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Comparison of primary care physician payment models in the management of hypertension

Karen Cauch-Dudek
Research co-coordinator at ICES.

Zhongliang Chen, MD MSc
Programmer and biostatistician at ICES

Correspondence: Dr Karen Tu, ICES, G1 06, 2075 Bayview Ave, Toronto, ON M4N 3M5; telephone 416 480-4055, extension 3871; fax: 416 480-6048; e-mailkaren.tu{at}ices.on.ca

OBJECTIVE To determine primary care physician screening, treatment, and control rates for hypertension and to examine whether type of physician payment model affected these rates.

DESIGN A cross-sectional chart abstraction study.

SETTING Community health centres (salary), primary care networks (capitation), or traditional fee-for-service practices in Ontario.

PARTICIPANTS A total of 135 primary care physicians, 45 from each of the 3 different models of care. Data were abstracted from 28 adult patient charts randomly selected from each physician.

MAIN OUTCOME MEASURES Screening rates were based on the presence of at least 1 blood pressure reading in the past 3 years, treatment rates on the number of patients with hypertension treated with antihypertensive medication, and control rates on the number of patients with hypertension whose most recent blood pressure readings were below 140/90 mm Hg, below 130/80 mm Hg for patients with diabetes, or below 120/75 mm Hg for patients with renal disease.

RESULTS Overall, 92.5% of all patients were screened for hypertension, 86.4% of patients with hypertension were treated with antihypertensive medications, and 44.9% of patients with hypertension had their blood pressure controlled. Mean screening rates were 90.6%, 93.5%, and 93.3% (P = .22), and after adjusting for sociodemographic factors and comorbid conditions, mean treatment rates were 90.9%, 81.0%, and 87.4% (P < .05) and mean control rates were 54.5%, 38.6%, and 41.6% (P < .05) for capitation, salary, and fee-for-service physicians, respectively.

CONCLUSION Our results showed that although screening rates were similar between all 3 models, there were differences in treatment and control rates, with capitation physicians having the best treatment and control rates. Further investigation into whether this type of payment model results in improved chronic disease management for other chronic diseases and preventative care maneuvers will give support to health care policy makers who are moving toward capitation-type payment models for primary care delivery.

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