# Who are the healthcare professionals involved in interprofessional team meetings in French multidisciplinary primary care centres? A quantitative analysis of eight centres

Laure Fiquet, Matthieu Peurois, François-Xavier Schweyer, Sébastien Fleuret, Maxime Esvan, Renaud Gay, Maud Jourdain, Aline Ramond-Roquin

<figure><img src="image_1.png" /></figure>

## To cite this version:

Laure Fiquet, Matthieu Peurois, François-Xavier Schweyer, Sébastien Fleuret, Maxime Esvan, et al. Who are the healthcare professionals involved in interprofessional team meetings in French multidisciplinary primary care centres? A quantitative analysis of eight centres. 2025. hal-05233856

HAL Id: hal-05233856

https://ehesp.hal.science/hal-05233856v1

Preprint submitted on 23 Jan 2026

HAL is a multi-disciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers.

L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.

<figure><img src="image_2.png" /></figure>

Distributed under a Creative Commons CC BY 4.0 - Attribution - International License
# Who are the healthcare professionals involved in interprofessional team meetings in French multidisciplinary primary care centres? A quantitative analysis of eight centres

Laure Fiquet

laure.fiquet@univ-rennes.fr

Univ Angers, POPS, SFR ICAT

Matthieu Peurois

Univ Angers, POPS, SFR ICAT

François-Xavier Schweyer

EHESP School of Public Health

Sébastien Fleuret

Univ Angers, CNRS, ESO [(Espaces et Sociétés)] - UMR 6590

Maxime Esvan

Univ Rennes, CHU Rennes

Renaud Gay

EHESP School of Public Health

Maud Jourdain

Univ Nantes

Aline Ramond-Roquin

Univ Angers, POPS, SFR ICAT

## Research Article

**Keywords:** Interprofessional relations, interprofessional collaboration, healthcare teams, primary care, healthcare professionals

**Posted Date:** August 28th, 2025

**DOI:** https://doi.org/10.21203/rs.3.rs-7086890/v1

**License:** © This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License

**Additional Declarations:** No competing interests reported.
**Version of Record:** A version of this preprint was published at BMC Primary Care on January 7th, 2026. See the published version at https://doi.org/10.1186/s12875-025-03142-z.
**Abstract**

**Background:** Interprofessional collaboration is crucial for providing high-quality care to patients with complex conditions in primary care. In France, multidisciplinary primary care centres (MPCC) receive funding if they organise at least 6 interprofessional team meetings (ITM) per year to discuss complex patient situations and collectively define care strategies. It remains unclear how ITM have been implemented in France. This study analyses healthcare professionals' involvement in ITMs within MPCCs.

**Method:** A multicenter retrospective quantitative study in 8 French MPCCs based on the analysis of ITM reports for the period from 2018 to 2019 was conducted.

**Results:** 1733 patients' situations (n=1733 cases) discussed during ITMs were analysed. The 8 MPCCs were heterogeneous in terms of geographical location, creation date, and size (3 MPCCs with >20,000 patients followed by more than 60 professionals and 3 MPCCs with <20 professionals). On average, five healthcare professionals attended each ITM, with huge variations among MPCCs. The nurse-general practitioner (GP) pair was central. At least one GP was present at 89% (n=1469) and nurses at 38.15% (n=630) of ITMs. Participation of other professionals was less frequent and varied according to the MPCC. Physiotherapists were present at 7.8% of ITMs, and other healthcare professionals were present at <6% of ITMs, including pharmacists (3% of ITMs). In some cases, external healthcare professionals, particularly those related to mental health, were also involved in ITMs.

**Conclusions:** Depending on the MPCC, the professionals involved in ITM vary widely, with the nurse-GP pair at the centre. The relative absence of certain professionals needs to be analysed in order to encourage interprofessional working.

**Trial registration:** not applicable.

**Background**

Interprofessional collaboration (IPC) is crucial for providing high-quality care to patients with chronic diseases or complex conditions. IPC involves different healthcare professionals who work with patients and their families, share a common vision of care, and agree on common goals ¹,². This approach increases patient satisfaction ³. Patients with complex needs and multiple chronic conditions require problem-focused and integrated care ⁴. In many countries, primary care is currently restructured to meet these needs, develop multidisciplinary practices, and strengthen integrated care practices ⁵. However, the scope of primary care teams and their composition are poorly described in the literature ⁶,⁷.

The French primary care system is mainly structured around private-sector healthcare professionals under contract with the national health insurance system and with a fee-for-service remuneration. Since 2007, multidisciplinary primary care centres (MPCC) have supported IPC through shared healthcare initiatives. At MPCCs, at least 2 general practitioners (GP) and other healthcare professionals work together, while maintaining autonomy in their activities within the fee-for-service model. Patients are advised to register with a GP. Patients registered with a GP of the MPCC can consult other healthcare professionals within or outside the MPCC.
In 2023, 7 million of the 68 million French citizens were followed by a GP working in one of the 2501 MPCCs identified⁸. In 2020, 1183 French MPCCs received funding from the national health insurance system for their collective actions, besides the fee-for-service payments. These MPCCs included 14200 professionals: ~10% of GPs in outpatient care (5000 GPs) and 8% of other healthcare professionals (e.g. nurses, pharmacists, midwives) ⁹. To be funded by the national health insurance system, these MPCCs are committed to ensure access to care for the population in their area, developing teamwork, and establishing a shared information system. They dedicate time and human resources (i.e. a coordinator) to team coordination. They must organise at least six interprofessional team meetings (ITM) per year to discuss complex patient situations and collectively define care strategies. The number of situations discussed each year during ITM should correspond to at least 5% of the patient population with a chronic disease recognised by the national health insurance system and/or older than 75 years¹⁰. However, although ITM is one of the MPCP's main multiprofessional activities and is supported by public funding, little is known about the types of health professionals who attend these meetings. Precise knowledge of the composition of the teams taking part in ITMs is essential to their development.

The aim of this study was to investigate the involvement of healthcare professionals in ITMs at MPCCs.

# Methods

## Design

This multicentre retrospective quantitative study used clinical data collected in the framework of a larger project called *Concert MSP*, a mixed-methods study with the objective of describing and analysing from an interdisciplinary perspective interprofessional activities at MPCCs ¹¹.

This was a retrospective study of reports of ITMs carried out by primary care teams.

## Population

The *Concert MSP* project involved 10 MPCPs receiving health insurance funding, in France. They were chosen based on their diversity in team composition, patient population, age range, and geographic location. Two of these MPCCs declined to participate in the present study.

## Ethics

In accordance with French regulations, patients were informed about the study through a notice and given the option to object to the use of their personal data, a no-objection procedure. If patients did not object, primary care teams anonymized data during data extraction. This procedure complied with data protection regulations. Each MPCC has signed an agreement for the data transmitted to be used for research purposes. The Ethics Committee of Rennes Hospital (n° 20.21), Rennes, France, approved this study.

## Data collection and questionnaire

As part of routine care, each ITM must result in a report that is added to the patient's electronic file in the MPCC software. There is no guideline on the report structure and format. Reports for 2018 and 2019 were retrospectively analysed. The year 2020 was not included due to the COVID-19 pandemic's impact on the MPCC teams' activities.
To standardise data collection, a collection grid was developed that included:

* MPCC number and patient number (for anonymisation)

* patient's socio-demographic characteristics

* professionals involved in the patient's usual care

* clinical situation discussed at the ITM, coded using the International Classification of Primary Care-3 (ICPC-3) ¹²

* professionals involved in the ITM: number, profession type, MPCC, or external professionals.

The grid was first tested with 50 cases and validated as a 31-item form (Appendix 1).

Data were extracted from February 1, 2021 to June 30, 2021 with Limesurvey® in parallel at each MPCC before the creation of a common database for the eight MPCCs.

Due to the huge diversity of data, several categories were defined:

* Clinical situations: the various ICPC-3 codes were classified into biomedical issues, psychologic/cognitive disorders, social problems and functioning-related issues.

* Healthcare professionals were grouped by profession within the MPCC and by status within the partner structures.

# Statistical analysis

The collected data were first described as a whole and then by MPCC to highlight the MPCC diversity. For each variable, the data completeness rate (or non-missing data) was recorded as an indicator of traceability (Appendix 2). Quantitative variables were presented as mean ± standard deviation, and qualitative variables as numbers and percentages. Due to the heterogeneous nature of the collected data and differences in sample size among MPCCs, data were not compared with statistical tests. Analyses were performed with SAS®9.4 (SAS Institute, Cary, NC, USA).

# Results

## Characteristics of the eight MPCCs

The 8 MPCCs varied in terms of geographical location, creation date, and size (Table 1).
<table><caption>Table 1
Characteristics of the included MPCCs</caption><thead><tr><th>Variable*</th><th>MPCC1</th><th>MPCC2</th><th>MPCC3</th><th>MPCC4</th><th>MPCC5</th><th>MPCC6</th><th>MPCC7</th><th>MPCC8</th></tr></thead><tbody><tr><td>MPCC creation date</td><td>2009</td><td>2012</td><td>2013</td><td>2013</td><td>2014</td><td>2014</td><td>2014</td><td>2010</td></tr><tr><td>MPCC location<br>(R = rural/UR =<br>urban/SR = semi-<br>rural)</td><td>R</td><td>R</td><td>R</td><td>U</td><td>SR</td><td>U</td><td>SR</td><td>U</td></tr><tr><td>Total number of<br>healthcare<br>professionals</td><td>64</td><td>23</td><td>69</td><td>22</td><td>14</td><td>83</td><td>43</td><td>33</td></tr><tr><td>Home nurses</td><td>26</td><td>6</td><td>21</td><td>9</td><td>8</td><td>17</td><td>8</td><td>4</td></tr><tr><td>GPs</td><td>17</td><td>5</td><td>8</td><td>6</td><td>3</td><td>18</td><td>8</td><td>7</td></tr><tr><td>Physiotherapists</td><td>1</td><td>3</td><td>13</td><td>3</td><td>1</td><td>8</td><td>11</td><td>6</td></tr><tr><td>Pharmacists</td><td>10</td><td>2</td><td>4</td><td>0</td><td>0</td><td>5</td><td>3</td><td>0</td></tr><tr><td>Speech therapists</td><td>2</td><td>1</td><td>4</td><td>2</td><td>0</td><td>7</td><td>3</td><td>2</td></tr><tr><td>Psychologists</td><td>1</td><td>1</td><td>3</td><td>2</td><td>1</td><td>8</td><td>0</td><td>3</td></tr><tr><td>Specialist doctors</td><td>0</td><td>1</td><td>3</td><td>0</td><td>1</td><td>5</td><td>0</td><td>3</td></tr><tr><td>Other healthcare<br>professionals</td><td>7</td><td>4</td><td>6</td><td>0</td><td>0</td><td>15</td><td>10</td><td>8</td></tr><tr><td>Number of patients<br>seen by GPs/year</td><td>24435</td><td>6032</td><td>12416</td><td>4438</td><td>3946</td><td>12772</td><td>9291</td><td>5862</td></tr><tr><td>Number of patients<br>seen by all MPCC<br>healthcare<br>professionals/year</td><td>26350</td><td>10715</td><td>33726</td><td>4697</td><td>4136</td><td>35777</td><td>18334</td><td>7659</td></tr><tr><td>% of &lt; 15-year-old<br>patients** (national<br>mean = 19%)</td><td>21</td><td>nd</td><td>18</td><td>27</td><td>20</td><td>18</td><td>22</td><td>27</td></tr><tr><td>% of &gt; 85-year-old<br>patients** (national<br>mean = 3%)</td><td>5</td><td>nd</td><td>5</td><td>2</td><td>6</td><td>2</td><td>3</td><td>1</td></tr><tr><td>% of patients with a<br>recognised chronic<br>disease and/or<br>older than 75<br>years**</td><td>25</td><td>27</td><td>33</td><td>19</td><td>25</td><td>17</td><td>18</td><td>21</td></tr><tr><td>*2018 data</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>** among all patients who consulted a healthcare professional at the MPCC</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr></tbody></table>
Three MPCCs (MPCC1, 3, and 6) had > 60 healthcare professionals and high volumes of registered patients (> 20,000). Conversely, three MPCCs (MPCC2, 4, and 5) had < 20 healthcare professionals. The most common professionals were nurses, GPs, and physiotherapists.

## Characteristics of the patients discussed during ITMs

In the 2018–2019 period, 1733 cases were discussed at ITMs. The number of cases varied greatly across MPCCs, independently of their size. For instance, both MPCC2 and 3, which strongly differed in size, had records for ~ 80 cases.

The patients' mean age (Table 2) varied from 41.7 years (MPCC6) to 80.2 years (MPCC2 and 5) and the percentage of women ranged from 47.1% (MPCC5) to 70.7% (MPCC2). Moreover, 97% of patients were registered with one of the GPs working at the MPCC, and 24.8% (n = 334) of patients received home care from a healthcare professional, mostly (n = 324) a nurse, at least once per week.

<table><caption>Table 2
Characteristics of patients whose case was discussed at ITMs</caption><thead><tr><th>Variable</th><th>MPCC1</th><th>MPCC2</th><th>MPCC3</th><th>MPCC4</th><th>MPCC5</th><th>MPCC6</th><th>MPCC7</th><th>MPCC8</th></tr></thead><tbody><tr><td></td><td>N = 333</td><td>N = 82</td><td>N = 80</td><td>N = 153</td><td>N = 34</td><td>N = 622</td><td>N = 265</td><td>N = 160</td></tr><tr><td>Women N (%)</td><td>178 (53.5%)</td><td>58 (70.7%)</td><td>48 (60.0%)</td><td>81 (52.9%)</td><td>16 (47.1%)</td><td>418 (67.2%)</td><td>152 (57.4%)</td><td>83 (51.9%)</td></tr><tr><td></td><td>N = 319</td><td>N = 80</td><td>N = 80</td><td>N = 153</td><td>N = 29</td><td>N = 610</td><td>N = 265</td><td>N = 160</td></tr><tr><td>Age (years): mean ± S D</td><td>57.3 ± 30.9</td><td>80.2 ± 10.5</td><td>75.4 ± 17.0</td><td>56.8 ± 21.8</td><td>80.2 ± 10.0</td><td>41.7 ± 24.1</td><td>51.9 ± 21.0</td><td>46.5 ± 20.1</td></tr></tbody></table>

## Patients' situations discussed in ITMs

Among the 1733 reports analysed, 1575 contained sufficient information to specify the clinical situation (Table 3). This allowed assigning 2725 ICPC-3 codes (range: 1 to 5 codes per case; mean: 1.73 ICPC-3 codes per case).
<table><caption>Table 3
Distribution of the ICPC-3code groups extracted from the ITM records</caption><thead><tr><th></th><th>MPCC1</th><th>MPCC2</th><th>MPCC3</th><th>MPCC4</th><th>MPCC5</th><th>MPCC6</th><th>MPCC7</th><th>MPCC8</th></tr><tr><th></th><th>N = 397</th><th>N = 98</th><th>N = 154</th><th>N = 410</th><th>N = 89</th><th>N = 946</th><th>N = 372</th><th>N = 259</th></tr></thead><tbody><tr><th>Biomedical issues</th><td>263<br>(66.2%)</td><td>18<br>(18.4%)</td><td>40<br>(26.0)</td><td>245<br>(59.8%)</td><td>21<br>(23.6%)</td><td>681<br>(72.0%)</td><td>88<br>(23.6%)</td><td>48<br>(18.5%)</td></tr><tr><th>Psychologic/ cognitive disorders</th><td>42<br>(10.6%)</td><td>5<br>(5.1%)</td><td>35<br>(22.7%)</td><td>97<br>(23.7%)</td><td>11<br>(12.4%)</td><td>133<br>(14.1%)</td><td>132<br>(35.5%)</td><td>54<br>(20.8%)</td></tr><tr><th>Social problems</th><td>50<br>(12.6%)</td><td>41<br>(41.8%)</td><td>20<br>(13.0%)</td><td>42<br>(10.2%)</td><td>23<br>(25.8%)</td><td>89-<br>(9.4%)</td><td>125<br>(33.6%)</td><td>78<br>(30.1%)</td></tr><tr><th>Functioning- related issues</th><td>42<br>(10.6%)</td><td>34<br>(34.7%)</td><td>59<br>(38.3%)</td><td>26<br>(6.3%)</td><td>34<br>(38.2%)</td><td>43<br>(4.5%)</td><td>27<br>(7.3%)</td><td>79<br>(30.5%)</td></tr></tbody></table>

Depending on the MPCC, healthcare professionals mostly met to discuss biomedical issues (66.2% and 72.0% of codes for MPCC1 and 6, respectively), psychological/cognitive disorders (35.5% of codes for MPCC7), social problems (41.8% of codes for MPCC2) or functioning-related issues (38.3% and 38.2% of codes for MPCC3 and 5, respectively).

Professionals participating in ITMs.

The list of professionals present was known for 1022 ITMs and on average, five healthcare professionals attended each ITM (Table 4). Their number varied from two-three (MPCC1) to more than seven (MPCC2, 5, and 6). The represented professions were known for 1651 ITMs (Table 5).

<table><caption>Table 4
Mean number of participants at ITMs</caption><thead><tr><th></th><th>MPCC1</th><th>MPCC2</th><th>MPCC3</th><th>MPCC4</th><th>MPCC5</th><th>MPCC6</th><th>MPCC7</th><th>MPCC8</th></tr></thead><tbody><tr><th>Number of ITMs</th><td>N = 331</td><td>N = 57</td><td>N = 78</td><td>N = 123</td><td>N = 8</td><td>N = 48</td><td>N = 264</td><td>N = 113</td></tr><tr><th>Mean number of participants</th><td>2.3 ±<br>1.2</td><td>7.3 ±<br>2.4</td><td>5.3 ±<br>3.1</td><td>5.9 ±<br>4.1</td><td>9.5 ±<br>0.9</td><td>8.7 ±<br>3.5</td><td>6.4 ±<br>4.6</td><td>5.0 ±<br>3.4</td></tr></tbody></table>
<table><caption>Table 5
Characteristics of the MPCC healthcare professionals at ITM</caption><thead><tr><th></th><th>MPCC1</th><th>MPCC2</th><th>MPCC3</th><th>MPCC4</th><th>MPCC5</th><th>MPCC6</th><th>MPCC7</th><th>MPCC8</th></tr></thead><tbody><tr><td></td><td>N = 333</td><td>N = 82</td><td>N = 80</td><td>N = 153</td><td>N = 8</td><td>N = 618</td><td>N = 265</td><td>N = 114</td></tr><tr><td>GPs</td><td>259 (77.8%)</td><td>26 (31.7%)</td><td>76 (95.0%)</td><td>142 (92.8%)</td><td>8 (100.0%)</td><td>613 (99.2%)</td><td>260 (98.1%)</td><td>85 (75.9%)</td></tr><tr><td>Home nurses</td><td>186 (55.9%)</td><td>74 (90.2%)</td><td>58 (72.5%)</td><td>89 (58.2%)</td><td>8 (100.0%)</td><td>6 (1.0%)</td><td>71 (26.8%)</td><td>0 (0.0%)</td></tr><tr><td>Public health nurses*</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>26 (32.5%)</td><td>51 (33.3%)</td><td>0 (0.0%)</td><td>13 (2.1%)</td><td>16 (6.0%)</td><td>32 (28.6%)</td></tr><tr><td>Physiotherapists</td><td>3 (0.9%)</td><td>0 (0.0%)</td><td>3 (3.8%)</td><td>75 (49.0%)</td><td>8 (100.0%)</td><td>9 (1.5%)</td><td>0 (0.0%)</td><td>31 (27.7%)</td></tr><tr><td>Speech therapists</td><td>9 (2.7%)</td><td>0 (0.0%)</td><td>1 (1.3%)</td><td>77 (50.3%)</td><td>0 (0.0%)</td><td>2 (0.3%)</td><td>0 (0.0%)</td><td>11 (9.8%)</td></tr><tr><td>Podiatrists</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>25 (9.4%)</td><td>0 (0.0%)</td></tr><tr><td>Dieticians</td><td>3 (0.9%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>53 (20.0%)</td><td>0 (0.0%)</td></tr><tr><td>Midwives</td><td>12 (3.6%)</td><td>5 (6.1%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>13 (2.1%)</td><td>34 (12.8%)</td><td>0 (0.0%)</td></tr><tr><td>Pharmacists</td><td>2 (0.6%)</td><td>27 (32.9%)</td><td>13 (16.3%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>7 (1.1%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td></tr><tr><td>Occupational therapists/ psychomotor therapists</td><td>22 (6.6%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>3 (0.5%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td></tr><tr><td>Psychotherapists</td><td>11 (3.3%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>6 (75.0%)</td><td>9 (1.5%)</td><td>14 (5.3%)</td><td>6 (5.4%)</td></tr><tr><td>Dentists</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td></tr><tr><td>Coordinator</td><td>15 (4.5%)</td><td>0 (0.0%)</td><td>43 (53.8%)</td><td>25 (16.3%)</td><td>0 (0.0%)</td><td>5 (0.8%)</td><td>0 (0.0%)</td><td>1 (0.9%)</td></tr><tr><td>Secretaries</td><td>7 (2.1%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>9 (5.9%)</td><td>0 (0.0%)</td><td>4 (0.6%)</td><td>0 (0.0%)</td><td>40 (35.1%)</td></tr><tr><td>Health students</td><td>4 (1.2%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>75 (12.1%)</td><td>0 (0.0%)</td><td>1 (0.9%)</td></tr></tbody></table>

The most common professions involved in ITMs were GPs (a GP present at 89% of ITMs, n = 1469) and nurses (38.15% of ITMs, n = 630). The nurse-GP pair was central, except at MPCC8 (no nurses present at ITMs) and MPCC2 where GPs were present at only 31.7% of ITMs.

<footnote>*Nurses who work in collaboration with GPs. They are responsible for developing prevention and patient education (in French: *Infirmière Asalée*).</footnote>
Participation of other healthcare professionals was less frequent, and varied between MPCCs. Physiotherapists were present at 7.8% of ITMs, and other professions were present at < 6% of ITMs. Participation of pharmacists varied widely (mean: 3%) among MPCCs: from 0% of ITMs at MPCC4, 5, 7 and 10 to 32.9% of ITMs at MPCC2.

Some MPCCs presented specific ITM features. At MPCC7, ITMs had a broad team composition, with many professions represented. At MPCC10, public health nurses participated in 28.6% of ITMs as well as physiotherapists (27.7%), speech therapists (9.8%), and psychologists (5.4%). At 562/623 ITMs (90.2%) of MPCC6, only GPs were present. The other 61 ITMs (9.8%) were interprofessional. This may be explained by the predominance of biomedical issues discussed at these meetings.

The MPCC coordinators' participation was infrequent, except at MPCC3 (58.3% of ITMs). Medical students participated in 12.1% ITMs of MPCC6.

Professionals from external organisations were present at the ITMs of seven MPCCs (but not of MPCC5) (Table 6).
<table><caption>Table 6
Characteristics of external healthcare professionals present at ITMs</caption><thead><tr><th colspan="9">External Professionals</th></tr><tr><th>Categories</th><th>MPCC1</th><th>MPCC2</th><th>MPCC3</th><th>MPCC4</th><th>MPCC5</th><th>MPCC6</th><th>MPCC7</th><th>MPCC8</th></tr></thead><tbody><tr><td></td><td>N = 333</td><td>N = 82</td><td>N = 80</td><td>N = 153</td><td>N = 8</td><td>N = 618</td><td>N = 265</td><td>N = 114</td></tr><tr><td>Primary care professionals</td><td>47 (14.2%)</td><td>35 (57.4%)</td><td>2 (2.6%)</td><td>1 (0.8%)</td><td>0 (0.0%)</td><td>11 (1,7%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td></tr><tr><td>Specialist doctors</td><td>17 (5.1%)</td><td>6 (7.3%)</td><td>2 (2.5%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>32 (5.2%)</td><td>0 (0.0%)</td><td>10 (8.8%)</td></tr><tr><td>Social workers</td><td>16 (4.8%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>1 (0.7%)</td><td>0 (0.0%)</td><td>15 (2.4%)</td><td>0 (0.0%)</td><td>28 (24.6%)</td></tr><tr><td>Local supporting structures for patients with complex conditions*</td><td>2 (0.6%)</td><td>56 (68.3%)</td><td>8 (10.0%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>4 (0.6%)</td><td>49 (18.5%)</td><td>0 (0.0%)</td></tr><tr><td>Mental health professionals</td><td>4 (1.2%)</td><td>0 (0.0%)</td><td>1 (1.3%)</td><td>1 (0.7%)</td><td>0 (0.0%)</td><td>4 (0.6%)</td><td>36 (13.6%)</td><td>41 (36.0%)</td></tr><tr><td>Health insurance or pension scheme representatives</td><td>4 (1.2%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>128 (48.3%)</td><td>0 (0.0%)</td></tr><tr><td>Educational institutions</td><td>17 (5.1%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td><td>2 (0,3%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td></tr><tr><td>Hospital professionals</td><td>21 (6,3%)</td><td>21 (36.8%)</td><td>33 (41.8%)</td><td>2 (1.6%)</td><td>0 (0.0%)</td><td>3 (0,4%)</td><td>0 (0.0%)</td><td>0 (0.0%)</td></tr><tr><td>Others</td><td>14 (4,2%)</td><td>33 (39.8%)</td><td>0 (0.0%)</td><td>3 (2.0%)</td><td>0 (0.0%)</td><td>30 (4,8%)</td><td>1 (0.4%)</td><td>0 (0.0%)</td></tr></tbody><tfoot><tr><td colspan="9">* Structures d'appui territorial patients complexes in French.</td></tr></tfoot></table>

The participation of external professionals or organisations reflected the partnership activities developed by MPCCs, for example, with specific local clinical-social and mental health services. MPCC2 organised meetings with a clinical-social support structure for complex situations. MPCC8 organised meetings with mental health services to discuss cases of patients with psychiatric disorders, particularly addictions. Social workers were present at 24.6% of MPCC8 ITMs, indicating a high level of clinical-social partnership.

During ITMs, the case was presented by different healthcare professionals, particularly GPs (n = 849, 78.3%) and nurses (n = 165, 15.2%), followed by other healthcare professionals (n = 70, 6.4% of all other professionals combined).

# Discussion

## Main findings
This study analysed the ITM reports from eight French MPCCs during the period 2018–2019, corresponding to a total of 1733 patients' situations (n = 1733 cases). Although the participation of healthcare professionals at ITMs varied depending on the MPCC, GPs and nurses were the most involved, in terms of number and role. The ITM composition was heterogeneous. Some MPCCs brought together many different professionals, including physiotherapists, pharmacists. External healthcare professionals were invited when difficult care situations were discussed, for example, patients with mental health problems.

## Strengths and limitations

The included MPCCs were different in terms of localization, date of creation and team composition. They are not representative of all French MPCCs and probably MPCC that have been teamworking for quite a long time (relative to the recent development of primary care teamwork in France) were over-represented.

The ITM report format varied among MPCCs because there is no guideline. Therefore, some data were missing and some reports were incomplete. The list of professionals present at ITMs was compiled from the sign-off sheets when available, but this information was not systematically recorded. Although data from only eight MPCCs were analysed, the findings provide original information on the professionals involved in ITMs and more generally, on teamwork within MPCCs. These aspects had not been analysed previously, despite the importance of interprofessional work in primary care. The clinical cases were classified using the ICPC-3 and then grouped into biomedical issues, psychologic/cognitive disorders, social problems, and functioning-related issues to reflect the primary care holistic approach. The ICPC-3 is primarily used to describe care activities, and its use to analyse complex situations could be questioned. ICPC-3 was developed to code an episode of care with one or more encounters with a healthcare professional, but this does not always align with the ITM report content ¹³. For example, it was difficult to code the homecare problems that were a frequent reason for ITMs.

Primary care teams with IPC have been developed in many countries, but their composition has not been described. A recent review on interprofessional work involving healthcare professionals identified only nine primary care studies among the 64 studies selected ¹⁴. They usually report the views of specific professions, such as nurse practitioners, and little is known about the teams' composition and the various healthcare professionals' role ¹⁵.

Our study showed that GPs and nurses were the most represented professions in ITMs and at the eight MPCCs. They are also key healthcare professionals implicated in the homecare of patients with complex conditions. Similarly, Schot et al. (2020) showed that GPs and nurses contributed the most to interprofessional work across all sectors ¹⁴. The GP-nurse pair is one of the collaborative practice models described in other studies ⁶. In our study, mainly home nurses were present at ITMs. Besides the regular nursing staff, some MPCCs also had public health nurses who have signed a collaboration contract with GPs and are salaried employees (infirmière Asalee in French). This collaboration has shown positive effects for the management of chronic pathologies ¹⁶. Advanced practice nurses (APN) are widely cited in international studies as important members of primary care teams ¹⁷. As APN training was introduced in France only in 2018, we did not find any APN in this study.

Other IPC models involve triads of community pharmacists, nurses, and GPs ⁶. Collaboration between community pharmacists and GPs is considered as a key factor for improving the care quality, especially concerning pharmacological treatments in patients with multimorbidity ¹⁸. However, our study found that
pharmacists were rarely present at ITMs, although IPC between pharmacists and GPs is promoted through
regular meetings and interprofessional work experiences<sup>19-21</sup>. This raises questions about the pharmacists'
place in primary care teams in France, and particularly about their ability to take part in these meetings.
Reinforcing the integration of pharmacists into ITMs is an important aspect of their development. This raises
questions about the actions to be deployed: interprofessional educational programs from initial training,
incentives for participation, etc.

This study also showed that ITMs could involve many different healthcare professionals (e.g. physiotherapists, speech therapists) with high interdisciplinarity ⁶. Although MPCCs were large, only a small number of healthcare professionals were present at ITMs, perhaps the most receptive to collaborative work. The IPC model proposed by Careau, stresses the need to bring together different professionals depending on the situation²². However, it does not seem easy to mobilise professionals in function of the needs, at least not within the formal framework of ITMs.

Besides the primary care team, ITMs also included representatives of other services outside primary care, such as social services and mental health services. Collaboration between mental health and primary care professionals is crucial, especially for patients with severe mental disorders <sup>23</sup>. Hunt et al. (2016) described interprofessional meetings between primary care teams and community mental health workers <sup>24</sup>. They highlighted the importance of dedicating time to these meetings, which enable the integration of different health professionals' perspectives, thereby improving patient care. Although mental health problems were a frequent reason for ITMs in our study, few mental health professionals were involved.

Collaboration between primary care and social services should be developed, especially for patients with complex needs (e.g. older adults)<sup>25,26</sup>. Some MPCCs worked with social structures, but this remained uncommon compared with the frequency of social problems discussed at ITMs. Several MPCCs developed interprofessional work that involves different care structures, demonstrating the maturity of their care approach and an interesting strategy based on an interprofessional local network.

Our study focused on the healthcare professionals’ participation in ITMs. The ITM reports did not provide sufficient information to explore the work processes that took place during these meetings. Van Dongen (2017) demonstrated that professionals valued these interprofessional meetings, despite the absence of a structured treatment plan <sup>27</sup>. Nisbet et al. (2015) studied interprofessional meetings in hospitals, as informal opportunities for interprofessional learning <sup>28</sup>. Participants reported that these meetings allowed them to learn more about the other healthcare professionals’ roles and scopes of practice. It could be an occasion to learn the soft skills of interprofessional work. More observational studies on ITMs are necessary to determine how these meetings are conducted. A qualitative study currently underway as part of the Concert MSP project will explore this aspect in more depth.

Conclusion

Depending on the team, the professionals involved in ITM vary considerably, with the nurse-GP duo playing a
central role. The lower involvement of other professionals in this study, particularly pharmacists, raises
questions despite the importance of this collaboration in primary care. In view of the patients' problems, closer
cooperation with mental health services and social workers should be encouraged by promoting interprofessional work outside the MPCC when required. In order to promote interprofessional working, it seems essential to analyse in detail the participation of different professionals and the reasons for their involvement in collaborative working in primary care.

## Abbreviations

APN advanced practice nurses

GP general practitioners

IPC interprofessional collaboration

ITM interprofessional team meetings

MPCC multidisciplinary primary care centres

## Declarations

### Ethics approval and consent to participate

The study was conducted in accordance with the Declaration of Helsinki. All the healthcare professionals from each MPCC decided to take part in the study and gave their consent. In accordance with French legislation on health data collection and treatment, this study contains anonymized data of the patients collected through their record. A notice was displayed informing patients of the study. None of the patients objected to the use of their data. The need for written informed consent was waived by the Rennes University Hospital Ethics Committee. The study was approved by Rennes University Hospital Ethics Committee (N°20-21, 2020).

### Consent for publication

Not applicable.

### Funding

The Concert-MSP project received funding as part of a call for projects on health services issued by IReSP (French public health research institute). The funder have not been involved in the conceptualization, design, data collection, analysis, nor preparation of the manuscript.

### Acknowledgments

We would like to express our gratitude to all the MPCCs who participated in the study.

We would like to thank all the students who took part in this work.

This article is supported by the French network of University Hospitals HUGO ('Hôpitaux Universitaires du Grand Ouest').

### Conflict of Interest
The authors declare that there is no conflict of interest regarding the publication of this article.

**Author contributions**

FXS, SF, ARR and LF designed the study. FXS coordinated the study. LF, MP, RG, FXS, SF, MJ and ARR recruited MPCCs. LF, MP, ARR researched data and ME performed the data-analysis. LF, MP and ARR drafted this manuscript. FXS, SF, RG, MJ contributed to the discussion and to the final version of the article. All authors read and approved the manuscript.

**Data sharing Statement**

The data underlying this article will be shared upon reasonable request to the corresponding author.

**Disclosure statement**

No potential conflict of interest was reported by the authors.

**References**

1. World Health Organization. Framework for Action on Interprofessional Education and Collaborative Practice. 2010 [cited 2025 jul 7]. https://www.who.int/publications/i/item framework-for-action-on- interprofessional-education-collaborative-practice

2. Reeves S, Pelone F, Harrison R, Goldman J, Zwarenstein M. Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2017;6:CD000072. 10.1002/14651858.CD000072.pub3.

3. Wen J, Schulman KA. Can Team-Based Care Improve Patient Satisfaction? A Systematic Review of Randomized Controlled Trials. PLoS ONE. 2014;9(7):e100603. 10.1371/journal.pone.0100603.

4. Pullon S, Morgan S, Macdonald L, McKinlay E, Gray B. Observation of interprofessional collaboration in primary care practice: A multiple case study. J Interprof Care. 2016;30(6):787-94. 10.1080/13561820.2016.1220929.

5. Organisation for Economic Co-operation and Development (OECD). Realising the Potential of Primary Health Care. [cited 2025 Feb 27]. https://www.oecd.org/health/realising-the-potential-of-primary-health-care-a92adee4-en.htm

6. Saint-Pierre C, Herskovic V, Sepúlveda M. Multidisciplinary collaboration in primary care: a systematic review. Fam Pract. 2018;35(2):132-41. 10.1093/fampra/cmx085.

7. Wranik WD, Price S, Haydt SM, Edwards J, Hatfield K, Weir J, et al. Implications of interprofessional primary care team characteristics for health services and patient health outcomes: A systematic review with narrative synthesis. Health Policy. 2019;123(6):550-63. 10.1016/j.healthpol.2019.03.015.

8. Ministère du Travail, de la Santé et des Solidarités. Les maisons de santé. [cited 2025 Feb 27]. https://sante.gouv.fr/systeme-de-sante/structures-de-soins/article/les-maisons-de-sante-300889

9. Haut Comité pour l'Avenir de l'Assurance Maladie. Organisation des Soins de proximité: Garantir l'accès de tous à des soins de qualité. [[cited 2025 Feb 27]. https://www.securite-sociale.fr/home/hcaam/zone-main-content/rapports-et-avis-1/rapport-hcaam-organisation-soins.html
10. Arrêté du 24. juillet 2017 portant approbation de l'accord conventionnel interprofessionnel relatif aux structures de santé pluriprofessionnelles. [[cited 2025 Feb 27].]
https://www.legifrance.gouv.fr/eli/arrete/2017/7/24/SSAS1722266A/jo/texte

11. Ramond-Roquin A, Allory E, Fiquet L. [Multi-professional consultation at multi- professional healthcare centres Varied practices and local strategies] La concertation pluriprofessionnelle au sein des maisons de santé pluriprofessionnelles: pratiques hétérogènes et stratégies locales. Rev Fr Aff Soc. 2020;(1):125-41.

12. ICPC-3 Browser. [cited 2025 Jun 22]. Disponible sur: https://browser.icpc-3.info/

13. Napel HT, van Boven K, Olagundoye OA, van der Haring E, Verbeke M, Härkönen M, et al. Ann Fam Med. 2022;20(4):358-61. 10.1370/afm.2830. Improving Primary Health Care Data With ICPC-3: From a Medical to a Person-Centered Perspective.

14. Schot E, Tummers L, Noordegraaf M. Working on working together. A systematic review on how healthcare professionals contribute to interprofessional collaboration. J Interprof Care. 2020;34(3):332-42.
10.1080/13561820.2019.1636007.

15. Quinlan E, Robertson S. The communicative power of nurse practitioners in multidisciplinary primary healthcare teams. J Am Acad Nurse Pract. 2013;25(2):91-102. 10.1111/j.1745-7599.2012.00790.x.

16. Mousquès J, Bourgueil Y, Le Fur P, Yilmaz E. Effect of a French experiment of team work between general practitioners and nurses on efficacy and cost of type 2 diabetes patients care. Health Policy. 2010;98(2-3):131-43. 10.1016/j.healthpol.2010.06.022.

17. Torrens C, Campbell P, Hoskins G, Strachan H, Wells M, Cunningham M, et al. Barriers and facilitators to the implementation of the advanced nurse practitioner role in primary care settings: A scoping review. Int J Nurs Stud. 2020;104:103443. 10.1016/j.ijnurstu.2019.103443.

18. White A, Fulda KG, Blythe R, Chui MA, Reeve E, Young R, et al. Defining and enhancing collaboration between community pharmacists and primary care providers to improve medication safety. Expert Opin Drug Saf. 2022;21(11):1357-64. 10.1080/14740338.2022.2131830.

19. Bardet JD, Vo TH, Bedouch P, Allenet B. Physicians and community pharmacists collaboration in primary care: A review of specific models. Res Social Adm Pharm. 2015;11(5):602-22.
10.1016/j.sapharm.2014.12.003.

20. Bollen A, Harrison R, Aslani P, van Haastregt JCM. Factors influencing interprofessional collaboration between community pharmacists and general practitioners: A systematic review. Health Soc Care Community. 2019;27(4):e189-212. 10.1111/hsc.12705.

21. Techer L, Dijols A, Budowski M, Legrand J. Collaboration between community pharmacists and general practitioners, pharmacists' and physicians' perspectives. Exercer. 2022;181:107-12.

22. Careau E, Brière N, Houle N, Dumont S, Vincent C, Swaine B. Interprofessional collaboration: Development of a tool to enhance knowledge translation. Disabil Rehabil. 2015;37(4):372-8.
10.3109/09638288.2014.923527.

23. Kates N, Arroll B, Currie E, Hanlon C, Gask L, Klasen H, et al. Improving collaboration between primary care and mental health services. World J Biol Psychiatry. 2019;20(10):748-65.
10.1080/15622975.2018.1509105.

24. Hunt CM, Spence M, McBride A. The role of boundary spanners in delivering collaborative care: A process evaluation. BMC Fam Pract. 2016;17(1):96. 10.1186/s12875-016-0499-5.
25. Douglas N, Mays N, Al-Haboubi M, Manacorda T, Thana L, Wistow G, et al. Observations of community-based multidisciplinary team meetings in health and social care for older people with long-term conditions in England. BMC Health Serv Res. 2022;22(1):758. 10.1186/s12913-022-08184-3.

26. Dambha-Miller H, Simpson G, Hobson L, Olaniyan D, Hodgson S, Roderick P, et al. Integrating primary care and social services for older adults with multimorbidity: A qualitative study. Br J Gen Pract. 2021;71(711):e753-61. 10.3399/BJGP.2021.0027.

27. van Dongen JJJ, van Bokhoven MA, Daniëls R, Lenzen SA, van der Weijden T, Beurskens A. Interprofessional primary care team meetings: A qualitative approach comparing observations with personal opinions. Fam Pract. 2017;34(1):98-106. 10.1093/fampra/cmw098.

28. Nisbet G, Dunn S, Lincoln M. Interprofessional team meetings: Opportunities for informal interprofessional learning. J Interprof Care. 2015;29(5):426-32. 10.3109/13561820.2015.1021001.