Does enrollment in multidisciplinary team-based primary care practice improve adherence to guideline-recommended processes of care? Quebec's Family Medicine Groups, 2002–2010. Issue 4 (April 2017)

• Record Type: Journal Article
• Authors: Diop, Mamadou; Fiset-Laniel, Julie; Provost, Sylvie; Tousignant, Pierre; Borgès Da Silva, Roxane; Ouimet, Marie-Jo; Latimer, Eric; Strumpf, Erin
• Is Part Of: Health policy. Volume 121:Issue 4(2017)
• Page Start: 378
• Page End: 388
• Publication Date: 2017-04
• Subjects: Clinical guideline adherence -- Team-based primary care -- Quality of care -- Chronic disease -- Difference-in-differences; Medical education -- Periodicals; Medical policy -- Periodicals; Delivery of Health Care -- Periodicals; Education, Medical -- Periodicals; Health Education -- Periodicals; Health Planning -- Periodicals; Public Policy -- Periodicals; Enseignement médical -- Périodiques; Politique sanitaire -- Périodiques; Medical education; Medical policy; Periodicals; Electronic journals; Electronic journals; 362.1
• DOI: 10.1016/j.healthpol.2017.02.001
• Languages: English
• ISSNs: 0168-8510

Abstract

Highlights: Adherence to clinical guidelines for 3 chronic diseases increased after enrollment with any GP. Enrollment in team-based practices decreased adherence to prescription drug-related guidelines. No evidence that team-based practices affect adherence to consultation-related guidelines. Abstract: Background: We investigated whether multidisciplinary team-based primary care practice improves adherence to process of care guidelines, in the absence of financial incentives related to pay-for-performance. Methods: We conducted a natural experiment including 135, 119 patients, enrolled with a general practitioner (GP) in a multidisciplinary team Family Medicine Group (FMG) or non-FMG practice, using longitudinal data from Quebec's universal insurer over the relevant time period (2000–2010). All study subjects had diabetes, chronic obstructive pulmonary disease, or heart failure and were followed over a 7-year period, 2 years prior to enrollment and 5 years after. We constructed indicators on adherence to disease-specific guidelines and composite indicators across conditions. We evaluated the effect of FMGs using propensity score methods and Difference-in-Differences (DD) models. Results: Rates of adherence to chronic disease guidelines increased for both FMG and non-FMG patients after enrollment, but not differentially so. Adherence to prescription-related guidelines improved less for FMG patients (DD [95% CI] = −2.83% [−4.08%, −1.58%]). We found no evidence of an FMG effect on adherence to consultation-related guidelines, (DD [95% CI] = −0.24% [−2.24%; 1.75%]). Conclusions: We found no evidence that FMGs increased adherence to the guidelines we evaluated. Future research is needed to assess why this reform did not improve performance on these quality-of-care indicators.