Getting it all done. Organizational factors linked with comprehensive primary care.

BACKGROUND: Comprehensiveness, a defining feature of primary care (PC) is associated with patient satisfaction and improved health status. This paper evaluates comprehensive services in fee-for-service (FFS), Health Service Organizations (HSOs), Family Health Networks (FHNs) and Community Health Centres (CHCs) payment models in Ontario.
OBJECTIVES: To assess how organizational models of PC differ in the delivery of comprehensive services and which organizational factors predict comprehensive PC delivery.
METHODS: Cross-sectional mixed-method study with nested qualitative case studies.
SETTING: PC practices in Ontario. PARTICIPANTS: One hundred and thirty-seven PC practices (35 FFS, 32 HSO, 35 FHN and 35 CHC) and 358 providers. INSTRUMENTS: Surveys based on the Primary Care Assessment Tool and qualitative interviews. OUTCOME MEASURES: Comprehensiveness scores were calculated from practice report of clinical services offered in women's health, psychosocial counselling, procedural and diagnostic services. Confounding variables were calculated from provider and patient surveys. Performance at a model level was compared using analysis of variance. Multiple regressions then established factors independently associated with comprehensiveness.
RESULTS: CHCs offered significantly more comprehensive services (74%) than other models (61%-63%; P < 0.005). Thirty-five per cent of the variance in comprehensiveness was explained by a regression model that included the number of family physicians working at the practice, presence of other allied health providers, rurality and length of practice operation.
CONCLUSIONS: Practice size and diversity of providers seemed to partially explain the better performance of CHCs. Practice setting and, probably, practice maturity are significant drivers in the provision of comprehensive PC services. These factors warrant further examination in other PC environments.