Which primary Care Physicians Deliver Home Visits to Their Dying Patients in Ontario? A Retrospective Cohort Study

Abstract

<h3>Context:</h3> Home visits have become increasingly uncommon although evidence suggests they improve healthcare quality and reduce overall expenditures. <h3>Objective:</h3> This study identifies the number of physicians delivering home visits at patients’ end of life, describes characteristics of primary care physicians delivering end-of-life home visits, and explores associations with delivery. <h3>Study Design and Analysis:</h3> A retrospective cohort design with descriptive analysis of association between primary care physician characteristics and the propensity to deliver home visits to patients at the end of life. <h3>Setting or Dataset:</h3> Ontario, Canada using population-level health administrative data housed at ICES. <h3>Population Studied:</h3> Primary care physicians in Ontario, Canada between April 1, 2014-March 31, 2019, who were registered in the College of Physicians and Surgeons of Ontario database (CPSO) dataset on or after January 1, 1990 and as of March 31, 2016. <h3>Intervention/Instrument:</h3> Patients who were in their last year of life. <h3>Outcome Measures:</h3> Home visits delivered <h3>Results:</h3> A total of 9,884 physicians were identified, of which 2,568 (25.7%) delivered at least one end-of- life home visit. Physician characteristics showing increased odds ratio (OR) of home visit delivery were older age (OR 1.01 [95% Confidence Interval (CI): 1.00-1.02]) international training (OR 1.28 [95% CI:1.04-1.59]), previous home visit experience (OR 1.02 [95% CI: 1.01-1.02]), capitation models of remuneration; namely enhanced fee-for-service models (OR 1.5 [95%CI: 1.17-2.00]) and mainly capitation model (OR 1.4 [95% CI:1.11-1.79]), and population size of practice location with highest odds in small rural or remote areas (&lt;9,000 residents) (OR 1.38 [95%CI: 1.02-1.88]) and the largest metropolitan areas (OR 1.84 [95%CI: 1.46-2.57]). <h3>Conclusions:</h3> This research demonstrates primary care physicians’ characteristics influence home visit practice patterns. Furthermore, it highlights characteristics amenable to policy or system-level changes that could increase the provision of home visits. Increasing physician home services could greatly improve the dying experience of Canadians.