Community orientation in primary care practices: Results from the Comparison of Models of Primary Health Care in Ontario Study.

OBJECTIVE: To determine which of 4 organizational models of primary care in Ontario were more community oriented.
DESIGN: Cross-sectional investigation using practice and provider surveys derived from the Primary Care Assessment Tool, with nested qualitative case studies (2 practices per model).
SETTING: Thirty-five fee-for-service family practices (including family health groups), 32 health service organizations, 35 family health networks, and 35 community health centres (CHCs) in Ontario. PARTICIPANTS: A total of 137 practices and 363 providers. MAIN OUTCOME MEASURES: Community orientation (CO) was assessed from the perspectives of the practices and the providers working in them. Practice CO scores reflect activities that practices use to reach out to their communities, assess the needs of their communities, and monitor or evaluate the effectiveness of their programs and services. The self-rated provider CO score reflects providers' participation in home visits and their perceptions of their own degree of CO.
RESULTS: At the practice level, CHCs had significantly higher CO scores than the other models did (P < .001 for most differences); in fact, the other models rarely reported meaningful levels of CO. Self-rated provider CO scores were also higher in CHCs, but were present in other models as well.
CONCLUSION: Primary care providers in Ontario give themselves high ratings for CO; however, indicators of CO activity at the practice level were found to a significantly higher degree in CHCs than in the other models.