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Comparison of primary care models in the prevention of cardiovascular disease - a cross sectional study
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, k...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2011
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3215648/ https://www.ncbi.nlm.nih.gov/pubmed/22008366 http://dx.doi.org/10.1186/1471-2296-12-114 |
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author | Liddy, Clare Singh, Jatinderpreet Hogg, William Dahrouge, Simone Taljaard, Monica |
author_facet | Liddy, Clare Singh, Jatinderpreet Hogg, William Dahrouge, Simone Taljaard, Monica |
author_sort | Liddy, Clare |
collection | PubMed |
description | 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 |
format | Online Article Text |
id | pubmed-3215648 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2011 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-32156482011-11-15 Comparison of primary care models in the prevention of cardiovascular disease - a cross sectional study Liddy, Clare Singh, Jatinderpreet Hogg, William Dahrouge, Simone Taljaard, Monica BMC Fam Pract Research Article 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 BioMed Central 2011-10-18 /pmc/articles/PMC3215648/ /pubmed/22008366 http://dx.doi.org/10.1186/1471-2296-12-114 Text en Copyright ©2011 Liddy et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Article Liddy, Clare Singh, Jatinderpreet Hogg, William Dahrouge, Simone Taljaard, Monica Comparison of primary care models in the prevention of cardiovascular disease - a cross sectional study |
title | Comparison of primary care models in the prevention of cardiovascular disease - a cross sectional study |
title_full | Comparison of primary care models in the prevention of cardiovascular disease - a cross sectional study |
title_fullStr | Comparison of primary care models in the prevention of cardiovascular disease - a cross sectional study |
title_full_unstemmed | Comparison of primary care models in the prevention of cardiovascular disease - a cross sectional study |
title_short | Comparison of primary care models in the prevention of cardiovascular disease - a cross sectional study |
title_sort | comparison of primary care models in the prevention of cardiovascular disease - a cross sectional study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3215648/ https://www.ncbi.nlm.nih.gov/pubmed/22008366 http://dx.doi.org/10.1186/1471-2296-12-114 |
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