Multidisciplinary Primary Care Teams Research Articles

Multidisciplinary Primary Care Teams

Multidisciplinary teams may hold promise for improving primary care quality. This study examined the influence of multidisciplinary teams on patients' assessments of primary care, including access, integration, and clinician-patient interaction quality. From January 2004 through March 2005, a large multispecialty practice in Massachusetts obtained data monthly from patients of 145 primary care physicians using a well-validated patient questionnaire. The analytic sample included respondents with at least 2 primary care visits over the study period (n=14,835). For each respondent, administrative data were used to compute visit continuity over the study period and to classify each primary care visit as PCP, on-team, or off-team. Multivariate regression modeled the relationship of visit continuity to each primary care measure. Approximately one-third of patients (35%) saw only their PCP; 15% had only PCP and "on-team" visits; 9% had a mix of PCP, on-, and off-team visits; and 41% had only "off-team" visits when not seeing their PCP. Greater PCP continuity was associated with more favorable scores on nearly all measures (P<0.001). An exception was patients' assessments of teams, which were better when on- versus off-team visits occurred (P<0.01). For other measures, the decrements associated with discontinuity were the same irrespective of whether discontinuities involved on- or off-team visits. The finding that PCP visit discontinuities are associated with more negative care experiences, irrespective of whether discontinuities involve on- or off-team visits, highlights the challenges of incorporating teams into primary care in ways that patients experience as value-added rather than disruptive to primary care relationships.

Preliminary outcomes from an integrated mental health primary care team.

The effects of establishing a multidisciplinary mental health primary care team in a Veterans Affairs internal medicine primary care clinic were evaluated. The multidisciplinary team worked in collaboration with primary care providers to evaluate and treat their patients, who had a wide variety of psychiatric disorders, in the primary care clinic. In the first year of operation preliminary outcomes indicated that the rate of referrals to specialty mental health care dropped from 38 percent to 14 percent. The mean number of appointments with the team for evaluation and stabilization was 2.5. These outcomes suggest that a multidisciplinary mental health primary care team can rapidly evaluate and stabilize patients with a wide range of psychiatric disorders, reduce the number of referrals to specialty mental health care, and improve collaborative care.

Changing clinical practice: evidence-based primary care in Australia.

Evidence-based health care (EBHC) is a concept which in the past decade has gained momentum internationally. Its emphasis on linking practice and policy more closely to evidence from research and literature has challenged many assumptions and established practices in health care, whilst helping the move away from an over-reliance on medical authority and accumulated wisdom. Since the concepts of EBHC were first introduced their relevance for primary care has been examined and there has been active debate over the extent to which primary care should be restructured to accommodate these new concepts. Many argue, for example, that they devalue important but less measurable aspects of primary care. Furthermore, little is known about whether EBHC has changed practice in primary care, despite a range of implementation strategies having been put in place. This paper focuses on the response of primary care practitioners and policy makers to the challenges of EBHC in Australia. Government investment in EBHC infrastructure is detailed, and the implementation of EBHC is described from the perspective of primary care providers, individuals with chronic illnesses and other consumers of primary care services. Current issues facing Australian primary care in implementing EBHC include the relative paucity of direction from a policy framework, the dearth of multi-disciplinary primary care teams and the lack of experience in Australia of primary care health service reform.

The Hampshire Depression Project: development and piloting of clinical practice guidelines and education about depression in primary health care.

This paper describes the development and piloting of a comprehensive educational programme about recognition and management of depressive illness in primary care. Full evaluation of the effectiveness of the programme is currently underway in a randomized controlled trial, the Hampshire Depression Project (HDP), involving 56 general practices. The programme consists of clinical practice guidelines, practice-based seminars and follow-up sessions. Each part of the programme has been designed to be flexible, clinically oriented and relevant to all members of the multidisciplinary primary care team. The pilot study established the need for a systematic approach to the access of practices and practice teams, and the organization and process of the seminars. Application of this approach was associated with excellent attendance in the main programme.