How do health care funding policies and models impact interprofessional collaboration and integrated service delivery in primary and allied care? 

The secondary research questions are as follows:

This review will consider literature pertaining to adults (defined as individuals ages 18 years and older) who are employed within the specified primary and allied health care disciplines or are the recipients of care provided by these disciplines. 

For the purposes of this review, primary health care professions will include physicians, physician assistants, nurses, and allied health professionals identified as working in primary health care settings. There is no international consensus on what constitutes allied health or the specific professions and disciplines included within the allied health field [25]. Therefore, the extensive list of potential inclusions makes achieving sufficient data saturation for all nationally and internationally recognized allied health professions impractical within the constraints of this review. As such, allied health professions were selected for inclusion based on the following criteria: (1) being recognized as an allied health profession and represented by a professional association member or affiliate member of Allied Health Professions Australia [26], (2) having a scope of practice that includes interprofessional collaboration and integration at the primary health care level, (3) having a practice that is treatment-based rather than diagnostic, and (4) not being recognized as an alternative health or complementary therapy discipline.

Therefore, the allied health professionals selected for inclusion in this scoping review are audiologists, chiropractors, dietitians, exercise physiologists, hand therapists, myotherapists, occupational therapists, optometrists, orthoptists, orthotists, osteopaths, physiotherapists, podiatrists, prosthetists, psychologists, rehabilitation counselors, social workers, and speech and language therapists. Multimedia Appendix 1 further outlines the rationale for the exclusion of several other allied health professions. Due to feasibility constraints, a decision was made to exclude literature concerning interprofessional collaboration and service integration involving secondary (eg, specialist services such as psychiatry, oncology, or surgery) or tertiary (eg, hospital) levels of care.

The following 3 concepts will be explored in this scoping review: health care funding, interprofessional collaboration, and integrated service delivery. Regarding health care funding, factors of particular interest will include health care funding models (eg, compensable, noncompensable, public, and private funding models) and health care funding policies (eg, governmental, nongovernmental, health system, organizational, or professional funding policies). Health care funding characteristics are also of interest. These will include units of funding (eg, per service, per hour, per case, or per capita funding), funding principles (eg, input-based, output-based, performance-based, or achievement-based funding), the timing of funding (eg, prospective, or retrospective funding), and funding modes (eg, cash, recourses, assets, or in-kind services) [27].

The elements of interprofessional collaboration addressed by this review will focus on the relationships, interactions, and collaborative processes between primary and allied health clinicians (eg, writing and receiving referrals and participating in case conferences, clinical discussions, and multipractitioner appointments, assessments, and interventions) [7,9-12,18]. As for health care integration, the type (eg, normative or functional integration), and level (eg, system, organizational, professional, or clinical integration), of horizontal connections between primary and allied health clinicians will be considered [3,6,8,9].

This scoping review will consider health care funding policies and funding models operating at the primary health care level only. The primary level was selected as it has long been stipulated that improving health care funding and implementing policies that facilitate greater interprofessional collaboration and service integration between primary and allied health care at this level could improve the ongoing quality and safety and future sustainability of the wider health care system [2,3,8,14-17].

All classifications of primary studies inclusive of quantitative, qualitative, and mixed-methods designs will be considered for inclusion. In addition, grey literature (including policy documents, government and organizational reports, academic theses and dissertations, white papers, book chapters, conference abstracts and proceedings, policy and procedure documents, and opinion papers) will also be considered. Due to feasibility constraints, the scoping review inclusion criteria will be limited to digitally available contemporary literature accessible in the English language (due to the absence of dedicated funding that would typically cover the cost of translation services). A contemporary period of 10 years (from 2011 to 2021) was selected for this review to capture the increased interest in health care funding models and policies post economic recovery from the global financial crisis between 2007 and 2009 [28].

Following search strategy implementation, the literature will be collated and uploaded into EndNote version X9 (Clarivate Analytics) for the removal of duplicate entries. Citations will then be exported to Covidence (Veritas Health Innovation), for screening of the titles and abstracts. Screening will be conducted against the inclusion criteria by 2 independent reviewers, with a third independent reviewer available to resolve any potential disagreements. Literature that the reviewers agree has met the inclusion criteria in the initial round of screening will be retrieved in full text and assessed against the inclusion criteria by the same independent reviewers, noting the reasons for any exclusions. The final search results (including reasons for exclusion) will be reported in full and presented using a PRISMA-ScR flow diagram [24].

A total of 2 independent reviewers will use a custom data extraction tool developed by the authors to extract data from the included studies. Data for extraction (Textbox 1) will include descriptive information about the resource in terms of the author(s), year, country of origin, research aims, design, methodology, and methods. Information about funding model characteristics (including the funding type, level, unit, amount, principle, timing, and mode), funding policy characteristics (including the policy type, level, and scope), and practitioner characteristics (including the sample size and disciplines of health care practitioners), will be included. The research findings and any relevant outcome measures used in the research will also be extracted. This data extraction tool may undergo further modification and refinement during the data extraction process, with any changes to be clearly outlined in the final scoping review.

Although not a requirement of scoping review methodology [22,23], we decided to include an assessment of the level of evidence (using the Research Evidence Appraisal Tool and Non-Research Evidence Appraisal Tool) [29] and methodological quality (using the Crowe Critical Appraisal Tool [CCAT]) [30]. Including this optional step is intended to improve the robustness of the scoping review findings [31] and will allow for a more consistent analysis of what is predicted to be considerable heterogeneity in the literature.

Due to the broad nature of the research questions and the descriptive purpose of this scoping review, considerable heterogeneity of the literature is expected. It is anticipated that data presentation and analysis will need to accommodate for heterogeneity in the following factors:

To meaningfully account for this complexity in the literature and provide a clear and accurate map of the evidence, a descriptive narrative analysis method of translating the research findings is proposed. Based on the 4-element convergent narrative synthesis framework outlined by Popay et al [31], a modified 3-element analysis encompassing (1) preliminary analysis, (2) robustness evaluation, and (3) relationship exploration is proposed.

The preliminary analysis will be conducted at the data extraction stage of the review. It will entail organizing and presenting the extracted data (Textbox 1) in tabular form to identify key themes. Also presented in the data extraction table will be the robustness evaluation. This will critically appraise the methodological quality of the literature using the CCAT (v1.4) [30] and assign a level of evidence to the included literature using the Johns Hopkins Nursing Evidence-Based Practice Evidence Level and Quality Guide Research Evidence Appraisal Tool [29] and Non-Research Evidence Appraisal Tool [29]. The relationship exploration will then consider the relationships and variability between the literature and identified themes, presented as a concept map that systematically highlights the evidence and research gaps that inform health care funding practices, policymaking, and research.