Primary care multidisciplinary teams in practice: a qualitative study.
Abstract
BACKGROUND: Current recommendations for strengthening the US healthcare system consider
restructuring primary care into multidisciplinary teams as vital to improving quality
and efficiency. Yet, approaches to the selection of team designs remain unclear. This
project describes current primary care team designs, primary care professionals' perceptions
of ideal team designs, and perceived facilitating factors and barriers to implementing
ideal team-based care. METHODS: Qualitative study of 44 health care professionals
at 6 primary care practices in North Carolina using focus group discussions and surveys.
Data was analyzed using framework content analysis. RESULTS: Practices used a variety
of multidisciplinary team designs with the specific design being influenced by the
social and policy context in which practices were embedded. Practices overwhelmingly
located barriers to adopting ideal multidisciplinary teams as being outside of their
individual practices and outside of their control. Participants viewed internal organizational
contexts as the major facilitators of multidisciplinary primary care teams. The majority
of practices described their ideal team design as including a social worker to meet
the needs of socially complex patients. CONCLUSIONS: Primary care multidisciplinary
team designs vary across practices, shaped in part by contextual factors perceived
as barriers outside of the practices' control. Facilitating factors within practices
provide a culture of support to team members, but they are insufficient to overcome
the perceived barriers. The common desire to add social workers to care teams reflects
practices' struggles to meet the complex demands of patients and external agencies.
Government or organizational policies should avoid one-size-fits-all approaches to
multidisciplinary care teams, and instead allow primary care practices to adapt to
their specific contextual circumstances.
Type
Journal articlePermalink
https://hdl.handle.net/10161/16033Published Version (Please cite this version)
10.1186/s12875-017-0701-6Publication Info
Leach, Brandi; Morgan, Perri; Strand de Oliveira, Justine; Hull, Sharon; Østbye, Truls;
& Everett, Christine (2017). Primary care multidisciplinary teams in practice: a qualitative study. BMC Fam Pract, 18(1). pp. 115. 10.1186/s12875-017-0701-6. Retrieved from https://hdl.handle.net/10161/16033.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
Collections
More Info
Show full item recordScholars@Duke
Christine M Everett
Adjunct Professor in the Department of Population Health Sciences
Dr. Everett joined the faculty of the Department of Community and Family Medicine
at Duke University in August 2013 and gained a secondary appointment in the Department
of Population Health in 2018. Prior to joining the faculty, she worked clinically
in emergency departments in rural Wisconsin. Prior to becoming a physician assistant
(PA), Dr. Everett worked in research at the National Institutes of Health and public
health policy at the Food and Drug Administration. Dr. Everett&rsqu
Sharon Kay Hull
Professor of Family Medicine and Community Health
Perri Anne Morgan
Professor in Family Medicine and Community Health
Dr. Morgan is a health services researcher focusing on PAs and NPs in the health workforce
and on outcomes associated with their use in different roles and settings. As Director
of Research in the Duke PA Division, she led the development of the PA Research section,
which is one of only a few such groups nationally. As a practicing PA for 25 years,
Dr. Morgan has extensive knowledge of the PA profession from the perspective of a
clinician. As one of a very few national exper
Justine Strand de Oliveira
Professor Emeritus in Family Medicine and Community Health
Public health, health workforce, physician associates, advanced practice nursing,
primary care, health policy, organizational behavior, provider-patient interactions,
medical sociology, sociology of professions, health equity, social mission in health
professions education.
Alphabetical list of authors with Scholars@Duke profiles.

Articles written by Duke faculty are made available through the campus open access policy. For more information see: Duke Open Access Policy
Rights for Collection: Scholarly Articles
Works are deposited here by their authors, and represent their research and opinions, not that of Duke University. Some materials and descriptions may include offensive content. More info