Preserving Continuity and Trust in Primary Care: Strategies for Implementing Team-Based Models in South Tyrol, Italy
Abstract
1. Introduction
2. Background
2.1. Importance of Continuity in Primary Care
2.2. Specific Risks in South Tyrol
2.2.1. Resistance Among GPs
2.2.2. Balancing Continuity with New Care Models
3. Key Challenges
3.1. Loss of Personal Connection
3.2. Increased Bureaucracy for GPs
3.3. Geographical and Cultural Barriers
4. Proposed Strategies
4.1. Integration of Services
4.1.1. Assign Primary Providers in Teams
- Shared Care Platforms: Implement secure, interoperable EHRs that allow GPs to share patient information with other team members (e.g., specialists, nurses, and physiotherapists) in real time.
- Regular Virtual Meetings: Schedule periodic virtual case discussions via video conferencing to align care plans while minimizing disruption to GPs’ routines.
- Integrated Communication Tools: Use secure messaging systems for quick queries and updates among team members.
- Defined Roles and Responsibilities: Clearly delineate the role of each team member, ensuring GPs retain oversight while delegating specific tasks (e.g., health education, follow-ups) to other professionals.
4.1.2. Personalized Care Contracts
4.2. Building Infrastructure for Local Needs
4.3. Strengthening Engagement and Trust
4.4. Supporting General Practitioners
4.5. Benefits of Interprofessional Care Management
5. Monitoring and Evaluation
6. Conclusions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
CHC | Community Health Centers |
EHR | Electronic Health Record |
GP | General practitioner |
MDPI | Multidisciplinary Digital Publishing Institute |
References
- McKinstry, B.; Ashcroft, R.E.; Car, J.; Freeman, G.K.; Sheikh, A. Interventions for Improving Patients’ Trust in Doctors and Groups of Doctors. Cochrane Database Syst. Rev. 2006, 19, CD004134. [Google Scholar] [CrossRef]
- Vinceti, S.R. The Legal Status of General Practitioners at the Dawn of the New Primary Care in Italy. Ann. Ig. 2022, 34, 431–438. [Google Scholar] [PubMed]
- Wiedermann, C.J.; Mahlknecht, A.; Barbieri, V.; Ausserhofer, D.; Plagg, B.; Felderer, C.; Marino, P.; Engl, A.; Piccoliori, G. Examining South Tyrol’s Experience: Digital Health Adoption and Workforce Issues in Implementing Italy’s Primary Care Reform Under Ministerial Decree No. 77/2022. Epidemiologia 2024, 5, 838–853. [Google Scholar] [CrossRef]
- Ministero Della Salute Repubblica Italiana Regolamento Recante la Definizione di Modelli e Standard per lo Sviluppo Dell’assistenza Territoriale nel Servizio Sanitario Nazionale. Decreto n. 77. Available online: https://www.gazzettaufficiale.it/eli/id/2022/06/22/22G00085/sg (accessed on 11 March 2025).
- Ye, T.; Xiao, W.; Li, Y.; Xiao, Y.; Fang, H.; Chen, W.; Lu, S. Trust in Family Doctor-Patient Relations: An Embeddedness Theory Perspective. BMC Public Health 2024, 24, 3278. [Google Scholar] [CrossRef] [PubMed]
- Esperat, M.C.; Hust, C.; Song, H.; Garcia, M.; McMurry, L.J. Interprofessional Collaborative Practice: Management of Chronic Disease and Mental Health Issues in Primary Care. Public Health Rep. 2023, 138, 29S–35S. [Google Scholar] [CrossRef]
- Lutfiyya, M.N.; Chang, L.F.; McGrath, C.; Dana, C.; Lipsky, M.S. The State of the Science of Interprofessional Collaborative Practice: A Scoping Review of the Patient Health-Related Outcomes Based Literature Published between 2010 and 2018. PLoS ONE 2019, 14, e0218578. [Google Scholar] [CrossRef]
- Wranik, W.D.; Price, S.; Haydt, S.M.; Edwards, J.; Hatfield, K.; Weir, J.; Doria, N. Implications of Interprofessional Primary Care Team Characteristics for Health Services and Patient Health Outcomes: A Systematic Review with Narrative Synthesis. Health Policy 2019, 123, 550–563. [Google Scholar] [CrossRef]
- Morgan, S.; Pullon, S.; McKinlay, E. Observation of Interprofessional Collaborative Practice in Primary Care Teams: An Integrative Literature Review. Int. J. Nurs. Stud. 2015, 52, 1217–1230. [Google Scholar] [CrossRef]
- Carter, R.; Riverin, B.; Levesque, J.-F.; Gariepy, G.; Quesnel-Vallée, A. The Impact of Primary Care Reform on Health System Performance in Canada: A Systematic Review. BMC Health Serv. Res. 2016, 16, 324. [Google Scholar] [CrossRef]
- Macinko, J.; Harris, M.J. Brazil’s Family Health Strategy—Delivering Community-Based Primary Care in a Universal Health System. N. Engl. J. Med. 2015, 372, 2177–2181. [Google Scholar] [CrossRef]
- Pereira Gray, D.J.; Sidaway-Lee, K.; White, E.; Thorne, A.; Evans, P.H. Continuity of Care with Doctors-a Matter of Life and Death? A Systematic Review of Continuity of Care and Mortality. BMJ Open 2018, 8, e021161. [Google Scholar] [CrossRef]
- Baker, R.; Freeman, G.K.; Haggerty, J.L.; Bankart, M.J.; Nockels, K.H. Primary Medical Care Continuity and Patient Mortality: A Systematic Review. Br. J. Gen. Pract. 2020, 70, e600–e611. [Google Scholar] [CrossRef] [PubMed]
- Sidaway-Lee, K.; Pereira Gray OBE, D.; Harding, A.; Evans, P. What Mechanisms Could Link GP Relational Continuity to Patient Outcomes? Br. J. Gen. Pract. 2021, 71, 278–281. [Google Scholar] [CrossRef] [PubMed]
- Barbieri, V.; Lombardo, S.; Gärtner, T.; Piccoliori, G.; Engl, A.; Wiedermann, C.J. Trust in Conventional Healthcare and the Utilization of Complementary and Alternative Medicine in South Tyrol, Italy: A Population-Based Cross-Sectional Survey. Ann. Ig. 2024, 36, 377–391. [Google Scholar] [CrossRef]
- Südtiroler Landesverwaltung Gesundheit: Multidisziplinäre Teams für Bessere Versorgung am Wohnort. Available online: https://news.provinz.bz.it/de/news/gesundheit-multidisziplinare-teams-fur-bessere-versorgung-am-wohnort?utm_source=chatgpt.com (accessed on 9 January 2025).
- Wiedermann, C.J. Advancing Precision Medicine in South Tyrol, Italy: A Public Health Development Proposal for a Bilingual, Autonomous Province. J. Pers. Med. 2023, 13, 972. [Google Scholar] [CrossRef]
- Rai—Radiotelevisione Italiana, T.G.R. Ärztegewerkschaft: „Für Wohnortnahe Gesundheitsversorgung Fehlt Personal“. Available online: https://www.rainews.it/tgr/tagesschau/articoli/2022/05/tag-aerztegewerkschaft-fuer-die-wohnortnahe-gesundheitsversorgung-fehlt-das-personal-domenico-bossio-hausaerzte-suedtirol-db3ef8f1-31ed-4dd7-9010-97af1c60c0c3.html (accessed on 9 January 2025).
- Bartoloni, M. Medici di Famiglia, Vecchio Studio Addio: I Nuovi Assunti Dentro le Case di Comunità. Il Sole 24 ORE 2025. Available online: https://www.ilsole24ore.com/art/medici-famiglia-vecchio-studio-addio-nuovi-assunti-dentro-case-comunita-AG8Vq28B (accessed on 20 March 2025).
- Rudebeck, C.E. Relationship Based Care—How General Practice Developed and Why It Is Undermined within Contemporary Healthcare Systems. Scand. J. Prim. Health Care 2019, 37, 335–344. [Google Scholar] [CrossRef] [PubMed]
- Frikha, Y.; Freeman, A.R.; Côté, N.; Charette, C.; Desfossés, M. Transformation of Primary Care Settings Implementing a Co-Located Team-Based Care Model: A Scoping Review. BMC Health Serv. Res. 2024, 24, 890. [Google Scholar] [CrossRef]
- Geneau, R.; Lehoux, P.; Pineault, R.; Lamarche, P. Understanding the Work of General Practitioners: A Social Science Perspective on the Context of Medical Decision Making in Primary Care. BMC Fam. Pract. 2008, 9, 12. [Google Scholar] [CrossRef]
- Kern, L.M.; Bynum, J.P.W.; Pincus, H.A. Care Fragmentation, Care Continuity, and Care Coordination—How They Differ and Why It Matters. JAMA Intern. Med. 2024, 184, 236–237. [Google Scholar] [CrossRef]
- do Nascimento, I.J.B.; Abdulazeem, H.M.; Vasanthan, L.T.; Martinez, E.Z.; Zucoloto, M.L.; Østengaard, L.; Azzopardi-Muscat, N.; Zapata, T.; Novillo-Ortiz, D. The Global Effect of Digital Health Technologies on Health Workers’ Competencies and Health Workplace: An Umbrella Review of Systematic Reviews and Lexical-Based and Sentence-Based Meta-Analysis. Lancet Digit. Health 2023, 5, e534–e544. [Google Scholar] [CrossRef]
- Erku, D.; Khatri, R.; Endalamaw, A.; Wolka, E.; Nigatu, F.; Zewdie, A.; Assefa, Y. Digital Health Interventions to Improve Access to and Quality of Primary Health Care Services: A Scoping Review. Int. J. Environ. Res. Public Health 2023, 20, 6854. [Google Scholar] [CrossRef]
- Barbieri, V.; Wiedermann, C.J.; Lombardo, S.; Plagg, B.; Gärtner, T.; Ausserhofer, D.; Wiedermann, W.; Engl, A.; Piccoliori, G. Rural-Urban Disparities in Vaccine Hesitancy among Adults in South Tyrol, Italy. Vaccines 2022, 10, 1870. [Google Scholar] [CrossRef] [PubMed]
- Barbieri, V.; Wiedermann, C.J.; Lombardo, S.; Ausserhofer, D.; Plagg, B.; Piccoliori, G.; Gärtner, T.; Wiedermann, W.; Engl, A. Vaccine Hesitancy during the Coronavirus Pandemic in South Tyrol, Italy: Linguistic Correlates in a Representative Cross-Sectional Survey. Vaccines 2022, 10, 1584. [Google Scholar] [CrossRef]
- Plagg, B.; Engl, A.; Piccoliori, G.; Atz, H.; Becker, U.; Kiem, J.; Barbieri, V.; Eisendle, K.; Wiedermann, C.J.; Elsen, S.U.; et al. Mutual Role Expectations by Patients and General Practitioners-A Mixed Methods Study on Complementarity. Healthcare 2022, 10, 2101. [Google Scholar] [CrossRef]
- Wiedermann, C.J.; Barbieri, V.; Engl, A.; Piccoliori, G. Relational Coordination at the Primary–Secondary Care Interface: Insights from a Cross-Sectional Survey in the South Tyrolean Healthcare System. Int. J. Environ. Res. Public Health 2024, 21, 425. [Google Scholar] [CrossRef] [PubMed]
- Piccoliori, G.; Wiedermann, C.J.; Barbieri, V.; Engl, A. The Role of Homogeneous Waiting Group Criteria in Patient Referrals: Views of General Practitioners and Specialists in South Tyrol, Italy. Healthcare 2024, 12, 985. [Google Scholar] [CrossRef]
- Wiedermann, C.J.; Barbieri, V.; Engl, A.; Piccoliori, G. Impact of Relational Coordination on Job Satisfaction and Willingness to Stay: A Cross-Sectional Survey of Healthcare Professionals in South Tyrol, Italy. Behav. Sci. 2024, 14, 397. [Google Scholar] [CrossRef] [PubMed]
- Harvey, G.; Kitson, A. PARIHS Revisited: From Heuristic to Integrated Framework for the Successful Implementation of Knowledge into Practice. Implement. Sci. 2016, 11, 33. [Google Scholar] [CrossRef]
- Massimi, A.; Vito, C.D.; Brufola, I.; Corsaro, A.; Marzuillo, C.; Migliara, G.; Rega, M.L.; Ricciardi, W.; Villari, P.; Damiani, G. Are Community-Based Nurse-Led Self-Management Support Interventions Effective in Chronic Patients? Results of a Systematic Review and Meta-Analysis. PLoS ONE 2017, 12, e0173617. [Google Scholar] [CrossRef]
- National Academies of Sciences, Engineering, and Medicine; National Academy of Medicine; Committee on the Future of Nursing 2020–2030; Flaubert, J.L.; Le Menestrel, S.; Williams, D.R.; Wakefield, M.K. (Eds.) The Role of Nurses in Improving Health Care Access and Quality. In The Future of Nursing 2020–2030: Charting a Path to Achieve Health Equity; National Academies Press (US): Washington, DC, USA, 2021. [Google Scholar]
- Onifade, A.; Quaife, S.L.; Holden, D.; Chung, D.; Birchall, M.; Peake, M.D.; Mughal, M.; McInnerney, D. Understanding the Effectiveness and Quality of Virtual Cancer Multidisciplinary Team Meetings (MDTMs): A Systematic Scoping Review. BMC Health Serv. Res. 2024, 24, 1481. [Google Scholar] [CrossRef]
- Taylor, M.J.; Shikaislami, C.; McNicholas, C.; Taylor, D.; Reed, J.; Vlaev, I. Using Virtual Worlds as a Platform for Collaborative Meetings in Healthcare: A Feasibility Study. BMC Health Serv. Res. 2020, 20, 442. [Google Scholar] [CrossRef] [PubMed]
- Horstman, C. Community Health Centers’ Progress and Challenges in Meeting Patients’ Essential Primary Care Needs: Findings from the Commonwealth Fund 2024 National Survey of Federally Qualified Health Centers. Available online: https://www.commonwealthfund.org/publications/issue-briefs/2024/aug/community-health-centers-meeting-primary-care-needs-2024-FQHC-survey (accessed on 9 January 2025).
- Ljungholm, L.; Edin-Liljegren, A.; Ekstedt, M.; Klinga, C. What Is Needed for Continuity of Care and How Can We Achieve It?—Perceptions among Multiprofessionals on the Chronic Care Trajectory. BMC Health Serv. Res. 2022, 22, 686. [Google Scholar] [CrossRef]
- Ezeamii, V.C.; Okobi, O.E.; Wambai-Sani, H.; Perera, G.S.; Zaynieva, S.; Okonkwo, C.C.; Ohaiba, M.M.; William-Enemali, P.C.; Obodo, O.R.; Obiefuna, N.G. Revolutionizing Healthcare: How Telemedicine Is Improving Patient Outcomes and Expanding Access to Care. Cureus 2024, 16, e63881. [Google Scholar] [CrossRef] [PubMed]
- Cay, G.; Finco, M.G.; Garcia, J.; McNitt-Gray, J.L.; Armstrong, D.G.; Najafi, B. Towards a Remote Patient Monitoring Platform for Comprehensive Risk Evaluations for People with Diabetic Foot Ulcers. Sensors 2024, 24, 2979. [Google Scholar] [CrossRef] [PubMed]
- Tran, V.-T.; Riveros, C.; Ravaud, P. Patients’ Views of Wearable Devices and AI in Healthcare: Findings from the ComPaRe e-Cohort. NPJ Digit. Med. 2019, 2, 53. [Google Scholar] [CrossRef]
- Carron, T.; Domeisen Benedetti, F.; Fringer, A.; Fierz, K.; Peytremann-Bridevaux, I. Integrated Care Models in Swiss Primary Care: An Embedded Multiple Case Study. J. Eval. Clin. Pract. 2023, 29, 1025–1038. [Google Scholar] [CrossRef]
- Nicholson, C.; Jackson, C.; Marley, J. A Governance Model for Integrated Primary/Secondary Care for the Health-Reforming First World—Results of a Systematic Review. BMC Health Serv. Res. 2013, 13, 528. [Google Scholar] [CrossRef]
- Shaw, J.G.; Winget, M.; Brown-Johnson, C.; Seay-Morrison, T.; Garvert, D.W.; Levine, M.; Safaeinili, N.; Mahoney, M.R. Primary Care 2.0: A Prospective Evaluation of a Novel Model of Advanced Team Care With Expanded Medical Assistant Support. Ann. Fam. Med. 2021, 19, 411–418. [Google Scholar] [CrossRef]
- Fraser, C.; Clark, G. Measuring Continuity of Care in General Practice. Available online: https://www.health.org.uk/reports-and-analysis/briefings/measuring-continuity-of-care-in-general-practice (accessed on 9 January 2025).
- Rocks, S.; Berntson, D.; Gil-Salmerón, A.; Kadu, M.; Ehrenberg, N.; Stein, V.; Tsiachristas, A. Cost and Effects of Integrated Care: A Systematic Literature Review and Meta-Analysis. Eur. J. Health Econ. 2020, 21, 1211–1221. [Google Scholar] [CrossRef]
- Blom, J.W.; Van den Hout, W.B.; Den Elzen, W.P.J.; Drewes, Y.M.; Bleijenberg, N.; Fabbricotti, I.N.; Jansen, A.P.D.; Kempen, G.I.J.M.; Koopmans, R.; Looman, W.M.; et al. Effectiveness and Cost-Effectiveness of Proactive and Multidisciplinary Integrated Care for Older People with Complex Problems in General Practice: An Individual Participant Data Meta-Analysis. Age Ageing 2018, 47, 705–714. [Google Scholar] [CrossRef]
- Starfield, B.; Cassady, C.; Nanda, J.; Forrest, C.B.; Berk, R. Consumer Experiences and Provider Perceptions of the Quality of Primary Care: Implications for Managed Care. J. Fam. Pract. 1998, 46, 216–226. [Google Scholar] [PubMed]
Goal | Strategy | Key Actions | Intended Outcomes |
---|---|---|---|
Maintain Continuity of Care | Assign Primary Providers in Teams | Designate a single GP or care provider as the main point of contact for each patient | Maintains trust, familiarity, and accountability in care |
Personalized Care Contracts | Develop agreements defining GP, nurse, and patient roles and responsibilities | Ensures clarity and confidence in maintaining personalized care | |
Structured Patient Assignments | Create a system considering existing relationships, patient preferences, and geography | Reduces disruption and ensures equitable access to care | |
Virtual Collaboration Tools | Use shared EHRs, secure messaging systems, and virtual meetings to support multidisciplinary teams | Enhances GP autonomy while enabling collaborative care | |
Care Coordinator Roles | Appoint coordinators to manage complex cases, follow-ups, and multidisciplinary inputs | Frees GPs for clinical tasks while ensuring cohesive care delivery | |
Build Infrastructure for Local Needs | Telemedicine and Home-Based Care | Expand telemedicine services and home care programs to address rural and underserved populations | Improves accessibility and reduces dependence on in-person visits |
Standardized Patient Pathways | Collaborate with GPs to design pathways for chronic disease and preventive care management | Promotes consistent, high-quality care delivery | |
Digital Integration | Implement user-friendly EHRs and automation tools to streamline administrative tasks | Enhances workflow efficiency and allows providers to focus on care | |
Strengthen Engagement and Trust | Transparent Communication | Conduct education campaigns and personalized discussions to explain reforms | Builds trust and reduces anxiety about the transition |
Incorporate Patient Feedback | Use surveys and focus groups to gather insights and improve care models | Aligns reforms with patient needs and fosters engagement | |
Support General Practitioners | Preserve Autonomy | Allow GPs to choose participation levels, maintain clinical judgment, and engage flexibly with CHCs | Reduces resistance to reforms and ensures satisfaction |
Incentives for Participation | Provide financial rewards, career development, and public recognition for GPs maintaining continuity | Encourages active participation and reinforces trust in reforms |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2025 by the author. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Wiedermann, C.J. Preserving Continuity and Trust in Primary Care: Strategies for Implementing Team-Based Models in South Tyrol, Italy. Int. J. Environ. Res. Public Health 2025, 22, 477. https://doi.org/10.3390/ijerph22040477
Wiedermann CJ. Preserving Continuity and Trust in Primary Care: Strategies for Implementing Team-Based Models in South Tyrol, Italy. International Journal of Environmental Research and Public Health. 2025; 22(4):477. https://doi.org/10.3390/ijerph22040477
Chicago/Turabian StyleWiedermann, Christian J. 2025. "Preserving Continuity and Trust in Primary Care: Strategies for Implementing Team-Based Models in South Tyrol, Italy" International Journal of Environmental Research and Public Health 22, no. 4: 477. https://doi.org/10.3390/ijerph22040477
APA StyleWiedermann, C. J. (2025). Preserving Continuity and Trust in Primary Care: Strategies for Implementing Team-Based Models in South Tyrol, Italy. International Journal of Environmental Research and Public Health, 22(4), 477. https://doi.org/10.3390/ijerph22040477