Impact of team-based primary care on health care utilization among patients with mental and substance use disorders: a systematic review of English-language articles.

Abstract

Objective: To conduct a systematic review of the literature on the impact of team-based primary care on downstream health care utilization (all-cause or mental health-specific emergency department (ED) visits and hospitalizations) among people with mental or substance use disorders.

Methods: A literature search was conducted using the Scopus, MEDLINE, and Web of Science databases. Gray literature and forward and backward citation searches yielded additional results. Two independent reviewers screened the abstracts and full texts. Both reviewers performed a critical appraisal of the methodological quality using a modified Downs and Black checklist. The data were extracted using a standardized data extraction spreadsheet, and the effect sizes of studies were synthesized.

Results: A total of 18 studies were included (16 in the USA and 2 in Canada). Seven of the 15 studies that assessed the effect of team-based care on all-cause ED visits found they were associated with a lower number or odds of visits. Of the 15 studies that assessed the effect of team-based approaches on all-cause hospitalizations, 8 found that they were associated with an overall decrease. Very few studies assessed mental health-related ED visits (n = 2) or hospitalizations (n = 4), and the findings varied. All included studies were of fair quality (mean score ± standard deviation: 17.4 ± 1.3).

Conclusion: Team-based care is likely associated with a decrease in all-cause ED visits and hospitalizations. A team-based primary care approach has the potential to reduce downstream healthcare utilization for patients with mental or substance use disorders and improve health outcomes.