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Comparison of primary care models in the prevention of cardiovascular disease - a cross sectional study.
- Source :
-
BMC family practice [BMC Fam Pract] 2011 Oct 18; Vol. 12, pp. 114. Date of Electronic Publication: 2011 Oct 18. - Publication Year :
- 2011
-
Abstract
- Background: Primary care providers play an important role in preventing and managing cardiovascular disease. This study compared the quality of preventive cardiovascular care delivery amongst different primary care models.<br />Methods: This is a secondary analysis of a larger randomized control trial, known as the Improved Delivery of Cardiovascular Care (IDOCC) through Outreach Facilitation. Using baseline data collected through IDOCC, we conducted a cross-sectional study of 82 primary care practices from three delivery models in Eastern Ontario, Canada: 43 fee-for-service, 27 blended-capitation and 12 community health centres with salary-based physicians. Medical chart audits from 4,808 patients with or at high risk of developing cardiovascular disease were used to examine each practice's adherence to ten evidence-based processes of care for diabetes, chronic kidney disease, dyslipidemia, hypertension, weight management, and smoking cessation care. Generalized estimating equation models adjusting for age, sex, rurality, number of cardiovascular-related comorbidities, and year of data collection were used to compare guideline adherence amongst the three models.<br />Results: The percentage of patients with diabetes that received two hemoglobin A1c tests during the study year was significantly higher in community health centres (69%) than in fee-for-service (45%) practices (Adjusted Odds Ratio (AOR) = 2.4 [95% CI 1.4-4.2], p = 0.001). Blended capitation practices had a significantly higher percentage of patients who had their waistlines monitored than in fee-for-service practices (19% vs. 5%, AOR = 3.7 [1.8-7.8], p = 0.0006), and who were recommended a smoking cessation drug when compared to community health centres (33% vs. 16%, AOR = 2.4 [1.3-4.6], p = 0.007). Overall, quality of diabetes care was higher in community health centres, while smoking cessation care and weight management was higher in the blended-capitation models. Fee-for-service practices had the greatest gaps in care, most noticeably in diabetes care and weight management.<br />Conclusions: This study adds to the evidence suggesting that primary care delivery model impacts quality of care. These findings support current Ontario reforms to move away from the traditional fee-for-service practice.<br />Trial Registration: ClinicalTrials.gov: NCT00574808.
- Subjects :
- Capitation Fee
Cardiovascular Diseases economics
Cardiovascular Diseases epidemiology
Community Health Centers organization & administration
Community Health Centers standards
Comorbidity
Cross-Sectional Studies
Evidence-Based Practice economics
Fee-for-Service Plans
Guideline Adherence economics
Guideline Adherence statistics & numerical data
Humans
Medical Audit
Models, Economic
Models, Organizational
Ontario epidemiology
Primary Health Care classification
Primary Health Care standards
Reimbursement Mechanisms classification
Reimbursement Mechanisms statistics & numerical data
Cardiovascular Diseases prevention & control
Community Health Centers economics
Evidence-Based Practice statistics & numerical data
Primary Health Care economics
Reimbursement Mechanisms economics
Subjects
Details
- Language :
- English
- ISSN :
- 1471-2296
- Volume :
- 12
- Database :
- MEDLINE
- Journal :
- BMC family practice
- Publication Type :
- Academic Journal
- Accession number :
- 22008366
- Full Text :
- https://doi.org/10.1186/1471-2296-12-114