The relationship between primary care models and processes of diabetes care in Ontario

Objective — This study aimed to examine the association between Ontario’s different primary care models and receipt of recommended testing for people with diabetes.

Method — The researchers analyzed available administrative data for 757,928 people with diabetes aged 40 and over. The researchers assigned them to a primary care physician and assessed whether they received three key monitoring tests between 2006 and 2008. The researchers used multivariable generalized estimating equation models to test the association between different primary care models and receipt of recommended testing.

Results — Ontarians with diabetes who were enrolled to a non-team blended capitation model (OR 1.18, 95% CI 1.09 to 1.27) and those enrolled to a team-based blended capitation model (OR 1.20, 95% CI 1.13 to 1.28) were more likely than those enrolled to a blended fee for service model to receive the optimal number of three recommended monitoring tests. Patients who were not enrolled to any model and who were assigned to a traditional fee for service physician were least likely to receive optimal monitoring compared to those enrolled to a blended fee for service model (OR 0.60, 95% CI 0.57, 0.62).

Conclusion — The biggest gap in diabetes care was for patients not enrolled to 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 enrolment, and efforts to remove barriers to care.