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Access to primary health care for immigrants: results of a patient survey conducted in 137 primary care practices in Ontario, Canada.

https://arctichealth.org/en/permalink/ahliterature117685
Source
BMC Fam Pract. 2012;13:128
Publication Type
Article
Date
2012
Author
Elizabeth Muggah
Simone Dahrouge
William Hogg
Author Affiliation
CT Lamont Primary Health Care Research Centre, Élisabeth Bruyère Research Institute, Ottawa, ON, Canada. emuggah@bruyere.org
Source
BMC Fam Pract. 2012;13:128
Date
2012
Language
English
Publication Type
Article
Keywords
Adult
Capitation Fee - statistics & numerical data - utilization
Community Health Centers - statistics & numerical data - utilization
Cross-Sectional Studies
Emigrants and Immigrants - statistics & numerical data
Fee-for-Service Plans - statistics & numerical data - utilization
Female
Health Services Accessibility - economics - statistics & numerical data
Health status
Humans
Male
Middle Aged
Ontario
Primary Health Care - economics - statistics & numerical data - utilization
Questionnaires
Self Report
Abstract
Immigrants make up one fifth of the Canadian population and this number continues to grow. Adequate access to primary health care is important for this population but it is not clear if this is being achieved. This study explored patient reported access to primary health care of a population of immigrants in Ontario, Canada who were users of the primary care system and compared this with Canadian-born individuals; and by model of primary care practice.
This study uses data from the Comparison of Models of Primary Care Study (COMP-PC), a mixed-methods, practice-based, cross-sectional study that collected information from patients and providers in 137 primary care practices across Ontario, Canada in 2005-2006. The practices were randomly sampled to ensure an equal number of practices in each of the four dominant primary care models at that time: Fee-For-Service, Community Health Centres, and the two main capitation models (Health Service Organization and Family Health Networks). Adult patients of participating practices were identified when they presented for an appointment and completed a survey in the waiting room. Three measures of access were used, all derived from the patient survey: First Contact Access, First Contact Utilization (both based on the Primary Care Assessment Tool) and number of self-reported visits to the practice in the past year.
Of the 5,269 patients who reported country of birth 1,099 (20.8%) were born outside of Canada. In adjusted analysis, recent immigrants (arrival in Canada within the past five years) and immigrants in Canada for more than 20 years were less likely to report good health compared to Canadian-born (Odds ratio 0.58, 95% CI 0.36,0.92 and 0.81, 95% CI 0.67,0.99). Overall, immigrants reported equal access to primary care services compared with Canadian-born. Within immigrant groups recently arrived immigrants had similar access scores to Canadian-born but reported 5.3 more primary care visits after adjusting for health status. Looking across models, recent immigrants in Fee-For-Service practices reported poorer access and fewer primary care visits compared to Canadian-born.
Overall, immigrants who were users of the primary care system reported a similar level of access as Canadian-born individuals. While recent immigrants are in poorer health compared with Canadian-born they report adequate access to primary care. The differences in access for recently arrived immigrants, across primary care models suggests that organizational features of primary care may lead to inequity in access.
Notes
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PubMed ID
23272805 View in PubMed
Less detail

Age equity in different models of primary care practice in Ontario.

https://arctichealth.org/en/permalink/ahliterature129640
Source
Can Fam Physician. 2011 Nov;57(11):1300-9
Publication Type
Article
Date
Nov-2011
Author
Simone Dahrouge
William Hogg
Meltem Tuna
Grant Russell
Rose Ann Devlin
Peter Tugwell
Elizabeth Kristjansson
Author Affiliation
C.T. Lamont Primary Health Care Research Centre, �lisabeth Bruyère Research Institute, Ottawa, ON. sdahrouge@bruyere.org
Source
Can Fam Physician. 2011 Nov;57(11):1300-9
Date
Nov-2011
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Capitation Fee - standards
Chronic Disease
Community health centers - standards
Cross-Sectional Studies
Delivery of Health Care - organization & administration - standards
Fee-for-Service Plans - standards
Female
Health Care Surveys
Health promotion
Healthcare Disparities - organization & administration - standards
Humans
Linear Models
Logistic Models
Male
Middle Aged
Ontario
Primary Health Care - organization & administration - standards
Quality of Health Care
Socioeconomic Factors
Abstract
To assess whether the model of service delivery affects the equity of the care provided across age groups.
Cross-sectional study.
Ontario.
One hundred thirty-seven practices, including traditional fee-for-service practices, salaried community health centres (CHCs), and capitation-based family health networks and health service organizations.
To compare the quality of care across age groups using multilevel linear or logistic regressions. Health service delivery measures and health promotion were assessed through patient surveys (N = 5111), which were based on the Primary Care Assessment Tool, and prevention and chronic disease management were assessed, based on Canadian recommendations for care, through chart abstraction (N = 4108).
Older individuals reported better health service delivery in all models. This age effect ranged from 1.9% to 5.7%, and was larger in the 2 capitation-based models. Individuals aged younger than 30 years attending CHCs had more features of disadvantage (ie, living below the poverty line and without high school education) and were more likely than older individuals to report discussing at least 1 health promotion subject at the index visit. These differences were deemed an appropriate response to greater needs in these younger individuals. The prevention score showed an age-sex interaction in all models, with adherence to recommended care dropping with age for women. These results are largely attributable to the fact that maneuvers recommended for younger women are considerably more likely to be performed than other maneuvers. Chronic disease management scores showed an inverted U relationship with age in fee-for-service practices, family health networks, and health service organizations but not in CHCs.
The salaried model might have an organizational structure that is more conducive to providing appropriate care across age groups. The thrust toward adopting capitation-based payment is unlikely to have an effect on age disparities.
Notes
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PubMed ID
22084464 View in PubMed
Less detail

An evaluation of gender equity in different models of primary care practices in Ontario.

https://arctichealth.org/en/permalink/ahliterature144701
Source
BMC Public Health. 2010;10:151
Publication Type
Article
Date
2010
Author
Simone Dahrouge
William Hogg
Meltem Tuna
Grant Russell
Rose Anne Devlin
Peter Tugwell
Elisabeth Kristjansson
Author Affiliation
C.T. Lamont Primary Health Care Research Centre, Elisabeth Bruyère Research Institute, Ontario, Canada. sdahrouge@bruyere.org
Source
BMC Public Health. 2010;10:151
Date
2010
Language
English
Publication Type
Article
Keywords
Chronic Disease - therapy
Cross-Sectional Studies
Delivery of Health Care - organization & administration - statistics & numerical data
Female
Humans
Male
Models, organizational
Ontario
Prejudice
Primary Health Care - organization & administration - statistics & numerical data
Quality of Health Care
Sex Factors
Abstract
The World Health Organization calls for more work evaluating the effect of health care reforms on gender equity in developed countries. We performed this evaluation in Ontario, Canada where primary care models resulting from reforms co-exist.
This cross sectional study of primary care practices uses data collected in 2005-2006. Healthcare service models included in the study consist of fee for service (FFS) based, salaried, and capitation based. We compared the quality of care delivered to women and men in practices of each model. We performed multi-level, multivariate regressions adjusting for patient socio-demographic and economic factors to evaluate vertical equity, and adjusting for these and health factors in evaluating horizontal equity. We measured seven dimensions of health service delivery (e.g. accessibility and continuity) and three dimensions of quality of care using patient surveys (n = 5,361) and chart abstractions (n = 4,108).
Health service delivery measures were comparable in women and men, with differences
Notes
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PubMed ID
20331861 View in PubMed
Less detail

Assessing methods for measurement of clinical outcomes and quality of care in primary care practices.

https://arctichealth.org/en/permalink/ahliterature122368
Source
BMC Health Serv Res. 2012;12:214
Publication Type
Article
Date
2012
Author
Michael E Green
William Hogg
Colleen Savage
Sharon Johnston
Grant Russell
R Liisa Jaakkimainen
Richard H Glazier
Janet Barnsley
Richard Birtwhistle
Author Affiliation
Department of Family Medicine, Queen's University, Kingston, Ontario, Canada. michael.green@dfm.queensu.ca
Source
BMC Health Serv Res. 2012;12:214
Date
2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Chronic Disease - epidemiology - therapy
Cross-Sectional Studies
Diagnosis-Related Groups - statistics & numerical data
Female
Health Knowledge, Attitudes, Practice
Health Surveys
Humans
Male
Medical Audit - methods
Middle Aged
Ontario - epidemiology
Outcome Assessment (Health Care) - methods
Patient Acceptance of Health Care - psychology - statistics & numerical data
Patient Credit and Collection
Patients - psychology
Physicians, Family - psychology - standards
Preventive Health Services - economics - standards - statistics & numerical data
Primary Health Care - standards
Quality Indicators, Health Care
Social Class
Abstract
To evaluate the appropriateness of potential data sources for the population of performance indicators for primary care (PC) practices.
This project was a cross sectional study of 7 multidisciplinary primary care teams in Ontario, Canada. Practices were recruited and 5-7 physicians per practice agreed to participate in the study. Patients of participating physicians (20-30) were recruited sequentially as they presented to attend a visit. Data collection included patient, provider and practice surveys, chart abstraction and linkage to administrative data sets. Matched pairs analysis was used to examine the differences in the observed results for each indicator obtained using multiple data sources.
Seven teams, 41 physicians, 94 associated staff and 998 patients were recruited. The survey response rate was 81% for patients, 93% for physicians and 83% for associated staff. Chart audits were successfully completed on all but 1 patient and linkage to administrative data was successful for all subjects. There were significant differences noted between the data collection methods for many measures. No single method of data collection was best for all outcomes. For most measures of technical quality of care chart audit was the most accurate method of data collection. Patient surveys were more accurate for immunizations, chronic disease advice/information dispensed, some general health promotion items and possibly for medication use. Administrative data appears useful for indicators including chronic disease diagnosis and osteoporosis/ breast screening.
Multiple data collection methods are required for a comprehensive assessment of performance in primary care practices. The choice of which methods are best for any one particular study or quality improvement initiative requires careful consideration of the biases that each method might introduce into the results. In this study, both patients and providers were willing to participate in and consent to, the collection and linkage of information from multiple sources that would be required for such assessments.
Notes
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PubMed ID
22824551 View in PubMed
Less detail

Barriers and facilitators to recruitment of physicians and practices for primary care health services research at one centre.

https://arctichealth.org/en/permalink/ahliterature138725
Source
BMC Med Res Methodol. 2010;10:109
Publication Type
Article
Date
2010
Author
Sharon Johnston
Clare Liddy
William Hogg
Melissa Donskov
Grant Russell
Elizabeth Gyorfi-Dyke
Author Affiliation
Department of Family Medicine, University of Ottawa, 43 Bruyère Street, Ottawa, Ontario, Canada. sjohnston@bruyere.org
Source
BMC Med Res Methodol. 2010;10:109
Date
2010
Language
English
Publication Type
Article
Keywords
Health Services Research
Humans
Interviews as Topic
Ontario
Personnel Selection - methods - statistics & numerical data
Primary Health Care
Abstract
While some research has been conducted examining recruitment methods to engage physicians and practices in primary care research, further research is needed on recruitment methodology as it remains a recurrent challenge and plays a crucial role in primary care research. This paper reviews recruitment strategies, common challenges, and innovative practices from five recent primary care health services research studies in Ontario, Canada.
We used mixed qualitative and quantitative methods to gather data from investigators and/or project staff from five research teams. Team members were interviewed and asked to fill out a brief survey on recruitment methods, results, and challenges encountered during a recent or ongoing project involving primary care practices or physicians. Data analysis included qualitative analysis of interview notes and descriptive statistics generated for each study.
Recruitment rates varied markedly across the projects despite similar initial strategies. Common challenges and creative solutions were reported by many of the research teams, including building a sampling frame, developing front-office rapport, adapting recruitment strategies, promoting buy-in and interest in the research question, and training a staff recruiter.
Investigators must continue to find effective ways of reaching and involving diverse and representative samples of primary care providers and practices by building personal connections with, and buy-in from, potential participants. Flexible recruitment strategies and an understanding of the needs and interests of potential participants may also facilitate recruitment.
Notes
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PubMed ID
21144048 View in PubMed
Less detail

Beyond fighting fires and chasing tails? Chronic illness care plans in Ontario, Canada.

https://arctichealth.org/en/permalink/ahliterature158322
Source
Ann Fam Med. 2008 Mar-Apr;6(2):146-53
Publication Type
Article
Author
Grant Russell
Patricia Thille
William Hogg
Jacques Lemelin
Author Affiliation
CT Lamont Primary Health Care Research Centre, Elisabeth Bruyère Research Institute, University of Ottawa, Ontario, Canada. grussell@scohs.on.ca
Source
Ann Fam Med. 2008 Mar-Apr;6(2):146-53
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Attitude of Health Personnel
Chronic Disease - therapy
Community Health Planning - methods - organization & administration
Comprehensive Health Care - methods - organization & administration
Female
Humans
Male
Middle Aged
Ontario
Physician-Patient Relations
Physicians, Family
Primary Health Care - organization & administration
Quality of Health Care
Quality of Life
Abstract
Recent work has conceptualized new models for the primary care management of patients with chronic illness. This study investigated the experience of family physicians and patients with a chronic illness management initiative that involved the joint formulation of comprehensive individual patient care plans.
A qualitative evaluation, framed by phenomenology, immediately followed a randomized controlled trial examining the effect of external facilitators in enhancing the delivery of chronic condition care planning in primary care. The study, set in Ontario family practices, used semistructured in-depth interviews with a purposive sample of 13 family physicians, 20 patients, and all 3 study facilitators. Analysis used independent transcript review and constant comparative methods.
Despite the intervention being grounded in patient-centered principles, family physicians generally viewed chronic illness management from a predominantly biomedical perspective. Only a few enthusiasts viewed systematic care planning as a new approach to managing patients with chronic illness. Most family physicians found the strategy to be difficult to implement within existing organizational and financial constraints. For these participants, care planning conflicted with preexisting concepts of their role and of their patient's abilities to become partners in care. The few patients who noticed the process spoke favorably about their experience.
Although the experiences of the enthusiastic family physicians were encouraging, we found important individual-level barriers to chronic illness management in primary care. These issues seemed to transcend existing organizational and resource constraints.
Notes
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PubMed ID
18332407 View in PubMed
Less detail

Cardiovascular Health Awareness Program (CHAP): a community cluster-randomised trial among elderly Canadians.

https://arctichealth.org/en/permalink/ahliterature158054
Source
Prev Med. 2008 Jun;46(6):537-44
Publication Type
Article
Date
Jun-2008
Author
Janusz Kaczorowski
Larry W Chambers
Tina Karwalajtys
Lisa Dolovich
Barbara Farrell
Beatrice McDonough
Rolf Sebaldt
Cheryl Levitt
William Hogg
Lehana Thabane
Karen Tu
Ron Goeree
J Michael Paterson
Mamdouh Shubair
Tracy Gierman
Shannon Sullivan
Megan Carter
Author Affiliation
Department of Family Practice, University of British Columbia, Canada. janusz.kaczorowski@familymed.ubc.ca
Source
Prev Med. 2008 Jun;46(6):537-44
Date
Jun-2008
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Awareness
Canada
Cardiovascular Diseases - prevention & control
Cardiovascular System
Cluster analysis
Community Medicine
Female
Health Knowledge, Attitudes, Practice
Health promotion
Humans
Hypertension - prevention & control
Male
Program Evaluation
Social Marketing
Abstract
High blood pressure is an important and modifiable cardiovascular disease risk factor that remains under-detected and under-treated. Community-level interventions that address high blood pressure and other modifiable risk factors are a promising strategy to improve cardiovascular health in populations. The present study is a community cluster-randomised trial testing the effectiveness of CHAP (Cardiovascular Health Awareness Program) on the cardiovascular health of older adults.
Thirty-nine mid-sized communities in Ontario, Canada were stratified by geographic location and size of the population aged >or=65 years and randomly allocated to receive CHAP or no intervention. In CHAP communities, residents aged >or=65 years were invited to attend cardiovascular risk assessment sessions held in pharmacies over 10 weeks in Fall, 2006. Sessions included blood pressure measurement and feedback to family physicians. Trained volunteers delivered the program with support from pharmacists, community nurses and local organisations.
The primary outcome measure is the relative change in the mean annual rate of hospital admission for acute myocardial infarction, congestive heart failure and stroke (composite end-point) among residents aged >or=65 years in intervention and control communities, using routinely collected, population-based administrative health data.
This paper highlights considerations in design, implementation and evaluation of a large-scale, community-wide cardiovascular health promotion initiative.
PubMed ID
18372036 View in PubMed
Less detail

Case report: adverse drug reactions in unrecognized kidney failure.

https://arctichealth.org/en/permalink/ahliterature177592
Source
Can Fam Physician. 2004 Oct;50:1385-7
Publication Type
Article
Date
Oct-2004
Author
Barbara Farrell
Kevin Pottie
William Hogg
Author Affiliation
Geriatric Day Hospital, SCO Health Service, Ottawa, Ont. bfarrell@scohs.on.ca
Source
Can Fam Physician. 2004 Oct;50:1385-7
Date
Oct-2004
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Ambulatory Care Facilities
Canada
Creatinine - blood
Drug-Related Side Effects and Adverse Reactions
Female
Glomerular Filtration Rate
Humans
Kidney Failure, Chronic - blood - diagnosis
Pharmaceutical Preparations - administration & dosage
Pharmacists
Notes
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PubMed ID
15526875 View in PubMed
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Change in appropriate referrals to nephrologists after the introduction of automatic reporting of the estimated glomerular filtration rate.

https://arctichealth.org/en/permalink/ahliterature127023
Source
CMAJ. 2012 Mar 20;184(5):E269-76
Publication Type
Article
Date
Mar-20-2012
Author
Ayub Akbari
Jeremy Grimshaw
Dawn Stacey
William Hogg
Tim Ramsay
Marcella Cheng-Fitzpatrick
Peter Magner
Robert Bell
Jolanta Karpinski
Author Affiliation
Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario. aakbari@ottawahospital.on.ca
Source
CMAJ. 2012 Mar 20;184(5):E269-76
Date
Mar-20-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Canada
Clinical Laboratory Techniques
Creatinine - blood
Female
Glomerular Filtration Rate
Humans
Kidney Diseases - diagnosis
Middle Aged
Nephrology
Primary Health Care
Referral and Consultation - statistics & numerical data
Regression Analysis
Abstract
Use of the serum creatinine concentration, the most widely used marker of kidney function, has been associated with under-reporting of chronic kidney disease and late referral to nephrologists, especially among women and elderly people. To improve appropriateness of referrals, automatic reporting of the estimated glomerular filtration rate (eGFR) by laboratories was introduced in the province of Ontario, Canada, in March 2006. We hypothesized that such reporting, along with an ad hoc educational component for primary care physicians, would increase the number of appropriate referrals.
We conducted a population-based before-after study with interrupted time-series analysis at a tertiary care centre. All referrals to nephrologists received at the centre during the year before and the year after automatic reporting of the eGFR was introduced were eligible for inclusion. We used regression analysis with autoregressive errors to evaluate whether such reporting by laboratories, along with ad hoc educational activities for primary care physicians, had an impact on the number and appropriateness of referrals to nephrologists.
A total of 2672 patients were included in the study. In the year after automatic reporting began, the number of referrals from primary care physicians increased by 80.6% (95% confidence interval [CI] 74.8% to 86.9%). The number of appropriate referrals increased by 43.2% (95% CI 38.0% to 48.2%). There was no significant change in the proportion of appropriate referrals between the two periods (-2.8%, 95% CI -26.4% to 43.4%). The proportion of elderly and female patients who were referred increased after reporting was introduced.
The total number of referrals increased after automatic reporting of the eGFR began, especially among women and elderly people. The number of appropriate referrals also increased, but the proportion of appropriate referrals did not change significantly. Future research should be directed to understanding the reasons for inappropriate referral and to develop novel interventions for improving the referral process.
Notes
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PubMed ID
22331970 View in PubMed
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Characteristics of primary care practices associated with high quality of care.

https://arctichealth.org/en/permalink/ahliterature108529
Source
CMAJ. 2013 Sep 3;185(12):E590-6
Publication Type
Article
Date
Sep-3-2013
Author
Marie-Dominique Beaulieu
Jeannie Haggerty
Pierre Tousignant
Janet Barnsley
William Hogg
Robert Geneau
Éveline Hudon
Réjean Duplain
Jean-Louis Denis
Lucie Bonin
Claudio Del Grande
Natalyia Dragieva
Author Affiliation
Centre de recherche du CHUM, Université de Montréal, Montréal, Que. marie-dominique.beaulieu@umontreal.ca
Source
CMAJ. 2013 Sep 3;185(12):E590-6
Date
Sep-3-2013
Language
English
Publication Type
Article
Keywords
Cross-Sectional Studies
Female
Humans
Male
Middle Aged
Practice Management - organization & administration - standards - statistics & numerical data
Primary Health Care - methods - organization & administration - standards - statistics & numerical data
Quality Indicators, Health Care
Quality of Health Care - organization & administration - standards - statistics & numerical data
Quebec
Questionnaires
Abstract
No primary practice care model has been shown to be superior in achieving high-quality primary care. We aimed to identify the organizational characteristics of primary care practices that provide high-quality primary care.
We performed a cross-sectional observational study involving a stratified random sample of 37 primary care practices from 3 regions of Quebec. We recruited 1457 patients who had 1 of 2 chronic care conditions or 1 of 6 episodic care conditions. The main outcome was the overall technical quality score. We measured organizational characteristics by use of a validated questionnaire and the Team Climate Inventory. Statistical analyses were based on multilevel regression modelling.
The following characteristics were strongly associated with overall technical quality of care score: physician remuneration method (27.0; 95% confidence interval [CI] 19.0-35.0), extent of sharing of administrative resources (7.6; 95% CI 0.8-14.4), presence of allied health professionals (15.3; 95% CI 5.4-25.2) and/or specialist physicians (19.6; 95% CI 8.3-30.9), the presence of mechanisms for maintaining or evaluating competence (7.7; 95% CI 3.0-12.4) and average organizational access to the practice (4.9; 95% CI 2.6-7.2). The number of physicians (1.2; 95% CI 0.6-1.8) and the average Team Climate Inventory score (1.3; 95% CI 0.1-2.5) were modestly associated with high-quality care.
We identified a common set of organizational characteristics associated with high-quality primary care. Many of these characteristics are amenable to change through practice-level organizational changes.
Notes
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PubMed ID
23877669 View in PubMed
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