Department of Public Health, Catholic University of the Sacred Heart, Rome, Italy.
Health Policy. 2013 Nov;113(1-2):180-7. doi: 10.1016/j.healthpol.2013.07.008. Epub 2013 Jul 31.
Since the 1970s, many countries have employed the use of the General practitioner group practice, but there is contrasting evidence about its effectiveness. A systematic review was performed to assess whether group practice has a more positive impact compared with the single-handed practice on different aspects of health care.
A systematic review was conducted by querying electronic databases and reviewing articles published between 1990 and 2012. A quality assessment was performed. The effect of group practice was evaluated by collecting all items analysed by the articles into four main categories: (1) studies of quality (measured in terms of clinical processes) and productivity (measured in terms of throughput), named "Clinical process measures and throughput"; (2) studies exploring physician's opinion--"Doctor's perspective"; (3) studies looking into the use of innovation, information and communication technology (ICT) and quality assurance--"Innovation, ICT and quality assurance"; (4) studies focused on patient's opinion--"Patient's perspective". The results were synthesized according to three levels of scientific evidence.
A total of 26 studies were selected. The most studied category was Clinical process measures and throughput (58%). A positive impact of group medicine on "Clinical process measures and throughput", "Doctor's perspective", "Innovation, ICT and quality assurance" was found. There was contrasting evidence considering the "Patient's perspective".
Group practice might be a successful organizational requirement to improve the quality of clinical practice in Primary Health Care. Further comparative studies are needed to investigate the impact of organizational and professional determinants such as physician's economic incentives, mode of payment, size of the groups and multispecialty on the effectiveness of medical primary care.
自 20 世纪 70 年代以来，许多国家都采用了全科医生团队实践的模式，但关于其有效性的证据却相互矛盾。本系统评价旨在评估团队实践是否在医疗保健的不同方面比单人实践具有更积极的影响。
通过查询电子数据库和审查 1990 年至 2012 年期间发表的文章，进行了系统评价。进行了质量评估。通过将文章分析的所有项目收集到四个主要类别中，评估了团队实践的效果：（1）研究质量（以临床过程衡量）和生产力（以吞吐量衡量），称为“临床过程措施和吞吐量”；（2）探索医生意见的研究-“医生观点”；（3）研究创新、信息和通信技术（ICT）以及质量保证的使用-“创新、ICT 和质量保证”；（4）关注患者意见的研究-“患者观点”。根据三个级别的科学证据对结果进行了综合分析。
共选择了 26 项研究。研究最多的类别是临床过程措施和吞吐量（58%）。发现团队医学对“临床过程措施和吞吐量”、“医生观点”、“创新、ICT 和质量保证”具有积极影响。但考虑到“患者观点”，则存在相互矛盾的证据。
团队实践可能是改善初级卫生保健临床实践质量的成功组织要求。需要进一步开展比较研究，以调查组织和专业决定因素（如医生的经济激励、支付方式、团队规模和多专业）对初级医疗保健效果的影响。
