Effects of Team Care of Frequent Attenders on Patients and Physicians

Frequent clinic attenders consume a large portion of health care resources while feeling underserved. At the same time, physicians are frustrated trying to adequately care for these patients. Previous trials of team care in primary care have rarely included control groups. Adults with eight or more clinic visits in the past year were nonrandomly assigned to usual care or team care. For the latter group, a Care Team met to review each case and create a care plan. Changes in patient health care use, well-being, and satisfaction from baseline to 6 months were compared between team care and usual care patients. In addition, Care Team members' perceptions of team care were assessed by quantitative and qualitative methods. Study patients were medically complex. Self-reported overall well-being and overall care satisfaction improved in the 12-patient team care group, but remained unchanged in the 8 patient usual care group. Median 6-month visits fell by 3 visits among team care patients and increased by 1.5 among usual care patients. Most Care Team members rated team care as positive and as improving quality of care. Members were divided on its effect on care efficiency and workload. Team care is feasible within a family medicine residency practice and may improve care.