Background: Multidisciplinary teams may hold promise for improving primary care quality. This study examined the influence of multidisciplinary teams on patients' assessments of primary care, including access, integration, and clinician-patient interaction quality.
Methods: From January 2004 through March 2005, a large multispecialty practice in Massachusetts obtained data monthly from patients of 145 primary care physicians using a well-validated patient questionnaire. The analytic sample included respondents with at least 2 primary care visits over the study period (n = 14,835). For each respondent, administrative data were used to compute visit continuity over the study period and to classify each primary care visit as PCP, on-team, or off-team. Multivariate regression modeled the relationship of visit continuity to each primary care measure.
Results: Approximately one-third of patients (35%) saw only their PCP; 15% had only PCP and on-team visits; 9% had a mix of PCP, on-, and off-team visits; and 41% had only off-team visits when not seeing their PCP. Greater PCP continuity was associated with more favorable scores on nearly all measures (P < 0.001). An exception was patients' assessments of teams, which were better when on- versus off-team visits occurred (P < 0.01). For other measures, the decrements associated with discontinuity were the same irrespective of whether discontinuities involved on- or off-team visits.
Conclusions: The finding that PCP visit discontinuities are associated with more negative care experiences, irrespective of whether discontinuities involve on- or off-team visits, highlights the challenges of incorporating teams into primary care in ways that patients experience as value-added rather than disruptive to primary care relationships.