TITLE:
Team Effectiveness in Patient Health Management: An Overview of Reviews
AUTHORS:
Amédé Gogovor, Bernard Burnand, Sara Ahmed, Terrence Montague, Isabelle Peytremann-Bridevaux
KEYWORDS:
Team Care Effectiveness; Chronic Disease Management; Chronic Care Model; Overview of Reviews
JOURNAL NAME:
International Journal of Clinical Medicine,
Vol.3 No.7,
December
31,
2012
ABSTRACT: Background: The desire to improve the quality of health care for
an aging population with multiple chronic diseases is fostering a rapid growth
in interprofessional team care, supported by health professionals,
governments, businesses and public institutions. However, the weight of
evidence measuring the impact of team care on patient and health system
outcomes has not, heretofore, been clear. To address this deficiency, we
evaluated published evidence for the clinical effectiveness of team care within
a chronic disease management context in a systematic overview. Methods: A
search strategy was built for Medline using medical subject headings and other
relevant keywords. After testing for performance, the search strategy was adapted to other
databases (Cinhal, Cochrane, Embase, PsychInfo) using their specific
descriptors. The searches were limited to reviews published between 1996 and
2011, in English and French languages. The results were analyzed by the number
of studies favouring team intervention, based on the direction of effect and
statistical significance for all reported outcomes. Results: Sixteen
systematic and 7 narrative reviews were included. Diseases most frequently
targeted were depression, followed by heart failure, diabetes and mental
disorders. Effectiveness
outcome measures most commonly used were clinical endpoints, resource
utilization (e.g., emergency room visits, hospital admissions), costs, quality
of life and medication adherence. Briefly, while improved clinical and resource
utilization endpoints were commonly reported as positive outcomes, mixed
directional results were often found among costs, medication adherence,
mortality and patient satisfaction outcomes. Conclusions: We conclude
that, although suggestive of some specific benefits, the overall weight of
evidence for team care efficacy remains equivocal. Further studies that examine
the causal interactions between multidisciplinary team care and clinical and
economic outcomes of disease management are needed to more accurately assess
its net program efficacy and population effectiveness.