Lindsay Hedden1, M Ruth Lavergne2, Kimberlyn M McGrail3, Michael R Law3, Ivy L Bourgeault4, Rita McCracken5, Morris L Barer3. 1. Centre for Clinical Epidemiology and Evaluation, Research Pavilion, Vancouver General Hospital, Vancouver, British Columbia, Canada lindsay.hedden@ubc.ca. 2. Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada. 3. Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada. 4. Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada. 5. Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.
Abstract
PURPOSE: Providing care in alternative (non-office) locations and outside office hours are important elements of access and comprehensiveness of primary care. We examined the trends in and determinants of the services provided in a cohort of primary care physicians in British Columbia, Canada. METHODS: We used physician-level payments for all primary care physicians practicing in British Columbia from 2006-2007 through 2011-2012. We examined the association between physician demographics and practice characteristics and payment for care in alternative locations and after hours across rural, urban, and metropolitan areas using longitudinal mixed-effects models. RESULTS: The proportion of physicians who provided care in alternative locations and after hours declined significantly during the period, in rural, urban, and metropolitan practices. Declines ranged from 5% for long-term care facility visits to 22% for after-hours care. Female physicians, and those in the oldest age category, had lower odds of providing care at alternative locations and for urgent after-hours care. Compared with those practicing in metropolitan centers, physicians working in rural areas had significantly higher odds of providing care both in alternative locations and after hours. CONCLUSION: Care provided in non-office locations and after office hours declined significantly during the study period. Jurisdictions where providing these services are not mandated, and where similar workforce demographic shifts are occurring, may experience similar accessibility challenges.
PURPOSE: Providing care in alternative (non-office) locations and outside office hours are important elements of access and comprehensiveness of primary care. We examined the trends in and determinants of the services provided in a cohort of primary care physicians in British Columbia, Canada. METHODS: We used physician-level payments for all primary care physicians practicing in British Columbia from 2006-2007 through 2011-2012. We examined the association between physician demographics and practice characteristics and payment for care in alternative locations and after hours across rural, urban, and metropolitan areas using longitudinal mixed-effects models. RESULTS: The proportion of physicians who provided care in alternative locations and after hours declined significantly during the period, in rural, urban, and metropolitan practices. Declines ranged from 5% for long-term care facility visits to 22% for after-hours care. Female physicians, and those in the oldest age category, had lower odds of providing care at alternative locations and for urgent after-hours care. Compared with those practicing in metropolitan centers, physicians working in rural areas had significantly higher odds of providing care both in alternative locations and after hours. CONCLUSION: Care provided in non-office locations and after office hours declined significantly during the study period. Jurisdictions where providing these services are not mandated, and where similar workforce demographic shifts are occurring, may experience similar accessibility challenges.
Authors: Robert A Lowe; A Russell Localio; Donald F Schwarz; Sankey Williams; Lucy Wolf Tuton; Staci Maroney; David Nicklin; Neil Goldfarb; Deneen D Vojta; Harold I Feldman Journal: Med Care Date: 2005-08 Impact factor: 2.983
Authors: Elizabeth F Wenghofer; Sophia M Kam; Patrick E Timony; Roger Strasser; Jessica Sutinen Journal: Can Fam Physician Date: 2018-06 Impact factor: 3.275
Authors: Ian R Cooper; Cameron Lindsay; Keaton Fraser; Tiffany T Hill; Andrew Siu; Sarah Fletcher; Jan Klimas; Michee-Ana Hamilton; Amanda D Frazer; Elka Humphrys; Kira Koepke; Lindsay Hedden; Morgan Price; Rita K McCracken Journal: JMIR Form Res Date: 2022-06-22
Authors: Tobias Morgan; Amanda Tapley; Andrew Davey; Elizabeth Holliday; Alison Fielding; Mieke van Driel; Jean Ball; Neil Spike; Kristen FitzGerald; Simon Morgan; Parker Magin Journal: Aust J Rural Health Date: 2022-02-23 Impact factor: 2.060