Primary care multidisciplinary teams in practice: a qualitative study.


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.





Published Version (Please cite this version)


Publication Info

Leach, Brandi, Perri Morgan, Justine Strand de Oliveira, Sharon Hull, Truls Østbye and Christine Everett (2017). Primary care multidisciplinary teams in practice: a qualitative study. BMC Fam Pract, 18(1). p. 115. 10.1186/s12875-017-0701-6 Retrieved from

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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 experts on education, practice, and workforce issues related to the PA profession, Dr. Morgan is regularly invited to serve in national and state level policy advisory positions.  Her research, linked below, addresses methodological problems of data sources for use in research on PAs and NPs, the effect of PA use on health resource utilization, and use and roles of PAs and NPs in various settings.

Strand de Oliveira

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.


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’s current research initiatives focus on healthcare team design and the impact on patient, provider, and organizational outcomes. Recent work has focused on understanding the role of primary care PAs and nurse practitioners (NPs) and how they relate to outcomes for patients with diabetes. Her work has been published in a variety of journals including Health Affairs, Journal of Rural Health , Medical Care Research and Review, and BMC Family Practice. She completed the first comparative effectiveness study of primary care PAs and NPs and has become the first PA faculty in the US to receive grant funding from the National Institutes of Health.

Nationally, Christine has served on a range of governmental and non-governmental groups, including the Healthy People 2010 Workgroup, the Agency for Healthcare Research and Quality Primary Care Team Workforce Models Workgroup, and the American Academy of Physician Assistant Research Council.  She is currently a member of the advisory board for the Center for Professionalism & Value in Healthcare and the Associate Editor for Research for the Journal of the American Academy of Physician Assistants.

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