Improving access, mixed continuity: effects of multidisciplinary teams on primary health-care in Finland - a quasi-experimental study.

Abstract

Objective: The multidisciplinary team (MDT) approach in primary care is a relatively recent innovation, developed over the past 15 years. There is limited data on MDTs' effects on Quadruple Aim (QA) goals. The object of this study is to evaluate the implementation of a novel MDT from 2021 to 2023 and its impact on access and continuity of care, compared to an established model. Future research will explore its effects on staff satisfaction, costs, and health outcomes.

Design, setting and patients: This quasi-experimental study compares five intervention health centers with three control centers. It includes all primary care patients from 2021 to 2023, presenting data on access and continuity before and after the intervention.

Intervention: Nurse-only consultations were replaced with a multidisciplinary nurse-physician model to address issues during initial contact more effectively. Nurses also took on the role of case managers, enhancing relational continuity. Lean daily visual management with continuous improvement, strategic goal setting, and coaching leadership style were implemented.

Main outcome measures: Access was measured using the 'third available appointment' (T3) metric, and continuity with the COC-index, both for physicians only.

Results: Access improved at all intervention centers, with T3 reduced from 90 to 1.125-4.75 days, while controls remained at 90 days. COC improved at three intervention centers but declined at two, with declines also observed at control centers.

Conclusion: The novel MDT enhanced primary care access compared to the traditional model. However, relying solely on T3 may be insufficient for evaluating effectiveness. Mixed results in continuity underscore the need for further investigation.