Developing primary care teams prepared to improve quality: a mixed-methods evaluation and lessons learned from implementing a microsystems approach

Pandhi, Nancy; Kraft, Sally A; Berkson, Stephanie; Davis, Sarah; Kamnetz, Sandra; Koslov, Steven; Trowbridge, Elizabeth; Caplan, William

doi:10.1186/s12913-018-3650-4

Cited by 9 publications

(21 citation statements)

References 29 publications

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“…Staffing was reported as a key element in 11 studies 30,32,34,[36][37][38][39]41,44,46,47 . Flexibility in the team structure was described as an effective way to adapt to local resource constraints 41,[44][45][46]48,49 .…”

Section: Deployment Of Resourcesmentioning

confidence: 99%

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Primary care micro-teams: an international systematic review of patient and healthcare professional perspectives

et al. 2023

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Background: There has been a recent trend, both in the UK and internationally, towards creating larger primary care practices with the assumption that interdisciplinary teams can increase patient accessibility and provide more cost-effective, efficient services. Micro-teams have been proposed to mitigate some of the potential challenges with practice expansion, including continuity of care. Aim: Review the available literature to examine how micro-teams are described and the opportunities which primary care micro-teams can provide for practice staff and patients and limitations to their introduction and implementation. Design and setting: International Systematic review of studies published in English. Method: A Framework analysis was used to synthesise the literature. Databases and grey literature were searched. Studies were included if they provided evidence regarding the implementation of micro-teams in primary care. We worked with a PPI co-author and conducted stakeholder discussions to those with and without experience in micro-team implementation. Results: The majority of the 24 included studies discussed empirical data from healthcare professionals, describing the implementation of micro-teams. Results include the characteristics of the literature; how micro-teams have been described; the range of ways micro-teams have been implemented; reported outcomes and experiences of patients and staff. Conclusion: The organisation of primary care has the potential to impact the nature and quality of patient care, safety and outcomes. This review contributes to current debates surrounding care delivery and how this can impact the experiences and outcomes of patients and staff. The analysis identifies several key opportunities and challenges for future research, policy and practice.

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Section: Deployment Of Resourcesmentioning

confidence: 99%

“…Flexibility in the team structure was described as an effective way to adapt to local resource constraints 41,[44][45][46]48,49 . The need for flexibility was balanced with the importance of role clarity 37,38,41,44,45,47 . This meant clearly defined expectations in roles and responsibilities of all team members 37,41 .…”

Section: Deployment Of Resourcesmentioning

confidence: 99%

Primary care micro-teams: an international systematic review of patient and healthcare professional perspectives

et al. 2023

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“…In a recent systematic review looking at whether clinical microsystems work, only 3 of the 35 papers included in the review targeted primary care [ 17 ]. However, the foci of these studies were highly specific to either a chronic condition [ 21 ] or to team effectiveness and care coordination activities [ 22 , 23 ], and neither focused on the patient and provider as a core unit of analysis nor a virtual micropractice delivery model in a rural setting.…”

Section: Introductionmentioning

confidence: 99%

Empowering Patients Through Virtual Care Delivery: Qualitative Study With Micropractice Clinic Patients and Health Care Providers

Burton¹,

Rush²,

Smith³

et al. 2022

JMIR Form Res

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Background Prior to the wider adoption of digital health technologies during the COVID-19 pandemic, applications of virtual care were largely limited to specialist visits and remote care using telehealth (phone or video) applications. Data sharing approaches using tethered patient portals were mostly built around hospitals and larger care systems. These portals offer opportunities for improved communication, but despite a belief that care has improved, they have so far shown few outcome improvements beyond medication adherence. Less is known about use of virtual care and related tools in the outpatient context and particularly in rural community contexts. Objective This study aims to reflect on the opportunities and barriers for sustainable virtual care through an example of a digitally enabled rural micropractice, which has provided 10%-15% virtual care since 2016 and 70% virtual care since March 2020. Methods Three focus groups, 1 with providers (physician and medical office manager) and 2 with a total of 8 patients from a rural micropractice in British Columbia, were conducted in November 2020 and December 2020. Virtual care delivery was explored through the topics of communication approach, mixing virtual and in-person care, the practice team’s journey in developing these approaches, and provider and patient satisfaction with the care model. Interviews were transcribed, checked for accuracy against recordings, and thematically analyzed. Results Both patients and providers reported ease of communication and high satisfaction. Either could initiate communication, and patients found the ability to share health information asynchronously through the portal allowed time to reflect and prepare their thoughts. Patients were highly engaged and reported feeling empowered and true partners in their health care, although they noted limited care coordination with specialists. The mix of virtual and in-person visits was highly regarded by patients and providers, and patients reported feeling safe and cared for 24/7, although both expressed concern about work spilling into the provider’s home life. The physician worried about missed diagnoses with virtual care. With respect to establishing the micropractice, solutions took about 5 years to optimize, with providers noting a learning curve requiring technical support for both themselves and their patients and a willingness to respond to patient feedback to identify the best solutions. Despite a mature virtual practice, patients reported deferred care due to COVID-19. Conclusions The micropractice’s hybrid care model encouraged patients to be true partners in their care and resulted in high patient engagement and satisfaction; yet, success may rely on the patient population being willing to engage and being comfortable with technology. Barriers lie in gaps in care coordination and provider fear that signs or symptoms more evident with an in-person exam could be missed. Even in this setting, deferral of care in light of COVID-19 was present, and opportunities to address care gaps should be sought.

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“…Faced with the challenges of an ageing population and increasing numbers of multi-morbid or complex patients, which create health and cost pressures, healthcare systems must aim to reduce the fragmented provision of care by promoting integrated care. In this context, many healthcare systems have introduced new models of care, often involving strengthening primary care and especially general practices [ 1 – 6 ]. Developing primary care teams [ 6 – 9 ] and introducing case managers [ 10 – 13 ] are two frequently chosen options.…”

Section: Introductionmentioning

confidence: 99%

“…In this context, many healthcare systems have introduced new models of care, often involving strengthening primary care and especially general practices [ 1 – 6 ]. Developing primary care teams [ 6 – 9 ] and introducing case managers [ 10 – 13 ] are two frequently chosen options. Indeed, case management has been recognized as an appropriate and highly responsive intervention to satisfy the particular needs of complex patients [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Identifying complex patients in family medicine for potential benefit from a case manager: a short questionnaire derived from the INTERMED Self-Assessment (IMSA) questionnaire

Cohidon

Gallay

Wild³

et al. 2022

BMC Prim. Care

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Purpose To investigate how useful the Intermed-Self Assessment (IMSA) questionnaire and its components were for identifying which patient candidates would benefit most from case management (CM) in general practice. Methods The study was carried out in a group family medicine practice in Lausanne comprising seven GPs and four medical assistants, from February to April 2019. All the patients attending the practice between February and April 2019 were invited to complete the IMSA questionnaire. Additionally, their GPs were asked for their opinions on the potential benefits of each patient being assigned a case manager. Each IMSA item’s value has been assessed as a predictor of GPs’ opinions by using multivariate logistic models. A score including items retained as predictor was built. Results Three hundred and thirty one patients participated in the study (participation rate: 62%). Three items from the 20 item IMSA were sufficient to predict GPs’ opinions about whether their patients could be expected to benefit if assigned a case manager. Those items addressed the patient’s existing chronic diseases (item1), quality of life in relation to existing diseases (item 3), and their social situation (item 9). Using these three items as a score, a cut-off at 4 gave a sensitivity of 70% (ability to correctly identify patients who could benefit from a CM) and specificity of 73% (ability to correctly identify patients who should not benefit from a CM) and concerned about one patient in two. Conclusion Identifying complex patients suitable for case management remains a challenge for primary care professionals. This paper describes a novel approach using a structured process of combining the results of standardized tools such as the one defined in this study, and the experience of the primary care team.

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Developing primary care teams prepared to improve quality: a mixed-methods evaluation and lessons learned from implementing a microsystems approach

Cited by 9 publications

References 29 publications

Primary care micro-teams: an international systematic review of patient and healthcare professional perspectives

Primary care micro-teams: an international systematic review of patient and healthcare professional perspectives

Empowering Patients Through Virtual Care Delivery: Qualitative Study With Micropractice Clinic Patients and Health Care Providers

Identifying complex patients in family medicine for potential benefit from a case manager: a short questionnaire derived from the INTERMED Self-Assessment (IMSA) questionnaire

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