247 How Do Canadian Primary Care Physicians in Family Health Teams Compare With Those in Solo-Physician Practices in Their Assessment and Management of Patients With Elevated Cardiometabolic Risk?

Abstract

Patients at elevated cardiometabolic risk (CMR) may benefit from being managed by integrated multidisciplinary healthcare teams. We compared cardiovascular (CV) risk assessment and treatment patterns at the primary care level in Family Health Teams (FHTs) and in solo-physician practices. Between April 2011 and March 2012, multiple physicians from 6 FHTs in Ontario and Québec and 88 individual physicians from British Columbia, Ontario and Québec completed a practice assessment on the current health profile and management of patients >40 years with no clinical evidence of cardiovascular (CV) disease and diagnosed with at least one of the following - dyslipidemia, type 2 diabetes mellitus (T2DM) or hypertension as per the current Canadian Practice Guidelines (CPGs). Key physician and patient characteristics are provided in the Tables and Figures. The Framingham Risk Score (FRS) was the preferred CV risk algorithm (100% FHT; 95.3% solo). Underestimation of CV risk was prevalent in patients without T2DM (45.5% FHT; 44.2% solo; P=0.722). In solo-physician practices, the largest discrepancy in CV risk estimation occurred in the high-risk patient category (16.9% as estimated by the physicians; 49.6% according to the actual FRS). Recommendations to increase physical activity (4.0% FHT; 17.1% solo), improve diet (14.2% FHT; 34.1% solo) and cease smoking (15.2% FHT; 19.8% solo) were suboptimal. Although most of the patients diagnosed with dyslipidemia were prescribed lipid-lowering therapy (85.7% FHT; 86.9% solo), only about half attained the LDL-C goal (53.1% FHT; 47.7% solo). Despite the high use of antihyperglycemic agents in patients with T2DM (70.0% FHT; 83.9% solo), target A1C was achieved by less than a third of the patients (31.3% FHT; 29.3% solo). Even though antihypertensives were widely prescribed to patients with hypertension (86.0% FHT; 97.7% solo), recommended blood pressure goals were only realized by 39.1% and 51.0% of the patients managed by FHTs and solo-physician practices respectively. The composite outcome of LDL-C, glycemic and blood pressure targets was met in even fewer patients (11.9% FHT; 12.1% solo). Assessment and management of CV risk remains suboptimal in the primary care setting. Patients managed in the FHT setting were no more likely to meet recommended therapeutic targets than those patients managed by physicians in solo-physician practices. Tabled 1