title: The relationship between primary care models and processes of diabetes care in Ontario.
abstract: This study examined the association between Ontario's differing primary care models and receipt of recommended testing for people with diabetes. We analyzed available administrative data for 757 928 people with diabetes aged 40 years and older. We assigned them to a primary care physician and assessed whether they had received 3 key monitoring tests between 2006 and 2008. We used multivariable generalized estimating equation models to test the associations among various primary care models and receipt of recommended testing. Ontarians with diabetes who were enrolled in a non-team blended capitation model (OR 1.18, 95% CI 1.09 to 1.27) and those enrolled in a team-based blended capitation model (OR 1.20, 95% CI 1.13 to 1.28) were more likely than those enrolled in a blended fee-for-service model to receive the optimal number of 3 recommended monitoring tests. Patients who were not enrolled in any model and who were assigned to a traditional fee-for-service physician were least likely to receive optimal monitoring compared to those enrolled in a blended fee-for-service model (OR 0.60, 95% CI 0.57 to 0.62). The biggest gap in diabetes care was for patients not enrolled in any primary care model. Research and policy work is needed to understand and reduce this care gap, especially which provider and patient-level factors are involved. Options may include intensive outreach to patients, knowledge translation to physicians, encouraging enrollment and efforts to remove barriers to care.
authors.affiliation: Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: tara.kiran@utoronto.ca.
authors.forename: Tara
authors.initials: T
authors.lastname: Kiran
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada.
authors.forename: J Charles
authors.initials: JC
authors.lastname: Victor
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kopp
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Baiju R
authors.initials: BR
authors.lastname: Shah
authors.affiliation: Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Glazier
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D018588:Fee-for-Service Plans / Q000458:organization & administration*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006302:Health Services Research / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D018670:Monitoring, Ambulatory / Q000191:economics / Q000706:statistics & numerical data*; D008991:Monitoring, Physiologic / Q000191:economics / Q000706:statistics & numerical data*; D020380:Needs Assessment; D009864:Ontario / Q000453:epidemiology; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000191:economics; D011787:Quality of Health Care / Q000191:economics / Q000592:standards
keywords: diabetes; diabète; physician payment; primary care; quality of care; qualité des soins; rémunération des médecins; soins primaires