1
|
Sierra-Heredia C, Tayyar E, Bozorgi Y, Thakore P, Hagos S, Carrillo R, Machado S, Peterson S, Goldenberg S, Wiedmeyer ML, Lavergne MR. Growing inequities by immigration group among older adults: population-based analysis of access to primary care and return to in-person visits during the COVID-19 pandemic in British Columbia, Canada. BMC PRIMARY CARE 2024; 25:332. [PMID: 39243016 PMCID: PMC11378608 DOI: 10.1186/s12875-024-02530-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 07/18/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND The onset of the COVID-19 pandemic drove a rapid and widespread shift to virtual care, followed by a gradual return to in-person visits. Virtual visits may offer more convenient access to care for some, but others may experience challenges accessing care virtually, and some medical needs must be met in-person. Experiences of the shift to virtual care and benefits of in-person care may vary by immigration experience (immigration status and duration), official language level, and age. We examined use of virtual care and return to in-person visits in the Canadian province of British Columbia (BC), comparing patterns by age and across immigration groups, including length of time in Canada and language level (official languages English and French) at time of arrival. METHODS We used linked administrative health and immigration data to examine total primary care visits (virtual or in-person) and return to in-person visits during the COVID-19 pandemic (2019/20-2021/2) in BC. We examined the proportion of people with any primary care visits and with any in-person visits within each year as measures of access to primary care. We estimated the odds of any primary care visits and any in-person visits by immigration group and official language level assessed prior to arrival: non-immigrants, long-term immigrants, recent immigrants (< 5 years) with high assessed official language level and recent immigrants (< 5 years) with low assessed official language level (assessed prior to arrival), stratified by age. RESULTS In general, changes in access to primary care (odds of any visits and odds of any in-person visits) were similar across immigration groups over the study period. However, we observed substantial disparities in access to primary care by immigration group among people aged 60 + , particularly in recent immigrants with low official language level (0.42, 0.40-0.45). These disparities grew wider over the course of the pandemic. CONCLUSION Though among younger adults changes in access to primary care between 2019-2021 were similar across immigration groups, we observed significant and growing inequities among older adults, with particularly limited access among adults who immigrated recently and with low assessed official language level. Targeted interventions to ensure acceptable, accessible care for older immigrants are needed.
Collapse
Affiliation(s)
| | - Elmira Tayyar
- Centre for Gender &, Sexual Health Equity, Vancouver, BC, Canada
| | - Yasmin Bozorgi
- Centre for Gender &, Sexual Health Equity, Vancouver, BC, Canada
| | - Padmini Thakore
- Centre for Gender &, Sexual Health Equity, Vancouver, BC, Canada
| | - Selamawit Hagos
- Centre for Gender &, Sexual Health Equity, Vancouver, BC, Canada
| | - Ruth Carrillo
- Centre for Gender &, Sexual Health Equity, Vancouver, BC, Canada
| | - Stefanie Machado
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Centre for Gender &, Sexual Health Equity, Vancouver, BC, Canada
| | - Sandra Peterson
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Shira Goldenberg
- Centre for Gender &, Sexual Health Equity, Vancouver, BC, Canada
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Mei-Ling Wiedmeyer
- Centre for Gender &, Sexual Health Equity, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - M Ruth Lavergne
- Department of Family Medicine, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
2
|
Spencer S, Hollingbery T, Bodner A, Hedden L, Rudoler D, Christian E, Lavergne MR. Evaluating engagement with equity in Canadian provincial and territorial primary care policies: Results of a jurisdictional scan. Health Policy 2024; 140:104994. [PMID: 38242021 DOI: 10.1016/j.healthpol.2024.104994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/23/2023] [Accepted: 01/09/2024] [Indexed: 01/21/2024]
Abstract
Equitable access to primary care is essential to achieving more equitable health outcomes, yet evidence suggests that structurally marginalized populations are less likely to have benefited from varied primary care reforms in Canada. Our objective is to determine how equity is incorporated in public primary care policy and strategy documents across Canada. We conducted string term and snowball searches for provincial/territorial primary care policy documents published between 01 January 2018 and 30 June 2022, extracted the policy objective, and applied a rubric to evaluate each document's engagement with equity. We performed content analysis of the documents which acknowledged inequities and articulated a related policy response. Of the 224 identified documents that discussed primary care policy: 63 (28 %) identified one or more structurally marginalized group(s) experiencing inequities related to primary care, 64 (29 %) identified a structurally marginalized group and articulated a policy response, and 16 (7 %) articulated a detailed policy response to address inequities. Even where policy responses were articulated, in most cases these did not directly address the acknowledged inequities. The absence of measurable goals, meaningful community consultation, and tenuous connections between the policy response and inequities mentioned may help explain persistent inequities in primary care across Canada.
Collapse
Affiliation(s)
- Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Tai Hollingbery
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa ON, L1G 0C5, Canada
| | - Aidan Bodner
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto ON, M5T 3M6, Canada
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - David Rudoler
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa ON, L1G 0C5, Canada
| | - Erin Christian
- IWK Health Centre, 5850/5980 University Avenue, Halifax NS, B3K 6R8, Canada
| | - M Ruth Lavergne
- Department of Family Medicine, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax NS, B3J 3T4, Canada.
| |
Collapse
|
3
|
Grierson L, Elma A, Aggarwal M, Bakker D, Johnston N, Agarwal G. Understanding the influence of medical education on physician geographic disposition: A qualitative study of family physician perspectives in Canada. J Eval Clin Pract 2023; 29:1261-1270. [PMID: 37904616 DOI: 10.1111/jep.13936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/09/2023] [Indexed: 11/01/2023]
Abstract
RATIONALE Primary care access challenges are experienced by many communities. In several jurisdictions, including Canada, family physicians (FP) have the professional autonomy to organize their practice in alignment with professional and personal interests. Although system-level interventions are tremendously important, investment in upstream interventions associated with the medical education of graduating FPs is a promising strategy for ameliorating primary healthcare access challenges. AIMS AND OBJECTIVES This study investigates the medical education experiences that influence FP's decisions about practice locations in Canada. METHODS We conducted semistructured interviews with FPs who completed undergraduate and postgraduate medical training in Canada and now have a practice in Ontario, Canada. Interview data were coded and analysed using an unconstrained descriptive approach. RESULTS FPs preferred practice locations are intimately tied to their desired practice scope. Practice preferences were shaped through training experiences with patient populations, heightened clinical responsibilities, practice models and locations, professional mentorships and networks. Proximity to family, partner and lifestyle preferences, cultural connections and the available practice opportunities also shaped practice location decisions. CONCLUSION Medical education influences the identification and refinement of professional family practice preferences. Health workforce policies and interventions should leverage medical education to promote more equitable primary healthcare access.
Collapse
Affiliation(s)
- Lawrence Grierson
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- McMaster Program for Education Research, Innovation, and Theory, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- McMaster Community and Rural Education Program, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Asiana Elma
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Monica Aggarwal
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Dorothy Bakker
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- McMaster Community and Rural Education Program, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Neil Johnston
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Gina Agarwal
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
4
|
McCracken MA, Cooper IR, Hamilton MA, Klimas J, Lindsay C, Fletcher S, Price M, Hedden L, McCracken RK. Access to episodic primary care: a cross-sectional comparison of walk-in clinics and urgent primary care centers in British Columbia. Prim Health Care Res Dev 2023; 24:e66. [PMID: 38014436 PMCID: PMC10689093 DOI: 10.1017/s1463423623000580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 07/13/2023] [Accepted: 10/02/2023] [Indexed: 11/29/2023] Open
Abstract
AIM This study aimed to identify publicly reported access characteristics for episodic primary care in BC and provided a clinic-level comparison between walk-in clinics and UPCCs. BACKGROUND Walk-in clinics are non-hospital-based primary care facilities that are designed to operate without appointments and provide increased healthcare access with extended hours. Urgent and Primary Care Centres (UPCCs) were introduced to British Columbia (BC) in 2018 as an additional primary care resource that provided urgent, but not emergent care during extended hours. METHODS This cross-sectional study used publicly available data from all walk-in clinics and UPCCs in BC. A structured data collection form was used to record access characteristics from clinic websites, including business hours, weekend availability, attachment to a longitudinal family practice, and provision of virtual services. FINDINGS In total, 268 clinics were included in the analysis (243 walk-in clinics, 25 UPCCs). Of those, 225 walk-in clinics (92.6%) and two UPCCs (8.0%) were attached to a longitudinal family practice. Only 153 (63%) walk-in clinics offered weekend services, compared to 24 (96%) of UPCCs. Walk-in clinics offered the majority (8,968.6/ 78.4%) of their service hours between 08:00 and 17:00, Monday to Friday. UPCCs offered the majority (889.3/ 53.7%) of their service hours after 17:00. CONCLUSION Most walk-in clinics were associated with a longitudinal family practice and provided the majority of clinic services during typical business hours. More research that includes patient characteristics and care outcomes, analyzed at the clinic level, may be useful to support the optimization of episodic primary healthcare delivery.
Collapse
Affiliation(s)
- Mary A. McCracken
- Innovation Support Unit, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Ian R. Cooper
- Innovation Support Unit, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Michee-Ana Hamilton
- Innovation Support Unit, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jan Klimas
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Cameron Lindsay
- Innovation Support Unit, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sarah Fletcher
- Innovation Support Unit, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Morgan Price
- Innovation Support Unit, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, V6T 2A1, Canada
| | - Rita K. McCracken
- Innovation Support Unit, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
5
|
Lavergne MR, Bodner A, Allin S, Christian E, Hajizadeh M, Hedden L, Katz A, Kephart G, Leslie M, Rudoler D, Spencer S. Disparities in access to primary care are growing wider in Canada. Healthc Manage Forum 2023; 36:272-279. [PMID: 37340726 PMCID: PMC10447912 DOI: 10.1177/08404704231183599] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
Canadian provinces and territories have undertaken varied reforms to how primary care is funded, organized, and delivered, but equity impacts of reforms are unclear. We explore disparities in access to primary care by income, educational attainment, dwelling ownership, immigration, racialization, place of residence (metropolitan/non-metropolitan), and sex/gender, and how these have changed over time, using data from the Canadian Community Health Survey (2007/08 and 2015/16 or 2017/18). We observe disparities by income, educational attainment, dwelling ownership, recent immigration, immigration (regular place of care), racialization (regular place of care), and sex/gender. Disparities are persistent over time or increasing in the case of income and racialization (regular medical provider and consulted with a medical professional). Primary care policy decisions that do not explicitly consider existing inequities may continue to entrench them. Careful study of equity impacts of ongoing policy reforms is needed.
Collapse
Affiliation(s)
| | | | - Sara Allin
- University of Toronto, Toronto, Ontario, Canada
| | | | | | - Lindsay Hedden
- Simon Fraser University, Burnaby, British Columbia, Canada
| | - Alan Katz
- University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | | | - Sarah Spencer
- Simon Fraser University, Burnaby, British Columbia, Canada
| |
Collapse
|
6
|
McCracken RK, Hedden L. What can publicly funded schools teach us about how to fix the family doctor shortage? Healthc Manage Forum 2023; 36:322-326. [PMID: 37335553 PMCID: PMC10447178 DOI: 10.1177/08404704231183175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Recent estimates suggest that up to 22% of Canadians over 18 do not have regular access to a family doctor or nurse practitioner. This lack of access is often characterized as a "family doctor shortage" and has been making headlines for decades. However, we have more family doctors than ever before, and in fact, the lack of primary care access is less about a shortage of physicians and more a need to develop a modern infrastructure and new way of funding and organizing care. Real change will require a paradigm shift from doctor- to clinic-organized care. The example of how schools are organized for public education may hold answers about how to make that paradigm shift and with investment in infrastructure see improvements in access to care across the country.
Collapse
Affiliation(s)
- Rita K. McCracken
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Lindsay Hedden
- Simon Fraser University, Burnaby, British Columbia, Canada
| |
Collapse
|
7
|
Bayoumi I, Glazier RH, Jaakkimainen L, Premji K, Kiran T, Frymire E, Khan S, Green ME. Trends in attachment to a primary care provider in Ontario, 2008-2018: an interrupted time-series analysis. CMAJ Open 2023; 11:E809-E819. [PMID: 37669813 PMCID: PMC10482493 DOI: 10.9778/cmajo.20220167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Attachment to a regular primary care provider is associated with better health outcomes, but 15% of people in Canada lack a consistent source of ongoing primary care. We sought to evaluate trends in attachment to a primary care provider in Ontario in 2008-2018, through an equity lens and in relation to policy changes in implementation of payment reforms and team-based care. METHODS Using linked, population-level administrative data, we conducted a retrospective observational study to calculate rates of patients attached to a regular primary care provider from Apr. 1, 2008, to Mar. 31, 2019. We evaluated the association of patient characteristics and attachment in 2018 using sex-stratified, adjusted, multivariable logistic regression models and used segmented piecewise regression to evaluate changing trends before and after implementation of a policy that restricted physician entry to alternate models. RESULTS Attachment increased from 80.5% (n = 10 352 385) in 2008 to 88.9% of the population (n = 12 537 172) in 2018, but was lower among people with low comorbidity, high residential instability, material deprivation, rural residence and recent immigrants. Inequities narrowed for recent immigrants, males and people with lower incomes over the study period, but disparities persisted for these groups. Attachment grew by 1.47% annually until 2014 (p < 0.0001), but was stagnant thereafter (annual percent change of 0.13, p = 0.16). INTERPRETATION Lack of sustained progress in attachment followed reduced levels of physician entry to alternate funding models. Although disparities narrowed for many groups over the study period, persistent gaps remained for immigrants and people with lower incomes; targeted interventions and policy changes are needed to address these persistent gaps.
Collapse
Affiliation(s)
- Imaan Bayoumi
- Department of Family Medicine (Bayoumi), Queen's University; ICES Queen's (Bayoumi, Frymire, Khan, Green), Kingston, Ont.; ICES Central (Glazier, Jaakkimainen, Premji, Kiran); Department of Family and Community Medicine (Glazier, Kiran), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green), Queen's University, Kingston, Ont.
| | - Richard H Glazier
- Department of Family Medicine (Bayoumi), Queen's University; ICES Queen's (Bayoumi, Frymire, Khan, Green), Kingston, Ont.; ICES Central (Glazier, Jaakkimainen, Premji, Kiran); Department of Family and Community Medicine (Glazier, Kiran), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green), Queen's University, Kingston, Ont
| | - Liisa Jaakkimainen
- Department of Family Medicine (Bayoumi), Queen's University; ICES Queen's (Bayoumi, Frymire, Khan, Green), Kingston, Ont.; ICES Central (Glazier, Jaakkimainen, Premji, Kiran); Department of Family and Community Medicine (Glazier, Kiran), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green), Queen's University, Kingston, Ont
| | - Kamila Premji
- Department of Family Medicine (Bayoumi), Queen's University; ICES Queen's (Bayoumi, Frymire, Khan, Green), Kingston, Ont.; ICES Central (Glazier, Jaakkimainen, Premji, Kiran); Department of Family and Community Medicine (Glazier, Kiran), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green), Queen's University, Kingston, Ont
| | - Tara Kiran
- Department of Family Medicine (Bayoumi), Queen's University; ICES Queen's (Bayoumi, Frymire, Khan, Green), Kingston, Ont.; ICES Central (Glazier, Jaakkimainen, Premji, Kiran); Department of Family and Community Medicine (Glazier, Kiran), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green), Queen's University, Kingston, Ont
| | - Eliot Frymire
- Department of Family Medicine (Bayoumi), Queen's University; ICES Queen's (Bayoumi, Frymire, Khan, Green), Kingston, Ont.; ICES Central (Glazier, Jaakkimainen, Premji, Kiran); Department of Family and Community Medicine (Glazier, Kiran), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green), Queen's University, Kingston, Ont
| | - Shahriar Khan
- Department of Family Medicine (Bayoumi), Queen's University; ICES Queen's (Bayoumi, Frymire, Khan, Green), Kingston, Ont.; ICES Central (Glazier, Jaakkimainen, Premji, Kiran); Department of Family and Community Medicine (Glazier, Kiran), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green), Queen's University, Kingston, Ont
| | - Michael E Green
- Department of Family Medicine (Bayoumi), Queen's University; ICES Queen's (Bayoumi, Frymire, Khan, Green), Kingston, Ont.; ICES Central (Glazier, Jaakkimainen, Premji, Kiran); Department of Family and Community Medicine (Glazier, Kiran), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green), Queen's University, Kingston, Ont
| |
Collapse
|
8
|
Fitzsimon J, Patel K, Peixoto C, Belanger C. Family physicians' experiences with an innovative, community-based, hybrid model of in- person and virtual care: a mixed-methods study. BMC Health Serv Res 2023; 23:573. [PMID: 37270531 DOI: 10.1186/s12913-023-09599-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/25/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Rural, remote, and underserved communities have often struggled to provide adequate access to family physicians. To bridge this gap in Renfrew County, a large, rural region in Ontario, Canada, a community- based, hybrid care model was implemented, combining virtual care from family physicians and in-person care from community paramedics. Studies have demonstrated the clinical and cost effectiveness of this model but its acceptability to physicians has not been examined. This study investigates the experiences of participating family physicians. METHODS A mixed-methods study, combining physician questionnaire response data and qualitative thematic analysis of focus group interview data. RESULTS Data was collected from n = 17 survey respondents and n = 9 participants in two semi-structured focus groups (n = 4 and n = 5 respectively). Physicians reported high satisfaction, driven by skills development and patient gratitude, and felt empowered to reduce ED visits, care for unattached patients, and address simple medical needs. However, physicians found it difficult to provide continuous care and were sometimes unfamiliar with local healthcare resources. CONCLUSION This study found that a hybrid model of in-person and virtual care from family physicians and community paramedics was associated with positive physician experiences in two main areas: clinical impacts, especially avoiding unnecessary ED visits, and physician satisfaction with the service. Potential improvements for this hybrid model were identified, and include better support for patients with complex needs, and more information about local health-system services. Our findings should be of interest to policymakers and administrators seeking to improve access to care through a hybrid model of in-person and virtual care.
Collapse
Affiliation(s)
- Jonathan Fitzsimon
- Department of Family Medicine, University of Ottawa, 600 Peter Morand Crescent #201, Ottawa, ON, K1G 5Z3, Canada.
| | - Kush Patel
- Faculty of Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON, K1H 8M5, Canada
| | - Cayden Peixoto
- Institut du Savoir Montfort, 713 Montréal Rd, Ottawa, ON, K1K 0T2, Canada
| | - Christopher Belanger
- Department of Family Medicine, University of Ottawa, 600 Peter Morand Crescent #201, Ottawa, ON, K1G 5Z3, Canada
| |
Collapse
|
9
|
Fitzsimon JP, Belanger C, Glazier RH, Green M, Peixoto C, Mahdavi R, Plumptre L, Bjerre LM. Clinical and economic impact of a community-based, hybrid model of in-person and virtual care in a Canadian rural setting: a cross-sectional population-based comparative study. BMJ Open 2023; 13:e069699. [PMID: 37188465 DOI: 10.1136/bmjopen-2022-069699] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVES To determine the clinical and economic impact of a community-based, hybrid model of in-person and virtual care by comparing health-system performance of the rural jurisdiction where this model was implemented with neighbouring jurisdictions without such a model and the broader regional health system. DESIGN A cross-sectional comparative study. SETTING Ontario, Canada, with a focus on three largely rural public health units from 1 April 2018 until 31 March 2021. PARTICIPANTS All residents of Ontario, Canada under the age of 105 eligible for the Ontario Health Insurance Plan during the study period. INTERVENTIONS An innovative, community-based, hybrid model of in-person and virtual care, the Virtual Triage and Assessment Centre (VTAC), was implemented in Renfrew County, Ontario on 27 March 2020. MAIN OUTCOME MEASURES Primary outcome was a change in emergency department (ED) visits anywhere in Ontario, secondary outcomes included changes in hospitalisations and health-system costs, using per cent changes in mean monthly values of linked health-system administrative data for 2 years preimplementation and 1 year postimplementation. RESULTS Renfrew County saw larger declines in ED visits (-34.4%, 95% CI -41.9% to -26.0%) and hospitalisations (-11.1%, 95% CI -19.7% to -1.5%) and slower growth in health-system costs than other rural regions studied. VTAC patients' low-acuity ED visits decreased by -32.9%, high-acuity visits increased by 8.2%, and hospitalisations increased by 30.0%. CONCLUSION After implementing VTAC, Renfrew County saw reduced ED visits and hospitalisations and slower health-system cost growth compared with neighbouring rural jurisdictions. VTAC patients experienced reduced unnecessary ED visits and increased appropriate care. Community-based, hybrid models of in-person and virtual care may reduce the burden on emergency and hospital services in rural, remote and underserved regions. Further study is required to evaluate potential for scale and spread.
Collapse
Affiliation(s)
- Jonathan P Fitzsimon
- Arnprior and District Memorial Hospital, Arnprior Regional Health, Arnprior, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
| | | | | | - Michael Green
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Roshanak Mahdavi
- Ottawa Hospital, Civic Campus, ICES Ottawa, Ottawa, Ontario, Canada
| | | | - Lise M Bjerre
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
| |
Collapse
|