Changes in comprehensiveness of services delivered by Canadian family physicians: Analysis of population-based linked data in 4 provinces

M Ruth Lavergne; David Rudoler; Sandra Peterson; David Stock; Carole Taylor; Andrew S Wilton; Sabrina T Wong; Ian Scott; Kimberlyn M McGrail; Rita K McCracken; Emily Gard Marshall; Adrian MacKenzie; Alan Katz; Margaret Jamieson; Lindsay Hedden; Agnes Grudniewicz; Laurie J Goldsmith; Richard H Glazier; Fred Burge; Doug Blackie

doi:10.46747/cfp.6908550

Changes in comprehensiveness of services delivered by Canadian family physicians: Analysis of population-based linked data in 4 provinces

Can Fam Physician. 2023 Aug;69(8):550-556. doi: 10.46747/cfp.6908550.

Authors

M Ruth Lavergne¹, David Rudoler², Sandra Peterson³, David Stock⁴, Carole Taylor⁵, Andrew S Wilton⁶, Sabrina T Wong⁷, Ian Scott⁸, Kimberlyn M McGrail⁹, Rita K McCracken¹⁰, Emily Gard Marshall¹¹, Adrian MacKenzie¹², Alan Katz¹³, Margaret Jamieson¹⁴, Lindsay Hedden¹⁵, Agnes Grudniewicz¹⁶, Laurie J Goldsmith¹⁷, Richard H Glazier¹⁸, Fred Burge¹⁹, Doug Blackie²⁰

Affiliations

¹ Associate Professor in the Department of Family Medicine at Dalhousie University in Halifax, NS, and holds a Tier II Canada Research Chair in Primary Care. ruth.lavergne@dal.ca.
² Assistant Professor in the Faculty of Health Sciences at Ontario Tech University in Oshawa and Research Chair at the Ontario Shores Centre for Mental Health Sciences in Whitby.
³ Research analyst in the Centre for Health Services and Policy Research at the University of British Columbia in Vancouver.
⁴ Senior health services researcher in the Department of Family Medicine at Dalhousie University.
⁵ Data analyst in the Manitoba Centre for Health Policy at the University of Manitoba in Winnipeg.
⁶ Senior research analyst with ICES in Toronto, Ont.
⁷ Senior investigator with the Division of Intramural Research of the National Institute of Nursing Research.
⁸ Associate Professor in the Department of Family Practice and Director of the Centre for Health Education Scholarship at the University of British Columbia.
⁹ Professor in the Centre for Health Services and Policy Research at the University of British Columbia.
¹⁰ Assistant Professor in the Department of Family Practice at the University of British Columbia.
¹¹ Professor in the Department of Family Medicine and the Primary Care Research Unit at Dalhousie University and with the Nova Scotia Health Authority.
¹² Project executive for Health Workforce Planning with the Nova Scotia Department of Health and Wellness, co-Investigator with the WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, Adjunct Faculty in the Department of Community Health and Epidemiology at Dalhousie University, and an affiliate scientist with Nova Scotia Health.
¹³ Professor in the Department of Family Medicine and the Department of Community Health Sciences at the University of Manitoba.
¹⁴ Doctoral candidate in the Institute of Health Policy Management and Evaluation at the University of Toronto.
¹⁵ Assistant Professor in the Faculty of Health Sciences at Simon Fraser University in Burnaby, BC.
¹⁶ Associate Professor in the Telfer School of Management at the University of Ottawa.
¹⁷ Adjunct Professor in the Faculty of Health Sciences at Simon Fraser and the founder and Principal of GoldQual Consulting.
¹⁸ Senior core scientist with ICES, a Professor of Family and Community Medicine at the University of Toronto, and a family physician and scientist at St Michael's Hospital.
¹⁹ Professor and a faculty researcher in the Department of Family Medicine at Dalhousie University.
²⁰ Associate Faculty member at the School of Leadership Studies, Royal Roads University, Victoria, BC and a certified health care consultant.

Abstract
in English, French

Objective: To describe changes in the comprehensiveness of services delivered by family physicians across service settings and service areas in 4 Canadian provinces, to identify which settings and areas have changed the most, and to compare the magnitude of changes by physician characteristics.

Design: Descriptive analysis of province-wide, population-based billing data linked to population and physician registries.

Setting: British Columbia, Manitoba, Ontario, and Nova Scotia.

Participants: Family physicians registered to practise in the 1999-2000 and 2017-2018 fiscal years.

Main outcome measures: Comprehensiveness was measured across 7 service settings (home care, long-term care, emergency departments, hospitals, obstetric care, surgical assistance, anesthesiology) and in 7 service areas consistent with office-based practice (prenatal and postnatal care, Papanicolaou testing, mental health, substance use, cancer care, minor surgery, palliative home visits). The proportion of physicians with activity in each setting and area are reported and the average number of service settings and areas by physician characteristics is described (years in practice, sex, urban or rural practice setting, and location of medical degree training).

Results: Declines in comprehensiveness were observed across all provinces studied. Declines were greater for comprehensiveness of settings than for areas consistent with office-based practice. Changes were observed across all physician characteristics. On average across provinces, declines in the number of service settings and service areas were highest among physicians in practice 20 years or longer, male physicians, and physicians practising in urban areas.

Conclusion: Declining comprehensiveness was observed across all physician characteristics, pointing to changes in the practice and policy contexts in which all family physicians work.

Objectif: Décrire les changements dans la globalité des services prodigués par les médecins de famille dans les divers milieux et domaines de services dans 4 provinces canadiennes, cerner les environnements et les régions qui ont le plus changé, et comparer l’ampleur des changements selon les caractéristiques des médecins.

Type d’étude: Une analyse descriptive des données de facturation basées sur la population à l’échelle de la province, reliées aux données des registres sur la population et les médecins.

Contexte: La Colombie-Britannique, le Manitoba, l’Ontario et la Nouvelle-Écosse.

Participants: Les médecins de famille détenteurs d’un permis d’exercice durant les exercices financiers 1999-2000 et 2017-2018.

Principaux paramètres à l’étude: La globalité était mesurée dans 7 milieux de services (soins à domicile, soins de longue durée, départements d’urgence, hôpitaux, soins obstétricaux, assistance chirurgicale, anesthésiologie) et dans 7 domaines de services conformes à l’exercice en clinique (soins prénataux et postnataux, test de Papanicolaou, santé mentale, toxicomanie, soins pour le cancer, chirurgie mineure, visites à domicile en soins palliatifs). La proportion de médecins actifs dans chaque environnement et domaine est rapportée, et le nombre moyen de milieux et de domaines de services selon les caractéristiques des médecins est mentionné (années de pratique, sexe, milieu de pratique rural ou urbain et lieu de la formation en médecine).

Résultats: Des déclins dans la globalité ont été observés dans toutes les provinces à l’étude. Les plus grands changements étaient les déclins dans la globalité des milieux, et de plus petits changements étaient dans des domaines conformes à l’exercice en clinique. Des changements ont été observés, quelles que soient les caractéristiques des médecins. En moyenne, dans ces provinces, les diminutions dans le nombre de milieux de services et de domaines de services étaient les plus élevées chez les médecins exerçant depuis 20 ans ou plus, de sexe masculin et en milieu urbain.

Conclusion: Un déclin dans la globalité a été observé chez les médecins, quelles que soient leurs caractéristiques, ce qui pointe vers des changements dans les contextes de la pratique et des politiques dans lesquels tous les médecins de famille travaillent.

MeSH terms

British Columbia / epidemiology
Humans
Male
Nova Scotia / epidemiology
Ontario / epidemiology
Physicians, Family*
Semantic Web*

Abstract in English, French

MeSH terms

Abstract
in English, French