title: Multidisciplinary primary care teams: effects on the quality of clinician-patient interactions and organizational features of care.
abstract: 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=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<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.
  
  
  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.
authors.affiliation: Harvard University, Cambridge, Massachusetts, USA.
authors.forename: Hector P
authors.initials: HP
authors.lastname: Rodriguez
authors.forename: William H
authors.initials: WH
authors.lastname: Rogers
authors.forename: Richard E
authors.initials: RE
authors.lastname: Marshall
authors.forename: Dana Gelb
authors.initials: DG
authors.lastname: Safran
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000458:organization & administration* / Q000523:psychology; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration*; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000458:organization & administration*; D011787:Quality of Health Care; D011795:Surveys and Questionnaires