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

BMC Fam Pract. 2011 Oct 18;12:114. doi: 10.1186/1471-2296-12-114.

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.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Capitation Fee
  • Cardiovascular Diseases / economics
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / prevention & control*
  • Community Health Centers / economics*
  • Community Health Centers / organization & administration
  • Community Health Centers / standards
  • Comorbidity
  • Cross-Sectional Studies
  • Evidence-Based Practice / economics
  • Evidence-Based Practice / statistics & numerical data*
  • Fee-for-Service Plans
  • Guideline Adherence / economics
  • Guideline Adherence / statistics & numerical data
  • Humans
  • Medical Audit
  • Models, Economic
  • Models, Organizational
  • Ontario / epidemiology
  • Primary Health Care / classification
  • Primary Health Care / economics*
  • Primary Health Care / standards
  • Reimbursement Mechanisms / classification
  • Reimbursement Mechanisms / economics*
  • Reimbursement Mechanisms / statistics & numerical data

Associated data

  • ClinicalTrials.gov/NCT00574808