Multidisciplinary care teams are the flavour of the month when it comes to health investment, but what are they?
Multidisciplinary care teams can result in either fragmented or strengthened patient care; the key to the outcome may lie in planning and implementation, says new Australian research.
A new paper from University of New South Wales health systems researcher Dr Shona Bates, co-authored by RACGP president Dr Michael Wright and chief medical officer Professor Michael Kidd, looked at the impact of multidisciplinary team care on the quality of primary care.
Published in The Lancet’s Discovery Science, the scoping review analysed 39 papers.
It comes at a particularly critical time, given that one of the four key reforms ordered by the Strengthening Medicare Taskforce in 2022 was to encourage more team-based care in the primary health sector.
As the paper itself points out, although multidisciplinary team (MDT) care is used in similar health systems across the world, it is not without its detractors.
“In the UK, there has been criticism of MDTs substituting rather than supporting GPs leading to poorer health outcomes; in Canada, there has been criticism that poor design has led to cost blowouts and maldistribution of services,” the researchers wrote.
Ultimately, the review identified significant variation in not only the design and implementation of multidisciplinary team care, but also the outcomes.
While there was some evidence to show that team-based care increased access to primary care in contexts where it was difficult to access a GP, this also led to higher fragmentation of care and dissatisfaction among patients, who preferred to see their regular GP.
There was a similar trade-off in terms of team size. Where larger teams were able to increase access to preventative care and could collect more complete information to facilitate screening, larger team sizes were also associated with lower continuity of care.
Although multidisciplinary teams, especially those focused on specific chronic conditions, were found to improve the comprehensiveness of primary care, there were also concerns that this led to specialised, disease-focused care, rather than comprehensive care.
While team-based care offered more opportunities for care coordination, the researchers also found that patients tended to prefer their regular GP to be in charge.
“The key thing for patients is they want to see their GP, and they want to see their regular GP,” Dr Bates told The Medical Republic.
“That preference for relational continuity with a GP is still strong, even if they benefit from seeing other providers.”
A common theme among successful multidisciplinary care teams, Dr Bates said, was clear roles.
“Having a clear lead, whether that was a GP or nurse or another party … knowing who was the lead [was helpful to patients],” she said.
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“In some of the studies, patients weren’t clear about who was doing what and who could do what in terms of their care.
“Another common theme was having IT systems that support multidisciplinary team care … workflows for clinicians, but also patients in terms of transferring [care].
“If there is more than one provider looking after a patient, then that IT system [should] support communication between service providers, allowing them to add notes.”
While seemingly basic, Dr Bates said, these functionalities were not necessarily always present in practice management software.
She also said that, while the purpose and makeup of a multidisciplinary care team tended to be open to some interpretation, a narrower definition would likely be more of a hindrance than a help.
“Different forms of teams work in different contexts for different reasons,” said Dr Bates.
“To say we should only have one form of multidisciplinary team care, I think, is a bit shortsighted, because not all contexts have the same patient needs, demographics, primary workforce or issues.
“For example, if you were looking at an inner Sydney practice serving many patients, your multidisciplinary team would look very different to a practice in rural, remote New South Wales or anywhere else in the country, and would provide a different service.
“And it’s not to say that either is right or wrong approach, but I think it needs to be tailored to the context that it’s operating in.”
