Primary care teams work harder in deprived areas

Carlisle, Robin; Avery, Anthony J; Marsh, Patricia

doi:10.1093/pubmed/24.1.43

Cited by 35 publications

(21 citation statements)

References 15 publications

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“…We used multiple factors to control for patient medical or social complexity, as complex patients require more time per visit and more visits per year. 40,41 Socioeconomic status and immigration, however, were determined by proxy measures. We also cannot exclude the possibility that some unmeasured and unaccounted-for factor may be contributing to the observed associations.…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

Primary Care Physician Panel Size and Quality of Care: A Population-Based Study in Ontario, Canada

Dahrouge

Hogg

Younger

et al. 2016

The Annals of Family Medicine

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PURPOSE The purpose of this study was to determine the relationship between the number of patients under a primary care physician's care (panel size) and primary care quality indicators. METHODSWe conducted a cross-sectional, population-based study of fee-forservice and capitated interprofessional and non-interprofessional primary health care practices in Ontario, Canada between April 2008 and March 2010, encompassing 4,195 physicians with panel sizes ≥1,200 serving 8.3 million patients. Data was extracted from multiple linked, health-related administrative databases and covered 16 quality indicators spanning 5 dimensions of care: access, continuity, comprehensiveness, and evidence-based indicators of cancer screening and chronic disease management. RESULTSThe likelihood of being up-to-date on cervical, colorectal, and breast cancer screening showed relative decreases of 7.9% (P <.001), 5.9% (P = .01), and 4.6% (P <.001), respectively, with increasing panel size (from 1,200 to 3,900). Eight chronic care indicators (4 medication-based and 4 screening-based) showed no significant association with panel size. The likelihood of individuals with a new diagnosis of congestive heart failure having an echocardiogram, however, increased by a relative 8.1% (P <.001) with higher panel size. Increasing panel size was also associated with a 10.8% relative increase in hospitalization rates for ambulatory-care-sensitive conditions (P = .04) and a 10.8% decrease in non-urgent emergency department visits (P = .004). Continuity was highest with medium panel sizes (P <.001), and comprehensiveness had a small decrease (P = .03) with increasing panel size. CONCLUSIONSIncreasing panel size was associated with small decreases in cancer screening, continuity, and comprehensiveness, but showed no consistent relationships with chronic disease management or access indicators. We found no panel size threshold above which quality of care suffered. Ann Fam Med 2016;14:26-33. doi: 10.1370/afm.1864. INTRODUCTIONG iven the central role that primary health care plays in creating a sustainable health care system, improving access to high quality primary health care is an international priority. 1 Where physician resources are scarce, one way to achieve better population coverage and ensure that all individuals have a primary care physician is to promote larger panel sizes, defined as the number of patients under the care of a primary care provider. There is, however, a concern that quality may decline at larger panel sizes. 2 Establishing the "ideal" panel size for a primary care physician by striking a balance between population access and quality of care is a key objective for decision-makers and clinicians. Setting a maximum size or range, however, is challenging because quality of care can be influenced by a large number of patient, provider, and contextual factors.Studies have reported significant correlations between larger panel sizes and shorter consultations, 3 fewer home visits, 4,5 and higher rates of referral to specialists. 6...

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Section: Comparison With Other Studiesmentioning

confidence: 99%

Primary Care Physician Panel Size and Quality of Care: A Population-Based Study in Ontario, Canada

Dahrouge

Hogg

Younger

et al. 2016

The Annals of Family Medicine

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“…112 Practices serving disadvantaged populations tend to have both greater workload and costs, neither of which is fully compensated by deprivation payments. 113,114 Such practices may be less likely to offer an expensive additional service such as chlamydia screening.…”

Section: Implications For Chlamydia Screening Programmesmentioning

confidence: 99%

Epidemiological, social, diagnostic and economic evaluation of population screening for genital chlamydial infection

Low

McCarthy²,

Macleod³

et al. 2007

Health Technol Assess

133

179

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“…Primary care utilisation is higher amongst more deprived and older patients, as their needs are greater and they face no price barriers (Carlisle et al, 2002). The 2001 Living In Ireland Survey conducted by the Economic and Social Research Institute gathered individual level data including socio-economic indicators and frequency of attendance at a GP surgery in the previous 12 months (Nolan, 2007).…”

Section: General Practice Utilisationmentioning

confidence: 99%

The distribution of GPs in Ireland in relation to deprivation

et al. 2010

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The aim of this study was to describe the distribution GP services in Ireland with respect to deprivation. Seven percent of rural inhabitants live within walking distance of the nearest GP compared to 89% of city dwellers. The longest average travel times occur in the most deprived rural areas. The variation in travel times across deprivation scores was modest, particularly in city, town and village areas. The highest workloads were observed in the most deprived urban areas. The current distribution of GPs in Ireland is relatively equitable although the most deprived practices have high workloads or appear to be overstretched. Incentives may be required to increase service provision in these highly deprived areas.

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Primary care teams work harder in deprived areas

Cited by 35 publications

References 15 publications

Primary Care Physician Panel Size and Quality of Care: A Population-Based Study in Ontario, Canada

Primary Care Physician Panel Size and Quality of Care: A Population-Based Study in Ontario, Canada

Epidemiological, social, diagnostic and economic evaluation of population screening for genital chlamydial infection

The distribution of GPs in Ireland in relation to deprivation

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