Government policies targeting primary care physician practice from 1998-2018 in three Canadian provinces: A jurisdictional scan

McKay, Madeleine; Lavergne, M. Ruth; Lea, Amanda Prince; Michael, Le; Grudniewicz, Agnes; Blackie, Doug; Goldsmith, Laurie J.; Marshall, Emily Gard; Mathews, Maria; McCracken, Rita; McGrail, Kimberlyn; Wong, Sabrina T.; Rudoler, David

doi:10.1016/j.healthpol.2022.03.006

Cited by 19 publications

(31 citation statements)

References 35 publications

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“…Our findings contribute to the scientific literature in two main ways. First, we provide additional evidence that virtual care models can help to address rural health disparities (2-4), and support the emerging literature on the increased use of virtual care during the COVID-19 pandemic (5)(6)(7)(8)(9). Second and more importantly, we extend this literature by demonstrating the clinical and economic effectiveness of a hybrid care model that combines virtual consultations with family physicians with in-person care provided by community paramedics.…”

Section: Comparison To Other Studiessupporting

confidence: 70%

“…Providing robust primary care for rural, remote and underserviced communities is a serious policy challenge for governments around the world (1)(2)(3). Primary care has long been considered the foundation of a high-performing healthcare system (4,5), and attachment to a family physician offering timely access to comprehensive primary care has been associated with improved health outcomes and reductions in total healthcare costs (6). However, healthcare systems in Canada and internationally have struggled to provide their citizens with timely access to and continuity of primary care (7).…”

Section: Introductionmentioning

confidence: 99%

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The 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

Fitzsimon

Belanger

Glazier

et al. 2022

Preprint

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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 April 1, 2018, until March 31, 2021. Participants: All residents of Ontario, Canada under the age of 105 eligible for the Ontario Health Insurance Plan (OHIP) 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 March 27, 2020. Main outcome measures: Primary outcome was change in emergency department (ED) visits anywhere in Ontario, secondary outcomes included changes in hospitalizations and health-system costs, using percent changes in mean monthly values of linked health-system administrative data for two years pre-implementation and one year post-implementation. Results: Renfrew County saw larger declines in ED visits (-34.4%, 95% confidence interval -41.9% to -26.0%) and hospitalizations (-11.1%, 95% confidence interval -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 hospitalizations increased by 30.0%. Conclusion: After implementing VTAC, Renfrew County saw reduced ED visits and hospitalizations and slower health-system cost growth compared to 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. Trial registration: Not applicable.

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Section: Comparison To Other Studiessupporting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

The 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

Fitzsimon

Belanger

Glazier

et al. 2022

Preprint

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“…13,41,42 Findings from these studies urge careful consideration of local context before creating policies and/or adding resources to increase episodic after-hours access versus longitudinal primary care. 9,11,43…”

Section: Upccs Offer Patient Services After-hours More Often Than Wal...mentioning

confidence: 99%

Access to Episodic Primary Care: A Cross-sectional Comparison of Walk-in Clinics and Urgent Primary Care Centers in British Columbia

McCracken

Cooper

Hamilton

et al. 2022

Preprint

Self Cite

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BackgroundWalk-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 Primary Care Centres (UPCCs) were introduced to British Columbia (BC) in 2018 as an additional primary care resource that provides urgent, but not emergent care during extended hours. This study identifies publicly-reported access characteristics for episodic primary care in BC, and provides a clinic-level comparison between walk-in clinics and UPCCs.MethodologyThis 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.ResultsIn 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 offer the majority (8,968.6/ 78.4%) of their service hours between 08:00 and 17:00, Monday to Friday. UPCCs offer the majority (889.3/ 53.7%) of their service hours after 17:00.ConclusionMost walk-in clinics are associated with a longitudinal family practice and provide 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 health care delivery.

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“…Providing robust primary care for rural, remote and underserviced communities is a serious policy challenge for governments around the world 1–3. Primary care has long been considered the foundation of a high-performing healthcare system,4 5 and attachment to a family physician offering timely access to comprehensive primary care has been associated with improved health outcomes and reductions in total healthcare costs 6. However, healthcare systems in Canada and internationally have struggled to provide their citizens with timely access to and continuity of primary care 7.…”

Section: Introductionmentioning

confidence: 99%

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

Fitzsimon

Belanger

Glazier³

et al. 2023

BMJ Open

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ObjectivesTo 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.DesignA cross-sectional comparative study.SettingOntario, Canada, with a focus on three largely rural public health units from 1 April 2018 until 31 March 2021.ParticipantsAll residents of Ontario, Canada under the age of 105 eligible for the Ontario Health Insurance Plan during the study period.InterventionsAn 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 measuresPrimary 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.ResultsRenfrew 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%.ConclusionAfter 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.

show abstract

Government policies targeting primary care physician practice from 1998-2018 in three Canadian provinces: A jurisdictional scan

Cited by 19 publications

References 35 publications

The 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

The 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

Access to Episodic Primary Care: A Cross-sectional Comparison of Walk-in Clinics and Urgent Primary Care Centers in British Columbia

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

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