Multidisciplinary Primary Health Care Research Articles

Factors associated with patients' experience of access to their multidisciplinary primary health care clinic: A multilevel analysis.

Understanding patients' experiences accessing primary health care (PHC) is necessary to improve service organisation. This study aims to examine individual, organisational, and contextual factors associated with patients' experience of accessing the multidisciplinary PHC clinic to which they are attached. This cross-sectional study builds on survey data collected in multidisciplinary PHC clinics located in 14 regions in the province of Quebec (Canada). Between September 2022 and June 2023, an online questionnaire was sent to patients with an email contact and attached to a family physician. Two patient-reported experience measures were assessed: (1) difficulty obtaining an appointment with their regular family physician or nurse practitioner and (2) perceived unmet healthcare needs. A self-reported online questionnaire based on the advanced access model was also sent to PHC professionals and administrative staff to assess the use of advanced access strategies in their practice. Multilevel logistic regression models were fit. Stratified analyses were conducted according to the number of consultations received. In total, 122,397 patients and 847 family physicians, 97 nurse practitioners and 347 administrative staff nested into 104 clinics answered the survey. In the overall sample, having a chronic disorder was the only individual factor associated with the patient experience of access. Organizational factors including estimation of demand and supply, use of a referral algorithm, and strategies to optimise consultations were associated with a better access experience. Patients from medium size clinics compared to small clinics had better experiences of care for both outcomes. Stratified analysis indicated similar results for patients who consulted at the clinic 1-5 times in the last 12months as observed in the overall sample. This study indicates that enhancing organizational processes can improve patients' access experiences.

“Cooperation between physicians and physios fosters trust you know”: a qualitative study exploring patients’ experience with first-contact physiotherapy for low back pain in French primary care

BackgroundPhysiotherapists working in collaboration with family physicians in French multidisciplinary primary healthcare clinics are now able to manage acute low back pain patients as first-contact practitioners in advanced practice roles. This includes medical act delegation such as making a medical diagnosis and prescribing medication. The aim of this study is to explore patients’ experience and perceptions when attending a first-contact physiotherapist (FCP) in an advanced practice collaborative primary care model for acute low back pain (LBP).MethodsA qualitative study using semi-structured interviews was conducted. Patients that consulted a FCP for acute LBP care in new collaborative model were included. Interviews were transcribed verbatim and inductive thematic analysis was performed to generate themes related to patients’ experience and perceptions.ResultsTen patients were interviewed (3 women, 7 men; mean age 36.5 ± 9.63 years). All LBP participants experienced important level of pain and disability. Four overarching themes related to patients’ experience with the new FCP model were formalized: 1) “Going to see a physiotherapist who specializes in painful movements, well that makes sense to me”, 2) “Physiotherapist offered to give me exercises to do at home to relieve the back pain”, 3) “I went there feeling confident”, 4) “The physiotherapist can do more than just send you to see more appropriate people”. Participants highlighted the need to receive timely and high-quality care and were receptive with being autonomously managed by a FCP. Overall, patients’ experiences with FCP model of care were positive. Participants were highly confident in the FCP’s ability to perform delegated medical tasks including making a medical diagnosis and prescribing oral medication such as analgesic drugs. Patients felt that a greater expansion of FCPs’ scope of practice was needed to improve the model.ConclusionFindings from this study can inform the implementation of FCP in countries where patients are not typically granted FCP by underlining that patients are favourable towards the advance practice model as such models support timely and high-quality care. Further research is needed to better determine the future advance practice physiotherapists’ scope of practice in French primary and secondary care settings.

Assistência fisioterapêutica a indivíduos com Acidente Vascular Encefálico residentes na comunidade na atenção básica no Brasil: um estudo transversal

ABSTRACT After hospital discharge, it is recommended that post-stroke individuals receive follow-up by a physical therapist throughout all the stages of recovery. Despite clinical recommendations, few studies have investigated physical therapy care to community-dwelling individuals with stroke. This study aimed to describe physical therapy care to community-dwelling individuals with stroke in primary care setting and identify clinical-functional and sociodemographic characteristics that determined physical therapy assistance. This is an exploratory cross-sectional study. Community-dwelling individuals with stroke who were assisted by the primary healthcare team from an important Brazilian metropolis were included. Their medical records were analyzed to identify the care provided by physical therapists. Individuals who received and did not receive physical therapy care were compared (α=0.05). Out of the 100 included individuals, 55% received assistance from the multidisciplinary primary healthcare team and 44% from physical therapists. Physical therapy approaches consisted mainly of general orientations (89%) and assessments (75%). Only 45% of the individuals who received physical therapy care were followed-up, and those who received this type of care had significantly more stroke events and higher levels of disability (p<0.001). It was observed that many individuals with various levels of disabilities have not received physical therapist assistance. Moreover, follow-up care and referrals were not frequent physical therapy approaches. Therefore, physical therapy care in primary care needs to be expanded to ensure that all individuals with some level of disability receive treatment. Moreover, it is necessary to increase the number of individuals receiving follow-up and encourage multidisciplinary work between physical therapists and other primary healthcare professionals.

Critically examining health complexity experienced by urban Indigenous peoples in Canada by exploring the factors that allow health complexity to persist: a qualitative study of Indigenous patients in Calgary, Alberta

ObjectivesThis study aims to identify and critically examine the components of health complexity, and explore the factors that allow it to exist, among urban Indigenous peoples in Canada.DesignQualitative exploration with...

30 years of primary health care reforms in Estonia: The role of financial incentives to achieve a multidisciplinary primary health care system

Estonia has a legacy of hospital-focused service provision, but since the 1990s, has introduced a series of reforms to strengthen primary health care (PHC). The recent PHC reforms have placed an increasing focus on multidisciplinary care, involving home nurses, midwives, and physiotherapists, and emphasize PHC centres over single physician practices. These incremental reforms, without a supporting legal basis nor explicitly defined timelines and targets, nonetheless demonstrated the ability of financial incentives to drive change. EU structural funds in particular provided essential funding for infrastructure investments in PHC. Yet not all stakeholders supported these initiatives, largely due to the uncertain sustainability of funding. The EHIF also adjusted contract and payment terms to support PHC reforms, with some concessions to PHC providers operating as single practitioners. Despite substantial progress over the last three decades to shift the focus to PHC, there are some important bottlenecks that hinder the progress. These include PHC providers’ hesitance to give up their freedom as single practitioners, low interest from specialists to start working at the PHC level, and a lack of financial incentives and adequate funding for a broader scope of PHC services. This looks to become more challenging in the future, as nearly half of family physicians are 60 years old or older. The development of the new PHC strategy in 2023 is very timely to comprehensively address these bottlenecks and to set the vision for the future of PHC in Estonia.

Inclusion of Naturopaths in Northern Ontario Primary Care: A Proposed Solution for The Health Human Resources Shortage

The shortage of primary healthcare practitioners, such as physicians and nurses, in northern Ontario has persisted fordecades despite multiple strategies to address it. Poor health outcomes for people living in northern Ontario must be viewed through an equity lens that takes into account the multiple proximal, intermediate, and distal social determinants of health, including, but not limited to, the impact of colonization and continued colonialism on the health of Indigenous Peoples, challenges in housing, education and employment, as well as lack of food security. The increase in chronic health conditions in northern Ontario and the need for interprofessional healthcare teams that offer patient-centred care are key issues. Whole person care that takes into consideration the integration of body, mind, and spirit is central to Indigenous concepts of health and wellness, as well as being central to the foundations of naturopathic medical philosophy. Inclusion of naturopathic doctors in publicly funded multi-disciplinary primary healthcare settings is proposed as an achievable strategy to fill gaps in health human resources and advance the movement towards holistic care for Indigenous Peoples and others living in northern Ontario.

Acceptability of a task sharing and shifting model between family physicians and physiotherapists in French multidisciplinary primary healthcare centres: a cross-sectional survey

ObjectivesThe rising prevalence of musculoskeletal disorders increases pressure on primary care services. In France, patients with musculoskeletal disorders are referred to physiotherapist (PT) by family physician (FP). To improve access...

Shaping Primary Health Care Teams and Integrated Care in Québec: An Overview of Policies (2000-2020)

Primary Health Care (PHC) teams are an important component of the health system – particularly in terms of integrating care for vulnerable patients living with complex health and social needs. Over the last two decades, PHC teams have been implemented in different forms across Canadian provinces and territories. This article explores the health care policies that shaped the form and functions of PHC team-based care in Québec over the past 20 years (2002-2022). In Québec, the main model of multidisciplinary PHC teams – Family Medicine Groups or Groupe de médecine de famille (GMFs) – were created in 2002. In 2004, structural reforms led to the creation of local health networks (LHNs). LHNs promoted coordinated and collaborative activities between health and social services providers such as GMFs located in the same geographic regions. This was followed by another structural reform of the health system in 2015, leading to the creation of broader territorial health networks with the aim to heighten coordination and collaboration among provider organizations. Various policies have strengthened the PHC team-based model. For instance, the introduction of nurse practitioners, pharmacists, and social workers with extended scopes of practice shaped the configuration of GMFs while enhancing inter-professional collaborative practices. This article highlights important insights that could advance the understanding and creation of future PHC policy initiatives.

Patient, carer and healthcare professional experiences of complex care quality in multidisciplinary primary healthcare centres: qualitative study with face-to-face, in-depth interviews and focus groups in five French multidisciplinary primary healthcare centres

ObjectivesTo explore care experiences in multidisciplinary primary healthcare centres from the patients, carers and healthcare professionals perspectives.DesignThis qualitative study used face-to-face, in-depth interviews and focus groups. Patients with multimorbidity monitored...

The quality of alternative models of primary health care and morbidity and mortality in Brazil: a national longitudinal analysis

BackgroundEvidence is limited on health benefits from quality improvement of primary healthcare (PHC) in low- and middle-income countries (LMICs). This study investigated whether increasing PHC quality in Brazil with highly-skilled health professionals and integrated community health workers (CHWs) was associated with reductions in hospitalizations and mortality beyond benefits derived from increasing access. MethodsAnnual municipal-level data for 5,411 municipalities between 2000 and 2014 were analysed using fixed effects panel regressions. PHC quality was measured as: i) the proportion of consultations provided by highly-skilled health professionals (doctors and nurses); and ii) the proportion of visits provided by CHWs from multidisciplinary PHC teams. Models assessed associations between PHC quality and hospitalization and mortality from diabetes, cardiovascular disease (CVD), tuberculosis, leprosy, perinatal and maternal causes, and adjusted for PHC access, utilisation, presence of secondary care services, and socioeconomic factors. FindingsA one percentage point increase in the proportion of consultations provided by highly-skilled health professionals was associated with 0•019 fewer deaths from diabetes per 100,000 population (95%CI: -0•034, -0•003; p-value: 0.0167) and 0•029 fewer hospitalizations per 100,000 from leprosy (95%CI: -0•055, -0•002; p-value: 0.0321). A one percentage point increase in the proportion of care provided by CHWs from multidisciplinary PHC teams was associated with 0•025 fewer deaths from CVD per 100,000 (95%CI: -0•050, -0•001; p-value: 0.0442) and 0•148 fewer maternal hospital admissions per 100,000 (95%CI: -0•286, -0•010; p-value: 0.0356). No significant associations were found for the other twenty pairs of exposures and outcomes analysed. InterpretationInvesting in higher-quality PHC models with highly-skilled health professionals and integrated CHWs can deliver reductions in mortality and hospitalizations in LMICs. FundingNone.

Testing the 2017 PHC reform through pilots: Strengthening prevention and chronic care coordination

Numerous official reports have highlighted insufficient provision of preventive services within primary health care (PHC) in Poland. Other identified weaknesses include inappropriate referrals to ambulatory care that contribute to long waiting times for specialist consultations. Since mid-2018, a new model of PHC organization has been piloted and can be seen as an attempt to address some of these weaknesses. It draws on the Primary Health Care Act of 2017 and puts much more emphasis on disease prevention and health promotion within PHC as well as shifts management of common chronic conditions to multidisciplinary PHC teams. The implementation of this model has been supported by a range of financial and non-financial measures, including a special grant that helps PHC practices to adapt their IT systems to the requirements of the pilot. Yet, the overall requirements were prohibitive to most PHC practices and only 42 were eventually included in the pilot. In this paper, we describe the content of this model, the difficulties in its implementation and how they were addressed and discuss its possible effects on PHC and the health system more broadly.

The feasibility and potential use of case-tracked client journeys in primary healthcare: a pilot study

ObjectivesTo determine the feasibility of case-tracking methods in documenting client journeys at primary healthcare (PHC) services in order to investigate the comprehensiveness of service responses and the experiences of clients.DesignProspective...

PsyScan e-tool to support diagnosis and management of psychological problems in general practice: a randomised controlled trial.

GPs are crucial in adequately diagnosing and initiating appropriate management for patients with psychological problems, but face many challenges and require support. To determine the effects of the e-tool PsyScan. A randomised controlled trial with a 1-year follow-up, comparing care using PsyScan with usual care for psychological problems, was undertaken in 10 multidisciplinary primary healthcare centres in Eindhoven, the Netherlands. Between consultations with their GP, participants in the intervention group could complete PsyScan. The e-tool consists of a distress screener and Four-Dimensional Symptom Questionnaire to differentiate between stress, depression, anxiety, and somatisation symptoms, and to explore symptom severity. PsyScan generated diagnostic and therapeutic advice for GPs and participants that was automatically transferred to each patient's electronic medical record. The primary outcome was the proportion of participants that achieved a successful treatment result; namely, a decrease of ≥50% on the Symptom Checklist-90-Revised, after 1 year. There were 176 participants in the intervention group and 160 in the control group. After multiple imputation, the participants in the intervention group had higher chances of achieving a successful treatment result compared with those in the control group (odds ratio [OR] 2.7, 95% confidence interval [CI] = 1.5 to 4.8, P = 0.002). Quality of life was higher in the intervention group at 12 months (mean difference in EuroQol 5 Dimensions 5 Levels index values was 0.076, 95% CI = 0.015 to 0.136, P = 0.01). The mean 1-year costs per participant were similar (€13 622 in intervention group, €12 487 in control group [β = -0.03, P = 0.71, R2 = 0.05]). PsyScan generated clinically relevant and statistically significant effects, and could be useful in offering effective individualised care to patients.

Health Professional Education And Universal Health Coverage: A Summary Of Challenges And Selected Case Studies.

Low- and middle-income countries are experiencing serious shortages in meeting health workforce requirements for universal health coverage. We examine how national-level policies can address these deficiencies and support the development of an appropriately skilled health workforce in line with population needs. We discuss three innovative, government-led solutions that are designed to align health workforce training with the demands of universal health coverage. Specifically, we discuss two initiatives to train and retain doctors in rural areas of Thailand, the large-scale training of community health workers within multidisciplinary primary health care teams in Brazil, and the introduction of a postgraduate diploma program in primary care for nurses in India. Several positive outcomes have been associated with these initiatives, including improvements in the rural retention of doctors in Thailand and reductions in infant and child mortality rates in Brazil. However, further research is needed to assess the impact of such initiatives on the long-term retention of workers-particularly doctors-and the adequacy of the training offered to lower-skilled workers to effectively plug medical personnel gaps. Systematic monitoring of program affordability and cost-effectiveness over time must be prioritized, alongside efforts to disseminate lessons learned.

Experiencing integration: a qualitative pilot study of consumer and provider experiences of integrated primary health care in Australia

BackgroundThe terms integration and integrated care describe the complex, patient-centred strategies to improve coordination of healthcare services. Frameworks exist to conceptualise these terms, but these have been developed from a professional viewpoint.The objective of this study was to explore consumers’ and providers’ concepts, expectations and experience of integrated care. A key focus was whether frameworks developed from a professional perspective are effective models to explore people’s experiences.MethodsA qualitative pilot study was undertaken at one Australian multidisciplinary primary health care centre. Semi-structured interviews were conducted with consumers (N = 19) and staff (N = 10). Data were analysed using a framework analysis approach.ResultsConsumers’ experience of integrated care tended to be implicit in their descriptions of primary healthcare experiences more broadly. Experiences related to the typologies involved clinical and functional integration, such as continuity of providers and the usefulness of shared information. Staff focused on clinical level integration, but also talked about a cultural shift that demonstrated normative, professional and functional integration.ConclusionsExisting frameworks for integration have been heavily influenced by the provider and organisational perspectives. They are useful for conceptualising integration from a professional perspective, but are less relevant for consumers’ experiences. Consumers of integrated primary health care may be more focussed on relational aspects of care and outcomes of care.

The impact of general practice nursing care on patient satisfaction and enablement in Australia: A mixed methods study

BackgroundThe numbers of nurses in general practice in Australia tripled between 2004 and 2012. However, evidence on whether nursing care in general practice improves patient outcomes is scarce. Although patient satisfaction and enablement have been examined extensively as outcomes of general practitioner care, there is little research into these outcomes from nursing care in general practice. The aim of this study was to examine the relationships between specific general practice characteristics and nurse consultation characteristics, and patient satisfaction and enablement MethodsA mixed methods study examined a cross-section of patients from 21 general practices in the Australian Capital Territory. The Patient Enablement and Satisfaction Survey was distributed to 1665 patients who received nursing care between September 2013 and March 2014. Grounded theory methods were used to analyse interviews with staff and patients from these same practices. An integrated analysis of data from both components was conducted using multilevel mixed effect models. ResultsData from 678 completed patient surveys (response rate=42%) and 48 interviews with 16 nurses, 23 patients and 9 practice managers were analysed. Patients who had longer nurse consultations were more satisfied (OR=2.50, 95% CI: 1.43–4.35) and more enabled (OR=2.55, 95% CI: 1.45–4.50) than those who had shorter consultations. Patients who had continuity of care with the same general practice nurse were more satisfied (OR=2.31, 95% CI: 1.33–4.00) than those who consulted with a nurse they had never met before. Patients who attended practices where nurses worked with broad scopes of practice and high levels of autonomy were more satisfied (OR=1.76, 95% CI: 1.09–2.82) and more enabled (OR=2.56, 95% CI: 1.40–4.68) than patients who attended practices where nurses worked with narrow scopes of practice and low levels of autonomy. Patients who received nursing care for the management of chronic conditions (OR=2.64, 95% CI: 1.32–5.30) were more enabled than those receiving preventive health care. ConclusionsThis study provides the first evidence of the importance of continuity of general practice nurse care, adequate time in general practice nurse consultations, and broad scopes of nursing practice and autonomy for patient satisfaction and enablement. The findings of this study provide evidence of the true value of enhanced nursing roles in general practice. They demonstrate that when the vision for improved coordination and multidisciplinary primary health care, including expanded roles of nurses, is implemented, high quality patient outcomes can be achieved.

‘Two working together is so much better than just one’: Professional support needs of primary healthcare dietitians

AbstractAimThis qualitative study explored the experiences of professional support received, and the perceptions of professional support required by New Zealand (NZ) registered dietitians working in primary health care (PHC).MethodsTwelve PHC dietitians across a range of ages, ethnic and professional backgrounds participated in individual, semistructured, face‐to‐face interviews. The interviews were audio‐recorded, transcribed verbatim and analysed using inductive thematic analysis.ResultsAll participants identified that professional support impacted their ability to develop the competency and confidence required to deliver effective services in the PHC setting. Four sources of intraprofessional support were described: being in a team with another dietitian, being involved in dietetic networks or peer support groups, undertaking professional supervision and having access to relevant professional development opportunities. Additionally, participants identified two sources of interprofessional support: being part of a multidisciplinary, culturally diverse team and collaborating with other PHC professionals.ConclusionsIt is evident that dietitians working in the NZ PHC sector value good professional support. This enables them to develop greater competence and confidence to work more effectively. While an essential source of professional support comes from within the dietetic profession, another important source is other PHC colleagues. Feeling part of a multidisciplinary culturally diverse PHC team and/or working in collaboration with other PHC health workers resulted in the dietitian feeling a stronger sense of interprofessional support. This aligns with NZ's current PHC strategy, supporting the development of multidisciplinary PHC teams and collaborative care to improve patient outcomes.

The pharmacist in a primary healthcare setting

In May 2015, the Australian Medical Association (AMA) proposed the addition of practice pharmacists to Australian general practices as a strategy to improve patient safety.1 As a general practitioner (GP) and a consultant pharmacist (AP) who recently implemented an integrated model of patient care, we welcome this announcement. Medication-related harm is a major public health issue. Overprescribing, non-concordance and adverse drug events can contribute to poor health outcomes. Adverse drug events cause an estimated 230 000 (2–3%) Australian hospital admissions annually;2 moreover, Australian GPs reported that more than 10% of their patients had experienced a preventable adverse medication event over the preceding 6 months.3 Clearly, strategies optimising medicine use can significantly improve public health outcomes. Currently, GPs refer most home medicine reviews to the local community pharmacy. In turn, the community pharmacies outsource these to third-party consultant pharmacists. Although local pharmacies tend to be on good terms with the GPs, communication tends to be intermittent and problem-focused. The community pharmacist does not play a major educational role for GPs or GP registrars. The current home medicines review model funds the consultant pharmacist to review a patient every 2 years; this is too infrequent for the consultant pharmacist and the patient to develop an ongoing therapeutic relationship. The consultant pharmacist usually needs to delegate home medicines review recommendations, such as ongoing patient education, to another health professional (e.g. the community pharmacist or GP). Medicare funds the GP to develop a written medication management plan with the patient and discuss this with the pharmacist: there is no budget for continued pharmacist follow-up with either GP or patient, so this rarely occurs. A non-prescribing, non-dispensing clinical pharmacist integrated into the multidisciplinary primary care team is an alternative model of care. An international meta-analysis of randomised controlled studies found improved medication concordance and reduced potential medication-related problems in general practices with an integrated pharmacist; however, it did not include any Australian studies.4 In an Australian retrospective analysis, pharmacist home medicines review recommendations were significantly more likely to be implemented (71 vs 53%) if the pharmacist was embedded in the practice.5 Our integrated multidisciplinary practice model is in accordance with the AMA suggestion that the practice pharmacist role should include a combination of patient services, physician-focused activities and systems-level interventions.1 Since the best outcomes for both practice staff and patients appear to result from the pharmacist working closely with GPs, the pharmacist (AP) works as an in-house specialist at the medical centre rather than as an external (ad hoc) consultant.5 GPs benefit in multiple ways from the pharmacist presence. Pharmacists’ support and input are provided in a timely manner in instances when they may not have previously been sought, from clinical meetings to incidental (‘corridor’) consultations. The practice pharmacist and GP relationship allows for advice tailored to the GP's preferred style and immediate needs and enables ongoing, long-term collaboration on more challenging cases. Further, GPs are more likely to enact advice from a trusted and respected colleague than recommendations from an external ‘contractor’.5 Patients benefit both directly and indirectly from the presence of a practice pharmacist. The pharmacist and patient can develop a therapeutic relationship, allowing regular and ongoing patient education and support. As practice pharmacists are able to access the patient's medical records and pathology results, they can more readily identify both underprescribing and overprescribing to support the GP in optimising the medication regime. The medical centre can potentially benefit, too. The practice is more capable of delivering integrated care since the multidisciplinary team encompasses a wider range of healthcare professionals. All staff members benefit from the opportunity to strengthen pharmacotherapeutic knowledge, while the simple presence of a pharmacist promotes increased medicine-based thinking. The practice pharmacist can support clinical governance through quality improvement activities across the practice, such as medication audits, drug usage evaluations and monitoring drug safety. Our practice pharmacist role includes a combination of patient, physician and systems-focused activities, with the services delivered tailored to local preferences and needs. Our embedded practice pharmacist has a continuous, ongoing role in the optimisation of medication use within the primary healthcare team. This reflects a valuable progression from an intermittent, reactive, problem-based model to a collaborative, integrated model of chronic disease care delivered by a multidisciplinary primary healthcare team. Whilst this is a positive move, further research into the effectiveness of this innovation in the Australian primary healthcare setting needs to be funded before this model can become accepted as the standard.

Physical activity as medicine among family health teams: an environmental scan of physical activity services in an interdisciplinary primary care setting

A Family Health Team (FHT) is a multi-disciplinary primary healthcare model that may be an ideal setting to engage patients in physical activity. An environmental scan was conducted to determine the prevalence and characteristics of physical activity services offered by FHTs in Ontario. Of the 186 FHTs, 102 (55%) completed the survey. Almost 60% of responding FHTs offered a physical activity service; however, the availability, duration, size, and target population of the services varied depending on the individual FHT.

Managing trust problems in multidisciplinary primary health care collaborations

Introduction: While trust is recognized as a key element for successful collaboration in primary care, little empirical research has been done on the management of trust problems. This study examined how trust problems in primary care are managed by investing in coordination activities. Theory and methods: Both sociological and economic theories about trust are used. Data was collected within the Dutch ‘Primary Focus’ program of the Netherlands Organization for Health Research and Development. Characteristics of 66 multidisciplinary collaborations in primary care were measured by 198 interviews, with project leaders and two partners per project. Results: Legal forms and risk management were more likely used when a large diversity of disciplines is involved in the multidisciplinary collaboration. Trust issues caused by high monitoring problems appeared to be managed by informal contact. Contrary to our expectation, partners who worked together before were more likely to invest in risk management during their collaboration. Conclusions: Coordination activities in primary care collaborations vary by diversity of the partners involved, their shared history and potential monitoring problems. Discussion: Trust problems in multidisciplinary collaborations are managed using different coordination activities. Future research is needed to explore the influence of trust on the outcomes of the collaboration itself.