Staff Teamwork May Aid Regular Follow-Up in Primary Care

TOPLINE:

Primary care clinics achieving higher appointment regularity for patients with chronic conditions exhibited stronger teamwork among the staff and flat organizational structures, supported by systematic follow-up strategies involving all members rather than hierarchical roles in improving follow-up regularity.

METHODOLOGY:

• A descriptive and exploratory qualitative study was conducted between July 2022 and September 2023 to examine the factors affecting regular visits to primary care clinics within a large health maintenance organization in Israel for adults with chronic health conditions.
• For each patient with at least one chronic condition, appointment regularity was calculated by considering the mean interval between primary care visits (in days) over 2 consecutive years.
• Researchers conducted semistructured interviews with 15 primary care physicians, 12 nurses, 15 administrative staff members, and four pharmacists working full-time at six clinics with extremely high appointment regularity and six clinics with extremely low appointment regularity.
• Interview topics included roles of and work relationships among staff members, decisions regarding follow-up intervals and discussion with patients, patient engagement strategies, staff’s perceived responsibilities and procedures regarding patient follow-ups, and experiences with nonadherent patients; the interviews lasted an average of 30 minutes.
• Audio-taped interviews were transcribed and analyzed by a communication expert, a qualitative researcher, and a mixed methods researcher who was also a primary care physician.

TAKEAWAY:

• Clinics with high appointment regularity exhibited close staff relationships and flat staff organizational structures, along with a peaceful approach toward challenging patients to facilitate regular patient follow-ups.
• The culture of follow-up at clinics with high regularity involved a clear system for identifying and contacting no-show patients, where the administrative staff, nurses, and primary care physicians worked collaboratively, along with help from social workers or family members. They engaged in informal modes of communication and held regular staff meetings to address issues related to patients who did not follow-up. However, these strategies were not generally followed in clinics with low regularity.
• The workflow at clinics with high appointment regularity was adapted to meet patient needs, emphasizing the accommodation of challenging patients. The staff assisted patients to follow-up on recommended treatments by scheduling appointments, and social workers were recruited to better understand patient circumstances and address barriers faced by them.
• Structural factors, such as administrative staff’s access to patient files and knowledge of incentives provided by the administration, were different between clinics with high and low appointment regularities, further affecting regularity.

IN PRACTICE:

“This study suggests that stronger teamwork between staff members and an interdisciplinary team where every team member is part of the process of promoting regular follow-ups of patients with chronic conditions can result in proactive medicine and improve patients’ regular follow-ups with medical recommendations in primary care settings,” the authors wrote.

SOURCE:

This study was led by Maram Khazen, PhD, Faculty of Medicine, The Hebrew University of Jerusalem in Jerusalem, Israel. It was published online on March 24, 2025, in Annals of Family Medicine.

LIMITATIONS:

The appointment regularities of both clinic types were only compared with each other; it is possible that none of the participating clinics achieved the ideal/optimal level of regularity. Patient perspectives at the participating clinics were not included in this study. Additionally, the limited number of participants from each group may restrict the generalizability of the findings.

DISCLOSURES:

This study was funded by a grant from the Israel Science Foundation. The authors reported no conflicts of interest. 

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.