Relationship Centred Care (RCC):
In our review, studies demonstrated associations between RCC and improved patient outcomes with emphasis on the importance of communication and collaboration (37,40). There is evidence that skills and behaviours related to collaboration are most likely to show significant effects on patient outcomes (37). Evaluation of RCC is important as relationships can be disrupted in poorly functioning teams.
Patient Experience:
From our review, there is considerable evidence that TBPCC can enhance patient experience of care through strategies related to accessibility, respectful supportive relationships, enhanced opportunities for knowledge sharing, self-management, and community advocacy (24,33,34,40). The availability of enhanced case management or specialized support roles also positively influences patient experience (44,45,72). These benefits are particularly salient for more vulnerable populations (47,65), who feel they are given the chance to ‘tell their story and be heard’ in team-based settings (48).
Provider Experience:
The review suggests that providers can find working in a team very useful, particularly for complex patients (36,57). Providers perceive there is improved access, continuity of care, and patient-centered-ness in TBC (5,44). Communication and shared understanding of roles contributes to enhanced provider experience (35,36,44,57) as does the availability of providers with specific expertise (e.g. mental health/counselling or CDM) (39,55).
Team Function:
Team Function was the most evaluated dimension in the included articles (24/45; 53%). The review underscored the value of proactively supporting effective communication and trusting relationships among team members (36–38,73). Common barriers to collaboration and team function include the time it takes to build relationships, the lack of opportunities for co-location, and challenges with role definition (59,64,66). Despite some studies that suggest only moderate success in the context of interdisciplinary collaboration (63,74), there is ample evidence of the importance of working to develop shared values in primary care teams and the value of efforts to improve group dynamics to support higher levels of interdisciplinary collaboration (5,44,74–76). Working to build understanding of roles and shared leadership is also widely attributed to enhancing collaboration (58,60,61,65). There is also evidence of the value of interprofessional education (67,77). Intentional, team-focused activities, including formal meetings, professional development programs, social activities, and retreats, are essential to sustaining and building relationships needed for highly functioning teams (75,78).
Care Process and Quality:
A number of studies included in our review suggest that TBC leads to improvements in patients’ perceptions of quality of care, accessibility of care, knowledge of medical conditions, and their ability to self-manage (24,34,40,44,50,53,72,79). Providers’ perceptions of capacity can be enhanced through shared care models and opportunities for interprofessional collaboration (39,48,52,61). However, other studies suggest the accessibility of care is still an issue, even in highly-functioning team-based practices (33,43,46). A pan-Canadian study found that the likelihood of reporting access issues or unmet needs was not significantly different in TBC vs. non-TBC settings (68). However, there is evidence that quality of care, particularly for CDM, is better in team-based practices and particularly in community health centres or practices with blended capitation models (62,69,80).
TBC Foundations:
The most salient issues for teams that emerged from our synthesis are physician remuneration, co-location, interoperable electronic health records, visionary leadership, and educational support (38,39,52,56,62). Larger numbers of physicians on teams and the distribution of teams across sites has been negatively associated with team performance (42,56,59); there is evidence that smaller, co-located teams are more likely to collaborate effectively (66).The physical layout of a space, the presence of coordinator or team management roles, and the use of alternative funding models have been highlighted as foundational to success (56,62,80).
Health of the Population:
TBPCC can improve outcomes in population health (e.g. fewer Emergency Room visits for low acuity) (81,82). Some studies highlight early indicators of improvement in population health through TBPCC (35). For example, one study found that increased accessibility to dietitians resulted in increased likelihood of PCPs discussing nutrition for weight management (52). Another study discovered improved CDM and preventive care in TBPCC (53). An addiction shared care program also showed early success (54).
Health Care Costs:
Physician remuneration is an important issue for interprofessional teams across Canada and is a frequent stumbling block (38). Due to the longitudinal nature of cost savings related to longer-term, expected outcomes, there is a paucity of evidence in this dimension. A study focused on the cost effectiveness of a team-based prevention program for complex patients found that it was both more expensive and more effective than other programs (50). There is also evidence that the integration of new team members becomes more cost effective over time (51).