title: The primary-specialty care interface in chronic diseases: patient and practice characteristics associated with co-management.
abstract: OBJECTIVE
  Specialist physicians may act either as consultants or co-managers for patients with chronic diseases along with their primary healthcare (PHC) physician. We assessed factors associated with specialist involvement.
  
  
  METHODS
  We used questionnaire and administrative data to measure co-management and patient and PHC practice characteristics in 702 primary care patients with common chronic diseases. Analysis included multilevel logistic regressions.
  
  
  RESULTS
  In all, 27% of the participants were co-managed. Persons with more severe chronic diseases and lower health-related quality of life were more likely to be co-managed. Persons who were older, had a lower socioeconomic status, resided in rural regions and who were followed in a PHC practice with an advanced practice nurse were less likely to be co-managed.
  
  
  CONCLUSIONS
  Co-management of patients with chronic diseases by a specialist is associated with higher clinical needs but demonstrates social inequalities. PHC practices more adapted to chronic care may help optimize specialist resources utilization.
authors.affiliation: Physiotherapist and Teacher, École de réadaptation, Université de Montréal, Montréal, QC.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Larochelle
authors.affiliation: Professor, École de réadaptation, Université de Montréal, Montréal, QC.
authors.forename: Debbie Ehrmann
authors.initials: DE
authors.lastname: Feldman
authors.affiliation: Chief Executive, Senior Management Team, Bureau of Health Information, Chatswood, NSW, Australia.
authors.forename: Jean-Frederic
authors.initials: JF
authors.lastname: Levesque
mesh_terms: D057179:Advanced Practice Nursing; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008511:Medicine; D011320:Primary Health Care; D011788:Quality of Life; D011792:Quebec; D012017:Referral and Consultation; D012111:Residence Characteristics; D012923:Social Class; D011795:Surveys and Questionnaires