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

Premji, Kamila; Sucha, Ewa; Glazier, Richard H.; Green, Michael E.; Wodchis, Walter P.; Hogg, William; Kiran, Tara; Frymire, Eliot; Freeman, Thomas R.; Ryan, Bridget L.

doi:10.9778/cmajo.20200235

Cited by 5 publications

(10 citation statements)

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“…[35][36][37] Financial penalties are built into team capitation and non-team capitation models to encourage physicians to offer after-hours access. 5,16,27,33 Patients enrolled in these models report higher levels of after-hours access, but lower levels of same-or next-day access than patients enrolled in enhanced fee-for-service models. 16 We found that reduced access of either type (after-hours or same-or next-day access) was associated with walk-in clinic use.…”

Section: Discussionmentioning

confidence: 99%

“… 5 , 27 Physician practices with capitated payment models also receive an access bonus, which is reduced if patients visit a physician outside the enrolling group. 5 , 16 , 27 …”

Section: Methodsmentioning

confidence: 99%

“…The association between patients' timely access to their usual primary care physician and use of walk-in clinics in Ontario, Canada: a cross-sectional study by Ontario's health care sector 14 and has opened new research opportunities in primary care. [15][16][17][18] Previously reported factors that contribute to patients' use of walk-in clinics instead of their usual primary care physician include a lack of access to their enrolled physician, the convenience of walk-in clinics, the perceived urgency of health conditions and a desire to be assessed within the same day. [19][20][21][22][23][24][25] However, earlier studies had limitations such as small or convenience sampling and exclusion of the patient's perspective, and most were conducted before Ontario's primary care reforms.…”

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confidence: 99%

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The association between patients’ timely access to their usual primary care physician and use of walk-in clinics in Ontario, Canada: a cross-sectional study

Rahman,

Costa,

Gayowsky

et al. 2023

cmajo

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Background: Challenges in timely access to one's usual primary care physician and the ongoing use of walk-in clinics have been major health policy issues in Ontario for over a decade. We sought to determine the association between patient-reported timely access to their usual primary care physician or clinic and their use of walk-in clinics. Methods:We conducted a cross-sectional study of Ontario residents who had a primary care physician by linking population-based administrative data to Ontario's Health Care Experience Survey, collected between 2013 and 2020. We described sociodemographic characteristics and health care use for users of walk-in clinics and nonusers. We measured the adjusted association between selfreported same-day or next-day access and after-hours access to usual primary care physicians or clinics and the use of walk-in clinics in the previous 12 months. Results:Of the 60 935 total responses from people who had a primary care physician, 16 166 (weighted 28.6%, unweighted 26.5%) reported visiting a walk-in clinic in the previous 12 months. Compared with nonusers, those who used walk-in clinics were predominantly younger, lived in large and medium-sized urban areas and reported a tight, very tight or poor financial situation. Respondents who reported poor same-day or next-day access to their primary care physician or clinic were more likely to report having attended a walk-in clinic in the previous 12 months than those with better access (adjusted odds ratio [OR] 1.23, 95% confidence interval [Cl] 1.13-1.34). Those who reported being unaware that their primary care physician offered after-hours care had a higher likelihood of going to a walk-in clinic (adjusted OR 1.14, 95% Cl 1.07-1.21). Interpretation:In this population-based health survey, patient-reported use of walk-in clinics was associated with a reported lack of access to same-day or next-day care and unawareness of after-hours care by respondents' usual primary care physicians. These findings could inform policies to improve access to primary care, while preserving care continuity.

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Section: Discussionmentioning

confidence: 99%

“… 5 , 27 Physician practices with capitated payment models also receive an access bonus, which is reduced if patients visit a physician outside the enrolling group. 5 , 16 , 27 …”

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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The association between patients’ timely access to their usual primary care physician and use of walk-in clinics in Ontario, Canada: a cross-sectional study

Rahman,

Costa,

Gayowsky

et al. 2023

cmajo

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“…Participants may refuse to answer questions on the HCES and may choose to stop the interview at any point. ISR also collects informed consent from participants over the phone interview to link HCES responses with administrative databases within ICES [ 30 ]. The response rate for included waves ranged from 29% to 39% [ 27 ].…”

Section: Methodsmentioning

confidence: 99%

The relationship between patient experience and real-world digital health access in primary care: A population-based cross-sectional study

Pasat,

Sinn,

Rahman

et al. 2024

PLoS ONE

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Implementing digital health technologies in primary care is anticipated to improve patient experience. We examined the relationships between patient experience and digital health access in primary care settings in Ontario, Canada. We conducted a retrospective cross-sectional study using patient responses to the Health Care Experience Survey linked to health and administrative data between April 2019—February 2020. We measured patient experience by summarizing HCES questions. We used multivariable logistic regression stratified by the number of primary care visits to investigate associations between patient experience with digital health access and moderating variables. Our cohort included 2,692 Ontario adults, of which 63.0% accessed telehealth, 2.6% viewed medical records online, and 3.6% booked appointments online. Although patients reported overwhelmingly positive experiences, we found no consistent relationship with digital health access. Online appointment booking access was associated with lower odds of poor experience for patients with three or more primary care visits in the past 12 months (adjusted odds ratio 0.16, 95% CI 0.02–0.56). Younger age, tight financial circumstances, English as a second language, and knowing their primary care provider for fewer years had greater odds of poor patient experience. In 2019/2020, we found limited uptake of digital health in primary care and no clear association between real-world digital health adoption and patient experience in Ontario. Our findings provide an essential context for ensuing rapid shifts in digital health adoption during the COVID-19 pandemic, serving as a baseline to reexamine subsequent improvements in patient experience.

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“…Enrolling practices are expected to meet all primary care needs, including after-hours care . In capitation-based models (the model for 65% of enrolling physicians), there is negation (reduction in an access bonus) when patients of enrolling physicians visit family physicians outside the enrolling group …”

Section: Methodsmentioning

confidence: 99%

Virtual Visits With Own Family Physician vs Outside Family Physician and Emergency Department Use

Lapointe-Shaw,

Salahub,

Austin

et al. 2023

JAMA Netw Open

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ImportanceVirtual visits became more common after the COVID-19 pandemic, but it is unclear in what context they are best used.ObjectiveTo investigate whether there was a difference in subsequent emergency department use between patients who had a virtual visit with their own family physician vs those who had virtual visits with an outside physician.Design, Setting, and ParticipantsThis propensity score–matched cohort study was conducted among all Ontario residents attached to a family physician as of April 1, 2021, who had a virtual family physician visit in the subsequent year (to March 31, 2022).ExposureThe type of virtual family physician visit, with own or outside physician, was determined. In a secondary analysis, own physician visits were compared with visits with a physician working in direct-to-consumer telemedicine.Main Outcome and MeasureThe primary outcome was an emergency department visit within 7 days after the virtual visit.ResultsAmong 5 229 240 Ontario residents with a family physician and virtual visit, 4 173 869 patients (79.8%) had a virtual encounter with their own physician (mean [SD] age, 49.3 [21.5] years; 2 420 712 females [58.0%]) and 1 055 371 patients (20.2%) had an encounter with an outside physician (mean [SD] age, 41.8 [20.9] years; 605 614 females [57.4%]). In the matched cohort of 1 885 966 patients, those who saw an outside physician were 66% more likely to visit an emergency department within 7 days than those who had a virtual visit with their own physician (30 748 of 942 983 patients [3.3%] vs 18 519 of 942 983 patients [2.0%]; risk difference, 1.3% [95% CI, 1.2%-1.3%]; relative risk, 1.66 [95% CI, 1.63-1.69]). The increase in the risk of emergency department visits was greater when comparing 30 216 patients with definite direct-to-consumer telemedicine visits with 30 216 patients with own physician visits (risk difference, 4.1% [95% CI, 3.8%-4.5%]; relative risk, 2.99 [95% CI, 2.74-3.27]).Conclusions and RelevanceIn this study, patients whose virtual visit was with an outside physician were more likely to visit an emergency department in the next 7 days than those whose virtual visit was with their own family physician. These findings suggest that primary care virtual visits may be best used within an existing clinical relationship.

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

Cited by 5 publications

References 12 publications

The association between patients’ timely access to their usual primary care physician and use of walk-in clinics in Ontario, Canada: a cross-sectional study

The association between patients’ timely access to their usual primary care physician and use of walk-in clinics in Ontario, Canada: a cross-sectional study

The relationship between patient experience and real-world digital health access in primary care: A population-based cross-sectional study

Virtual Visits With Own Family Physician vs Outside Family Physician and Emergency Department Use

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