ORIGINAL RESEARCH
Tara Kiran, MD, MSc; Mike Green, MD, MPH; Li Bai, MPH, PhD; Lidija Latifovic, MSc; Shahriar Khan, MSc, MA; Alex Kopp, BA; Eliot Frymire, MA, BEd; Richard H. Glazier, MD MPH
Corresponding Author: Tara Kiran, MD, MSc; Department of Family and Community Medicine - University of Toronto.Email: tara.kiran@utoronto.caDOI: 10.3122/jabfm.2022.220235R1Keywords: Canada, Continuity of Patient Care, Patient Care Team, Primary Health CareDates: Submitted: 07-07-2022; Revised: 10-03-2022; Accepted: 10-04-2022
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PURPOSE: Continuity is a core component of primary care and known to differ by patient characteristics. However, it is unclear how primary care physician payment and organization are associated with continuity.
METHODS: We analyzed administrative data from 7,110,036 individuals aged 16+, who were residents of Ontario, Canada on September 30, 2019, were enrolled to a physician and made at least 2 visits between October 1, 2017 and September 30, 2019. Continuity with physician and practice group was quantified using the Usual Provider of Care index. We used log-binomial regression to assess the relationship between enrolment model and continuity adjusting for patient characteristics.
RESULTS: Mean physician and group continuity were 67.3% and 73.8%, respectively, for patients enrolled in Enhanced fee-for-service, 70.7% and 76.2% for Non-team capitation and 70.6% and 78.7% for Team-based capitation. These differences were attenuated in regression models for both physician-level continuity (Non-team capitation RR 1.003, 95%CI 1.003-1.003, Team-based capitation RR 0.980, 95%CI 0.979-0.980 vs Enhanced fee-for-service) and group-level continuity (Non-team capitation RR 0.994, 95%CI 0.994-0.995, Team-based capitation RR 1.003, 95%CI 1.002-1.003 vs Enhanced fee-for-service). Older age was the most notable factor associated with continuity. Compared to those age 16 to 34, those 80 and older had 1.45 times higher continuity with their physician (57.0% vs 79.6%, RR: 1.447, 95%CI 1.446 – 1.448).
CONCLUSION: Our results suggest that continuity does not differ substantially by physician payment or organizational model among primary care patients who are formally enrolled with a physician in a setting with universal health insurance.