Group versus single handed primary care: A performance evaluation of the care delivered to chronic patients by Italian GPs

Objectives: In family medicine contrasting evidence exists on the effectiveness of teampractice compared with solo practice on chronic disease management. In Italy, severalexperiences of team practice have been introduced since the late 1990s but few studiesdetail their impact on the quality of care.The aim of this paper is to evaluate the impact of team practice in family medicine insix Italian regions using chronic disease management process indicators as a measure ofoutcome. Methods: Cross-sectional studies were performed to assess impact on quality of care fordiabetes, congestive heart failure and ischaemic heart disease. The impact of team vs. solopractice was approximated through performance comparison of general practitioners (GPs)adhering to a team with respect to GPs working in a solo practice.Among the 2082 practitioners working in the 6 regions those assisting 300+ patientswere selected. Quality of care towards 164,267 patients having at least one of three chronicconditions was estimated for the year 2008 using administrative databases.Quality indicators (% of patients receiving appropriate care) were selected (4 for diabetes,4 for congestive heart failure, 3 for ischaemic heart disease) and a total score was computedfor each patient. For each disease the response variable associated to each physician wasthe average score of the patients on his/her list. A multilevel model was estimated assessingthe impact of team vs. solo practice. Results: No impact was found for diabetes and heart failure. For ischaemic heart disease aslightly significant impact was observed (0.040; 95% CI: 0.015, 0.065). Conclusions: No significant difference was found between team practice and solo practiceon chronic disease management in six Italian regions.