Literature Collection

BACKGROUND: Primary care practices experience challenges to implementing team-based care, and these challenges may be more pronounced in small-to-medium-sized independent primary care practices (SIPs). Our objective is to provide a review of the literature on team-based care implemented within SIPs. METHODS: The literature was identified using keywords related to primary care and team-based care in PubMed/MEDLINE, CINAHL, Cochrane Library, and EMBASE. Studies on team-based care within small-primary care settings were extracted and organized according to the four domains of the Integrated (Health Care) Team Effectiveness Model (ITEM) framework. RESULTS: Twenty-five studies met our criteria for inclusion and were included in our review. Of those, only nine of the included studies solely focused on SIPs. Studies addressed some component of task design, including the composition of the team (i.e. MA and MD dyads) and the features of the task (i.e. role interdependence). Studies also discussed team processes, such as communication and coordination. Few studies discussed psychosocial traits during implementation, including trust and psychological safety. Lastly, studies described the organizational context of the practices, which includes their structure, resources or training environment. Identified barriers for team-based care implementation included financial constraints when hiring additional staff and issues with the current payment models that reward team-based care. CONCLUSIONS: Studies solely focused on small primary care practices are limited. Of the four key domains, the biggest gap was identified around psychosocial traits and how mutual trust is fostered. Areas of future research include attention to how trust is built as practices implement team-based care and shift their mental model.

Suicide prevention in clinical settings requires coordination among multiple clinicians with expertise in different disciplines. We aimed to understand the benefits and challenges of a team approach to suicide prevention in primary care, with a particular focus on Veterans. The Veterans Health Administration has both a vested interest in preventing suicide and it has rapidly and systematically adopted team-based approaches for primary care interventions, including suicide prevention. We conducted eight focus groups and eight in-depth interviews with primary care providers (PCPs), behavioral health providers and nurses located in six regions within one Veterans Administration Catchment Area in the northeast of the US. Transcripts were analyzed using simultaneous deductive and inductive content analysis. Findings revealed that different clinicians were thought to have particular expertise and roles. Nurses were recognized as being well positioned to identify subtle changes in patient behavior that could put patients at risk for suicide; behavioral health providers were recognized for their skill in suicide risk assessment; and PCPs were felt to be an integral conduit between needed services and treatment. Our findings suggest that clinician role-differentiation may be an important by-product of team-based suicide prevention efforts in VHA settings. We contextualize our findings within both a processual and relational interprofessional framework and discuss implications for the implementation of team-based suicide prevention.