Impact of grassroots development of interprofessional team-based practices: retrospective matched cohort study using ICES data

Objective — To evaluate the impact of self-initiated and community-driven “grassroots” interprofessional teams relative to formally designated family health teams (FHTs) supported by government transition programs and non-team practices in Ontario.

Design — Retrospective matched cohort study.

Setting — Health administrative data spanning 2016 to 2021 from ICES in Ontario.

Participants — Grassroots practices were matched to FHTs and non-team physician practices in the health administrative data set.

Main outcome measures — Patient attachment, visits, continuity, and preventive care metrics were compared using descriptive and inferential statistics.

Results — Grassroots clinics had significantly more attached patients per physician (n=1371) than FHTs (n=1227; P<.0001) and non-team clinics (n=586; P<.0001). Annual patient visits per physician were also higher in grassroots clinics (n=2792) compared to FHTs (n=2321; P=.0002) and non-team clinics (n=1378; P<.0001). Continuity of care measures were higher for grassroots and FHTs than non-team practices (P=.02). Preventive care delivery was significantly higher in grassroots clinics compared to non-team practices for most metrics (P<.01) except for lipid screening (P=.18).

Conclusion — Grassroots team-based care in Ontario is associated with positive impacts on primary care access and delivery of preventive services, inspiring confidence in these developments. Initiatives that encourage family practices to pursue their own conceptualization of effective team-based care may be beneficial, although there is a need for further research to assess the broader effects and scalability of such models.