Department of Family Medicine, Western University, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, London, Ontario, Canada.
ICES Western, ICES, London, Ontario, Canada.
J Rural Health. 2023 Jan;39(1):69-78. doi: 10.1111/jrh.12661. Epub 2022 Mar 15.
Many rural communities experience poor family physician retention. We examined the association between community-level physician retention and hospitalization for all causes and ambulatory care-sensitive conditions (ACSCs) in 2017 among residents of rural communities in Ontario, Canada.
We conducted a population-based cross-sectional study by linking administrative data from the public health insurance program in Ontario. To create the physician retention measure for each rural community, we divided the number of family physicians who worked in the community in both 2016 and 2017 by the total number of unique family physicians in the community in either year. We grouped retention level by tertile and added a fourth category, "no physician" to include communities that did not have any residing physicians in either 2016 or 2017. Outcomes were all-cause hospitalization and ACSC hospitalization between April 1, 2017 and March 31, 2018.
Among 1,436,794 rural residents, there were 93,752 all-cause hospitalizations and 8,691 ACSC hospitalizations in 2017. After controlling for other predictors, compared to residents in low-retention communities, residents of medium- and high-retention communities were 0.888 (95% CI: 0.868-0.909) and 0.937 (95% CI: 0.915-0.960) times as likely to have all-cause hospitalization, and residents of high-retention communities were 0.918 (95% CI: 0.858-0.981) times as likely to have ACSC hospitalization in 2017.
Community-level physician retention is significantly associated with all cause and ACSC hospitalization in rural communities in Ontario, and may serve as an alternate measure to assess the impact of disrupted continuity of care.
许多农村社区的家庭医生流失率较高。我们研究了 2017 年加拿大安大略省农村社区居民的社区级医生保留率与全因住院率和非紧急医疗原因门诊服务可及性条件（ACSCs）住院率之间的关系。
我们通过链接安大略省公共医疗保险计划的行政数据进行了一项基于人群的横断面研究。为了为每个农村社区创建医生保留率指标，我们将 2016 年和 2017 年在该社区工作的家庭医生人数除以该社区在任何一年的家庭医生总数。我们按三分位法将保留率水平分组，并添加了第四个类别“无医生”，以包括在 2016 年或 2017 年都没有任何常驻医生的社区。结果是 2017 年 4 月 1 日至 2018 年 3 月 31 日期间的全因住院和 ACSC 住院。
在 1436794 名农村居民中，2017 年有 93752 例全因住院和 8691 例 ACSC 住院。在控制了其他预测因素后，与低保留率社区的居民相比，中保留率和高保留率社区的居民全因住院的可能性分别为 0.888（95%CI：0.868-0.909）和 0.937（95%CI：0.915-0.960）倍，高保留率社区的居民 ACSC 住院的可能性为 0.918（95%CI：0.858-0.981）倍。
社区级医生保留率与安大略省农村社区的全因和 ACSC 住院率显著相关，可作为评估连续性护理中断影响的替代指标。
