Natasha E Lane1,2, Vicki Ling3, Richard H Glazier3,4,5,6,7, Thérèse A Stukel3,5,8. 1. Department of Medicine, University of British Columbia, British Columbia, 2775 Laurel Street, 10th Floor , Vancouver, V5Z 1M9, Canada. natasha.lane@alumni.ubc.ca. 2. ICES, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada. natasha.lane@alumni.ubc.ca. 3. ICES, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada. 4. Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada. 5. Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada. 6. Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada. 7. MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. 8. Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine At Dartmouth, 74 College Street, Hanover, NH, 03755, USA.
Abstract
BACKGROUND: Some jurisdictions restrict primary care physicians' daily patient volume to safeguard quality of care for complex patients. Our objective was to determine whether people with dementia receive lower-quality care if their primary care physician sees many patients daily. METHODS: Population-based retrospective cohort study using health administrative data from 100,256 community-living adults with dementia aged 66 years or older, and the 8,368 primary care physicians who cared for them in Ontario, Canada. Multivariable Poisson GEE regression models tested whether physicians' daily patient volume was associated with the adjusted likelihood of people with dementia receiving vaccinations, prescriptions for cholinesterase inhibitors, benzodiazepines, and antipsychotics from their primary care physician. RESULTS: People with dementia whose primary care physicians saw ≥ 30 patients daily were 32% (95% CI: 23% to 41%, p < 0.0001) and 25% (95% CI: 17% to 33%, p < 0.0001) more likely to be prescribed benzodiazepines and antipsychotic medications, respectively, than patients of primary care physicians who saw < 20 patients daily. Patients were 3% (95% CI: 0.4% to 6%, p = 0.02) less likely to receive influenza vaccination and 8% (95% CI: 4% to 13%, p = 0.0001) more likely to be prescribed cholinesterase inhibitors if their primary care physician saw ≥ 30 versus < 20 patients daily. CONCLUSIONS: People with dementia were more likely to receive both potentially harmful and potentially beneficial medications, and slightly less likely to be vaccinated by high-volume primary care physicians.
BACKGROUND: Some jurisdictions restrict primary care physicians' daily patient volume to safeguard quality of care for complex patients. Our objective was to determine whether people with dementia receive lower-quality care if their primary care physician sees many patients daily. METHODS: Population-based retrospective cohort study using health administrative data from 100,256 community-living adults with dementia aged 66 years or older, and the 8,368 primary care physicians who cared for them in Ontario, Canada. Multivariable Poisson GEE regression models tested whether physicians' daily patient volume was associated with the adjusted likelihood of people with dementia receiving vaccinations, prescriptions for cholinesterase inhibitors, benzodiazepines, and antipsychotics from their primary care physician. RESULTS:People with dementia whose primary care physicians saw ≥ 30 patients daily were 32% (95% CI: 23% to 41%, p < 0.0001) and 25% (95% CI: 17% to 33%, p < 0.0001) more likely to be prescribed benzodiazepines and antipsychotic medications, respectively, than patients of primary care physicians who saw < 20 patients daily. Patients were 3% (95% CI: 0.4% to 6%, p = 0.02) less likely to receive influenza vaccination and 8% (95% CI: 4% to 13%, p = 0.0001) more likely to be prescribed cholinesterase inhibitors if their primary care physician saw ≥ 30 versus < 20 patients daily. CONCLUSIONS:People with dementia were more likely to receive both potentially harmful and potentially beneficial medications, and slightly less likely to be vaccinated by high-volume primary care physicians.
Entities:
Keywords:
Dementia; Patient volume; Primary health care; Quality indicators
Authors: Andrew Cheung; Thérèse A Stukel; David A Alter; Richard H Glazier; Vicki Ling; Xuesong Wang; Baiju R Shah Journal: Ann Intern Med Date: 2016-12-13 Impact factor: 25.391
Authors: C Venkata Naga Saritha; T Y Sree Sudha; G V Ramana Rao; K S B S Krishna Sasanka; Pugazhenthan Thangaraju Journal: J Family Med Prim Care Date: 2022-01-31