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Health Policy. 2014 Jun;116(2-3):264-72. doi: 10.1016/j.healthpol.2014.02.010. Epub 2014 Feb 18.

Characteristics of physicians and patients who join team-based primary care practices: evidence from Quebec's Family Medicine Groups.

Author information

1
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
2
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada; Department of Economics, McGill University, Montreal, QC, Canada; Direction de la santé publique de l'Agence de la Santé et des services sociaux de Montréal, Montreal, QC, Canada. Electronic address: erin.strumpf@mcgill.ca.
3
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada; Direction de la santé publique de l'Agence de la Santé et des services sociaux de Montréal, Montreal, QC, Canada.
4
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada; Direction de la santé publique de l'Agence de la Santé et des services sociaux de Montréal, Montreal, QC, Canada; Institut national de santé publique du Québec, Montreal, QC, Canada.
5
Direction de la santé publique de l'Agence de la Santé et des services sociaux de Montréal, Montreal, QC, Canada.

Abstract

PURPOSE:

New models of delivering primary care are being implemented in various countries. In Quebec, Family Medicine Groups (FMGs) are a team-based approach to enhance access to, and coordination of, care. We examined whether physicians' and patients' characteristics predicted their participation in this new model of primary care.

METHODS:

Using provincial administrative data, we created a population cohort of Quebec's vulnerable patients. We collected data before the advent of FMGs on patients' demographic characteristics, chronic illnesses and health service use, and their physicians' demographics, and practice characteristics. Multivariate regression was used to identify key predictors of joining a FMG among both patients and physicians.

RESULTS:

Patients who eventually enrolled in a FMG were more likely to be female, reside outside of an urban region, have a lower SES status, have diabetes and congestive heart failure, visit the emergency department for ambulatory sensitive conditions and be hospitalized for any cause. They were also less likely to have hypertension, visit an ambulatory clinic and have a usual provider of care. Physicians who joined a FMG were less likely to be located in urban locations, had fewer years in medical practice, saw more patients in hospital, and had patients with lower morbidity.

CONCLUSIONS:

Physicians' practice characteristics and patients' health status and health care service use were important predictors of joining a FMG. To avoid basing policy decisions on tenuous evidence, policymakers and researchers should account for differential selection into team-based primary health care models.

KEYWORDS:

Health care reform; Primary care physicians; Primary health care; Selection bias

PMID:
24602377
DOI:
10.1016/j.healthpol.2014.02.010
[Indexed for MEDLINE]
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