Increasing primary care capacity by adding team members

Context Over 6.5 million adults in Canada do not have a family doctor or nurse practitioner. Interprofessional team-based care can expand access to primary care, however, the relationship between interprofessional teams and their impact on primary care capacity is not well-understood.

Objective To discover what is known in the literature about whether and how interprofessional primary care teams can impact the “capacity” (ability of the most-responsible clinician to serve more patients).

Study Design Rapid scoping review. Teams were defined as at least one most-responsible clinician and one regulated health professional working together on an ongoing basis with shared patients.

Setting Primary care teams in high income countries

Population Studied Study selection was limited to the peer-reviewed literature examining the impact of interprofessional primary care teams on the most-responsible clinician’s capacity. Studies that were qualitative, published before 2000, or non-English were excluded.

Intervention (if appropriate): N/A

Outcome Measures The main outcome of interest was a quantitative assessment of the capacity of the most responsible clinician(s) on the team. Secondary outcomes of interest were provider experience, health outcomes and cost of care, which were extracted only from studies that reported the primary outcome.

Results The search strategy resulted in 35 relevant studies. Results demonstrated substantial heterogeneity in measuring capacity of the most-responsible clinician. There was substantial variation in: patient populations served; the team size and composition; comparator groups; physician payment models; team governance and culture of teamwork; types of health professionals and their roles and ratios; and the total basket of services provided.

Conclusion Our study highlights the need for extensive further research in order to elucidate the mechanisms through which interprofessional teams facilitate or optimize primary care capacity, and the patient populations who may be best served by the different team configurations.