title: Enrolment in primary care networks: impact on outcomes and processes of care for patients with diabetes.
abstract: BACKGROUND
  Primary care networks are a newer model of primary care that focuses on improved access to care and the use of multidisciplinary teams for patients with chronic disease. We sought to determine the association between enrolment in primary care networks and the care and outcomes of patients with diabetes.
  
  
  METHODS
  We used administrative health care data to study the care and outcomes of patients with incident and prevalent diabetes separately. For patients with prevalent diabetes, we compared those whose care was managed by physicians who were or were not in a primary care network using propensity score matching. For patients with incident diabetes, we studied a cohort before and after primary care networks were established. Each cohort was further divided based on whether or not patients were cared for by physicians enrolled in a network. Our primary outcome was admissions to hospital or visits to emergency departments for ambulatory care sensitive conditions specific to diabetes.
  
  
  RESULTS
  Compared with patients whose prevalent diabetes is managed outside of primary care networks, patients in primary care networks had a lower rate of diabetes-specific ambulatory care sensitive conditions (adjusted incidence rate ratio 0.81, 95% confidence interval [CI] 0.75 to 0.87), were more likely to see an ophthalmologist or optometrist (risk ratio 1.19, 95% CI 1.17 to 1.21) and had better glycemic control (adjusted mean difference -0.067, 95% CI -0.081 to -0.052).
  
  
  CONCLUSIONS
  Patients whose diabetes was managed in primary care networks received better care and had better clinical outcomes than patients whose condition was not managed in a network, although the differences were very small.
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alta. braden.manns@albertahealthservices.ca
authors.forename: Braden J
authors.initials: BJ
authors.lastname: Manns
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
authors.forename: Jianguo
authors.initials: J
authors.lastname: Zhang
authors.forename: David J T
authors.initials: DJ
authors.lastname: Campbell
authors.forename: Peter
authors.initials: P
authors.lastname: Sargious
authors.forename: Bharati
authors.initials: B
authors.lastname: Ayyalasomayajula
authors.forename: Fiona
authors.initials: F
authors.lastname: Clement
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Johnson
authors.forename: Andreas
authors.initials: A
authors.lastname: Laupacis
authors.forename: Richard
authors.initials: R
authors.lastname: Lewanczuk
authors.forename: Kerry
authors.initials: K
authors.lastname: McBrien
authors.forename: Brenda R
authors.initials: BR
authors.lastname: Hemmelgarn
mesh_terms: D000416:Alberta; D048909:Diabetes Complications / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D057216:Propensity Score; D011787:Quality of Health Care / Q000706:statistics & numerical data