Exploration of primary care models and timely access to care in New Brunswick (Canada).


Journal

BMC primary care
ISSN: 2731-4553
Titre abrégé: BMC Prim Care
Pays: England
ID NLM: 9918300889006676

Informations de publication

Date de publication:
14 Oct 2024
Historique:
received: 03 06 2023
accepted: 03 10 2024
medline: 15 10 2024
pubmed: 15 10 2024
entrez: 14 10 2024
Statut: epublish

Résumé

This correlative study aimed to examine how the different primary care models (physicians in solo practice, physicians in collaborative practice, physicians and nurse practitioners in collaborative practice, after-hours clinics, community centers, or emergency rooms) were associated with their capability to offer timely access to their patients. The data collected from the primary care provider's perspective was to complete the New Brunswick Health Council results on patients' perspective. A convenience sample of 120 primary care providers (33 physicians in solo practice, 33 physicians in collaborative practice, 27 providers in collaborative practice with nurse practitioners, 2 providers working in after-hours clinics, and 10 providers in Emergency departments) responded to an online survey about their primary care models and accessibility. We used the Statistical Package for Social Sciences software to run correlations, independent t-tests and Fisher's exact tests to compare timely access to care between variable groups. A positive correlation was observed between patient load (or the number of patients under a primary care provider's practice), age and years of experience. However, the patient load did not translate to more timely access to care. However, a statistically significant difference (p = 0.032) was observed when primary care providers kept appointment slots available for daily urgent requests. When a primary care provider booked all available appointment slots, only 85% of them could offer timely appointments (in 5 days or less), compared to 97% who could deliver it when appointment slots were left open in their daily schedule. The primary care model (solo vs. collaboration), the use of health technologies and the type of provider did not significantly influence timely access to care. In contrast, the primary care providers who reported teleworking (or working remotely) were less likely to offer timely access to care. Timely access to care is not always available to patients, even those with a primary care provider. Certain organizational practices may improve access to care and should be integrated into primary care in New Brunswick and elsewhere in Canada.

Sections du résumé

BACKGROUND BACKGROUND
This correlative study aimed to examine how the different primary care models (physicians in solo practice, physicians in collaborative practice, physicians and nurse practitioners in collaborative practice, after-hours clinics, community centers, or emergency rooms) were associated with their capability to offer timely access to their patients. The data collected from the primary care provider's perspective was to complete the New Brunswick Health Council results on patients' perspective.
METHODS METHODS
A convenience sample of 120 primary care providers (33 physicians in solo practice, 33 physicians in collaborative practice, 27 providers in collaborative practice with nurse practitioners, 2 providers working in after-hours clinics, and 10 providers in Emergency departments) responded to an online survey about their primary care models and accessibility. We used the Statistical Package for Social Sciences software to run correlations, independent t-tests and Fisher's exact tests to compare timely access to care between variable groups.
RESULTS RESULTS
A positive correlation was observed between patient load (or the number of patients under a primary care provider's practice), age and years of experience. However, the patient load did not translate to more timely access to care. However, a statistically significant difference (p = 0.032) was observed when primary care providers kept appointment slots available for daily urgent requests. When a primary care provider booked all available appointment slots, only 85% of them could offer timely appointments (in 5 days or less), compared to 97% who could deliver it when appointment slots were left open in their daily schedule. The primary care model (solo vs. collaboration), the use of health technologies and the type of provider did not significantly influence timely access to care. In contrast, the primary care providers who reported teleworking (or working remotely) were less likely to offer timely access to care.
CONCLUSION CONCLUSIONS
Timely access to care is not always available to patients, even those with a primary care provider. Certain organizational practices may improve access to care and should be integrated into primary care in New Brunswick and elsewhere in Canada.

Identifiants

pubmed: 39402440
doi: 10.1186/s12875-024-02618-8
pii: 10.1186/s12875-024-02618-8
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

366

Informations de copyright

© 2024. The Author(s).

Références

New Brunswick Health Council (NBHC). In. Search of a better access to primary care services in New Brunswick. New Brunswick: Moncton; 2021.
Peckham A, Ho J, Marchildon G. Innovations en matière de politiques sur les soins primaires Au Canada. Toronto, Ontario: la Fondation canadienne pour l’amélioration des services de santé; 2018.
Duong D, Vogel L. National survey highlights worsening primary care access. Can Med Assoc J. 2023;195(16):E592–3.
doi: 10.1503/cmaj.1096049
Haggerty J, Pineault R, Beaulieu M-D, Goulet F, Rodrigue J, Gauthier J, et al. Continuité et accessibilité des soins de première ligne Au Québec: Barrières et facteurs facilitants: Rapport final. Fondation canadienne de la recherche sur les services de santé; 2004.
Manuel V, Bien-Aimé I, Boutot É, Dupuis JB, Johnson C. Timely access to primary care in New Brunswick: variability across health regions. Can Family Physician Medecin De Famille Canadien. 2023;69(3):e61–5.
doi: 10.46747/cfp.6903e61
Shahaed H, Glazier RH, Anderson M, Barbazza E, Bos VLLC, Saunes IS, et al. Primary care for all: lessons for Canada from peer countries with high primary care attachment. Can Med Assoc J. 2023;195(47):E1628–36.
doi: 10.1503/cmaj.221824
Anderson M, O’Neill C, Macleod Clark J, Street A, Woods M, Johnston-Webber C, et al. Securing a sustainable and fit-for-purpose UK health and care workforce. Lancet. 2021;397(10288):1992–2011.
doi: 10.1016/S0140-6736(21)00231-2 pubmed: 33965066 pmcid: 9634455
Charleson JS, Teal SM, Seebeck JMS, Kameguchi K, Thoburn JW. A review of Collaborative Healthcare Worldwide. Japanese J Family Psychol. 2020;34(1):1–14.
Lautamatti E, Sumanen M, Raivio R, Mattila KJ. Continuity of care is associated with satisfaction with local health care services. BMC Fam Pract. 2020;21(1):181.
doi: 10.1186/s12875-020-01251-5 pubmed: 32887566 pmcid: 7487808
Smits M, Rutten MH, Keizer E, Wensing M, Westert GP, Giesen PHJ. The development and performance of after-hours primary care in the Netherlands: a narrative review. Ann Intern Med. 2017;166(10):737–42.
doi: 10.7326/M16-2776 pubmed: 28418455
Saunes Ingrid Sperre. International health care system profiles: Norway New York: The Commonwealth Fund. 2020 https://www.commonwealthfund.org/international-health-policy-center/countries/norway
Campbell SM, Kontopantelis E, Reeves D, Valderas JM, Gaehl E, Small N, et al. Changes in patient experiences of primary care during health service reforms in England between 2003 and 2007. Ann Fam Med. 2010;8(6):499–506.
doi: 10.1370/afm.1145 pubmed: 21060119 pmcid: 2975684
Johnson C, Bourgoin D, Dupuis JB, Félix JM, LeBlanc V, McLennan D et al. Exploration of how primary care models influence job satisfaction among primary care providers during the COVID-19 pandemic in New Brunswick: a descriptive and comparative study. BMC Health Serv Res. 2023;23(223).
Rahman B, Costa AP, Gayowsky A, Rahim A, Kiran T, Ivers N, et al. The association between patients’ timely access to their usual primary care physician and use of walk-in clinics in Ontario, Canada: a cross-sectional study. CMAJ Open. 2023;11(5):E847–58.
doi: 10.9778/cmajo.20220231 pubmed: 37751920 pmcid: 10521921
New Brunswick Health Council (NBHC). Access to primary health care in New Brunswick: still a challenge. New Brunswick: Moncton; 2021.
Statistics Canada. Tables 17-10-0005-01 Population estimates on July 1st, by age and sex. 2021.
New Brunswick Health Council. NBHC, Communities Moncton. New Brunswick 2023 https://nbhc.ca/data/browse/nbhc-communities
Marshall EG, Wuite S, Lawson B, Andrew MK, Edwards L, MacKenzie A et al. What Do You Mean I Can’t Have a Doctor? This is Canada! – A qualitative study of the myriad consequences for unattached patients awaiting primary care attachment. Can Fam Physician. 2021;67(5).
New Brunswick Health Council (NBHC). Health system grades Moncton, New BrunswickN.D. https://nbhc.ca/health-system-report-card
Buchman S, Woollard R, Meili R, Goel R. Pratiquer La responsabilité Sociale: De La théorie à L’action. Can Family Physician • Le Médecin De Famille Canadien. 2016;62(1):24–7.
Institut canadien d’information sur la santé (ICIS). Les médecins au Canada, 2019. Ottawa, ON. 2020. Report No.: 978-1-77109-970-7.
New Brunswick Nurses Association. Nurse Practitioner Fredericton, New BrunswickN.D. https://www.nanb.nb.ca/nurse-practitioner-pp/
College of Physicians and Surgeons of New Brunswick. Find a physician Rothsay, New BrunswickN.D. https://cpsnb.alinityapp.com/Client/PublicDirectory
New Brunswick Medical Society. Walk-in Clinic Locations Fredericton, New Brunswick 2022 https://www.nbms.nb.ca/walk-in-clinics/
The New Brunswick Health Council. Primary Health & Primary Care Surveys Moncton, New Brunswick2023 https://nbhc.ca/surveys/primary-health-primary-care-surveys
IBM Corp. SPSS statistics for Windows. 28.0. Ed. Armonk, New York: IBM Corp; Released; 2021.
Fournier J, Heale R, Rietze L. « I can’t wait »: Advanced Access Decreases Wait Times in Primary Health. Healthc Q. 2012;15(1):64–8.
doi: 10.12927/hcq.2012.22763 pubmed: 22354058
Agency for Healthcare Research and Quality. Strategy 6A: Open access scheduling for routine and urgent appointments 2017 https://www.ahrq.gov/sites/default/files/wysiwyg/cahps/quality-improvement/improvement-guide/6-strategies-for-improving/access/cahps-section-6a.pdf
Barry DW, Melhado TV, Chacko KM, Lee RS-M, Steiner JF, Kutner JS. Patient and physician perceptions of Timely Access to Care. J Gen Intern Med. 2006;21(1):130–3.
doi: 10.1007/s11606-006-0246-1 pubmed: 16336617 pmcid: 1484658
Le collège des médecins de famille du Canada. Conseil pratique- Accès en temps opportun aux soins dans les cabinets ou cliniques de médecin familiale. 2012.
Murray M, Berwick DM. Advanced access: reducing waiting and delays in primary care. JAMA Intern Med. 2003;289(8):1035–40.
Sartini M, Carbone A, Demartini A, Giribone L, Oliva M, Spagnolo AM et al. Overcrowding in Emergency Department: causes, consequences, and Solutions-A narrative review. Healthc (Basel). 2022;10(9).
New Brunswick Health Council. The Cost of Chronic Health Conditions to New Brunswick Moncton, New Brunswick 2016 https://nbhc.ca/news/cost-chronic-health-conditions-new-brunswick
Muldoon L, Dahrouge S, Russell G, Hogg W, Ward N. How many patients should a family physician have? Factors to consider in answering a deceptively simple question. Healthc Policy. 2012;7(4):26–34.
pubmed: 23634160 pmcid: 3359082
New Brunswick Health Council (NBHC). Being patient - accessibility, primary health and emergency rooms. New Brunswick: Moncton; 2017.
Watson DE, Reid RJ, Roos N, Hepper P. Growing Old together: the influence of Population and Workforce Aging on Supply and Use of Family Physicians. J Aging / La Revue Canadienne Du Vieillissement. 2005;24(S1):37–45.
doi: 10.1353/cja.2005.0058
Province of New Brunswick. We are all in this together: an aging strategy for New Brunswick. New Brunswick: Fredericton; 2017.
Bourgueil Y, Marek A, Mousquès J. La Pratique collective en soins primaires dans six pays européens, en Ontario Et Au Québec: État Des Lieux et perspectives dans le contexte français. Sante Publique. 2009;21(hs1):27–38.
doi: 10.3917/spub.090.0027 pubmed: 20441649
Chevillard G, Mousquès J. Les maisons de santé attirent-elles les jeunes médecins généralistes dans les zones sous-dotées en offre de soins ? Volume 247. Questions d’économie de la santé Irdes; 2020.
Ashcroft R. Ontario’s Family Health teams: Politics within the Model. Can Social Work Rev / Revue Canadienne De Service Social. 2015;32(1–2):117–32.
doi: 10.7202/1034146ar
Beaulieu M-D, Denis J-L, D’amour D, Goudreau J, Haggerty J, Hudon É, et al. L’implantation Des Groupes De médecine de famille: Le défi de la réorganisation de la pratique et de la collaboration interprofessionnelle : étude de cas dans cinq GMF de la première vague Au Québec. Montréal, Québec: Université de Montréal; 2006.
Breton M, Levesque JF, Pineault R, Hogg W. L’implantation Du modèle des groupes de médecine de famille Au Québec: Potentiel et limites pour l’accroissement de la performance des soins de santé primaires. Pratiques et Organisation des Soins. 2011;42(2):101–9.
doi: 10.3917/pos.422.0101
Family Medicine New Brunswick. Family Medicine New Brunswick Fredericton, New Brunswick 2021 https://www.fmnb.ca/for-physicians/
Martin BH, MacDonnell R. Is telework effective for organizations? A meta-analysis of empirical research on perceptions of telework and organizational outcomes. Manage Res Rev. 2012;35(7):602–16.
doi: 10.1108/01409171211238820
Filip A, Stancu A, Mehedințu M, Streinu-Cercel A, Pauceanu AM. Particularities of Telework Applicable to the Health System in the context of the COVID-19 pandemic. Int J Environ Res Public Health. 2022;19(17).
Hayes B. Working from home in medicine during coronavirus: what equipment do you need to get started and what can you do to help from home? Future Healthc J. 2020;7(2):163–4.
doi: 10.7861/fhj.2020-0025 pubmed: 32550285 pmcid: 7296585
Johnson C, Dupuis JB, Goguen P, Grenier G. Changes to telehealth practices in primary care in New Brunswick (Canada): a comparative study pre and during the COVID-19 pandemic. PLoS ONE. 2021;16(11):e0258839.
doi: 10.1371/journal.pone.0258839 pubmed: 34813618 pmcid: 8610241
Gohoungodji P, N’Dri AB, Matos ALB. What makes telework work? Evidence of success factors across two decades of empirical research: a systematic and critical review. Int J Hum Resource Manage. 2023;34(3):605–49.
doi: 10.1080/09585192.2022.2112259
Mehdi T, Morissette R. Working from home: Productivity and preferences. Statistics Canada; 2021 April. p. 1.
O’Cathail M, Sivanandan MA, Diver C, Patel P, Christian J. The Use of patient-facing teleconsultations in the National Health Service: scoping review. JMIR Med Inf. 2020;8(3):e15380.
doi: 10.2196/15380
Graves M, Doucet S, Dubé A, Johnson M. Health professionals’ and patients’ perceived barriers and facilitators to collaborating when communicating through the use of information and communication technologies. J Interprofessional Educ Pract. 2018;10:85–91.
doi: 10.1016/j.xjep.2017.03.002
Knop M, Mueller M, Niehaves B. Investigating the Use of Telemedicine for digitally mediated delegation in Team-based primary care: mixed methods study. J Med Internet Res. 2021;23(8).
Mohammed HT, Hyseni L, Bui V, Gerritsen B, Fuller K, Sung J et al. Exploring the use and challenges of implementing virtual visits during COVID-19 in primary care and lessons for sustained use. PLoS ONE. 2021;16(6).

Auteurs

Claire Johnson (C)

School of Public Policy, Université de Moncton, Moncton, New Brunswick, E1A 3E9, Canada. Claire.Johnson@umoncton.ca.

Dominique Bourgoin (D)

School of Public Policy, Université de Moncton, Moncton, New Brunswick, E1A 3E9, Canada.

Jérémie B Dupuis (JB)

Office of the Vice-President Academic and Research , Université de Moncton, Moncton, New Brunswick, Canada.

Jenny Manuèle Félix (JM)

School of Public Policy, Université de Moncton, Moncton, New Brunswick, E1A 3E9, Canada.

Véronique LeBlanc (V)

School of Public Policy, Université de Moncton, Moncton, New Brunswick, E1A 3E9, Canada.

Danielle McLennan (D)

School of Public Policy, Université de Moncton, Moncton, New Brunswick, E1A 3E9, Canada.

Luveberthe St-Louis (L)

School of Public Policy, Université de Moncton, Moncton, New Brunswick, E1A 3E9, Canada.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female
Humans United States Aged Cross-Sectional Studies Medicare Part C
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH