Views of family physicians in southwestern Ontario on preventive care services and performance incentives

Anderson, Kelly K.; Sebaldt, Rolf J.; Lohfeld, Lynne; Burgess, K. J.; Donald, Faith; Kaczorowski, Janusz

doi:10.1093/fampra/cml013

Cited by 14 publications

(7 citation statements)

References 1 publication

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“…6,9,23,28,29 Several regions have implemented such incentives, but the evidence supporting their impact remains scarce and inconclusive. 30,31 In Ontario, incentives to send reminders to patients to obtain preventive care and inducements to achieve greater patient coverage of preventive care have recently been implemented.…”

Section: Discussionmentioning

confidence: 99%

Impact of remuneration and organizational factors on completing preventive manoeuvres in primary care practices

Dahrouge

Hogg

Russell

et al. 2011

CMAJ

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P rimary care providers are increasingly in terested in ensuring that preventive health care be part of their work routines.1 This reorientation fits with the evidence that recommendations from family practitioners increase substantially the likelihood of patients undergoing preventive manoeuvres, 2 whereas the lack of such recommendations has been linked with patient noncompliance. 3,4 Studies evaluating adherence to recommended preventive care suggest that the most pervasive barriers rest with the organization of the health care system and the practice itself, such as the absence of external financial incentives for the work done and the lack of a reminder system in the office. 3,5−9 Countries attempting to reform their delivery of primary care and improve the delivery of preventive services have often directed their efforts in finding alternatives to the traditional fee-forservice model, in which providers receive payment for each service provided. There are two predominant alternative funding models: capitation (pro viders receive a fixed lump-sum payment per pa tient per period, independent of the number of services performed) and salaried remuneration. Some health care systems blend components of fee for service with either of these models or offer additional incentives for reaching defined qualityof-care targets. Despite considerable rhetoric, there is little evidence to point to the remuneration models associated with superior delivery of primary care services. 10 The complexity of health

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Section: Discussionmentioning

confidence: 99%

Impact of remuneration and organizational factors on completing preventive manoeuvres in primary care practices

Dahrouge

Hogg

Russell

et al. 2011

CMAJ

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“…Without lists of overdue patients, most Canadian family physicians take an opportunistic approach to cancer screening. 3 In 2014, the Ontario government introduced a central provincial cancer screening registry that contains screening information for cervical, breast, and colorectal cancer for all patients in Ontario enrolled to a medical home. 4 Physicians can access the cancer screening registry electronically, which provides them with lists of their patients who were eligible for screening.…”

Section: Problemmentioning

confidence: 99%

Measuring and improving cervical, breast, and colorectal cancer screening rates in a multi-site urban practice in Toronto, Canada

Feldman

Davie

Kiran

2017

BMJ Qual Improv Report

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Our Family Health Team is located in Toronto, Canada and provides care to over 35 000 patients. Like many practices in Canada, we took an opportunistic approach to cervical, breast, and colorectal cancer screening. We wanted to shift to a proactive, population-based approach but were unable to systematically identify patients overdue for screening or calculate baseline screening rates. Our initiative had two goals: (1) to develop a method for systematically identifying patients eligible for screening and whether they were overdue and (2) to increase screening rates for cervical, breast, and colorectal cancer. Using external government data in combination with our practice's electronic medical record, we developed a process to identify patients eligible and overdue for cancer screening. After generating baseline data, we implemented an evidence-based, multifaceted intervention to improve cancer screening rates. We sent a personalized reminder letter to overdue patients, provided physicians with practice-level audit and feedback, and improved our electronic reminder function by updating charts with accurate data on the Fecal Occult Blood Test (FOBT). Following our initial intervention, we sought to maintain and further improve our screening rates by experimenting with alternative recall methods and collecting patient feedback. Screening rates significantly improved for all three cancers. Between March 2014 and December 2016, the cervical cancer screening rate increased from 60% to 71% (p<0.05), the breast cancer screening rate increased from 56% to 65% (p<0.05), and the overall colorectal screening rate increased from 59% to 70% (p<0.05). The increase in colorectal screening rates was largely due to an increase in FOBT screening from 18% to 25%, while colonoscopy screening remained relatively unchanged, shifting from 45% to 46%. We also found that patients living in low income neighbourhoods were less likely to be screened. Following our intervention, this equity gap narrowed modestly for breast and colorectal cancer but did not change for cervical cancer screening. Our future improvement efforts will be focused on reducing the gap in screening between patients living in low-income and high-income neighbourhoods while maintaining overall gains.

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“…The profile of the 232 physicians with valid data in both fiscal years was comparable both to the remaining physicians and to the general profile of family physicians in Canada in terms of sex, year of graduation from medical school, and practice setting (urban or rural). 18 After acquiring and merging relevant data from both the enrolled family practices and the external databases, approval was received from the practices to create and mail the first and second reminder letters to women who were due or overdue for Pap tests (23 889 and 6740, respectively) and for mammograms (12 877 and 4280, respectively) in 2005 to 2006 (Table 1).…”

Section: Methodsmentioning

confidence: 99%

Effect of provider and patient reminders, deployment of nurse practitioners, and financial incentives oncervical and breast cancer screening rates

Kaczorowski¹,

Hearps²,

Lohfeld³

et al. 2021

Preprint

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Views of family physicians in southwestern Ontario on preventive care services and performance incentives

Cited by 14 publications

References 1 publication

Impact of remuneration and organizational factors on completing preventive manoeuvres in primary care practices

Impact of remuneration and organizational factors on completing preventive manoeuvres in primary care practices

Measuring and improving cervical, breast, and colorectal cancer screening rates in a multi-site urban practice in Toronto, Canada

Effect of provider and patient reminders, deployment of nurse practitioners, and financial incentives oncervical and breast cancer screening rates

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