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Annals of Family Medicine 7:309-318 (2009)
© 2009 Annals of Family Medicine, Inc.
doi: 10.1370/afm.982
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Managing Chronic Disease in Ontario Primary Care: The Impact of Organizational Factors

Grant M. Russell, MBBS, FRACGP, MFM, PhD1,2, Simone Dahrouge, MSc1, William Hogg, MSc, MClSc, MD, FCFP1,2,3, Robert Geneau, PhD1,2, Laura Muldoon, MD, MPH, FCFP1,2 and Meltem Tuna, PhD1

1 C.T. Lamont Primary Health Care Research Centre, Élisabeth Bruyère Research Institute, Ottawa, Ontario, Canada
2 Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
3 Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada

CORRESPONDING AUTHOR: Grant M. Russell, MBBS, PhD C.T. Lamont Primary Health Care Research Centre Élisabeth Bruyère Research Institute 43 Bruyère St Ottawa, Ontario K1N 5C8 Canada grussell{at}bruyere.org

PURPOSE New approaches to chronic disease management emphasize the need to improve the delivery of primary care services to meet the needs of chronically ill patients. This study (1) assessed whether chronic disease management differed among 4 models of primary health care delivery and (2) identified which practice organizational factors were independently associated with high-quality care.

METHODS We undertook a cross-sectional survey with nested qualitative case studies (2 practices per model) in 137 randomly selected primary care practices from 4 delivery models in Ontario Canada: fee for service, capitation, blended payment, and community health centers (CHCs). Practice and clinician surveys were based on the Primary Care Assessment Tool. A chart audit assessed evidence-based care delivery for patients with diabetes, congestive heart failure, and coronary artery disease. Intermediate outcomes were calculated for patients with diabetes and hypertension. Multiple linear regression identified those organizational factors independently associated with chronic disease management.

RESULTS Chronic disease management was superior in CHCs. Clinicians in CHCs found it easier than those in the other models to promote high-quality care through longer consultations and interprofessional collaboration. Across the whole sample and independent of model, high-quality chronic disease management was associated with the presence of a nurse-practitioner. It was also associated with lower patient-family physician ratios and when practices had 4 or fewer full-time-equivalent family physicians.

CONCLUSIONS The study adds to the literature supporting the value of nurse-practitioners within primary care teams and validates the contributions of Ontario’s CHCs. Our observation that quality of care decreased in larger, busier practices suggests that moves toward larger practices and greater patient-physician ratios may have unanticipated negative effects on processes of care quality.

Key Words: Primary health care • chronic disease • quality of health care




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TRACK Comments:

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Managing Chronic Disease in Ontario Primary Care.
Loretta A. Planavsky
Annals of Family Medicine, 15 Jul 2009 [Full text]
Organisational Factors Influencing the Management of Chronic Disease
Mark F Harris
Annals of Family Medicine, 18 Jul 2009 [Full text]
Context, practices and individuals
Grant M Russell, et al.
Annals of Family Medicine, 25 Aug 2009 [Full text]

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