Intended for healthcare professionals

Education And Debate

The role of patient care teams in chronic disease management

BMJ 2000; 320 doi: (Published 26 February 2000) Cite this as: BMJ 2000;320:569
  1. Edward H Wagner, director (
  1. W A MacColl Institute for Healthcare Innovation, Center for Health Studies, Group Health Cooperative of Puget Sound, 1730 Minor Ave, Suite 1290, Seattle WA 98101, USA
  • Accepted 2 February 2000

“In the gradual division of labor, by which civilization has emerged from barbarism, the doctor and nurse have been evolved”

Sir William Osler (1891)

The delivery of health care by a coordinated team of individuals has always been assumed to be a good thing. Patients reap the benefits of more eyes and ears, the insights of different bodies of knowledge, and a wider range of skills. Thus team care has generally been embraced by most as a criterion for high quality care. Despite its appeal, team care, especially in the primary care setting, remains a source of confusion and some scepticism.1 Which disciplines are essential on the team? What do the team members other than the doctor do to support patient care?

With the ageing of the population and the advances in the treatment of chronic diseases, teamwork in the context of chronic diseases needs to be re-examined. Successful chronic disease interventions usually involve a coordinated multidisciplinary care team.25

In this article I consider the implications of these observations for the structure and functioning of patient care teams in primary care. My work is rooted in US health care, and the references and roles described largely reflect that perspective. I performed a Medline search for randomised controlled trials of team care using the MeSH heading “patient care team.”

Summary points

Effective chronic illness interventions generally rely on multidisciplinary care teams

Successful teams often include nurses and pharmacists with clinical and behavioural skills

Such teams ensure that critical elements of care that doctors may not have the training or time to do well are competently performed

These elements include population management, protocol based regulation of medication, self management support, and intensive follow up

The participation of medical specialists in consultative and educational roles outside conventional referrals may contribute to …

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