Literature Collection

Patient-centred care is the foundation for safe and high-quality care that enhances patient health outcomes, with multidisciplinary team-based care (MTBC) being a key enabling factor. MTBC is an integrated approach in care provision involving health professionals with different skillsets working in collaboration. Shared goals, clarity of roles, mutual trust, effective communication, and the evaluation of team functions are important for MTBC success. No reviews were identified on the system or cross-organisational approaches that support MTBC in primary care settings. A scoping review was conducted between October and December 2024 to identify international innovations in operationalising MTBC in primary care and the factors that impact its success. The databases searched were CINAHL, ProQuest Central, PubMed, Scopus, and Web of Science, in October 2024. The search terms were informed by two central concepts: MTBC (concept 1) and primary care (concept 2). Concepts of design (concept 3) and factors (concept 4) were added to refine the scope of the search. Following the Arksey and O'Malley framework, the scoping review included 58 articles on data extraction, and confirmed 14 key success factors and 14 barriers that could affect the implementation and adoption of MTBC. The strengths of MTBC in the primary care setting are summarised by six themes: patient-centred benefits, teamwork and collaboration, decision-making and clinical care, communication and coordination, improved access and performance management, and supportive infrastructure. This review further confirms six core benefits and 11 core components of the MTBC model, providing important guidance for MTBC development. A multidisciplinary team-based care model was designed to deliver comprehensive patient-centred care by integrating expertise from various disciplines. By integrating the key elements identified in this review into a specific primary care context, successful implementation of an adaptable MTBC model may lead to improved service delivery and outcomes in primary care.

BACKGROUND: The Veterans Affairs (VA) Healthcare System maintains the largest integrated health system in the United States but also supports fee-for-service insurance for veterans receiving care in community facilities outside the VA. We sought to evaluate the management and outcomes of patients referred for consultation in either venue, using cardiovascular evaluation as a model. METHODS: We conducted a retrospective cohort study identifying patients enrolled in the VA Healthcare System referred for cardiovascular evaluation from October 2020 through September 2024 and stratified the population based on the venue in which evaluation was completed. The primary outcome was major adverse cardiovascular events (acute coronary syndromes/stroke/mortality) in a matched population. RESULTS: Among 235 197 consultations for cardiovascular evaluation, 201 453 were completed in the chosen venue within 6 months. The time between consultation and evaluation was similar across venues (community, 35 days [95% CI, 17-65] versus VA, 33 days [95% CI, 19-53]), with comparable delays to diagnostic testing or therapeutic interventions. Patients receiving care in the community were more likely to undergo stress testing (43.2% versus 36.4%, P=1.5×10(-46)) and coronary angiography (23.1% versus 17.4%, P=2.1×10(-51)) within 2 years compared with those treated in the VA Healthcare System. Despite this, patients treated in the community had a significantly higher rate of major adverse events at 2 years (17.6% versus 15.3%, P=5.9×10(-10)) compared with those treated in the VA Healthcare System. CONCLUSIONS: Patients undergoing cardiovascular evaluation in community practices were not evaluated more rapidly than those seen in the VA, though they were more likely to receive initial and repeat diagnostic testing. Adverse events were more common among community-treated patients than those in the VA, suggesting an opportunity to optimize access to care while improving clinical outcomes.

BACKGROUND: Hidradenitis suppurativa (HS) is a painful, chronic, inflammatory skin condition affecting the skin folds. It is frequently misdiagnosed, leading to delays in care and the progression of the disease to permanent scarring. AIM: To understand the level of knowledge and confidence of healthcare professionals (HCPs) in primary care managing patients with HS. To establish their ability to recognise the early signs of HS, awareness of associated comorbidities, and recognition of treatment options available in primary care. DESIGN & SETTING: A survey was distributed to HCPs working in primary care in the UK. METHOD: The survey was disseminated via weekly GP bulletins distributed by local integrated care boards, the Primary Care Dermatology Society (PCDS) mailing lists, and at professional events. RESULTS: Of 183 responders, most (93%) did not have a specialist role in dermatology or a postgraduate qualification in dermatology (69%), 36 (20%) were not doctors, and there was a good geographical spread over the UK. Of the responders, 74% felt confident diagnosing HS, but only 39% were confident in managing the pain associated with the disease. Perceived confidence did not correlate with understanding the importance of early referral to secondary care where multiple skin sites were affected. CONCLUSION: Further education in diagnosing and managing HS in primary care is needed. Future research could focus on developing a tool to support the diagnosis of HS in primary care and a clear, primary care-focused management guideline for identified patients.