Identification of physicians providing comprehensive primary care in Ontario: a retrospective analysis using linked administrative data.
Identification of physicians providing comprehensive primary care in Ontario: a retrospective analysis using linked administrative data.
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DOI：
10.9778/cmajo.20170083
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发表时间：
2017-12-19
期刊：
影响因子：
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通讯作者：
Glazier, Richard H
中科院分区：
文献类型：
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作者：
Schultz, Susan E;Glazier, Richard H
背景：鉴于初级保健格局的变化，可以为所有年龄组和健康状况的患者提供广泛服务的初级保健医生可能会减少。我们试图使用管理数据来确定在安大略省拥有全面初级保健实践的医生，调查提供全面初级保健的医生的数量和比例，以及这种情况随着时间的推移是如何变化的。方法：我们在基于人口的数据库链接的安大略省从1992/93到2014/15确定了活跃的初级保健医生池。在排除了那些每年看病人少于44天的人后，我们确定了如果他们的服务超过一半是核心初级保健，并且如果这些服务至少属于22个活动领域中的7个，就是提供综合保健的医生。结果：2014/15年度，共有12名 891名医生在初级保健池中工作：1254名(9.7%)年工作时间少于44天，1619名(12.6%)集中执业，1009名(7.8%)无法归类。从1992/93年度到2014/15年度，综合执业的比例从67.5%到74.9%不等，2002/03年度达到峰值，2009/10到2014/15年度相对稳定。在此期间，每个综合初级保健医生的人口增加了8.8%。干预：我们发现，2014/15年度略高于三分之二的初级保健医生提供全面保健，这表明传统的初级保健医生队伍估计可能过高。尽管实施情况因环境和可用数据而异，但这种方法很可能适用于其他地方。
BACKGROUND: Given the changing landscape of primary care, there may be fewer primary care physicians available to provide a broad range of services to patients of all age groups and health conditions. We sought to identify physicians with comprehensive primary care practices in Ontario using administrative data, investigating how many and what proportion of primary care physicians provided comprehensive primary care and how this changed over time.METHODS: We identified the pool of active primary care physicians in linked population-based databases for Ontario from 1992/93 to 2014/15. After excluding those who saw patients fewer than 44 days per year, we identified physicians as providing comprehensive care if more than half of their services were for core primary care and if these services fell into at least 7 of 22 activity areas. Physicians with 50% or less of their services for core primary care but with more than 50% in a single location or type of service were identified as being in focused practice.RESULTS: In 2014/15, there were 12 891 physicians in the primary care pool: 1254 (9.7%) worked fewer than 44 days per year, 1619 (12.6%) were in focused practice, and 1009 (7.8%) could not be classified. The proportion in comprehensive practice ranged from 67.5% to 74.9% between 1992/93 and 2014/15, with a peak in 2002/03 and relative stability from 2009/10 to 2014/15. Over this period, there was an increase of 8.8% in population per comprehensive primary care physician.INTERPRETATION: We found that just over two-thirds of primary care physicians provided comprehensive care in 2014/15, which indicates that traditional estimates of the primary care physician workforce may be too high. Although implementation will vary by setting and available data, this approach is likely applicable elsewhere.