Skip to main content

Main menu

  • Home
  • Content
    • Current Issue
    • Online First
    • Multimedia
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • Plain Language Summaries
    • Call for Papers
  • Info for
    • Authors
    • Reviewers
    • Job Seekers
    • Media
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • RSS
    • Email Alerts
    • Journal Club
    • Annals Forum (Archive)
  • Contact
    • Contact Us
  • Careers

User menu

  • My alerts

Search

  • Advanced search
Annals of Family Medicine
  • My alerts
Annals of Family Medicine

Advanced Search

  • Home
  • Content
    • Current Issue
    • Online First
    • Multimedia
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • Plain Language Summaries
    • Call for Papers
  • Info for
    • Authors
    • Reviewers
    • Job Seekers
    • Media
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • RSS
    • Email Alerts
    • Journal Club
    • Annals Forum (Archive)
  • Contact
    • Contact Us
  • Careers
  • Follow annalsfm on Twitter
  • Visit annalsfm on Facebook
Research ArticleOriginal Research

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

Grant M. Russell, Simone Dahrouge, William Hogg, Robert Geneau, Laura Muldoon and Meltem Tuna
The Annals of Family Medicine July 2009, 7 (4) 309-318; DOI: https://doi.org/10.1370/afm.982
Grant M. Russell
MBBS, FRACGP, MFM, PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Simone Dahrouge
MSc
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
William Hogg
MSc, MClSc, MD, FCFP
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Robert Geneau
PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Laura Muldoon
MD, MPH, FCFP
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Meltem Tuna
PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • eLetters
  • PDF
Loading

Published eLetters

If you would like to comment on this article, click on Submit a Response to This article, below. We welcome your input.

Submit a Response to This Article
Compose eLetter

More information about text formats

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Statement of Competing Interests

Vertical Tabs

Jump to comment:

  • Context, practices and individuals
    Grant M Russell
    Published on: 25 August 2009
  • Organisational Factors Influencing the Management of Chronic Disease
    Mark F Harris
    Published on: 18 July 2009
  • Managing Chronic Disease in Ontario Primary Care.
    Loretta A. Planavsky
    Published on: 15 July 2009
  • Published on: (25 August 2009)
    Page navigation anchor for Context, practices and individuals
    Context, practices and individuals
    • Grant M Russell, Ottawa, Canada
    • Other Contributors:

    We appreciate Prof Harris (1) and Ms Planavsky’s (2) comments on our paper (3) evaluating factors associated with quality chronic disease management in our large sample of primary care practices in Ontario. Our findings of better performance in Community Health Centres (CHCs) highlights how good performance can follow when, as in the CHCs, primary care delivery system are designed in part to optimise the care of patients...

    Show More

    We appreciate Prof Harris (1) and Ms Planavsky’s (2) comments on our paper (3) evaluating factors associated with quality chronic disease management in our large sample of primary care practices in Ontario. Our findings of better performance in Community Health Centres (CHCs) highlights how good performance can follow when, as in the CHCs, primary care delivery system are designed in part to optimise the care of patients with complex problems. As Professor Harris suggests, such an orientation brings with it the need to provide the structure to deliver such care – a principle linked with our finding that smaller practice size, smaller list sizes and presence of nurse practitioners were associated with better processes of primary care delivery. Policy makers should take note of the fact that this strength of association was enough to account for any observed differences between different organisational models of care. Professor Harris reminds of the importance of providing an environment to nurture the provision of care required as our health systems reorient themselves to the demands of chronic illness. Our study is one of a series that are beginning to look at how structural features of primary care influence health care outcomes.

    One of these structural features, the incorporation of nurse practitioners, is the subject of Ms Planavsky’s letter. She highlights recent literature comparing the performance of nurse practitioners (NPs) and primary care physicians and wonders whether our study was able to generate data on the nurse practitioner and physician experience. She suggests a series of other interesting comparisons between physicians and NPs.

    Professional organizations, clinicians and policy makers will always be interested in comparisons between NPs and physicians (and for that matter other primary care clinicians such as registered nurses and medical assistants). Our study was not designed to make these comparisons – we used, first, the model of care delivery, and second, the practice, as units of analysis. As such it’s difficult for us to separate individual provider contributions from the activities of the practice as a whole.

    It may well be that with the reality of the primary care team and the continuing evolution of the patient centred medical home, simple comparisons between physicians and nurse practitioners will become less and less important as research efforts move towards optimising the contributions and balance between each member of the primary care team.

    References:
    (1) Mark F Harris. Organisational Factors Influencing the Management of Chronic Disease Annals of Family Medicine (18 July 2009)
    (2) Loretta A. Planavsky. Managing Chronic Disease in Ontario Primary Care. Annals of Family Medicine (15 July 2009)
    (3) Russell GM, Dahrouge S, Hogg W, Geneau R, Muldoon L, Tuna M. Managing Chronic Disease in Ontario Primary Care: The Impact of Organizational Factors. Annals of Family Medicine 2009; 7:309-318.

    Competing interests:   None declared

    Show Less
    Competing Interests: None declared.
  • Published on: (18 July 2009)
    Page navigation anchor for Organisational Factors Influencing the Management of Chronic Disease
    Organisational Factors Influencing the Management of Chronic Disease
    • Mark F Harris, Sydney, Australia

    The paper by Russell et al. on “Managing Chronic Disease in Ontario Primary Care: The Impact of Organisational Factors”[1] has important implications in the Australian context. The finding that models of care in Canada differ in their performance is relevant to the current moves in Australia to establish more integrated multidisciplinary primary health care services especially for those with chronic illness. The findin...

    Show More

    The paper by Russell et al. on “Managing Chronic Disease in Ontario Primary Care: The Impact of Organisational Factors”[1] has important implications in the Australian context. The finding that models of care in Canada differ in their performance is relevant to the current moves in Australia to establish more integrated multidisciplinary primary health care services especially for those with chronic illness. The finding that Community Health Centres performed best adds to findings in relation to the impact of Community Health Centres in the US especially in disadvantaged communities [2,3].

    The study also found that better care processes were associated with lower patient to family physician ratios and workloads. This is an important reminder that ervices need to have sufficient capacity to deliver better care especially longer consultations. In Australia we have demonstrated that while there is good access into primary medical care, the inverse care law applies in relation to consultation length because of higher demands on doctors working in disadvantaged areas [4]. Services providing care to disadvantaged population need to have sufficient staff to provide better care especially preventive and chronic disease care.

    The finding that smaller practices provide better process of care is also consistent with the findings of our own research on the management of diabetes, cardiovascular disease and asthma in Australia [5]. As the authors discuss, this is a challenge as we develop new models of multidisciplinary primary health care. One option being explored in Australia at present is the creation of more virtual integration between relatively smaller services to try and provide the best of both the larger and smaller services.

    Finally, the lack of difference in outcome measures (except for diastolic blood pressure) is an important reminder that recorded processes of care are not necessarily associated with health outcomes. It is important that these continue to be monitored along with patient assessments of the quality care when evaluating service models.

    Mark Harris, Centre for Primary Health Care and Equity, University of New South Wales, Sydney Australia.

    References
    [1]Russell GM, Dahrouge S, Hogg W, Geneau R, Muldoon L, Tuna M. Managing Chronic Disease in Ontario Primary Care: The Impact of Organizational Factors. Annals of Family Medicine 2009; 7:309-318.
    [2] Shi, L., G. D. Stevens, Politzer, R. Access to Care for U.S. Health Center Patients and Patients Nationally: How Do the Most Vulnerable Populations Fare? Medical Care 2007 45: 206-213.
    [3] Eisert, SL, Mehler PS, Gabow PA. Can America’s Urban Safety Net Systems be a Solution to Unequal Treatment? Journal of Urban Health 2008; 85: 766-778.
    [4] Furler JS, Harris E, Chondros P, Powell Davies PG, Harris MF, Young DYL. The inverse care law revisited: impact of disadvantaged location on accessing longer GP consultation times. Med J Aust 2002; 177: 80-83.
    [5] Jayasinghe UJ, Proudfoot J, Holton C, Powell Davies G, Amoroso C, Bubner T, Beilby J, Harris MF. Chronically ill Australians' satisfaction with accessibility and patient-centredness. International Journal for Quality in Health Care 2008 20: 105-114

    Competing interests:   None declared

    Show Less
    Competing Interests: None declared.
  • Published on: (15 July 2009)
    Page navigation anchor for Managing Chronic Disease in Ontario Primary Care.
    Managing Chronic Disease in Ontario Primary Care.
    • Loretta A. Planavsky, Cleveland, US

    Thank you for the opportunity to read this paper and for citing our paper from the Journal of Interprofessional Care, 2003. I have been working as an adult NP since 1996, and the past several years in an out- patient Preventive Cardiology Department, working with management of cardiovascular disease risk factors and/or chronic diseases, specifically dyslipidemia, diabetes & hypertension.

    As I read this pap...

    Show More

    Thank you for the opportunity to read this paper and for citing our paper from the Journal of Interprofessional Care, 2003. I have been working as an adult NP since 1996, and the past several years in an out- patient Preventive Cardiology Department, working with management of cardiovascular disease risk factors and/or chronic diseases, specifically dyslipidemia, diabetes & hypertension.

    As I read this paper, I experienced the following thoughts. With the reality of our growing health care systems as a competitive business, NP's must be careful to not be forced into seeing a set volume of patients in a set time frame as some MD's during their office visits. NP's are seeing similar patient types as their MD colleagues, but our service should be unique with how each patient visit is accomplished in order to support our NP role as having unique benefit to our mutual patients and to the organization as a whole.

    You may be interested in reviewing a qualitative paper based on our 2003 study and published in the JAANP, September 2001, vol.13, issue 9 entitled, Ending A Nurse Practitioner-Patient Relationship." This paper reports patients' reactions & perceptions to ending a year-long relationship with the NP.

    It would also be interesting to consider publishing data on the NP's & MD's experience.

    Other factors to consider in looking at chronic disease management by NP's vs. MD's would be:
    1. Provider age, yrs. of practice and practice type/location, provider's educational background.
    2. Look at the same patient populations a set number of yrs. after being seen by the NP or if changed back to seeing an MD to see if outcomes remain stable or change.
    3. Similarities & differences with various provider as well as patient ethnic groups.

    Thanks for this opportunity and best wishes-
    Loretta Planavsky, MSN, CRNP

    Competing interests:   None declared

    Show Less
    Competing Interests: None declared.
PreviousNext
Back to top

In this issue

The Annals of Family Medicine: 7 (4)
The Annals of Family Medicine: 7 (4)
Vol. 7, Issue 4
1 Jul 2009
  • Table of Contents
  • Index by author
  • In Brief
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Annals of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Managing Chronic Disease in Ontario Primary Care: The Impact of Organizational Factors
(Your Name) has sent you a message from Annals of Family Medicine
(Your Name) thought you would like to see the Annals of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
10 + 4 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Managing Chronic Disease in Ontario Primary Care: The Impact of Organizational Factors
Grant M. Russell, Simone Dahrouge, William Hogg, Robert Geneau, Laura Muldoon, Meltem Tuna
The Annals of Family Medicine Jul 2009, 7 (4) 309-318; DOI: 10.1370/afm.982

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Get Permissions
Share
Managing Chronic Disease in Ontario Primary Care: The Impact of Organizational Factors
Grant M. Russell, Simone Dahrouge, William Hogg, Robert Geneau, Laura Muldoon, Meltem Tuna
The Annals of Family Medicine Jul 2009, 7 (4) 309-318; DOI: 10.1370/afm.982
Reddit logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • INTRODUCTION
    • METHODS
    • RESULTS
    • DISCUSSION
    • Acknowledgments
    • Footnotes
    • REFERENCES
  • Figures & Data
  • Info & Metrics
  • eLetters
  • PDF

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • Use of standardized brief geriatric evaluation compared with routine care in general practice for preventing functional decline: a pragmatic cluster-randomized trial
  • Effect of involving certified healthcare assistants in primary care in Germany: a cross-sectional study
  • Attachment to primary care and team-based primary care: Retrospective cohort study of people who experienced imprisonment in Ontario
  • Staff perceptions of community health centre team function in Ontario
  • Protocol for determining primary healthcare practice characteristics, models of practice and patient accessibility using an exploratory census survey with linkage to administrative data in Nova Scotia, Canada
  • Preconsult interactive computer-assisted client assessment survey for common mental disorders in a community health centre: a randomized controlled trial
  • Outcomes For High-Needs Patients: Practices With A Higher Proportion Of These Patients Have An Edge
  • Association between registered nurse staffing and management outcomes of patients with type 2 diabetes within primary care: a cross-sectional linkage study
  • Primary Care Physician Panel Size and Quality of Care: A Population-Based Study in Ontario, Canada
  • Roles of nurse practitioners and family physicians in community health centres
  • Patient-reported access to primary care in Ontario: Effect of organizational characteristics
  • Patients' Experiences in Different Models of Community Health Centers in Southern China
  • Family-centred care delivery: Comparing models of primary care service delivery in Ontario
  • Characteristics of primary care practices associated with high quality of care
  • Patient poverty and workload in primary care: Study of prescription drug benefit recipients in community health centres
  • Patients' experience of chronic illness care in a network of teaching settings
  • The Relationship Between Financial Incentives and Quality of Diabetes Care in Ontario, Canada
  • Innovative and Diverse Strategies Toward Primary Health Care Reform: Lessons Learned from the Canadian Experience
  • Self-reported teamwork in family health team practices in Ontario: Organizational and cultural predictors of team climate
  • Progress of Ontario's Family Health Team Model: A Patient-Centered Medical Home
  • Quality of congestive heart failure care: Assessing measurement of care using electronic medical records
  • Community orientation in primary care practices: Results from the Comparison of Models of Primary Health Care in Ontario Study
  • Faudrait-il partager avec des non-medecins l'autorisation de prescrire?: OUI
  • Should prescribing authority be shared with nonphysicians?: YES
  • Organizing Health Care for Value
  • In This Issue: Systematic Strategies and Individualized Approaches to Care
  • Google Scholar

More in this TOC Section

  • Prescribing Medications for Alcohol Use Disorder: A Qualitative Study of Primary Care Physician Decision Making
  • Reducing Acute Hospitalizations at High-Performing CPC+ Primary Care Practice Sites: Strategies, Activities, and Facilitators
  • Impact of Service-Based Student Loan Repayment Program on the Primary Care Workforce
Show more Original Research

Similar Articles

Subjects

  • Domains of illness & health:
    • Chronic illness
  • Methods:
    • Mixed methods
  • Other research types:
    • Health policy
    • Health services
  • Core values of primary care:
    • Coordination / integration of care

Content

  • Current Issue
  • Past Issues
  • Past Issues in Brief
  • Multimedia
  • Articles by Type
  • Articles by Subject
  • Supplements
  • Online First
  • Calls for Papers

Info for

  • Authors
  • Reviewers
  • Job Seekers
  • Media

Engage

  • E-mail Alerts
  • e-Letters (Comments)
  • RSS
  • Journal Club
  • Submit a Manuscript
  • Subscribe
  • Family Medicine Careers

About

  • About Us
  • Editorial Board & Staff
  • Sponsoring Organizations
  • Copyrights & Permissions
  • Contact Us
  • eLetter/Comments Policy

© 2023 Annals of Family Medicine