title: Variations in patients' assessment of chronic illness care across organizational models of primary health care: a multilevel cohort analysis.
abstract: OBJECTIVE
  To measure patients' assessment of chronic illness care and its variation across primary healthcare (PHC) models.
  
  
  METHODS
  We recruited 776 patients with diabetes, heart failure, arthritis or chronic obstructive pulmonary disease from 33 PHC clinics. Face-to-face interviews, followed by a telephone interview at 12 months, were conducted using the Patient Assessment of Chronic Illness Care (PACIC). Multilevel regression was used in the analysis.
  
  
  RESULTS
  The mean PACIC score was low at 2.5 on a scale of 1 to 5. PACIC scores were highest among patients affiliated with family medicine groups (mean, 2.78) and lowest for contact models (mean, 2.35). Patients with arthritis and older persons generally reported a lower assessment of chronic care.
  
  
  CONCLUSIONS
  Family medicine groups represent an integrated model of PHC associated with higher levels of achievement in chronic care. Variations across PHC organizations suggest that some models are more appropriate for improving management of chronic illness.
authors: Scientific Director, Institut National de Santé Publique du Québec, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, QC. jean-frederic.levesque@inspq.qc.ca
authors: Jean-Frédéric
authors: JF
authors: Lévesque
authors: Debbie Ehrmann
authors: DE
authors: Feldman
authors: Valérie
authors: V
authors: Lemieux
authors: André
authors: A
authors: Tourigny
authors: Jean-Pierre
authors: JP
authors: Lavoie
authors: Pierre
authors: P
authors: Tousignant
mesh_terms: D000368:Aged; D001168:Arthritis / Q000523:psychology / Q000628:therapy; D002908:Chronic Disease / Q000523:psychology / Q000628:therapy*; D015331:Cohort Studies; D003151:Community Health Centers / Q000592:standards; D019033:Delivery of Health Care, Integrated / Q000592:standards; D003920:Diabetes Mellitus / Q000523:psychology / Q000628:therapy; D005194:Family Practice / Q000592:standards; D005260:Female; D006123:Group Practice / Q000592:standards; D006333:Heart Failure / Q000523:psychology / Q000628:therapy; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology / Q000628:therapy; D011792:Quebec; D011795:Surveys and Questionnaires
references: Healthc Policy. 2010 Nov;6(2):67-84
references: 22043224
references: Annu Rev Public Health. 1990;11:267-96
references: 2191662
references: BMC Fam Pract. 2011 Oct 18;12:114
references: 22008366
references: Healthc Policy. 2011 May;6(4):e89-e105
references: 22548102
references: Qual Saf Health Care. 2008 Dec;17(6):442-6
references: 19064660
references: BMC Health Serv Res. 2008 Sep 01;8:182
references: 18761749
references: Ann Fam Med. 2005 Jan-Feb;3(1):73-81
references: 15671195
references: Chronic Dis Inj Can. 2011 Jun;31(3):109-20
references: 21733348
references: Am J Manag Care. 2005 Aug;11(8):478-88
references: 16095434
references: J Gen Intern Med. 2008 Jan;23(1):77-80
references: 18030539
references: Am J Prev Med. 2008 Nov;35(5 Suppl):S398-406
references: 18929987
references: Am J Prev Med. 2006 May;30(5):413-22
references: 16627129
references: Ann Behav Med. 1999 Spring;21(2):159-70
references: 10499137
references: Milbank Q. 2011 Jun;89(2):256-88
references: 21676023
references: Ann Fam Med. 2009 Jul-Aug;7(4):309-18
references: 19597168
references: Fam Pract. 2010 Oct;27(5):535-41
references: 20534791
references: Med Care. 2005 May;43(5):436-44
references: 15838407
references: Health Aff (Millwood). 2001 Nov-Dec;20(6):64-78
references: 11816692
references: BMC Fam Pract. 2010 Dec 01;11:95
references: 21122145
references: JAMA. 2004 Jun 2;291(21):2616-22
references: 15173153
references: Soc Sci Med. 1997 Dec;45(12):1829-43
references: 9447632