Association of physician payment model and team-based care with timely access in primary care: a population-based cross-sectional study

Abstract

ealth care systems with strong primary care have better health outcomes, lower costs and fewer inequities. 1 First-contact access is one of the pillars of primary care, 2 yet, in Canada, timely access to primary care continues to be a challenge. For example, only 43% of patients in Canada report being able to get an appointment the same day or the next day when sick, compared to 77% in the Netherlands, the top-ranked country for this type of access in the Commonwealth Fund's 2016 survey. 3 Canada also has the highest rates of emergency department use, with many patients reporting they went to the emergency department for a condition that could have been managed in primary care. 3 Policy-makers have hoped to address some of these issues by supporting practices to transition to medical homes. 4,5 Medical homes typically incorporate blended payment for physicians, a focus on quality and safety, and mechanisms for enhanced access. 6,7 In Ontario, reforms have included options for physicians to transition from fee-for-service to blended capitation and to apply for funding for nonphysician health

Facilitating Integration Through Team-Based Primary Healthcare: A Cross-Case Policy Analysis of Four Canadian Provinces

“…There is also low-quality evidence that shows a blended fee-for-service and capitation model may be a viable option for compensation of IPHC teams [ 64 ], such as used in ON and QC. Overall, the mixed evidence and complexity of team compensation demonstrates the need for further research to enable IPHC funding decisions to be evidence-based [ 65 ].…”

Comparing primary care Interprofessional and non-interprofessional teams on access to care and health services utilization in Ontario, Canada: a retrospective cohort study

“…Our findings showed a non-significant difference in patient-reported after-hours access to care between interprofessional and non-interprofessional teams. The provision of after-hours care is an expectation that all FHOs need to meet as part of their contractual agreement with the Ministry of Health [ 32 ]. Although some interprofessional teams operate out of multiple locations, the after-hours services only need to be offered at one location, which may not be convenient for many of the enrolled patients.…”

“…Those investments should theoretically be reflected in better outcomes among interprofessional teams. The government’s first priority in establishing interprofessional teams was to increase access to primary care and health services utilization [ 32 ]. Our results show that interprofessional teams perform better than non-interprofessional teams in some but not all aspects related to access to care and health services utilization.…”

“…The professional management and clinical structure available through interprofessional teams, such as having an Executive Director and allied health professionals can theoretically support access to care. Although more timely access to care among patients in interprofessional teams is not an expectation in the contractual agreement between teams and the Ministry of Health, previous evidence indicates that enhanced interprofessional team structure can support the availability of the primary care provider by shifting some of their duties to other team members [28][29][30][31][32][33]. The evaluations of Patient-Centered Medical Homes in the United States related to timely access to care suggest that greater availability of providers can free more of their time for patient encounters [34].…”

Primary care bonus payments and patient-reported access in urban Ontario: a cross-sectional study

“…We identified covariates by reviewing previous literature that evaluated factors related to primary care access. 13,14,[21][22][23][24] Patient-level covariates were age, sex, education, primary lang uage, health status, income quintile, and immigration status. Physician-level covariates were age, sex, Canadian medical graduate (yes or no), years in practice and roster size.…”