Implementation of a Team‑Based Care Model for Multi‑Morbidity (Hypertension + Diabetes + Dyslipidaemia) in Nigerian Primary Care: Outcomes on Quality and Cost

Abstract

Background: Multi-morbidity involving hypertension, diabetes, and dyslipidaemia is increasing in Nigeria and poses significant challenges for fragmented, physician-centered primary care systems. Team-based care models may improve clinical outcomes and reduce costs, but evidence from low- and middle-income settings remains limited. This study evaluated the implementation of a team-based care model for managing cardiometabolic multi-morbidity in Nigerian primary care and assessed its impact on quality of care and healthcare costs. Methods: A prospective implementation study was conducted in selected primary healthcare facilities, where multidisciplinary teams comprising physicians, nurses, pharmacists, and community health workers delivered coordinated care using standardized treatment protocols, patient education, and follow-up systems. Clinical outcomes (blood pressure, glycaemic         control, and lipid levels), process indicators (guideline adherence, visit frequency, and patient satisfaction), and direct healthcare costs were measured at baseline and after 12 months of implementation. Results: The team-based care model was associated with significant improvements in clinical outcomes, including increased proportions of patients achieving target blood pressure, HbA1c, and LDL-cholesterol levels. Adherence to clinical guidelines and patient retention in care improved, while unplanned hospital visits decreased. Cost analysis demonstrated a reduction in per-patient annual healthcare expenditures driven by fewer complications and hospitalizations, despite modest increases in primary care service utilization. Conclusion: Implementing a team-based care model for cardiometabolic multi-morbidity in Nigerian primary care settings improved quality of care and was cost-saving over one year. Scaling up multidisciplinary, protocol-driven care may strengthen chronic disease management and enhance health system efficiency in resource-limited settings.