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The Canadian Psychiatric Association practice profile survey: II. General description of results.

https://arctichealth.org/en/permalink/ahliterature185146
Source
Can J Psychiatry. 2003 May;48(4):244-9
Publication Type
Article
Date
May-2003
Author
D Blake Woodside
Elizabeth Lin
Author Affiliation
Inpatient Eating Disorders Program, Toronto General Hospital, Department of Psychiatry, University of Toronto, Toronto, Ontario. b.woodside@utoronto.ca
Source
Can J Psychiatry. 2003 May;48(4):244-9
Date
May-2003
Language
English
Publication Type
Article
Keywords
Canada
Female
Health status
Humans
Male
Mental Disorders - classification - therapy
Physician's Practice Patterns - economics - organization & administration
Physician-Patient Relations
Psychiatry - economics - organization & administration
Questionnaires
Abstract
To provide an overview of the results of the Canadian Psychiatric Association (CPA) practice profile survey (PPS), a national survey of psychiatrists and psychiatric practice.
Mail-in interviews were sent to all Canadian psychiatrists listed in their provincial registers and to all active CPA members (total = 3628). Respondents provided general information about their professional activities for one 24-hour day and detailed information for 1 randomly selected hour. Patient information--including sociodemographics, diagnostic profiles, functioning levels, risk of harm to self or others, and disposition--was elicited for 1 patient seen during the random hour as well as for the most seriously ill patient receiving clinical services that day.
Psychiatrists work 10 hours daily on average and take calls for 5 hours. Sixty percent of the overall work time is in the provision of direct patient care, and fee-for-service payments account for 55% of hours worked. Forty percent of the clinical work is provided in a hospital setting, and 34% is in a private office. Agency work accounted for only 6% of clinical hours worked. Relatively few practitioners provide services to children, older, or forensic patients. The average patient seen is female, aged 40 years, unmarried or with a marital disruption, significantly impaired in multiple areas of functioning, and likely to suffer from depression (21%), schizophrenia (14%), an anxiety disorder (13%), or bipolar disorder (12%). Comorbid Axis I and Axis II disorders are common (each over 30%) and fairly high rates of suicidal (15% to 30%) and homicidal (10% to 20%) risk are present.
This paper suggests a wide diversity of practice in psychiatry in Canada, with services being provided to a wide range of individuals with many different conditions.
PubMed ID
12776391 View in PubMed
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Impact of remuneration and organizational factors on completing preventive manoeuvres in primary care practices.

https://arctichealth.org/en/permalink/ahliterature129094
Source
CMAJ. 2012 Feb 7;184(2):E135-43
Publication Type
Article
Date
Feb-7-2012
Author
Simone Dahrouge
William E Hogg
Grant Russell
Meltem Tuna
Robert Geneau
Laura K Muldoon
Elizabeth Kristjansson
John Fletcher
Author Affiliation
Department of Family Medicine, University of Ottawa, C.T. Lamont Primary Health Care Research Centre, Ottawa, Ont. sdahrouge@bruyere.org
Source
CMAJ. 2012 Feb 7;184(2):E135-43
Date
Feb-7-2012
Language
English
Publication Type
Article
Keywords
Analysis of Variance
Capitation Fee - organization & administration - statistics & numerical data
Chi-Square Distribution
Community Health Services - economics - organization & administration - statistics & numerical data
Cross-Sectional Studies
Fee-for-Service Plans - economics - organization & administration - statistics & numerical data
Female
Humans
Linear Models
Male
Ontario
Physician's Practice Patterns - economics - organization & administration - statistics & numerical data
Preventive Health Services - economics - organization & administration - statistics & numerical data
Primary Health Care - economics - organization & administration - statistics & numerical data
Remuneration
Sex Factors
Abstract
Several jurisdictions attempting to reform primary care have focused on changes in physician remuneration. The goals of this study were to compare the delivery of preventive services by practices in four primary care funding models and to identify organizational factors associated with superior preventive care.
In a cross-sectional study, we included 137 primary care practices in the province of Ontario (35 fee-for-service practices, 35 with salaried physicians [community health centres], 35 practices in the new capitation model [family health networks] and 32 practices in the established capitation model [health services organizations]). We surveyed 288 family physicians. We reviewed 4108 randomly selected patient charts and assigned prevention scores based on the proportion of eligible preventive manoeuvres delivered for each patient.
A total of 3284 patients were eligible for at least one of six preventive manoeuvres. After adjusting for patient profile and contextual factors, we found that, compared with prevention scores in practices in the new capitation model, scores were significantly lower in fee-for-service practices (ß estimate for effect on prevention score = -6.3, 95% confidence interval [CI] -11.9 to -0.6) and practices in the established capitation model (ß = -9.1, 95% CI -14.9 to -3.3) but not for those with salaried remuneration (ß = -0.8, 95% CI -6.5 to 4.8). After accounting for physician characteristics and organizational structure, the type of funding model was no longer a statistically significant factor. Compared with reference practices, those with at least one female family physician (ß = 8.0, 95% CI 4.2 to 11.8), a panel size of fewer than 1600 patients per full-time equivalent family physician (ß = 6.8, 95% CI 3.1 to 10.6) and an electronic reminder system (ß = 4.6, 95% CI 0.4 to 8.7) had superior prevention scores. The effect of these three factors was largely but not always consistent across the funding models; it was largely consistent across the preventive manoeuvres.
No funding model was clearly associated with superior preventive care. Factors related to physician characteristics and practice structure were stronger predictors of performance. Practices with one or more female physicians, a smaller patient load and an electronic reminder system had superior prevention scores. Our findings raise questions about reform initiatives aimed at increasing patient numbers, but they support the adoption of information technology.
Notes
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PubMed ID
22143227 View in PubMed
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Out-of-hours service in Denmark: the effect of a structural change.

https://arctichealth.org/en/permalink/ahliterature203116
Source
Br J Gen Pract. 1998 Aug;48(433):1497-9
Publication Type
Article
Date
Aug-1998
Author
B L Hansen
A. Munck
Author Affiliation
Odense University, Denmark.
Source
Br J Gen Pract. 1998 Aug;48(433):1497-9
Date
Aug-1998
Language
English
Publication Type
Article
Keywords
Denmark
Emergency Medical Services - economics - organization & administration
Family Practice - economics - organization & administration
Humans
Patient satisfaction
Physician's Practice Patterns - economics - organization & administration
Time Factors
Abstract
In Denmark, the provision of out-of-hours care by general practitioners (GPs) was reformed at the start of 1992. Rota systems were replaced locally by county-based services. The new out-of-hours service resulted in a considerable reduction in the total number of GPs on call.
To describe how the patients experienced the change from a satisfaction point of view, and how the pattern of patient contact and the fee for GPs changed with the new system.
The county of Funen was chosen as the geographical area where data were collected. A questionnaire measuring patient satisfaction was posted before the change, immediately after the change, and three years later to a random selection of patients who had been in contact with the out-of-hours service within two weeks before the mailing date. All primary care services for the Danish population are stored in a database (National Health Service Registry). From this continuously updated database, the contact pattern and the fee for GPs were extracted for 1991, 1992, and 1995.
The total number of patient contacts was reduced by 16% in the first year, but by only 6% three years later. Three years after the change, there were more than twice as many telephone consultations as before the change, and there were only a third as many home visits. After three years, the GPs' fees were reduced by 20%. There was a significant decrease in patient satisfaction, although the overall level remained high. This decrease was lower three years after the change than immediately after the new system was introduced.
The new service had a major cost-effectiveness benefit, but there was a price to pay in patient satisfaction.
Notes
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Comment In: Br J Gen Pract. 1998 Oct;48(435):170310071412
PubMed ID
10024709 View in PubMed
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