Family-centred care delivery: comparing models of primary care service delivery in Ontario.
OBJECTIVE
To determine whether models of primary care service delivery differ in their provision of family-centred care (FCC) and to identify practice characteristics associated with FCC.


METHODS
Cross-sectional study.


METHODS
Primary care practices in Ontario (ie, 35 salaried community health centres, 35 fee-for-service practices, 32 capitation-based health service organizations, and 35 blended remuneration family health networks) that belong to 4 models of primary care service delivery.


METHODS
A total of 137 practices, 363 providers, and 5144 patients.


METHODS
Measures of FCC in patient and provider surveys were based on the Primary Care Assessment Tool. Statistical analyses were conducted using linear mixed regression models and generalized estimating equations.


RESULTS
Patient-reported FCC scores were high and did not vary significantly by primary care model. Larger panel size in a practice was associated with lower odds of patients reporting FCC. Provider-reported FCC scores were significantly higher in community health centres than in family health networks (P = .035). A larger number of nurse practitioners and clinical services on-site were both associated with higher FCC scores, while scores decreased as the number of family physicians in a practice increased and if practices were more rural.


CONCLUSIONS
Based on provider and patient reports, primary care reform strategies that encourage larger practices and more patients per family physician might compromise the provision of FCC, while strategies that encourage multidisciplinary practices and a range of services might increase FCC.
C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 369Y-43 Bruyère St, Ottawa, ON K1N 5C8. whogg@bruyere.org.
Liesha
L
Mayo-Bruinsma
William
W
Hogg
Monica
M
Taljaard
Simone
S
Dahrouge
D000328:Adult; D000368:Aged; D003151:Community Health Centers / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000379:methods* / Q000706:statistics & numerical data; D005190:Family; D005192:Family Health; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D018802:Patient-Centered Care / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods* / Q000706:statistics & numerical data