Examining the impact of team-based care for people living with multimorbidity in primary care

The increase of the ageing population and patients with complex care needs (e.g., people living with multimorbidity [PLWMM] and those with social vulnerabilities) has driven the primary care systems to undertake reforms based on team-based care to meet patient care needs and reduce health care costs. However, there is limited evidence on how team-based care in primary care impacts patient outcomes for PLWMM (≥ 2 chronic conditions). This dissertation aimed to examine how team-based care impacts patient outcomes for PLWMM in primary care. This study used a convergent mixed methods design including a systematic review and a secondary data analysis of a cross-sectional study. The systematic review included peer-reviewed studies conducted in primary care for PLWMM and published from 2000 to May 2024. Of 3,075 studies identified, 26 studies met the inclusion criteria. The results indicate that team-based primary care improved mental health, general health, health/disease management, and functional health outcomes. Additionally, team-based primary care improved mental health for older people, females, and those with lower socioeconomic status. The secondary analysis was performed from cross-sectional data collected from 87 practices and 1,929 patients. The results showed that team functioning had no association with self-efficacy and quality of life for primary care patients. However, team functioning had a strong positive association with self-efficacy in PLWMM. Likewise, the results showed strong positive association between team functioning and quality of life for people with more social vulnerabilities compared to those < 2 social vulnerabilities. On the contrary, team size and team composition were not associated with patient outcomes. Altogether, these studies show that team-based primary care is effective in improving multiple patient outcomes. Team-based primary care and how teams function matter in improving patient outcomes, particularly for PLWMM and those with social vulnerabilities. Policymakers, health care leaders, and clinicians should ensure that the structure of team-based primary care is tailored to patient individual experiences and needs such as social vulnerabilities, and set strategies to facilitate team functioning so that team-based primary care can be optimized. Future research examining the impact of team size and team composition on patient outcomes is needed.