The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
Department of Pediatrics, University of Toronto, Toronto, Canada.
BMC Fam Pract. 2019 Mar 5;20(1):42. doi: 10.1186/s12875-019-0927-6.
The general health check, which includes the periodic health visit and annual physical exam, is not recommended to maintain the health of asymptomatic adults with no risk factors. Different funding mechanisms for primary care may be associated with the provision of service delivery according to recommended guidelines. We sought to determine how use of the periodic health visit for healthy individuals without comorbidities, despite evidence against its use, differed by primary care model.
Population-based cross-sectional study using linked health and administrative datasets in Ontario, Canada, where most residents are insured for physician services through Ontario's single payer, provincially funded Ontario Health Insurance Plan. Participants included all living adults (> 19 years) in Ontario on January 1st, 2014, eligible for the Ontario Health Insurance Plan. Primary care enrollment model was the main exposure and included traditional fee-for-service, enhanced fee-for-service, capitation, team-based care, other (including salaried), and unenrolled. The main outcome measure was receipt of a periodic health visit during 2014. Age-sex standardized rates of periodic health visits performed during the one-year study period were analyzed by number of comorbid conditions.
Of 10,712,804 adults in Ontario, 2,350,386 (21.9%) had a periodic health visit in 2014. The age-sex standardized rate was 6.1% (95% confidence interval [CI] 6.0, 6.1%) for healthy individuals. In the traditional fee-for-service model, the periodic health visit was performed for 55.3% (95% CI 54.4, 56.3%) of healthy individuals versus 10.2% (95% CI 10.0, 10.3%) in team-based care. Periodic health visit rates varied by primary care provider models. Traditional and enhanced fee-for-service models had higher rates across all comorbidity groups.
Patients whose primary care physicians are funded exclusively through fee-for-service had the highest rates of periodic health visits in healthy individuals. Primary care reform initiatives must consider the influence of remuneration on providing evidence-based primary care.
一般健康检查（包括定期健康访问和年度体检）不建议用于无风险因素的无症状成年人保持健康。初级保健的不同供资机制可能与根据建议指南提供服务提供有关。我们试图确定尽管有证据表明不使用，但没有合并症的健康个体是否定期使用健康访问，其使用方式是否因初级保健模式而异。
这是一项基于人群的横断面研究，使用加拿大安大略省的健康和行政数据集进行链接，该省大多数居民通过安大略省的单一付款人、省级资助的安大略省医疗保险计划获得医生服务保险。参与者包括 2014 年 1 月 1 日在安大略省居住的所有成年人（>19 岁），有资格获得安大略省医疗保险计划。初级保健注册模式是主要暴露因素，包括传统的按服务收费、增强的按服务收费、人头费、团队为基础的护理、其他（包括薪资）和未注册。主要结果测量是在 2014 年进行定期健康访问。在为期一年的研究期间，根据合并症的数量分析了进行定期健康访问的年龄-性别标准化率。
在安大略省的 10712804 名成年人中，有 2350386 人（21.9%）在 2014 年进行了定期健康访问。年龄-性别标准化率为 6.1%（95%置信区间[CI] 6.0, 6.1%）对于健康个体。在传统的按服务收费模式下，55.3%（95%CI 54.4, 56.3%）的健康个体进行了定期健康访问，而团队为基础的护理则为 10.2%（95%CI 10.0, 10.3%）。定期健康访问率因初级保健提供者模式而异。传统和增强的按服务收费模式在所有合并症组中均具有较高的比率。
其初级保健医生仅通过按服务收费获得资金的患者在健康个体中进行定期健康访问的比率最高。初级保健改革举措必须考虑薪酬对提供基于证据的初级保健的影响。
