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BMC Primary Care
Published in: BMC Primary Care 1/2011

Open Access 01-12-2011 | Research article

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

Authors: Clare Liddy, Jatinderpreet Singh, William Hogg, Simone Dahrouge, Monica Taljaard

Published in: BMC Primary Care | Issue 1/2011

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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.

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.

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.

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.

Trial Registration

ClinicalTrials.gov: NCT00574808
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Metadata
Title
Comparison of primary care models in the prevention of cardiovascular disease - a cross sectional study
Authors
Clare Liddy
Jatinderpreet Singh
William Hogg
Simone Dahrouge
Monica Taljaard
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2011
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/1471-2296-12-114

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