Comparison of primary care models in the prevention of cardiovascular disease - a cross sectional study

BMC Family Practice

Research Article

Simone Dahrouge¹  Jatinderpreet Singh¹  Clare Liddy²  William Hogg²  Monica Taljaard³ 

[1] C.T. Lamont Primary Health Care Research Centre, Élisabeth Bruyère Research Institute, 43 Bruyère St, K1N 5C8, Ottawa, Ontario, Canada;C.T. Lamont Primary Health Care Research Centre, Élisabeth Bruyère Research Institute, 43 Bruyère St, K1N 5C8, Ottawa, Ontario, Canada;Department of Family Medicine, University of Ottawa, Room, 43 Bruyère St, K1N 5C8, Ottawa, Ontario, Canada;Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Ave, K1Y 4E9, Ottawa, Ontario, Canada;Department of Epidemiology and Community Medicine, University of Ottawa, Room 3105, 451 Smyth Road, K1H 8M5, Ottawa, Ontario, Canada;

关键词: Smoking Cessation;    Primary Care Practice;    Community Health Centre;    Smoking Cessation Counselling;    Primary Care Model;   

DOI  :  10.1186/1471-2296-12-114

 received in 2011-06-21, accepted in 2011-10-18,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundPrimary 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.MethodsThis 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.ResultsThe 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.ConclusionsThis 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.Trial RegistrationClinicalTrials.gov: NCT00574808

【 授权许可】

CC BY   
© Liddy et al; licensee BioMed Central Ltd. 2011