Primary care practice characteristics associated with team functioning in primary care settings in Canada: A practice-based cross-sectional survey

Figures & data

Table 1. Organizational characteristics of all participating primary care practices (n= 87).

	Fraser East-BC (n=22, 25%)		Eastern Ontario Health Unit-ON (n=26, 30%)		Central Zone-NS (n=39, 45%)		Total (n=87, 100%)
Practice characteristics	n	%	n	%	n	%	n	%	p-value
Clinic internal meetings to discuss…clinical issues:									.651
At least weekly	2	9	8	32	8	22	18	22
Monthly	12	55	9	36	16	44	37	45
Other	5	23	4	16	6	17	15	18
Never	3	14	4	16	6	17	13	16
Care coordination through informal or adhoc									.006
exchange**:
Regularly	17	90	21	91	19	56	57	75
Sometimes	2	11	2	9	7	21	11	15
Rarely	0	0	0	0	8	24	8	11
Care coordinated through electronic medical records (EMRs)**:									.006
Regularly	16	84	14	67	16	49	46	63
Sometimes	2	11	7	33	7	21	16	22
Rarely	1	5	0	0	10	30	11	15
Clinic professionals share clinic’ mission, values and objectives:									.728
Totally/partly disagree	3	14	1	5	4	11	8	10
Partly agree	7	33	10	46	12	32	29	36
Totally agree	11	52	11	50	22	58	44	54
Payment model for physician**:									<.001
Fee-for-service	21	96	1	4	28	78	50	60
Capitation or roster	0	0	17	65	0	0	17	20
Salary	0	0	4	15	5	14	9	11
Blended model	1	5	1	4	1	3	3	4
Other	0	0	3	12	2	6	5	6
Team size*:									.013
≤5	2	9	10	39	10	26	22	25
6-10	9	41	1	4	7	18	17	20
≥11	11	50	15	58	22	56	48	55
Patients registered in clinic*:									.024
≤3000	3	16	12	46	13	38	28	35
3001-10,000 patients	12	63	10	39	8	24	30	38
˃10,000 patients	4	21	4	15	13	38	21	27

*p < 0.05, **p < 0.01; chi-square test was used to test differences of practices characteristics across regions. Clinic internal meeting to discuss clinical issues missing data: 4(5%); care coordination through informal or ad hoc exchange_missing data or not applicable:11(13%); care coordination through EMR_missing data or not applicable: 14(16%) and sharing clinic’s mission, values and objectives among health professionals_missing data or nor applicable: 6(7%)

Table 2. Team composition and team climate inventory scores across regions (n = 63).

Characteristics	Regions						Overall		p-value
	Fraser East, BC (n=20)		Eastern Ontario, ON (n=21)		Central Zone, NS (n=22)
Team composition*	n	%	n	%	n	%	n	%
GPs only	10	50	6	29	6	30	22	35
GPs and RNs only	2	10	4	19	3	15	9	14
GPs, RNs and others	1	5	10	48	7	35	18	29	.035
GPs+others excluding RNs	7	35	1	5	4	20	12	19
Team climate inventory score	M	SD	M	SD	M	SD	M	SD
Participative safety	77	13	74	11	76	11	75	11	.790
Team objectives	70	12	75	12	71	9	72	12	.231
Task orientation	72	12	72	13	69	11	71	11	.662
Support for new ideas	72	12	74	14	70	11	72	12	.526
and innovation
Overall TCI	73	11	74	12	72	10	73	11	.789

M: Mean; SD: Standard deviation; *: Statistically significant at p < .05; **: Statistically significant at p < .01; ***: Statistically significant at p <.001; GPs: General practitioners; RNs: registered nurses.

Table 3. Team functioning scores overall and by team size and team composition for eligible practices (n = 63).

	TCI mean score (SD)						Sig.
Variables	Fraser East, BC (n = 20)		Eastern Ontario, ON (n = 21)		Central Zone, NS (n = 22)
Team Size^a	M	SD	M	SD	M	SD	NS
≤5	77	0	80	14	78	9
6–10	75	4	60	0	78	2
≥11	71	15	71	9	69	9
Team composition^a
GPs only	71	7	75	8	74	9	NS
GPs+RNs only	78	11	82	20	78	8
GPs+ RN and others	72	0	69	9	65	11
GPs+others excluding RNs	73	11	90	0	74	9

NS: Non statistically significant; ^a: ANOVA; M: Mean; SD: Standard deviation

Table 4. Bivariate analysis results between practice characteristics and team functioning in primary care (n = 63).

	TCI-overall
Factors	M	SD	F	P-value	η^2
Frequency of internal clinic meetings to discuss…Clinical issues			1.76	.17	.082
At least weekly	76	9
Monthly	70	10
Other	76	12
Never	74	14
Care coordination through informal or adhoc exchange			.09	.91	.003
	73	12
Regularly	75	9
Sometimes	72	6
Rarely
Care coordinated through electronic medical records (EMRs)			1.49	.23	.054
RegularlySometimes Rarely	74 68 73	11 11 6
Clinic professionals share clinic’ mission, values and objectives.			6.28*	.001**	.255
Totally disagree	57	16
Partly disagree	53	7
Partly agree	73	8
Totally agree	75	10
			.92	.46	.060
Payment model for physicians
Fee-for-service	74	10
Capitation or roster Salary	74 72	12 12
Blended model	65	14
Other	63	10
Team size			4.32	.02	.126
≤5	79	12
6-10	74	6
≥ 11	70	11
Patients registered in clinic			4.41*	.02*	.132
≤ 3000 patients	78	10
3001-10000 patients	71	11
˃10,000 patients	68	10
GPs			3.78*	.03*	.112
1-2	77	10
3-5	71	11
≥6	69	8
Administrative staff			2.78	.07	.085
1-3	76	11
4-8	73	11
≥ 9	68	9
Other health professionals			.48	.62	.025
1-2	75	16
3-5	72	9
>=6	71	8
Team composition			2.82*	.05*	.129
GPs only	73	8
GPs+RNs only	80	13
GPs +RNs and others	68	9
GPs+others excluding RNs	75	14

Note: *: P < .05; **: p < .01; ***: p < .001. Care coordination through informal or adhoc exchange missing responses: n = 6. Care coordinated through electronic medical records (EMRs) missing responses: n = 7. Clinic professionals share clinic mission, values, and objectives: n = 4. Patients registered in clinic missing responses: n = 2. Post hoc comparisons using the Tukey HSD test indicated that the mean score of overall TCI for totally agree was significantly higher than totally disagree and partly disagree. The mean score of TCI for partly agree was significantly higher than totally disagree and partly disagree. Post hoc comparisons indicated that larger team size had a significantly lower overall TCI score compared to small team size. M= mean; SD =standard deviation; TCI = Team Climate Inventory. The mean score of TCI for teams of GPs+RNs only was significantly higher compared to the teams composed of GPs+RNs and other health professionals

Table 5. Correlation matrix of independent and dependent variables.

Variables	1	2	3	4	5	6	7	8
(1) Physician payment model	1
(2) Team size	.117	1
(3) Patients registered in clinic/ patient panel	−.065	.557**	1
(4) Clinic professionals share clinic’s mission, values and objective.	−.002	−.013	−.139	1
(5) Clinic internal meeting to discuss clinical issues	.011	.138	.203	.055	1
(6) Care coordination through informal or adhoc exchange	.221	.116	−.047	−.167	.262*	1
(7) Care coordination through electronic medical records	.252*	.170	.084	.076	.067	.428***	1
(8) Overall team functioning	−.209	−.354**	−.353**	.436**	−.086	−.003	.107	1

*: Significance at p <.05; ** p <.01; *** p < .001 (two-tailed).

Table 6. Primary care practice predictors of team functioning in primary care-hierarchical regression analysis results (n= 63).

Variables		R^2		Coefficients		95% CI for B		Sig.
		R^2	∆R^2	B	SE B	Lower	Upper
Step 1		.152						.045
	Constant			79.399
	Team size 6–10			−3.104	4.429	−11.969	5.761	.486
	Team size ≥11			−5.658	4.320	−14.305	2.989	.195
	Panel size_3001-10,000			−3.439	3.709	−10.863	3.984	.358
	Panel size >10,000			−5.795	4.340	−14.481	2.892	.187
Step 2		.570	.418					.002
	Constant			67.251		56.241	78.261	<.001
	Team size 6–10			−6.930	4.643	−16.287	2.427	.143
	Team size ≥11			−10.764	4.406	−19.643	−1.886	.019
	Panel size_3001-10,000			−.228	3.441	−7.163	6.708	.948
	Panel size >10,000			.055	4.242	−8.494	8.603	.990
	Fee-for services			2.436	4.221	−6.072	10.944	.567
	Payment capitation			3.884	4.549	−5.374	13.143	.402
	Payment-blended			−3.344	7.506	−18.471	11.782	.658
	Payment-others			−6.942	6.053	−19.141	5.257	.258
	At least weekly clinic meetings			−.586	5.495	−11.660	10.498	.916
	Monthly clinic meeting			−5.993	4.423	−14.906	2.921	.182
	Other meeting frequencies			−1.675	5.262	−12.280	8.930	.752
	Regular care coordination through informal and adhoc exchange			10.763	4.743	1.204	20.322	.028
	Care coordination through informal and adhoc exchange-sometimes			12.257	6.200	−.239	24.753	.05
	Regular coordinated care through EMR			−9.147	4.261	−17.734	−.560	<.037
	Sometimes coordinated care through EMR			−19.436	5.132	−29.778	−9.094	<.001
	Extent of sharing clinic mission, values and objectives among professionals-Partly disagree			3.772	8.796	−13.954	21.499	.670
	Extent of sharing clinic mission, values and objectives among professionals-Partly agree			15.172	5.184	4.723	25.620	.005
	Extent of sharing clinic mission, values and objectives among professionals-Totally agree			17.346	4.806	7.659	27.033	.001

R² = .152 for step 1, ∆R² = .418 for step 2. * p < .005; **p <.01; ***p <.001

Physician’s payment model reference (salary); frequency of clinic meetings to discuss clinical issues_reference (never); care coordination frequency through informal and adhoc exchange_reference (rarely); care coordinated through Electronic Medical Records (EMR)_reference (rarely), Extent of sharing clinic mission, values and objectives among health professionals_reference (Totally disagree); Team size) _reference (team size ≤5) and panel size-reference (≤3000 patients)