加拿大安大略省提供上门医疗服务的家庭医生的特征和实践模式：一项横断面研究。

Characteristics and practice patterns of family physicians who provide home visits in Ontario, Canada: a cross-sectional study.

机构信息

Support, Systems, and Outcomes Department (Salahub, Lapointe-Shaw), Toronto General Hospital Research Institute, University Health Network; ICES Central (Kiran, Na, Ivers, Lapointe-Shaw); Institute of Health Policy, Management and Evaluation (Kiran, Sinha, Stall, Ivers, Lapointe-Shaw), and Department of Family and Community Medicine (Kiran, Sinha, Ivers), University of Toronto; Department of Family and Community Medicine and MAP Centre for Urban Health Solutions (Kiran), St Michael's Hospital; Division of General Internal Medicine and Geriatrics (Sinha, Stall, Lapointe-Shaw), University Health Network and Sinai Health System; Department of Medicine (Sinha, Stall, Lapointe-Shaw), University of Toronto; Women's College Institute for Health System Solutions and Virtual Care (Ivers, Lapointe-Shaw), and Department of Family Medicine (Ivers), Women's College Hospital, Toronto, Ont.; ICES McMaster (Costa, Jones); Department of Health Research Methods, Evidence, and Impact (Costa, Jones), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.

出版信息

CMAJ Open. 2023 Mar 21;11(2):E282-E290. doi: 10.9778/cmajo.20220124. Print 2023 Mar-Apr.

DOI:10.9778/cmajo.20220124

PMID:36944429

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10035667/

Abstract

BACKGROUND

Physician home visits are essential for populations who cannot easily access office-based primary care. The objective of this study was to describe the characteristics, practice patterns and physician-level patient characteristics of Ontario physicians who provide home visits.

METHODS

This was a retrospective cross-sectional study, based on health administrative data, of Ontario physicians who provided home visits and their patients, between Jan. 1, 2019, and Dec. 31, 2019. We selected family physicians who had at least 1 home visit in 2019. Physician demographic characteristics, practice patterns and aggregated patient characteristics were compared between high-volume home visit physicians (the top 5%) and low-volume home visit physicians (bottom 95%).

RESULTS

A total of 6572 family physicians had at least 1 home visit in 2019. The top 5% of home visit physicians ( = 330) performed 58.6% of all home visits ( = 227 321 out of 387 139). Compared with low-volume home visit physicians ( = 6242), the top 5% were more likely to be male and practise in large urban areas, and rarely saw patients who were enrolled to them (median 4% v. 87.5%, standardized mean difference 1.12). High-volume physicians' home visit patients were younger, had greater levels of health care resource utilization, resided in lower-income and large urban neighbourhoods, and were less likely to have a medical home.

INTERPRETATION

A small subset of home visit physicians provided a large proportion of home visits in Ontario. These home visits may be addressing a gap in access to primary care for certain patients, but could be contributing to lower continuity of care.

摘要

背景

对于那些难以获得门诊基本医疗服务的人群来说，医生上门服务至关重要。本研究的目的是描述在安大略省提供上门服务的医生的特征、实践模式以及患者的个体特征。

方法

这是一项基于健康管理数据的回顾性横截面研究，研究对象为 2019 年 1 月 1 日至 12 月 31 日期间提供上门服务的安大略省医生及其患者。我们选择了 2019 年至少有 1 次上门服务的家庭医生。比较了高上门服务量医生（前 5%）和低上门服务量医生（后 95%）之间的医生人口统计学特征、实践模式和汇总患者特征。

结果

共有 6572 名家庭医生在 2019 年至少进行了 1 次上门服务。上门服务量排名前 5%的医生（330 名）完成了所有上门服务的 58.6%（227321 次，占 387139 次的 58.6%）。与低上门服务量医生（6242 名）相比，排名前 5%的医生更可能是男性，且在大城市执业，很少接诊自己的患者（中位数为 4%比 87.5%，标准化均数差为 1.12）。高上门服务量医生的上门服务患者更年轻，医疗资源利用率更高，居住在低收入和大型城市社区，且更不可能有家庭医生。