Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia.
Med J Aust. 2011 Mar 7;194(5):236-9. doi: 10.5694/j.1326-5377.2011.tb02952.x.
To explore factors associated with the frequency of multidisciplinary Team Care Arrangements (TCAs) and the impact of TCAs on patient-assessed quality of care in Australian general practice.
Data were collected as part of a cluster randomised controlled trial conducted in 60 general practices in New South Wales, the Australian Capital Territory and Victoria between July 2006 and June 2008. Multilevel logistic regression analysis evaluated factors associated with the frequency of TCAs recorded in the 12 months after baseline, and multilevel multivariable analysis examined the association between TCAs and patient-assessed quality of chronic illness care, adjusted for patient and practice characteristics.
Frequency of TCAs; Patient Assessment of Chronic Illness Care (PACIC) scores.
Of 1752 patients with clinical audit data available at 12-month follow-up, 398 (22.7%) had a TCA put in place since baseline. Women, patients with two or more chronic conditions, and patients from metropolitan areas had an increased probability of having a TCA. There was an association between TCAs and practices with solo general practitioners and those with greater levels of teamwork involving non-GP staff for the control group but not the intervention group. Patients who had a TCA self-assessed their quality of care (measured by PACIC scores) to be higher than those who did not.
Findings were consistent with the purpose of TCAs--to provide multidisciplinary care for patients with longer-term complex conditions. Significant barriers to TCA use remain, especially in rural areas and for men, and these may be more challenging to overcome in larger practices.
探索与多学科团队护理安排（TCAs）频率相关的因素，以及 TCAs 对澳大利亚普通实践中患者评估的护理质量的影响。
数据是作为 2006 年 7 月至 2008 年 6 月在新南威尔士州、澳大利亚首都领地和维多利亚州的 60 家普通实践中进行的一项集群随机对照试验的一部分收集的。多水平逻辑回归分析评估了与基线后 12 个月内记录的 TCAs 频率相关的因素，多水平多变量分析检查了 TCAs 与患者评估的慢性疾病护理质量之间的关联，调整了患者和实践特征。
TCAs 的频率；患者评估的慢性疾病护理（PACIC）评分。
在 12 个月随访时具有临床审计数据的 1752 名患者中，有 398 名（22.7%）自基线以来已实施了 TCA。女性、患有两种或多种慢性疾病的患者以及来自大都市区的患者具有增加的可能性具有 TCA。TCAs 与只有全科医生的实践和涉及非全科医生的团队合作水平较高的实践之间存在关联，但与对照组而不是干预组之间存在关联。接受 TCA 的患者自我评估其护理质量（通过 PACIC 评分测量）高于未接受 TCA 的患者。
研究结果与 TCAs 的目的一致，即为患有长期复杂疾病的患者提供多学科护理。TCAs 的使用仍然存在重大障碍，特别是在农村地区和男性中，在较大的实践中，这些障碍可能更难克服。
