Relational Continuity, Physician Payment, and Team-Based Primary Care in the Canadian Health Care System

Journal of the American Board of Family Medicine: JABFM

article

Richard H. Glazier¹  Tara Kiran¹  Michael E. Green³  Li Bai⁴  Lidija Latifovic⁵  Shahriar Khan³  Alex Kopp⁴  Eliot Frymire³ 

[1] Department of Family and Community Medicine, St. Michael’s Hospital;Department of Family and Community Medicine, University of Toronto;ICES Queen’s;ICES Central;MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health

关键词: Canada;    Continuity of Patient Care;    Patient Care Team;    Primary Health Care;   

DOI  :  10.3122/jabfm.2022.220235R1

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

Purpose: Continuity is a core component of primary care and known to differ by patient characteristics. It is unclear how primary care physician payment and organization are associated with continuity.Methods: We analyzed administrative data from 7,110,036 individuals aged 16+ in Ontario, Canada who were enrolled to a physician and made at least 2 visits between October 1, 2017 and September 30, 2019. Continuity with physician and practice group was quantified using the usual provider of care index. We used log-binomial regression to assess the relationship between enrollment model and continuity adjusting for patient characteristics.Results: Mean physician and group continuity were 67.3% and 73.8%, respectively, for patients enrolled in enhanced fee-for-service, 70.7% and 76.2% for nonteam capitation, and 70.6% and 78.7% for team-based capitation. These differences were attenuated in regression models for physician-level continuity and group-level continuity. Older age was the most notable factor associated with continuity. Compared with those 16 to 34, those 80 and older had 1.45 times higher continuity with their physician.Conclusion: Our results suggest that continuity does not differ substantially by physician payment or organizational model among primary care patients who are formally enrolled with a physician in a setting with universal health insurance.

【 授权许可】

CC BY