A Cross-sectional Study of Community-level Physician Retention and Diabetes Management in Rural Ontario

Abstract

Objective: Our aim in this study was to determine the impact of community-level physician retention on the quality of diabetes care in rural Ontario.

Methods: Using administrative data, we compared diabetes quality of care. We defined retention as the proportion of physicians in a community from one year to the next. We grouped retention level by tertile and added a category for those communities with no physician.

Results: Residents of high-retention communities were more likely to have had glycated hemoglobin (odds ratio [OR], 1.10; 95% confidence interval [CI], 1.06 to 1.14) and low-density lipoprotein (OR, 1.17; 95% CI, 1.13 to 1.22) testing, but less likely to have had testing for urine albumin-to-creatine ratio (OR, 0.86; 95% CI, 0.83 to 0.89) or to have received an angiotensin-converting enzyme inhibitor or angiotensin-2 receptor blocker (OR, 0.91; 95% CI, 0.86 to 0.95) or a statin (OR, 0.91; 95% CI, 0.87 to 0.96), when compared with low-retention communities. Communities with no residing physician had care that was equivalent to or better than that in high-retention communities.

Conclusions: Community-level physician retention, based on a 2-year time frame, was significantly related to quality of diabetes care. A closer look at models of care in communities with no residing physician is warranted. Community-level physician retention can be used to assess the impact of physician shortages on diabetes management in rural communities.

Keywords: cross-sectional study; diabetes care; données sur l’effectif; family physician; maintien en poste des médecins; médecin de famille; physician retention; rural; soins du diabète; workforce data; étude transversale.