Full-Service Family Practice in British Columbia: Policy Interventions and Trends in Practice, 1991–2010

Abstract

Background: British Columbia' s primary care reform (initiated in 2002) aims to promote "full-service family practice" through incentive payments and other practice support programs. Despite attention to policy, no longitudinal analysis has been conducted of the activities of BC primary care physicians. Methods: This study employed linked administrative health data from 1991/92 through 2009/10 to describe dimensions of care from the definition of "full-service family practice" used in BC reform, grouped into four categories: access, continuity, coordination and comprehensiveness. Results: Access, continuity and coordination of care fell over the study period (p<0.001). Some dimensions reflecting comprehensiveness of care declined (obstetrics and geriatric care), though the remainder did not change significantly. Overall declining trends were consistent across physician characteristics and remained significant when accounting for shifts to nonfee-for-service payment. Conclusion: Findings suggest efforts are not achieving their intended aims. Rigorous evaluation of individual components of reform is needed. Résumé Contexte : La réforme des soins de santé primaires en Colombie-Britannique (amorcée en 2002) vise la promotion de « cliniques familiales offrant des services intégraux » par le biais de primes d'incitation et autres programmes de soutien aux cliniques. Malgré l' attention portée à la politique, il n'y a eu aucune analyse longitudinale sur les activités des médecins de première ligne en Colombie-Britannique. Méthodes : Cette étude fait appel à des données administratives sur la santé de 1991/1992 à 2009/2010 afin de décrire les aspects des soins au regard de la définition des « cliniques familiales offrant des services intégraux » utilisée dans le cadre de la réforme en Colombie-Britannique, et ce, en fonction de quatre catégories : accès, continuité, coordination et intégralité. Résultats : L' accès, la continuité et la coordination des soins ont diminué au cours de la période étudiée (p<0,001). Certains aspects liés à l'intégralité des soins ont décliné (soins obstétriques et gériatriques), bien que les autres n' aient pas connu de changements significatifs. Les tendances générales du déclin sont cohérentes par rapport aux caractéristiques des médecins et demeurent significatives si on tient compte des déplacements vers des méthodes de paiement qui ne fonctionnent pas à l' acte. Conclusion : Les résultats laissent croire que les efforts ne permettent pas d' atteindre les objectifs visés. Il y a grand besoin d'une évaluation rigoureuse des diverses composantes de la réforme.

Practice variation in surgical procedures and IUD-insertions among general practitioners in Norway – a longitudinal study

“…We do not know whether this indicates that GPs’ definition of comprehensive services is narrowing, patients increasingly prefer specialist care or simply if GPs restrict their portfolio of services for convenience or economic reasons. While a recent study from O’Malley described a declining comprehensiveness in the U.S. and Canada, there are also studies that suggest otherwise in the Netherlands [17, 34, 35]. Our findings could be interpreted as a sign of increasing fragmentation or declining comprehensiveness of PHC.…”

“…In Ontario, GPs make fewer house calls and work more exclusively in their surgeries [16]. In British Colombia, comprehensive geriatric and obstetric care by GP declined over a 20-year study period [17]. In Denmark and Norway, there has been an increase in referrals of patients to secondary care over the last two decades, a phenomenon that might reflect a similar decline in comprehensive GP care [10, 18].…”

Trends in Providing Out-of-Office, Urgent After-Hours, and On-Call Care in British Columbia

“…Understanding who is and is not providing these services is critical; however, evidence is limited. The studies that exist suggest that care provision in non-office locations by primary care physicians may be declining [9][10][11][12] ; these studies, however, are based on cross-sectional survey data. They did not capture trends over time among the same cohort of providers, nor differences between rural, urban, and metropolitan practices, and also may be subject to recall and selection biases.…”

Regional differences in where and how family medicine residents intend to practise: a cross-sectional survey analysis

“…C hallenges in accessing primary care persist across Canada despite historically high ratios of primary care providers per capita. [1][2][3][4] Changes in the amounts primary care physicians work 5 and in the types of services they deliver 6,7 may help explain this. Upon completion of training, family physicians may choose comprehensive (generalist) practice or may focus their practice on a particular clinical area (e.g., emergency medicine, palliative care, sports medicine or addictions medicine).…”