Multidisciplinary Primary Care Teams: Effects on the Quality of Clinician???Patient Interactions and Organizational Features of Care (original) (raw)
Background: 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. Methods: 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 ϭ 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. Results: 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 Ͻ 0.001). An exception was patients' assessments of teams, which were better when on-versus off-team visits occurred (P Ͻ 0.01). For other measures, the decrements associated with discontinuity were the same irrespective of whether discontinuities involved on-or offteam visits. Conclusions: 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.
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