Abstract
Background: The desire to improve the quality of health care for an aging population with multiple chronic diseases is fostering a rapid growth in inter-professional team care, supported by health professionals, governments, businesses and public institutions. However, the weight of evidence measuring the impact of team care on patient and health system outcomes has not, heretofore, been clear. To address this deficiency, we evaluated published evidence for the clinical effectiveness of team care within a chronic disease management context in a systematic overview. Methods: A search strategy was built for Medline using medical subject headings and other relevant keywords. After testing for performance, the search strategy was adapted to other databases (Cinhal, Cochrane, Embase, PsychInfo) using their specific descriptors. The searches were limited to reviews published between 1996 and 2011, in English and French languages. The results were analyzed by the number of studies favouring team intervention, based on the direction of effect and statistical significance for all reported outcomes. Results: Sixteen systematic and 7 narrative reviews were included. Diseases most frequently targeted were depression, followed by heart failure, diabetes and mental disorders. Effectiveness outcome measures most commonly used were clinical endpoints, resource utilization (e.g., emergency room visits, hospital admissions), costs, quality of life and medication adherence. Briefly, while improved clinical and resource utilization endpoints were commonly reported as positive outcomes, mixed directional results were often found among costs, medication adherence, mortality and patient satisfaction outcomes. Conclusions: We conclude that, although suggestive of some specific benefits, the overall weight of evidence for team care efficacy remains equivocal. Further studies that examine the causal interactions between multidisciplinary team care and clinical and economic outcomes of disease management are needed to more accurately assess its net program efficacy and population effectiveness.
Highlights
IntroductionPrincipal perceived benefits for team members include enhanced job satisfaction, sense of being valued, respected and trusted, learning from others’ expertise, sharing of workload, and enhanced sense of well-being [4,9,10,11,13]
To address the growing burden of managing chronic diseases in aging populations, with increasing demand for services over time and across various care settings, innovative models of care are needed
The desire to improve the quality of health care for an aging population with multiple chronic diseases is fostering a rapid growth in inter-professional team care, supported by health professionals, governments, businesses and public institutions
Summary
Principal perceived benefits for team members include enhanced job satisfaction, sense of being valued, respected and trusted, learning from others’ expertise, sharing of workload, and enhanced sense of well-being [4,9,10,11,13] These feelgood perceptions among team members, sometimes referred to as the “romance of teams” phenomenon, probably contribute, in some degree, to the common belief that teams are a very effective health care work structure [3] and that the delivery of care by a coordinated team is a good thing [6,14,15,16]. The weight of evidence measuring the impact of team care on patient and health system outcomes has not, heretofore, been clear To address this deficiency, we evaluated published evidence for the clinical effectiveness of team care within a chronic disease management context in a systematic overview. Further studies that examine the causal interactions between multidisciplinary team care and clinical and economic outcomes of disease management are needed to more accurately assess its net program efficacy and population effectiveness
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