William Hogg1, Ahmed Kotb2, Anna Chu3, Peter Gozdyra4, Atul Sivaswamy5, Jiming Fang6, Claire E Kendall7, Jack Tu8. 1. Director of Faculty Affairs in the Department of Family Medicine at the University of Ottawa in Ontario. whogg@uottawa.ca. 2. Family physician and Lecturer at the University of Ottawa. 3. Associate Research Methodologist at ICES in Toronto, Ont. 4. Medical Geographer at ICES. 5. Senior Research Analyst at ICES. 6. Research Methodologist at ICES. 7. Associate Professor in the Department of Family Medicine and is cross-appointed to the School of Epidemiology and Public Health at the University of Ottawa; Senior Investigator at the Bruyère Research Institute in Ottawa; a practising family physician with the Bruyère Family Health Team; Adjunct Scientist at ICES; Affiliate Investigator in the Clinical Epidemiology Program at the Ottawa Hospital Research Institute; Affiliate Scientist in the Li Ka Shing Knowledge Institute at St Michael's Hospital in Toronto; and Associate Dean of Social Accountability in the Faculty of Medicine at the University of Ottawa. 8. Was Professor of Medicine, Health Policy, Management and Evaluation, and Public Health Sciences at the University of Toronto, was an attending physician at Sunnybrook Health Sciences Centre in Toronto, and oversaw the Cardiovascular Research Group at ICES.
Abstract
OBJECTIVE: To determine whether neighbours who share the same family physicians have better cardiovascular and health care outcomes. DESIGN: Retrospective cohort study using administrative health databases. SETTING: Ontario. PARTICIPANTS: The study population included 2,690,482 adult patients cared for by 1710 family physicians. INTERVENTIONS: Adult residents of Ontario were linked to their family physicians and the geographic distance between patients in the same panel or list was calculated. Using distance between patients within a panel to stratify physicians into quintiles of panel proximity, physicians and patients from close-proximity practices were compared with those from more-distant-proximity practices. Age- and sex-standardized incidence rates and hazard ratios from cause-specific hazards regression models were determined. MAIN OUTCOME MEASURES: The occurrence of a major cardiovascular event during a 5-year follow-up period (2008 to 2012). RESULTS: Patients of panels in the closest-proximity quintile lived an average of 3.9 km from the 10 closest patients in their panel compared with 12.4 km for the 10 closest patients of panels in the distant-proximity quintile. After adjusting for various patient and physician characteristics, patients in the most-distant-proximity practices had a 24% higher rate of cardiovascular events (adjusted hazard ratio=1.24 [95% CI 1.20 to 1.28], P<.001) than patients in the closest-proximity practices. Age- and sex-standardized all-cause mortality and total per patient health care costs were also lowest in the closest-proximity quintile. In sensitivity analyses restricted to large urban communities and to White long-term residents, results were similar. CONCLUSION: The better cardiovascular outcomes observed in close-proximity panels may be related to a previously unrecognized mechanism of social connectedness that extends the effectiveness of primary care practitioners.
OBJECTIVE: To determine whether neighbours who share the same family physicians have better cardiovascular and health care outcomes. DESIGN: Retrospective cohort study using administrative health databases. SETTING: Ontario. PARTICIPANTS: The study population included 2,690,482 adult patients cared for by 1710 family physicians. INTERVENTIONS: Adult residents of Ontario were linked to their family physicians and the geographic distance between patients in the same panel or list was calculated. Using distance between patients within a panel to stratify physicians into quintiles of panel proximity, physicians and patients from close-proximity practices were compared with those from more-distant-proximity practices. Age- and sex-standardized incidence rates and hazard ratios from cause-specific hazards regression models were determined. MAIN OUTCOME MEASURES: The occurrence of a major cardiovascular event during a 5-year follow-up period (2008 to 2012). RESULTS: Patients of panels in the closest-proximity quintile lived an average of 3.9 km from the 10 closest patients in their panel compared with 12.4 km for the 10 closest patients of panels in the distant-proximity quintile. After adjusting for various patient and physician characteristics, patients in the most-distant-proximity practices had a 24% higher rate of cardiovascular events (adjusted hazard ratio=1.24 [95% CI 1.20 to 1.28], P<.001) than patients in the closest-proximity practices. Age- and sex-standardized all-cause mortality and total per patient health care costs were also lowest in the closest-proximity quintile. In sensitivity analyses restricted to large urban communities and to White long-term residents, results were similar. CONCLUSION: The better cardiovascular outcomes observed in close-proximity panels may be related to a previously unrecognized mechanism of social connectedness that extends the effectiveness of primary care practitioners.
Authors: Erik von Elm; Douglas G Altman; Matthias Egger; Stuart J Pocock; Peter C Gøtzsche; Jan P Vandenbroucke Journal: J Clin Epidemiol Date: 2008-04 Impact factor: 6.437
Authors: Jack V Tu; Laura C Maclagan; Dennis T Ko; Clare L Atzema; Gillian L Booth; Sharon Johnston; Karen Tu; Douglas S Lee; Arlene Bierman; Ruth Hall; R Sacha Bhatia; Andrea S Gershon; Sheldon W Tobe; Claudia Sanmartin; Peter Liu; Anna Chu Journal: CMAJ Open Date: 2017-04-25
Authors: Simone Dahrouge; Emily Seale; William Hogg; Grant Russell; Jaime Younger; Elizabeth Muggah; David Ponka; Jay Mercer Journal: Med Care Date: 2016-03 Impact factor: 2.983
Authors: Ivaylo Vassilev; Anne Rogers; Christian Blickem; Helen Brooks; Dharmi Kapadia; Anne Kennedy; Caroline Sanders; Sue Kirk; David Reeves Journal: PLoS One Date: 2013-04-02 Impact factor: 3.240