Effect of primary health care reforms in the province of Newfoundland and Labrador: Interrupted time-series analysis.
Journal
Canadian family physician Medecin de famille canadien
ISSN: 1715-5258
Titre abrégé: Can Fam Physician
Pays: Canada
ID NLM: 0120300
Informations de publication
Date de publication:
07 2019
07 2019
Historique:
entrez:
14
7
2019
pubmed:
14
7
2019
medline:
23
9
2020
Statut:
ppublish
Résumé
To examine the effects of primary health care (PHC) reforms in the Canadian province of Newfoundland and Labrador on ambulatory care-sensitive (ACS) hospitalization rates and mortality. Interrupted time-series analysis of administrative data. All communities in the province of Newfoundland and Labrador were divided into 3 groups: rural reform (n = 69 143), rural nonreform (n = 228 914), and urban nonreform (n = 197 012). No urban communities introduced PHC reforms. All residents of the province who held a valid health card and did not change their address during the 2001-2009 study period were included. Individuals were assigned to 1 of the 3 study groups based on community of residence. Hospitalization rates for ACS conditions, hospitalization rates for control conditions, and ACS-related mortality were compared using interrupted time-series models. Results are reported as rate ratio or odds ratio (OR) (95% CI). In rural reform and rural nonreform communities, there was a decreasing trend in ACS hospitalization rates that preceded reforms (rate ratio of 0.97 [0.94-1.00]) and rate ratio of 0.98 [0.96-1.00], respectively) but no change following reforms. There were no significant changes in the urban group. In all 3 groups, there was a significant increasing trend in ACS-related mortality before reforms (OR of 1.09 [1.02-1.15], OR of 1.10 [1.06-1.13], and OR of 1.09 [1.05-1.14] for rural reform, rural nonreform, and urban communities, respectively), which was reversed after the introduction of reforms ( Primary health care reforms in Newfoundland and Labrador had no observed effect on ACS hospitalization rates, but a potential effect might have been masked by a decreasing trend that preceded the introduction of reforms. The increase in mortality rates that was reversed after the introduction of reforms cannot be attributed to the reforms because it occurred in all studied populations including those that did not introduce reforms.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e296-e304Informations de copyright
Copyright© the College of Family Physicians of Canada.
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