Primary care staff and health policymakers’ perspectives on the Israeli special team management program for complex patients and its further enhancement: a qualitative study

BACKGROUND/AIM: The healthcare of complex patients is challenging, requiring holistic multidisciplinary teamwork. The targeted Team Management for Complex Patients Program (TMCP) was therefore initiated in Israel and implemented by Leumit Health Services. The aim of the current study was to examine the perceptions and insights of healthcare stakeholders regarding the program implementation and its further enhancement. METHODS: A descriptive qualitative study using semi-structured remote videoconference interviews was conducted. A purposive sampling of primary care practitioners, managers and policymakers, with operational experience in the TMCP, was employed. Interviewees were categorized into three levels: field staff and service providers, mid-level management staff and high-level policymakers. RESULTS: Five main themes were examined amongst the 22 interviewees: detection of complex patients for inclusion in the TMCP; quality and access to healthcare; team function, governance and accountability; and provider experience. These themes were extracted from the three levels of interviewees, all of whom endorsed a broad definition of complexity that integrates clinical, functional, mental and social dimensions and emphasized the critical role of multidisciplinary teamwork in complex patient care. Optimal patient identification combines clinical assessment ("bottom-up") with data-driven lists ("top-down"). There was unanimous rejection of using age ≥ 65 years as a threshold, as complexity exists across all age groups. A consensus emerged on transitioning to personalized, goal-oriented care that integrates pharmacological and mental health consultations. The nurse was identified as the central coordinator for care integration, while the physician remained the primary clinical authority. Significant barriers mentioned by the interviewees included administrative focus on economic efficiency versus the frontline need for dedicated time and training. Participants preferred to use existing management structures rather than create new roles to maintain continuity of care within primary clinics, and unanimously supported program monitoring to track clinical outcomes. CONCLUSION: Stakeholders participating in the study highlighted diverse insights and recommendations regarding the healthcare policy for managing complex patients. Effective teamwork by empowered and trained teams, patient-centered goals and rigorous monitoring seem fundamental for the success of the Israeli TMCP.