Abstract
BackgroundMany countries, including Canada, have introduced primary care reforms to improve health system functioning and value. The purpose of this study was to examine the association between receiving care from interprofessional primary care teams and after-hours access to care, patient-reported walk-in clinic visits and emergency department use.MethodsWe conducted a retrospective cohort study linking population-based administrative databases to Ontario’s Health Care Experience Survey (HCES) between 2012 and 2018. We adjusted for physician group characteristics as well as individual physician and patient characteristics while assessing the relationship between receiving care from interprofessional teams and the outcomes of interest.ResultsAs of March 31st, 2015, there were 465 physician groups with HCES respondents of which 177 (38.0%) were interprofessional teams and 288 (62.0%) were non-interprofessional teams in the same blended capitation reimbursement model. In this period, there were 4518 physicians with HCES respondents, of whom 2131 (47.2%) were in interprofessional teams and 2387 (52.8%) were in non-interprofessional teams. There were 10,102 HCES respondents included in this study, of whom 42.4% were in interprofessional teams and 42.3% were in non-interprofessional teams. After adjustment, we found that being in an interprofessional team was associated with an increase in the odds of patients reporting same/next day access to care by 12.0% (OR = 1.12 CI = 1.00 to 1.24 p-value 0.0436) and a decrease in the odds of patients reporting walk-in clinic use by 16% (OR = 0.84 CI = 0.75 to 0.94 p-value 0.0019). After adjustment, there were no significant differences in patient-reported after-hours access to care and emergency department use.ConclusionsOntario has invested heavily in interprofessional primary care teams. As compared to patients in non-interprofessional teams, patients in interprofessional teams self-reported more timely access to care and less walk-in clinic use but no significant difference in self-reported access to after-hours care or in emergency department use. For jurisdictions aiming to expand physician voluntary participation in interprofessional teams, our study results inform expectations around access to care and health services utilization.
Highlights
Many countries, including Canada, have introduced primary care reforms to improve health system functioning and value
As compared to patients in noninterprofessional teams, patients in interprofessional teams self-reported more timely access to care and less walk-in clinic use but no significant difference in self-reported access to after-hours care or in emergency department use
Our study examined the association between receiving care from interprofessional versus non-interprofessional primary care teams and patient-reported timely and after-hours access to care, patient-reported walk-in clinic visits and emergency department use
Summary
Many countries, including Canada, have introduced primary care reforms to improve health system functioning and value. A strong primary care system is recognized as the cornerstone of health systems and is associated with better outcomes, improved patient experience and lower cost [3]. Many countries around the world, including Canada, have introduced primary care reform to deliver on those goals. Interprofessional teams are “groups of professionals from different disciplines who communicate and work together in a formal arrangement to care for a patient population in a primary care setting.” [8] They typically include primary care physicians, nurses or nurse practitioners, and at least one other health care professional (e.g. pharmacist, social worker, dietitian or physiotherapist).
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