Building Teams in Primary Care: Lessons from 15 Case Studies

Much of the practice of medicine is predicated on teams of people working together. Not so in primary care. A busy primary care office handles such a wide array of patients that it is difficult to organize the staff around a routine. Given the challenges posed by rendering hundreds of diagnoses and the need to provide acute, chronic, and preventive care services, primary care is inherently chaotic.
How to solve the problem? Many practices have found the answer in the creation of high-functioning primary care teams with nonphysician team members taking on clinical tasks that physicians have insufficient time to perform, and that focus several people on each patient's problems. Some have also demonstrated that many primary care visits, especially for chronic disease, involve relatively simple matters that could be handled by nonphysician team members via protocols or standing orders.

This two-part report examines the approaches taken by 15 primary care practices across the United States. The case studies demonstrate that teams are a necessary and effective foundation upon which other innovations — such as the chronic care model, advanced access, group visits, and electronic encounters — can be pursued.

The introductory volume of the report summarizes some general issues regarding teams in primary care and points readers to the overall lessons provided by the case studies. The bulk of the report, presented as a separate volume, provides case studies of practices and clinics making considerable progress in forging primary care teams.