title: Under the same roof: co-location of practitioners within primary care is associated with specialized chronic care management.
abstract: BACKGROUND
  International and national bodies promote interdisciplinary care in the management of people with chronic conditions. We examine one facilitative factor in this team-based approach - the co-location of non-physician disciplines within the primary care practice.
  
  
  METHODS
  We used survey data from 330 General Practices in Ontario, Canada and New Zealand, as a part of a multinational study using The Quality and Costs of Primary Care in Europe (QUALICOPC) surveys. Logistic and linear multivariable regression models were employed to examine the association between the number of disciplines working within the practice, and the capacity of the practice to offer specialized and preventive care for patients with chronic conditions.
  
  
  RESULTS
  We found that as the number of non-physicians increased, so did the availability of special sessions/clinics for patients with diabetes (odds ratio 1.43, 1.25-1.65), hypertension (1.20, 1.03-1.39), and the elderly (1.22, 1.05-1.42). Co-location was also associated with the provision of disease management programs for chronic obstructive pulmonary disease, diabetes, and asthma; the equipment available in the centre; and the extent of nursing services.
  
  
  CONCLUSIONS
  The care of people with chronic disease is the 'challenge of the century'. Co-location of practitioners may improve access to services and equipment that aid chronic disease management.
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Suite 425, Toronto, ON M5T 3M6, Canada. jrs@otagoalumni.ac.nz.
authors.forename: Juliet
authors.initials: J
authors.lastname: Rumball-Smith
authors.forename: Walter P
authors.initials: WP
authors.lastname: Wodchis
authors.forename: Anna
authors.initials: A
authors.lastname: Koné
authors.forename: Tim
authors.initials: T
authors.lastname: Kenealy
authors.forename: Jan
authors.initials: J
authors.lastname: Barnsley
authors.forename: Toni
authors.initials: T
authors.lastname: Ashton
mesh_terms: D000328:Adult; D000368:Aged; D001249:Asthma / Q000628:therapy; D002908:Chronic Disease / Q000628:therapy*; D003920:Diabetes Mellitus / Q000628:therapy; D019468:Disease Management; D004864:Equipment and Supplies; D005260:Female; D006268:Health Facilities; D006299:Health Services for the Aged / Q000458:organization & administration; D006801:Humans; D006973:Hypertension / Q000628:therapy; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D009739:Nursing Services / Q000706:statistics & numerical data; D009864:Ontario; D010348:Patient Care Team / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy; D011787:Quality of Health Care