Abstract
BackgroundResearchers often use survey data to study the effect of health and social variables on physician use, but how self-reported physician use compares to administrative data, the gold standard, in particular within the context of multimorbidity and functional limitations remains unclear. We examine whether multimorbidity and functional limitations are related to agreement between self-reported and administrative data for physician use.MethodsCross-sectional data from 52,854 Ontario participants of the Canadian Community Health Survey linked to administrative data were used to assess agreement on physician use. The number of general practitioner (GP) and specialist visits in the previous year was assessed using both data sources; multimorbidity and functional limitation were from self-report.ResultsFewer participants self-reported GP visits (84.8%) compared to administrative data (89.1%), but more self-reported specialist visits (69.2% vs. 64.9%). Sensitivity was higher for GP visits (≥90% for all multimorbidity levels) compared to specialist visits (approximately 75% for 0 to 90% for 4+ chronic conditions). Specificity started higher for GP than specialist visits but decreased more swiftly with multimorbidity level; in both cases, specificity levels fell below 50%. Functional limitations, age and sex did not impact the patterns of sensitivity and specificity seen across level of multimorbidity.ConclusionsCountries around the world collect health surveys to inform health policy and planning, but the extent to which these are linked with administrative, or similar, data are limited. Our study illustrates the potential for misclassification of physician use in self-report data and the need for sensitivity analyses or other corrections.
Highlights
Researchers often use survey data to study the effect of health and social variables on physician use, but how self-reported physician use compares to administrative data, the gold standard, in particular within the context of multimorbidity and functional limitations remains unclear
Specificity levels for self-report tended to start higher for general practitioner (GP) visits than specialist visits but decreased more swiftly with multimorbidity level; in both cases specificity levels fell below 50%
We found the average number of physician visits based on Agreement on the number of physician visits Prior studies [9, 11, 12, 29,30,31] generally found physician visits were under-reported compared to administrative data, but most combined GP and specialist visits
Summary
Researchers often use survey data to study the effect of health and social variables on physician use, but how self-reported physician use compares to administrative data, the gold standard, in particular within the context of multimorbidity and functional limitations remains unclear. We examine whether multimorbidity and functional limitations are related to agreement between self-reported and administrative data for physician use. The most frequently used health service [1], commonly come from claims-based administrative and self-report sources [2]. Administrative data have limited information on the social determinants of health, physical function, symptoms, and other factors associated with healthcare utilization [3]. Large population-based health surveys, (such as the Canadian Longitudinal Study on Aging, Health and Retirement Study, and others collected in over 100 countries [4]) often include in-depth measures of these factors as well as self-report healthcare use data, which means they can be used to study the impact of a larger variety of variables on service use
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