Abstract
BACKGROUND: People with complex conditions may be managed by a number of different clinicians, including primary care practitioners and specialist teams. The organisation of health systems may lead to compartmentalised care, duplication of services or ineffcient delivery. In 1999, the Australian Government began remunerating general practitioners (GPs) for participating in the multidisciplinary care of patients with chronic or complex conditions. Teamwork systems have also been implemented in other countries. Little is known about the effect of involving GPs in specialist teams.
Objective: To assess the effect of formal liaison between GPs and specialist teams on patients’ health, medical practitioners’ behaviour and health delivery costs.
Method: Systematic review.
Search strategy: The authors searched MEDLINE; EMBASE, PsychInfo, CINAHL and the Cochrane Library for published studies to August 2001.
Inclusion/exclusion criteria: Randomised trials comparing formal liaison with controls were eligible if they reported selection and blinding of adequate quality. Full inclusion criteria were not reported. Seven studies were included with 1862participants. Meta-analysis was not possible due to differences in medical conditions, methodologies and interventions.
Outcomes: Patient health outcomes, functional outcomes and satisfaction; doctor behaviours.
Main results: In most studies, there was no difference in health outcomes among the formal liaison versus control groups. There were some improvements in physical and functional health outcomes in the formal liaison group, particularly among people with chronic mental illness. Some health outcomes worsened during interventions. Treatment retention rates and patient satisfaction improved with formal liaison compared to controls. The reported behaviour of GPs and specialists also changed, with reduced duplication of diagnostic tests, improved clinical skills, more frequent use of appropriate treatments and more frequent attempts to detect complications. There was limited evidence about the cost efectiveness of formal liaison.
Authors' conclusions: Formal liaison between GPs and specialist teams may not improve physical health outcomes, but may improve patient satisfaction and some functional outcomes.
Objective: To assess the effect of formal liaison between GPs and specialist teams on patients’ health, medical practitioners’ behaviour and health delivery costs.
Method: Systematic review.
Search strategy: The authors searched MEDLINE; EMBASE, PsychInfo, CINAHL and the Cochrane Library for published studies to August 2001.
Inclusion/exclusion criteria: Randomised trials comparing formal liaison with controls were eligible if they reported selection and blinding of adequate quality. Full inclusion criteria were not reported. Seven studies were included with 1862participants. Meta-analysis was not possible due to differences in medical conditions, methodologies and interventions.
Outcomes: Patient health outcomes, functional outcomes and satisfaction; doctor behaviours.
Main results: In most studies, there was no difference in health outcomes among the formal liaison versus control groups. There were some improvements in physical and functional health outcomes in the formal liaison group, particularly among people with chronic mental illness. Some health outcomes worsened during interventions. Treatment retention rates and patient satisfaction improved with formal liaison compared to controls. The reported behaviour of GPs and specialists also changed, with reduced duplication of diagnostic tests, improved clinical skills, more frequent use of appropriate treatments and more frequent attempts to detect complications. There was limited evidence about the cost efectiveness of formal liaison.
Authors' conclusions: Formal liaison between GPs and specialist teams may not improve physical health outcomes, but may improve patient satisfaction and some functional outcomes.
| Original language | English |
|---|---|
| Pages (from-to) | 68-69 |
| Number of pages | 2 |
| Journal | Evidence-Based Healthcare |
| Volume | 7 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - 9 May 2003 |