The Article in Brief

Managing Chronic Disease in Ontario Primary Care: The Impact of Organizational Factors

Grant M. Russell , and colleagues

Background Primary care is well-suited to treating patients with chronic diseases, but there are many differences in how chronic disease management programs and services are delivered. This study analyzes the impact of different primary care models and practice features on chronic disease management in Ontario, Canada.

What This Study Found Community health centers provided superior chronic disease management because of longer patient visits and collaboration with other professionals. Across all practice types, regardless of model, what accounted most for high-quality management was the presence of a nurse-practitioner, smaller practices, and lower patient load. Quality of care decreases with patient load and in practices with more than 4 full-time-equivalent family physicians. There is no evidence that a practice's use of electronic medical records influences the quality of chronic disease management.

Implications

• These findings suggest that having a nurse-practitioner and the organization of the primary care team influences the delivery of quality care.
• Further research should examine the effects of larger practices and greater patient-physician ratios on quality care.