Written By :
Suhl A Choi, PharmD Candidate 2015
Reviewed By :
Livia Macedo, Pharm.D.
Rodriguez HP, Roger WH, Marshall RE, et al. Multidisciplinary Primary Care Teams Effects on the Quality of Clinician-Patient Interactions and Organizational Features of Care. Medical Care. 2007;45: 19-27.
Who did you see in your last primary care visit? Your primary care physician or some other health care providers, such as a physician assistant, or a nurse practitioner?
In old days, primary care physicians (PCP) were the main health care providers in a primary health care setting. However, now many primary care settings have adopted the multidisciplinary team practice models to improve patient outcome and safety. Physician assistants, and registered nurse practitioners collaborate with primary care physicians to provide advanced patient care. Pharmacists are also considered as members of a multidisciplinary primary care team in some practices and they provide patient education on drug administration and medication safety.
According to a study “Multidisciplinary Primary Care Teams Effects on the Quality of Clinician-Patient Interactions and Organizational Features of Care” by Rodrigues et al., patients who regularly received medical care from their PCP reported higher quality physician-patient relationship compared to those who did not regularly seek medical attention from their PCP1. Those patients who frequently visited their PCP were satisfied with PCP’s communication skill, knowledge of patient, and health promotion support1. Other studies2-5 suggested that patients often did not experience additive values from a multidisciplinary team in their primary care setting and some patients did not even recognize the team1. If this is true, then why is interprofessional team based care considered as the advanced and better practice model in primary care setting?
Many studies suggested the benefits of multidisciplinary team in primary care practice. One study argued that primary care service provided by mid-level practitioners lowered overall health care cost per patient6. It was also demonstrated that health care providers from different disciplines bring diverse knowledge and skills that were required to provide high quality comprehensive care to patients who suffer from multi-disease states7. Therefore patients will clearly benefit from multidisciplinary team based care if the team is well managed and meets the patients’ need.
In the study, Rodrigues et al., categorized teams based on their “relationality” and “visibility”1.
Relationality: strong relationship among the members of the multidisciplinary primary care team
- Visible: non-PCP clinicians in the patients’ primary care physician’s office contributed significantly in the patient care
- Invisible: only PCP played an important role in the patient care
Patients who reported their multidisciplinary primary care team as moderately or highly visible had more favorable experience than those who reported their team as invisible. Patients who receive care from high relationality had more favorable primary care experience than those who received care from low to moderate relationality team. Lastly, patients who seen by low relationality primary care team showed worse experience than those patients who received care from invisible team.
This study demonstrates the importance of coherence in an interprofessional primary care team. Patients will benefit from the team-based care only when the team is well organized and consistent. Unstable relationships among the multidisciplinary primary care team members can lead to discontinuity of care because patients lost the clinician-patient relationship. The result of this study also highlighted patients’ positive experience when the team is visible. Therefore, from this study, we can conclude that an interprofessional team, which all members in the team are working closely to provide the best patient care, can improve patient care and for better patient outcomes. Each member in the team will need to build a strong clinician-patient relationship so that the patient can be aware of each clinician’s contribution.
How can an interprofessional primary care team improve relationality?
The authors of the study argued that hierarchy within the team members prevented the participation of the members on the bottom of the hierarchy pyramid. This could create dissatisfaction among members and lead to unstable and poor functioning team. For this reason, a team should be built based on vertical hierarchy. This structure allows free communication between health care providers from different disciplines. All health care providers in the team have the equal opportunity to participate in patient care. Secondly, role and responsibility of each member of the team should be clearly defined as well. The role should be defined based on each health care discipline’s strength and should not be overlap with another member of the team. For example, pharmacists are the drug experts thus pharmacists can provide input on medication, such as patient counseling on drug administration, drug side effects, and drug adherence.
This article successfully demonstrated that a continuous physician- patient relationship was associated with favorable patient outcome. It also described the importance of visibility and relationality of a multidisciplinary team in order to achieve better patient satisfaction. However, this study did not explain barriers that prevent patients from regularly visiting their PCP and receiving medical care. Unfortunately, this study did not clearly explain how a multidisciplinary team could function in order to improve physician- patient relationship in a primary care setting. Identifying services, which a multidisciplinary team can provide to a patient, to improve patient’s satisfaction and health outcome would be valuable information for those health care providers who want to build a new multidisciplinary health care team.
In conclusion, current studies suggest mixed opinion regarding the importance of multidisciplinary primary care team. However, I think the interdisciplinary team based care will improve patient care in primary care setting. The success of interdisciplinary team based practice in primary care will be largely dependent on health care providers’ willingness to cooperate. I believe that the ability to work with other health care professionals from different discipline is a critical skill that all future health care providers should learn in school. As a pharmacy student, I know what I can offer to my patients and the team but I do not clearly understand the responsibility of other health care providers. This is why interprofessional education is important. Discussing each other’s role to provide the best patient care in early stage of career will increase the students’ understanding on each other’s responsibility and help to form vertical hierarchy. This will help students to learn how to improve relationality in the real world practice. This is a big homework for future health care providers to build a strong interdisciplinary team, which our patients can trust and willing to form sustained patient-clinician relationship.
1. Rodriguez HP, Roger WH, Marshall RE, et al. Multidisciplinary Primary Care Teams Effects on the Quality of Clinician-Patient Interactions and Organizational Features of Care. Medical Care. 2007;45: 19-27.
2. Safran DG, Montgomery JE, Chang H, et al. Switching doctors: predictors of voluntary disenrollment from a primary physician’s practice. J Fam Pract. 2001;50:130-136.
3. Safran DG, Tarlov AR, Rogers WH. Primary care performance in fee-for-service and prepaid health care systems. Results from the Medical Outcomes Study. JAMA. 1994; 271: 1579-1586.
4. Safran DG, Rogers WH, Tarlov AR, et al. Organizational and financial characteristics of health plans: do they affect primary care performance. J Gen Intern Med. 1998;13:66.
5. Safran DG, Wilson IB, Rogers WH, et al. Primary care quality in the Medicare Program: comparing the performance of Medicare health maintenance organizations and traditional fee-for-service medicare. Arch Intern Med. 2002; 162:757-765.
6. Robin DW, Howard DH, Becker ER, et al. Use of midlevel practitioners to achieve labor cost savings in the primary care practice of an MCO. Health Serv Res. 2004;39:607-626.
7. Fried BJ, Topping S, Rundall TG. Groups and teams in organizations. In: Shortell SM, Kaluzny AD, eds. Health Care Management: Organization Design and Behavior. Albany, NY: Delmar; 2000:154-190.