Team-based care in small primary care practices: a scoping review.

Area of Science:

• Health Services Research
• Primary Care Management
• Team Effectiveness Models

Background:

• Small independent primary care practices (SIPs) face unique challenges implementing team-based care.
• Existing literature often overlooks the specific context of SIPs.

Purpose of the Study:

• To review existing literature on team-based care implementation within SIPs.
• To identify gaps in research regarding team-based care in small primary care settings.

Main Methods:

• Systematic literature search across major databases (PubMed/MEDLINE, CINAHL, EMBASE, Cochrane Library).
• Extracted studies on team-based care in small primary care settings.
• Organized findings using the Integrated (Health Care) Team Effectiveness Model (ITEM) framework.

Main Results:

• Twenty-five studies were included; only nine focused exclusively on SIPs.
• Studies covered task design, team composition (e.g., MA/MD dyads), and processes (communication, coordination).
• Limited discussion on psychosocial traits (trust, psychological safety) and organizational context (structure, resources, training).
• Key barriers included financial constraints and misaligned payment models.

Conclusions:

• Significant research gap exists regarding psychosocial factors, especially trust-building, in SIPs.
• Future research should focus on developing strategies for fostering trust during team-based care implementation in SIPs.
• Shifting the mental model within SIPs is crucial for successful team-based care adoption.