Multidisciplinary primary care teams: effects on the quality of clinician-patient interactions and organizational features of care.
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.
Rodriguez
Hector P
HP
Harvard University, Cambridge, Massachusetts, USA.
Rogers
William H
WH
Marshall
Richard E
RE
Safran
Dana Gelb
DG
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