Claudio Del Grande

Characteristics of primary care practices associated with high quality of care

Background: No primary practice care model has been shown to be superior in achieving high-quality primary care. We aimed to identify the organizational characteristics of primary care practices that provide high-quality primary care. Methods: We performed a cross-sectional observational study involving a stratified random sample of 37 primary care practices from 3 regions of Quebec. We recruited 1457 patients who had 1 of 2 chronic care conditions or 1 of 6 episodic care conditions. The main outcome was the overall technical quality score. We measured organizational characteristics by use of a validated questionnaire and the Team Climate Inventory. Statistical analyses were based on multilevel regression modelling. Results: The following characteristics were strongly associated with overall technical quality of care score: physician remuneration method (27.0; 95% confidence interval [CI] 19.0–35.0), extent of sharing of administrative resources (7.6; 95% CI 0.8–14.4), presence of allied health professionals (15.3; 95% CI 5.4–25.2) and/or specialist physicians (19.6; 95% CI 8.3–30.9), the presence of mechanisms for maintaining or evaluating competence (7.7; 95% CI 3.0–12.4) and average organizational access to the practice (4.9; 95% CI 2.6–7.2). The number of physicians (1.2; 95% CI 0.6–1.8) and the average Team Climate Inventory score (1.3; 95% CI 0.1–2.5) were modestly associated with high-quality care. Interpretation: We identified a common set of organizational characteristics associated with high-quality primary care. Many of these characteristics are amenable to change through practice-level organizational changes.

Community-Based Programs to Improve Prevention and Management of Hypertension: Recent Canadian Experiences, Challenges, and Opportunities

High blood pressure (BP) is the greatest risk of ill health and an early death worldwide. It is a key factor in the development of atherosclerosis, the main cause of vascular and cerebrovascular diseases, and is causally linked to kidney failure and dementia. Healthy lifestyle choices coupled with effective, population-based prevention strategies, early detection, and optimal treatment and control of high BP can substantially reduce the burden of vascular and cerebrovascular diseases. Considering the projected increases in the risk factors responsible for these conditions, it is imperative that effective population-based prevention strategies are developed, evaluated, and scaled-up. Extensive and rigourous evidence supports the promotion of healthy lifestyle choices to maintain low BP and prevent associated chronic diseases. Community-based programs are the prime tool for implementing a population strategy of prevention. Their aim is to shift the distribution of risk factors to lower levels across entire populations. Despite their great potential and more than a 4-decade history, it remains unclear to what extent such programs can be effectively implemented, scaled-up and sustained. We provide a broad overview of community-based programs implemented to address cardiovascular disease risk factors, focus on the recent Canadian experience in this area, and highlight the main challenges and opportunities currently associated with them. Recent Canadian initiatives have shown encouraging results, some of them focusing on high-risk subgroups. These initiatives demonstrate feasibility and benefits of implementing community-based programs for the prevention and management of cardiovascular disease in Canada.