Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada.
Soc Sci Med. 2012 Nov;75(10):1811-9. doi: 10.1016/j.socscimed.2012.07.028. Epub 2012 Aug 4.
One of the core primary care reform initiatives seen across provinces in Canada is the introduction of inter-professional primary healthcare teams in which family physicians are encouraged to collaborate with other health professionals. Although a higher proportion of physicians are collaborating with various health professionals now compared to the previous decade, a substantial number of physicians still do not work in a collaborative setting. The objective of this paper is to examine the age, period and cohort effects of Canadian family physicians' decisions to collaborate with seven types of health professionals: specialists, nurse practitioners, nurses, dieticians, physiotherapists, psychologists and occupational therapists. To this end, this paper employs a multivariate probit model consisting of seven equations and a cross-classified fixed-effects strategy to explain the collaborative decisions of family physicians. Utilizing three cross-sectional physician surveys from Canada over the 2001-2007 period, cohorts are defined over five-year intervals according to their year of graduation from medical school. We find that newer cohorts of physicians are more likely to collaborate with dieticians, physiotherapists, psychologists and occupational therapists; newer female cohorts are more likely to collaborate with nurses while newer male cohorts are less likely to collaborate with nurses but more likely to collaborate with specialists. Older physicians are more likely to collaborate with specialists, physiotherapists, psychologists, and occupational therapists; the age effect for nurses is U-shaped for male physicians while it is inverse U-shaped for females. Family physicians are collaborating more with all seven health professionals in 2004 and 2007 compared to 2001. Belonging to a group practice has a largely positive influence on collaborations; and being paid by a fee-for-service remuneration scheme exerts a negative influence on collaboration, ceteris paribus. The findings suggest that combining a non-fee-for-service remuneration arrangement with a group practice structure would facilitate effective collaboration.
加拿大各省推行的核心初级保健改革举措之一是引入跨专业初级保健团队，鼓励家庭医生与其他卫生专业人员合作。尽管与前十年相比，现在有更多的医生与各种卫生专业人员合作，但仍有相当数量的医生不在合作环境中工作。本文的目的是研究加拿大家庭医生与七种卫生专业人员（专家、执业护士、护士、营养师、物理治疗师、心理学家和职业治疗师）合作的决定的年龄、时期和队列效应。为此，本文采用了一个由七个方程组成的多元概率比模型和交叉分类固定效应策略，以解释家庭医生的合作决策。本文利用加拿大 2001-2007 年期间进行的三次横断面医生调查，根据他们从医学院毕业的年份将队列定义为五年期。我们发现，较新的医生队列更有可能与营养师、物理治疗师、心理学家和职业治疗师合作；较新的女性队列更有可能与护士合作，而较新的男性队列则不太可能与护士合作，但更有可能与专家合作。年长的医生更有可能与专家、物理治疗师、心理学家和职业治疗师合作；对于男性医生，护士的年龄效应呈 U 形，而对于女性则呈倒 U 形。与 2001 年相比，2004 年和 2007 年家庭医生与所有七种卫生专业人员的合作更多。加入小组实践对合作有很大的积极影响；在其他条件相同的情况下，按按服务收费薪酬计划支付薪酬会对合作产生负面影响。研究结果表明，将非按服务收费薪酬安排与小组实践结构相结合，将有助于实现有效的合作。
