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An article by Compagni, Longo and colleagues highlights that general practitioners provide a better management of chronic conditions when they are involved in collaborative organizational arrangements. But the caring attitude needs to be fostered

General practitioners' collaborative organizational arrangements, such as group practices, foster the good management of chronic diseases in primary care, Amelia Compagni and Francesco Longo (Department of Policy Analysis and Public Management) assert in General Practitioners' Adherence to Evidence-Based Guidelines: A Multilevel Analysis (Health Care Management Review, 2012 Jan-Mar; 37(1):67-76), a paper written with Maria Pia Fantini, Paola Rucci and Stefano Mimmi (Università di Bologna). Collaborative organizational arrangements, though, could be much more effective if they took into consideration behavioural aspects, such as psychosocial and emotional communication.

Last decades revealed a growing burden of chronic diseases in developed countries and a consequent attention to primary care. In this framework, the tasks of health promotion, early diagnosis and management of chronic conditions were entrusted to general practitioners (GPs) and several collaborative organizational models aimed at improving clinical effectiveness of GPs were implemented. Collaborative organizational arrangements include coordination of opening hours, sharing of electronic patients records, network connection of the ambulatories, working in the same facility and sharing administrative and clinical staff.

To date, evidence of the impact of collaborative organizational arrangements is, though, contradictory.

The authors of this study investigate the relationship between collaborative practices in primary care, the clinical behaviour of GPs and the resulting quality of care, measured in terms of adherence to evidence-based guidelines, focusing on the treatment of four illnesses (diabetes, heart failure, stroke and post-acute myocardial infarction) in Emilia Romagna, an Italian region where collaborative practices are pervasive.

"Our findings", the scholars write, "suggest that organizational models are significantly associated with better adherence to evidence-based guidelines for diabetes management. In contrast, for stroke, heart failure and post-AMI, the impact of the organizational model appeared to be rather weak". Being diabetes the only disease of the four in which GPs' role is more important that the role of hospital specialists, the outcome is consistent with the idea that the likelihood of compliance with guidelines is higher when GPs feel responsible for the overall care of the patient; then collaborative arrangements become relevant with respect to sharing and consolidating an agreed approach.

Another important result is that GPs' characteristic such as gender and age are good predictors of clinical compliance. In particular, female and young GPs comply more often. If gender and age are considered proxies for an attitude more oriented towards care than cure, and for the willingness to provide counselling and invest in the relationship with patients through psychosocial and emotional communication, an important managerial implication for health systems is the need to invest in fostering such attitudes among GPs of any age and gender.

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