Interprofessional collaboration in primary care for patients with chronic illness: a scoping review mapping leadership and followership

Background: Effective interprofessional collaboration (IPC) in primary care is essential in providing high-quality care for patients with chronic illness. However, the traditional role-based leadership approach may hinder IPC. Instead, physicians should also take followership roles, allowing other healthcare team members (OHCTMs) to lead when they have expertise and/or experience. Understanding of leadership and followership within IPC remains limited in primary care for patients with chronic illness. Hence, this review aims to explore the definitions and conceptualisations of leadership and followership and to map relevant training in this context.

Methods: Following the Joanna Briggs Institute methodology for scoping reviews, an electronic search was conducted across PubMed, Embase and Web of Science. Three independent reviewers assessed publications for eligibility. Descriptive and thematic analysis were employed.

Results: From 2194 identified articles, 57 were included. Only two articles defined leadership approaches, and none explicitly addressed followership. Nevertheless, our analysis identified leadership shifts from physicians to OHCTMs, and vice versa for followership, driven by complexity of care, physician shortages and healthcare costs. Enablers of these shifts included physician trusting OHCTMs, collaborative practice agreements and physicians' interprofessional experience. Barriers included traditional hierarchies, OHCTMs' lack of competence and physicians' lack of IPC experience. Four articles mentioned relevant training however without detailed information.

Discussion: Leadership in IPC for chronic illness in primary care is rarely defined, and followership is largely neglected. Nevertheless, leadership-followership shifts do occur in leadership and followership roles of physicians and OHCTMs. Further research needs to explore physicians' followership and relevant competencies, and relevant training is required.