Primary Care Team and its Association with Quality of Care for People with Multimorbidity: A Systematic Review

Abstract Background:Multimorbidity is posing an enormous burden to health systems, especially for primary healthcare system. While primary care team (PCT) is believed to have potentials to improve quality of primary health care (PHC), less is known about its impact on the quality of care for people with multimorbidity. We assessed the characteristics of PCT and its impact on the quality of care for people with multimorbidity and the mechanisms. Methods: We searched PubMed, MEDLINE, EMBASE, ProQuest from January 2000 to October 2021 for English studies. Patients with multimorbidity, studies focusing on PCTs and reporting quality of care were eligible. Results: Seventeen studies (13 RCT, 3 cohort studies, and 1 non-randomized trial) were identified. PCTs were summarized into three types - upward PCT, downward PCT and traditional PCT according to the skill mix. The upward PCT included primary care workers and specialists from upper-level hospitals, downward PCT involving primary care workers and lay health workers, and traditional PCT involving physicians and care managers. PCTs improved patients’ mental and psychological health outcomes greatly, and also improved patients’ perceptions towards care including satisfaction with care, sense of improvement, and patient-centeredness. PCTs also improved the process of care and changed providers’ behaviors. However, PCTs showed mixed effects on objective and validated outcome measures. Conclusions: PCTs have improved mental and psychological health outcomes, the process of care, patients’ care experiences, and satisfaction towards care for patients with multimorbidity. The effect of PCTs on objective and validated clinical outcomes and changes in patient behaviors need to be further explored.