Open Access Highly Accessed Research article

Under the same roof: co-location of practitioners within primary care is associated with specialized chronic care management

Juliet Rumball-Smith1*, Walter P Wodchis12, Anna Koné1, Tim Kenealy3, Jan Barnsley12 and Toni Ashton4

Author Affiliations

1 Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Suite 425, Toronto, ON M5T 3M6, Canada

2 Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

3 Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand

4 Health Systems, School of Population Health, University of Auckland, Auckland, New Zealand

For all author emails, please log on.

BMC Family Practice 2014, 15:149  doi:10.1186/1471-2296-15-149

Published: 2 September 2014



International and national bodies promote interdisciplinary care in the management of people with chronic conditions. We examine one facilitative factor in this team-based approach - the co-location of non-physician disciplines within the primary care practice.


We used survey data from 330 General Practices in Ontario, Canada and New Zealand, as a part of a multinational study using The Quality and Costs of Primary Care in Europe (QUALICOPC) surveys. Logistic and linear multivariable regression models were employed to examine the association between the number of disciplines working within the practice, and the capacity of the practice to offer specialized and preventive care for patients with chronic conditions.


We found that as the number of non-physicians increased, so did the availability of special sessions/clinics for patients with diabetes (odds ratio 1.43, 1.25–1.65), hypertension (1.20, 1.03–1.39), and the elderly (1.22, 1.05–1.42). Co-location was also associated with the provision of disease management programs for chronic obstructive pulmonary disease, diabetes, and asthma; the equipment available in the centre; and the extent of nursing services.


The care of people with chronic disease is the ‘challenge of the century’. Co-location of practitioners may improve access to services and equipment that aid chronic disease management.

Canada; New Zealand; Chronic disease; Patient care team; Primary care; Co-location