Bai Yihong, Reid Jennifer, Habbous Steven, Devlin Rose Anne, Jaakkimainen Liisa, Sarma Sisira
Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, 1465 Richmond Street, London, ON, N6G 2M1, Canada.
ICES, Toronto, ON, Canada.
Eur J Health Econ. 2024 Dec 9. doi: 10.1007/s10198-024-01745-4.
Health care reforms introduced interprofessional team-based primary care to optimize access to health care and preventive services. In this context, preventive cancer screening represents an important measure as it is essential for the early detection of cancer and treatment. We investigated the effects of Family Health Teams (FHTs), an interprofessional team-based primary care practice setting, on cancer screening rates in Ontario, Canada. By utilizing comprehensive health administrative data from April 1st 2011 to March 31st 2023, we determined the effect of FHT on screening rates for breast, cervical, and colorectal cancer while controlling for relevant physician and patient characteristics. Our analytical framework employs fractional probit models, including the Mundlak procedure, and generalized estimating equations to assess the impact of practicing in FHTs on cancer screening rates, while accounting for unobserved physician heterogeneity. Our results indicate that compared to non-FHTs, physicians practicing in FHTs have higher breast (2.4%), cervical (2%), and colon (0.8%) cancer screening rates per physician per year. The effectiveness of FHTs in promoting cancer screenings is particularly pronounced in smaller practices and among populations in rural and economically deprived areas. Our findings highlight the role of teams in enhancing preventive health care services potentially through task shifting mechanisms and suggest that such models may offer a pathway to improving access to preventive health care, especially in marginalized populations. Our research contributes to the literature by providing empirical evidence on the benefits of interprofessional team-based primary care in improving cancer screening.
医疗保健改革引入了以跨专业团队为基础的初级保健，以优化获得医疗保健和预防服务的机会。在这种背景下，癌症预防筛查是一项重要措施，因为它对癌症的早期发现和治疗至关重要。我们调查了家庭健康团队（FHTs），一种以跨专业团队为基础的初级保健实践模式，对加拿大安大略省癌症筛查率的影响。通过利用2011年4月1日至2023年3月31日的全面健康管理数据，我们在控制相关医生和患者特征的同时，确定了FHT对乳腺癌、宫颈癌和结直肠癌筛查率的影响。我们的分析框架采用分数概率模型，包括蒙德拉科程序，以及广义估计方程，以评估在FHT中执业对癌症筛查率的影响，同时考虑未观察到的医生异质性。我们的结果表明，与非FHT相比，在FHT中执业的医生每年每位医生的乳腺癌（2.4%）、宫颈癌（2%）和结肠癌（0.8%）筛查率更高。FHT在促进癌症筛查方面的有效性在较小的诊所以及农村和经济贫困地区的人群中尤为明显。我们的研究结果强调了团队可能通过任务转移机制在加强预防性医疗保健服务方面的作用，并表明这种模式可能提供一条改善获得预防性医疗保健机会的途径，特别是在边缘化人群中。我们的研究通过提供关于跨专业团队为基础的初级保健在改善癌症筛查方面的益处的实证证据，为文献做出了贡献。
