The Impact of Provider Characteristics on Selected Primary Health Care Indicators Open Access
- Other title
Primary Health Care
- Type of item
- Degree grantor
University of Alberta
- Author or creator
- Supervisor and department
Devidas Menon (School of Public Health)
- Examining committee member and department
Irina Dinu (School of Public Health)
Allan Casson (School of Public Health)
Department of Public Health Sciences
Health Policy Research
- Date accepted
- Graduation date
Master of Science
- Degree level
While the physician population in Canada is growing at a higher rate that the overall population, there has been a noticeable decline in the comprehensiveness of primary health care services provided by general practitioners/family physicians. This study aims to assess the impacts of physician characteristics such as physician age, gender and location (rural or urban practice) on selected primary health care indicators including whether or not physicians deliver babies, make home visits or are accepting new patients. There were a total of 42 discrete studies included; they addressed the impact of physician age, gender and location of practice on the provision of home visits, obstetrical care and access. The literature suggests that older physicians, male physicians and rural physicians are more likely to provide home visits, that younger physicians, female physicians and rural physicians are more likely to provide obstetrical care and based on the limited research to date, that younger physicians, male physicians and rural physicians are more likely to be accepting new patients.
Statistical analysis was also performed on available data to verify findings from the literature review on the Alberta physician population. Information on physician characteristics was obtained through the College of Physicians and Surgeons of Alberta and Ministry of Health. A quantitative approach was taken to analyze the physician data. Univariate and multivariate analyses were performed using multiple logistic regression. The statistical analysis found that in Alberta, although location and decades in practice are both significant predictors of whether or not physicians provide home visits, gender was not statistically significant when all other variables were controlled for. This is likely because of the relationship between gender and age, considering that older physicians were more likely to be male. This study has also confirmed that age, gender and location were all significant predictors of whether physicians delivered babies. Importantly physicians involved in Primary Care Networks (PCNs) were 3.6 times more likely to deliver babies than their non-PCN colleagues, even with all other variables adjusted for. Lastly, this study has found that gender and location were significant predictors of whether or not physicians were accepting new patients, but that with all other variables considered, decades in practice was no longer statistically significant. Again PCN physicians were 1.6 times more likely to be accepting new patients then their colleagues. The relationship between gender and age may be the reason previous studies have concluded that older physicians were more likely to be accepting new patients. As female physicians are on average younger, and female physicians are less likely to be accepting new patients, gender was acting as an effect modifier on the relationship between age and the likelihood of a physician to be accepting new patients. The most important finding of this study is that compared to non-PCN physicians, PCN physicians are 3.9 times more likely to make home visits, 3.6 times more likely to deliver babies and 1.6 times more likely to be accepting new patients. Because physicians who provide a full scope of practice may be more likely to join a PCN, this study cannot assert a causal relationship between the outcomes and explanatory variables. That being said, there may be an incentive for PCN physicians to accept new patients, due to the per capita funding they receive. That funding may also allow physicians the flexibility to provide a full scope of practice, by utilizing other health care professional in the management of patient care. Furthermore, the values and goals of the PCN are designed to promote the coordination of comprehensive primary health care. The evidence presented in this paper may support a conclusion that the PCNs in Alberta have been successful.
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