title: When peers count: The effects on integrated type II diabetes care of communication within general practitioner-only subgroups in interprofessional primary care teams.
abstract: Primary care teams (hereafter referred to as primary care units [PCUs]) composed of general practitioners (GPs), nurses, and specialist doctors have recently been established in the Italian context, with the main aim of improving integrated care for chronic diseases.
  
  
  
  The aim of the study was to assess whether the increased professional diversity of PCUs has resulted in an improvement in the integrated care of type II diabetes and to identify a potential mechanism mediating this effect.
  
  
  
  We analyzed 213 PCUs, comparing their performance in integrated type II diabetes care at two time points. Using social categorization theory and a fixed effects regression analysis, we tested a mediation model in which the frequency of communication among GPs in the PCUs, that is, within-subgroup communication, mediates the relationship between PCU professional diversity and team performance in diabetes care.
  
  
  
  We show that when the professional diversity of the PCUs increases, integrated care of type II diabetes improves and better meets the standards of optimal care. Within-GP subgroup communication works as a mediating mechanism that translates the PCU professional diversity into better team performance. The mediation effect, however, is curvilinear. Beyond certain levels, within-subgroup communication can hamper PCUs' capacity to work collaboratively in integrated type II diabetes care.
  
  
  
  The article suggests that, when creating interprofessional primary care teams, managers might be able to steer teams toward a better performance by encouraging communication among peers of the same profession.
authors.affiliation: Amelia Compagni, PhD, is Associate Professor, Department of Policy Analysis and Public Management, Center for Research in Health and Social Care Management, Bocconi University, Milan, Italy. E-mail: amelia.compagni@unibocconi.it. Patrizio Armeni, PhD, is Research Fellow, Center for Research in Health and Social Care Management, Bocconi University, Milan, Italy. E-mail: patrizio.armeni@unibocconi.it. Stefano Tasselli, PhD, is Assistant Professor, Department of Technology and Operations Management, Rotterdam School of Management, Erasmus University Rotterdam, The Netherlands. E-mail: tasselli@rsm.nl.
authors.forename: Amelia
authors.initials: A
authors.lastname: Compagni
authors.forename: Patrizio
authors.initials: P
authors.lastname: Armeni
authors.forename: Stefano
authors.initials: S
authors.lastname: Tasselli
mesh_terms: D002908:Chronic Disease / Q000628:therapy; D003142:Communication; D019033:Delivery of Health Care, Integrated; D003924:Diabetes Mellitus, Type 2 / Q000451:nursing / Q000628:therapy*; D058005:General Practitioners / Q000706:statistics & numerical data*; D006801:Humans; D007400:Interprofessional Relations; D007558:Italy; D011320:Primary Health Care; D036301:Qualitative Research; D066269:Social Theory