perspectives on interprofessional collaboration in prehospital emergency care for older patients with complex care needs: a mixed-methods study

Abstract

Background: Coordinated, multidisciplinary care is essential when addressing the complex needs of an aging population, with prehospital emergency care providers often serving as a common point of contact. Addressing complex care needs while maintaining continuity of care necessitates seamless collaboration between diverse healthcare providers. Despite this, there is limited research on interprofessional collaboration in prehospital care of older patients with complex needs. Understanding what influences interprofessional collaboration and identifying areas for improvement are vital for optimizing prehospital care for this vulnerable population. This study aimed to explore ambulance clinicians' perspectives on interprofessional collaboration in prehospital emergency care for older patients with complex care needs and to identify key factors influencing collaboration.

Methods: An explanatory sequential mixed-methods design was employed in this study, conducted in southern Sweden. In Phase 1, quantitative data were collected via an online survey completed by 118 ambulance clinicians (ACs). Descriptive statistics, chi-square tests, and Kruskal-Wallis tests were used to analyze the data. Qualitative responses were analyzed through inductive content analysis, informing the development of an interview guide. In Phase 2, semi-structured interviews were conducted with 20 ACs and analyzed using inductive content analysis. Findings from both phases were integrated using a joint-display matrix, combining quantitative patterns with qualitative insights for a comprehensive interpretation.

Results: Quantitative findings revealed that although collaboration with patients' families and care staff was generally rated as satisfactory by ACs, significant challenges were reported in coordinating care with other healthcare actors, especially home care nurses. About 89% of respondents reported insufficient access to patient information, highlighting difficulties in retrieving such information. Qualitative data underscored the importance of comprehensive patient information for effective decision-making and alignment with patient preferences and care goals. The integrated analysis identified three key factors influencing interprofessional collaboration: defined goals of care, access to information, and clarity in roles and responsibilities. Challenges in maintaining continuity and responsiveness, particularly during night shifts, were emphasized as barriers to effective collaboration.

Conclusion: Addressing deficiencies in nighttime care coordination, improving access to comprehensive patient information, and strengthening communication pathways between healthcare providers are essential steps in improving interprofessional collaboration to strengthen prehospital care of older patients with complex care needs.

Keywords: Ambulance clinicians; Care plan; Complex care needs; Interprofessional collaboration; Mixed-methods design; Older patients; Prehospital emergency care.

Fig. 1

Explanatory sequential mixed-method study design in three phases

Fig. 2

Distribution and frequencies of patient information requested by ambulance clinicians (n = 118)

Fig. 3

Distribution of ratings of access to patient information by educational level