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Patient registration with a primary care providers supports continuity in the patient-provider relationship. This paper develops a framework for analysing the characteristics of patient registration across countries; applies this framework to a selection of countries; and identifies challenges and ongoing reform efforts. Twelve jurisdictions (Denma...
Contexts in source publication
Context 1
... is underpinned by individual patientprovider agreements, which define the responsibilities and rights of both patients and providers [ 39 , 40 ]. Table 3 summarizes the current status of patient registration in the 12 countries studied. All jurisdictions have either enrollment forms or patient-provider agreements with explicit expectations placed on either patients or providers. ...Context 2
... all 12 jurisdictions, patients now have free choice of provider. As shown in Table 3 , the only constraints placed on the patient's choice of provider concerns the right of providers to refuse to register patients under certain conditions and the rules of exit from the primary care clinic/group practice or GP they originally chose. There are no limits of when registered patients can leave their primary care provider in eight countries. ...Context 3
... most countries, the main incentive for primary care providers to register patients is that they receive capitation payments based on the number of patients. As shown in Table 3 , the proportion of provider income determined by capitation payments varies considerably across countries, from only 6% in France to about 90% in the UK and almost 100% in some Swedish regions. Other payment components include fee-for-service (FFS) payments, ranging from 20 to 50%, pay for performance (P4P) related adjustments, and other payment components, none of which necessarily incentivize a primary care practice or clinic having a patient roster. ...Context 4
... is underpinned by individual patientprovider agreements, which define the responsibilities and rights of both patients and providers [ 39 , 40 ]. Table 3 summarizes the current status of patient registration in the 12 countries studied. All jurisdictions have either enrollment forms or patient-provider agreements with explicit expectations placed on either patients or providers. ...Context 5
... all 12 jurisdictions, patients now have free choice of provider. As shown in Table 3 , the only constraints placed on the patient's choice of provider concerns the right of providers to refuse to register patients under certain conditions and the rules of exit from the primary care clinic/group practice or GP they originally chose. There are no limits of when registered patients can leave their primary care provider in eight countries. ...Context 6
... most countries, the main incentive for primary care providers to register patients is that they receive capitation payments based on the number of patients. As shown in Table 3 , the proportion of provider income determined by capitation payments varies considerably across countries, from only 6% in France to about 90% in the UK and almost 100% in some Swedish regions. Other payment components include fee-for-service (FFS) payments, ranging from 20 to 50%, pay for performance (P4P) related adjustments, and other payment components, none of which necessarily incentivize a primary care practice or clinic having a patient roster. ...Similar publications
This empirical analysis endeavors to trace out the causal nexus between core inflation and economic growth from the perspective of twenty world’s leading economies with the help of the nonlinear Granger causality approach by using time series data from 1981 to 2016. Based on nonlinear Granger causality results, it has been found that there is a uni...
Citations
... The scoping review identified 12 explicit definitions of attachment 6,7,29,46-54 and 4 implicit definitions of provider-patient attachment. 10,11,55,56 The term attachment is sometimes used interchangeably with enrolment (also known as registration, 57,58 rostering, and empanelment 51 ). Enrolment and empanelment are also sometimes used interchangeably. ...
... 51,52 Formal confirmation might involve official registration or enrolment processes, where patient and provider explicitly agree to the formal relationship. 58 Informal confirmation, on the other hand, might involve a mutual understanding or verbal agreement between the patient and the provider regarding their ongoing care relationship. 58 In explicit and implicit definitions of attachment, most definitions identify the FP or GP as the regular PC provider. ...
... 58 Informal confirmation, on the other hand, might involve a mutual understanding or verbal agreement between the patient and the provider regarding their ongoing care relationship. 58 In explicit and implicit definitions of attachment, most definitions identify the FP or GP as the regular PC provider. 6,7,46 Definition of enrolment. ...
Objective:
To explore definitions of provider-patient attachment in primary care (PC) and help inform a universal definition of provider-patient attachment.
Data sources:
Comprehensive searches were conducted using the electronic databases MEDLINE (Ovid), PubMed, CINAHL (EBSCO), PsycInfo (Ovid), Social Sciences Abstracts (EBSCO), Cochrane Library, Scopus, Embase (Ovid), Google Scholar, and ResearchGate.
Study selection:
A scoping review was conducted. Articles focusing on PC setting, provider-patient attachment, and attachment approaches (enrolment, rostering, registration, empanelment) were included. All articles were from English-language publications and were available in full text in or after 2005. Of the 5955 unique titles, 97 peer-reviewed articles and 45 gray literature sources were included.
Synthesis:
The term attachment is sometimes used interchangeably with enrolment and empanelment. Provider-patient attachment is a confirmed affiliation between a patient and a regular primary care provider (PCP). This affiliation can be formal or informal. The goals are to deliver longitudinal care and establish a therapeutic relationship (relational continuity). Enrolment and empanelment are mechanisms that enable the affiliation of a patient with a PCP. Enrolment is a formal process of provider-patient affiliation, while empanelment is the assignment of a patient to a PCP.
Conclusion:
A universal definition of provider-patient attachment is provided: the confirmed and documented affiliation between a patient and a regular PCP (a clinician, ie, a family physician or nurse practitioner, etc), or a combination of clinician and care team or practice in which the PCP is responsible for providing longitudinal and continuous care to the patient via any delivery channel (ie, in person, remotely, or both), enabled by provider access to patient health information.
... This programme seeks to formalise the relationship between patients with their general practice to support continuity of care, and strengthen health outcomes (Department of Health and Aged Care 2022). While such a programme has been relatively successful internationally (Marchildon et al. 2021), its impact on the Australian healthcare system and patient outcomes is yet to be evaluated. Hours inactive/day Mean 6.5 ...
Aim
To explore men's health status and lifestyle risk profile and understand how they engage with preventive health care.
Design
A cross‐sectional survey within a sequential mixed‐methods project.
Methods
Four hundred thirty‐one adult males, working or volunteering for the New South Wales Rural Fire Service (NSW RFS) completed the survey between September and November 2022. The survey captured demographic data, health status and lifestyle characteristics, as well as engagement with preventive health care.
Results
Nearly three‐quarters of respondents (n = 314; 72.8%) described themselves as being in good or very good health. Just 18.6% of respondents recorded a ‘healthy’ body mass index (BMI), despite only 29.9% having been told by a doctor that they were overweight/obese. Most (n = 344; 79.8%) respondents identified having a regular general practitioner (GP)/general practice. Nearly all respondents described having had blood pressure measurements (n = 403; 93.5%) and lipid profile (n = 346, 80.3%) in the last 2 years. Having a regular GP/general practice was significantly associated with engaging in all preventive and screening activities, except having a dental check.
Conclusion
Our findings demonstrate a significant opportunity to support men to reduce lifestyle risk, despite their current engagement with general practice. Strategies need to support men and health professionals to have conversations about risk and risk reduction to promote behaviour change. Nurses are well placed to provide preventive health care to men in general practice. The general practice nurse has a key role in communicating lifestyle risk, supporting patients in modifying their behaviours and reducing the impact of such factors on their health and well‐being.
Implications for the Profession and/or Patient Care
Communicating the importance of lifestyle risk factors is imperative in supporting men to achieve behavioural change in the reduction in lifestyle risk. Nurses are well‐placed to take a leading role in this area.
Reporting Method
The STROBE checklist guided reporting.
Patient or Public Contribution
Survey development was undertaken in collaboration with members of the NSW RFS. Key contacts within the organisation were involved in reviewing the analysis and interpretation of findings.
... Many countries have sought to strengthen the role of primary care as a hub for care coordination [1]. Patient registration with a primary care provider, with or without the requirement of referral from primary to secondary care (gatekeeping), can be seen as an important means to achieve improved coordination [2], and is widely considered as a key feature of strong primary care systems [3,4]. ...
... Although other countries, such as France and Germany, have introduced voluntary patient registration with a primary care provider to strengthen care coordination, the RD policy implemented in Luxembourg differs in that it does not require or incentivise registered patients to obtain an RD referral to access a specialist. There is so far little robust evidence of the effects of patient registration within countries [2]. This work aims to address this important research gap. ...
... Some interviewees indicated that the RD programme was not well known, implying a need to promote the programme among doctors and patients. While patient registration is voluntary in many countries, there are often incentives for patients to register including lower user charges and easier access to GPs and specialist doctors [2]. In Luxembourg, the RD programme could be reformed to include an additional incentive for patients, such as a reduction in or even an abolishment of co-payments for specific services, which could encourage more patients to register with an RD. ...
Background
In 2012, Luxembourg introduced a Referring Doctor (RD) policy, whereby patients voluntarily register with a primary care practitioner, who coordinates patients’ health care and ensures optimal follow-up. We contribute to the limited evidence base on patient registration by evaluating the effects of the RD policy.
Methods
We used data on 16,775 people with type 2 diabetes on oral medication (PWT2D), enrolled with the Luxembourg National Fund from 2010 to 2018. We examined the utilisation of primary and specialist outpatient care, quality of care process indicators, and reimbursed prescribed medicines over the short- (until 2015) and medium-term (until 2018). We used propensity score matching to identify comparable groups of patients with and without an RD. We applied difference-in-differences methods that accounted for patients’ registration with an RD in different years.
Results
There was low enrolment of PWT2D in the RD programme. The differences-in-differences parallel trends assumption was not met for: general practitioner (GP) consultations, GP home visits (medium-term), HbA1c test (short-term), complete cholesterol test (short-term), kidney function (urine) test (short-term), and the number of repeat prescribed cardiovascular system medicines (short-term). There was a statistically significant increase in the number of: HbA1c tests (medium-term: 0.09 (95% CI: 0.01 to 0.18)); kidney function (blood) tests in the short- (0.10 (95% CI: 0.01 to 0.19)) and medium-term (0.11 (95% CI: 0.03 to 0.20)); kidney function (urine) tests (medium-term: 0.06 (95% CI: 0.02 to 0.10)); repeat prescribed medicines in the short- (0.19 (95% CI: 0.03 to 0.36)) and medium-term (0.18 (95% CI: 0.02 to 0.34)); and repeat prescribed cardiovascular system medicines (medium-term: 0.08 (95% CI: 0.01 to 0.15)). Sensitivity analyses also revealed increases in kidney function (urine) tests (short-term: 0.07 (95% CI: 0.03 to 0.11)) and dental consultations (short-term: 0.06, 95% CI: 0.00 to 0.11), and decreases in specialist consultations (short-term: -0.28, 95% CI: -0.51 to -0.04; medium-term: -0.26, 95% CI: -0.49 to -0.03).
Conclusions
The RD programme had a limited effect on care quality indicators and reimbursed prescribed medicines for PWT2D. Future research should extend the analysis beyond this cohort and explore data linkage to include clinical outcomes and socio-economic characteristics.
... Another way of improving the flow of information between primary care providers and specialists or tertiary care centers would be to increase the proportion of those registered with a GP. This could be achieved by introducing incentives for patients (e.g., lowering health insurance charges) or providers (e.g., capitation payments), or by mandatory registration [53]. As a result, the gatekeeping function of GPs would be strengthened. ...
Background: Epidemiological studies often rely on self-reported health problems and validation greatly improves study quality. In a study of late effects after childhood cancer, we validated self-reported cardiovascular problems by contacting general practitioners (GPs). This paper describes: (a) the feasibility of this approach; and (b) the agreement between survivor-reports and reports from their GP.
Methods: The Swiss Childhood Cancer Survivor Study (SCCSS) contacts all childhood cancer survivors registered in the Swiss Childhood Cancer Registry since 1976 who survived at least 5 years from cancer diagnosis. We validated answers of all survivors who reported a cardiovascular problem in the questionnaire. Reported cardiovascular problems were hypertension, arrhythmia, congestive heart failure, myocardial infarction, angina pectoris, stroke, thrombosis, and valvular problems. In the questionnaire, we further asked survivors to provide a valid address of their GP and a consent for contact. We sent case-report forms to survivors' GPs and requested information on cardiovascular diagnoses of their patients. To determine agreement between information reported by survivors and GPs, we calculated Cohen's kappa (κ) coefficients for each category of cardiovascular problems.
Results: We used questionnaires from 2172 respondents of the SCCSS. Of 290 survivors (13% of 2172) who reported cardiovascular problems, 166 gave consent to contact their GP and provided a valid address. Of those, 135 GPs (81%) replied, and 128 returned the completed case-report form. Survivor-reports were confirmed by 54/128 GPs (42%). Of the 54 GPs, 36 (28% of 128) confirmed the problems as reported by the survivors; 11 (9% of 128) confirmed the reported problem(s) and gave additional information on more cardiovascular outcomes; and seven GPs (5% of 128) confirmed some, but not all cardiovascular problems. Agreement between GPs and survivors was good for stroke (κ = 0.79), moderate for hypertension (κ = 0.51), arrhythmias (κ = 0.41), valvular problems (κ = 0.41) and thrombosis (κ = 0.56), and poor for coronary heart disease (κ = 0.15) and heart failure (κ = 0.32).
Conclusions: Despite excellent GP compliance, it was found unfeasible to validate self-reported cardiovascular problems via GPs because they do not serve as gatekeepers in the Swiss health care system. It is thus necessary to develop other validation methods to improve the quality of patient-reported outcomes.
... In Australia general practice is funded by the federal government on a fee-for-service basis with most services eligible for rebates from the universal health insurance scheme known as Medicare. In contrast to other countries [3] where patients register to a particular GP or to a specific practice Australian patients are free to consult with multiple GPs, including those at different general practices [4]. Despite the lack of a formal registration system most Australians with (85%) or without (70%) a long term health condition report having a preferred GP [5] although multiple practice attendance, particularly for younger people, is not uncommon [6]. ...
... Systematic reviews suggest that there is an association between continuity of care and patient satisfaction and health service utilisation [8,9] but this evidence has mainly been generated from cross-sectional studies with very few interventional trials. Observational studies from countries that have introduced primary care registration systems to promote continuity of care are suggestive of better patient outcomes and reduced costs but overall the evidence base is considered weak [3]. ...
Background
This study reports the experiences of general practice staff and patients at high risk of poor health outcomes who took part in a clustered randomised controlled trial of a multicomponent general practice intervention. The intervention comprised patient enrolment to a preferred General Practitioner (GP) to promote continuity of care, access to longer GP appointments, and timely general practice follow-up after hospital care episodes. The aims of the study were to better understand participant’s (practice staff and patients) perspectives of the intervention, their views on whether the intervention had improved general practice services, reduced hospital admissions and finally whether they believed the intervention would be sustainable after the trial had completed.
Methods
A qualitative study design with semi-structured interviews was employed. The practice staff sample was drawn from both the control and intervention groups. The patient sample was drawn from those who had expressed an interest in taking part in an interview during the trial and who had also experienced a recent hospital care episode.
Results
Interviews were conducted with 41 practice staff and 45 patients. Practice staff and patients expressed support for the value of appointments with a regular GP and having sufficient time in appointments for the provision of comprehensive care. There were mixed views with respect to the extent to which the intervention had improved services. The positive changes reported were related to services being provided in a more proactive, thorough, and systematic manner with a greater emphasis on team based care involving the Practice Nurse. Patients nominated after hours care and financial considerations as the key reasons for seeking hospital care. Practice staff noted that the intervention would be difficult to sustain financially in the absence of additional funding.
Conclusions
The multicomponent intervention was supported by practice staff and patients and some patients perceived that it had led to improvements in care.
... Patient registration has been linked to enhancing care continuity and coordination [67], which, in turn, has been linked to improved patient outcomes [68] and lower service use and cost [69]. However, the nature and extent of how countries define and implement 'patient registration' varies substantially [70], and it is likely that the variable as conceptualized in the data source [44] used in this study captures some other mechanism that would explain our finding. ...
Background
Primary care is widely seen as a core component of resilient and sustainable health systems, yet its efficiency is not well understood and there is a lack of evidence about how primary care efficiency is associated with health system characteristics. We examine this issue through the lens of diabetes care, which has a well-established evidence base for effective treatment and has previously been used as a tracer condition to measure health system performance.
Methods
We developed a conceptual framework to guide the analysis of primary care efficiency. Using data on 18 European countries during 2010–2016 from several international databases, we applied a two-stage data envelopment analysis to estimate (i) technical efficiency of primary care and (ii) the association between efficiency and health system characteristics.
Results
Countries varied widely in terms of primary care efficiency, with efficiency scores depending on the range of population characteristics adjusted for. Higher efficiency was associated with bonus payments for the prevention and management of chronic conditions, nurse-led follow-up, and a financial incentive or requirement for patients to obtain a referral to specialist care. Conversely, lower efficiency was associated with higher rates of curative care beds and financial incentives for patients to register with a primary care provider.
Conclusions
Our results underline the importance of considering differences in population characteristics when comparing country performance on primary care efficiency. We highlight several policies that could enhance the efficiency of primary care. Improvements in data collection would enable more comprehensive assessments of primary care efficiency across countries, which in turn could more effectively inform policymaking.
... The organisation of first-contact care varies across health systems. 10 Gatekeeping is the term usually applied to mandatory first-contact, meaning that a patient must visit a GP before seeing a secondary care specialist. 11 Mandatory gatekeeping is less satisfactory to patients, 11 is seen as a potential cause of delay in diagnosis and treatment 12 and has less sound evidence for its beneficial effects on health outcomes. ...
Objective
The objective of this study is to characterise the self-reported first contact with the health system and the reasons stated for each choice, testing associations with population characteristics.
Design
Cross-sectional survey.
Setting
Primary care department of a local health unit in northern Portugal.
Participants
Random sample of 4286 persons, retrieved from all registered adults.
Outcomes
Participants who stated they usually see the same doctor when a health problem arises were considered to adopt first-contact care and were asked to identify their regular doctor. Participants were asked why they adopt first-contact care or why they choose to do otherwise. Associations between personal characteristics and the adoption of first-contact care were tested using logistic regression.
Results
There were 808 valid questionnaires received (19% response rate). The mean age of respondents was 53 years, 58% were women and 60% had a high school or higher degree. Most (71%) stated always seeing the same doctor when facing a health problem. This was a general practitioner (GP) in 84%. The main reasons were previous knowledge and trust in the doctor. When this doctor was not a GP, the main reason was the need to obtain an appointment quickly. Participants who chose first-contact care were less likely to have university degrees than those who did not (OR 0.31; 95% CI 0.13 to 0.76). Being registered with the same GP for over 1 year increased the odds of adopting first-contact care: twice as likely for those registered for 1–4 years with the same GP (2.07; 95% CI 1.04 to 4.11), and three times more likely for those registered for over 10 years (3.21; 95% CI 1.70 to 6.08).
Conclusions
The high adoption of first-contact care and the reasons given for this suggest a strong belief in primary care in this population. The longer patients experience continuity, the more they adopt first-contact care. The preferences of higher-educated patients regarding first-contact care deserve reflection.
... Formal attachment (also known as empanelment, rostering, patient registration, or enrollment) is a traceable administrative agreement that formalizes the patient-provider relationship and o cially enrolls the patient as part of the provider's panel. Internationally, formal attachment has become a major policy feature of primary care and universal health coverage reforms including in Denmark, France, Germany, Ireland, Israel, Norway, Canada, Sweden, Switzerland and the United Kingdom (32). In Canada, the provinces of Quebec and Ontario introduced formal attachment in the early 2000s as part of new team-based models of primary care. ...
... The effects of enrollment have been largely understudied (32). Several studies in Quebec and Ontario examined whether there was a reduction in ED use following patient enrollment in speci c team-based primary care models (e.g., family health networks, family health organizations, family health groups, groupes de médecine de famille). ...
... Several studies in Quebec and Ontario examined whether there was a reduction in ED use following patient enrollment in speci c team-based primary care models (e.g., family health networks, family health organizations, family health groups, groupes de médecine de famille). Generally, these studies report no change or a small decrease in ED utilization (32,(35)(36)(37)(38)(39)(40). However, in these studies, the effect of enrollment or attachment on ED utilization is di cult to disentangle from the other features of the models, such as team-based care, after-hours coverage, and changes in physicians' remuneration. ...
Background
Patients without a regular primary care provider – unattached patients – are more likely to visit hospital emergency departments (ED), leading to poor patient and health system outcomes. In many Canadian provinces, policy responses to improve primary care access and reduce ED utilization of unattached patients have included centralized waiting lists to help find a primary care provider and formal attachment (rostering, empanelment, enrollment, registration) to a family physician. While previous work suggests attachment improves access and continuity of primary care (1), it is unknown whether this translates into fewer ED visits. The aim of this study was to determine whether the rate of emergency department visits significantly decreases in patients attached to a family physician through Quebec’s centralized waiting lists for unattached patients.
Methods
We used a quasi-experimental difference-in-differences approach, studying patients attached through Quebec’s centralized waiting lists in 2012–2014. We used administrative medical services physicians’ billing data from the Régie de l’Assurance Maladie du Québec (RAMQ). Attachment was determined based on fee codes used to formalize attachment. We compared the change in the rate of emergency department visits over two 12-month periods, for ‘exposed’ patients who became attached (n = 207,669) and ‘control’ patients who remained unattached during the study period (n = 90,637). To balance baseline patient characteristics in the exposed and control cohorts, we calculated a propensity score including age, sex, Charlson-co-morbidity index, medical vulnerability, and region remoteness and performed inverse probability of treatment weighting. We used descriptive statistics and estimated negative binomial regression models, fitted with generalized estimating equations.
Results
After weighting, cohorts had similar characteristics (standardized differences < 10%). Attached (exposed) patients’ mean annual ED visits decreased from 0.60 to 0.49 (18.3%) following attachment, while unattached (control) patients’ increased from 0.54 to 0.69 (27.8%). The difference-in-differences estimate (Time period*exposure) showed a significant 36% relative reduction (IRR = 0.64, p < 0.001) in the rate of ED visits for patients who were attached, compared to patients who remained unattached on the centralized waiting lists during the study period.
Conclusion
Our findings suggest that attachment to a family physician through centralized waiting lists for unattached patients significantly reduces the rate of ED utilization.
... [8][9][10][11][12][13][14] Many high-income countries have successfully adopted blends of FFS payment and PBP to pay primary care clinicians. 15 Numerous countries now provide between 35% and 70% of primary care payments via PBP, with the remaining share paid mostly FFS. Yet, the United States continues through a seemingly never-ending succession of demonstration projects-now exceeding 10 years-to adopt a hybrid payment model in Medicare, which would also serve as a model for adoption by other public and private payers. ...
The National Academies of Sciences, Engineering, and Medicine's (NASEM’s) 2021 report on primary care called for a hybrid payment approach—a mix of fee-for-service and population-based payment—with performance accountability to strike the proper balance for desired practice transformation and to support primary care's important and expanding role. The NASEM report also proposed substantial increases to primary care payment and reforms to the Medicare Physician Fee Schedule. This paper addresses pragmatic ways to implement these recommendations, describing and proposing solutions to the main implementation challenges. The urgent need for primary care payment reform calls for adopting a hybrid model within the Medicare fee schedule rather than engaging in another round of demonstrations, despite legal and practical obstacles to adoption. The paper explores reasons for adopting a roughly 50:50 blend of fee-for-service and population-based payment and addresses other design features, presenting reasons why spending accountability should rely on utilization measures under primary care control rather than performance on total cost of care, and proposes a fresh approach to quality, emphasizing that quality measures should be parsimonious, focused on important outcomes with demonstrated quality improvement.
... Attachment involves an administrative patient-provider agreement and is meant to assure access to a regular primary care provider or team who is most responsible for a patient's care [28,29]. Internationally, attachment is increasingly widespread as a building block of primary care [30,31]. It is a key feature of the patient medical home, and supports practice management (e.g., establishing panel size, balancing supply and demand) and health system planning (e.g., accountability, performance, provider remuneration, resource allocation) [29][30][31][32][33][34][35][36]. ...
... Internationally, attachment is increasingly widespread as a building block of primary care [30,31]. It is a key feature of the patient medical home, and supports practice management (e.g., establishing panel size, balancing supply and demand) and health system planning (e.g., accountability, performance, provider remuneration, resource allocation) [29][30][31][32][33][34][35][36]. However, very little research has evaluated the effects of attachment. ...
... Attachment, which is considered a key feature of the patient medical home [86][87][88] and a building block of high performing care [31], has been implemented in countries such as Canada, Denmark, France, Germany, Ireland, Israel, Italy, the Netherlands, Norway, Sweden, Switzerland, New Zealand, the United Kingdom, Mongolia, Costa Rica, and the United States [30,33,34,36]. Other research conducted in Quebec suggests that, at the populational level, attachment policies from 2003 and 2009 have not meaningfully impacted measures of having a regular physician and concentration of care [42]. ...
Background:
Having a regular family physician is associated with many benefits. Formal attachment - an administrative patient-family physician agreement - is a popular feature in primary care, intended to improve access to and continuity of care with a family physician. However, little evidence exists about its effectiveness. In Quebec, Canada, where over 20% of the population is unattached, centralized waiting lists help attach patients. This provides a unique opportunity to observe the influence of attachment in previously unattached patients. The aim was to evaluate changes in access to and continuity of primary care associated with attachment to a family physician through Quebec's centralized waiting lists for unattached patients.
Methods:
We conducted an observational longitudinal population cohort study, using medical services billing data from public health insurance in the province of Québec, Canada. We included patients attached through centralized waiting lists for unattached patients between 2012 and 2014 (n = 410,140). Our study was informed by Aday and Andersen's framework for the study of access to health services. We compared outcomes during four 12-month periods: two periods before and two periods after attachment, with T0-2 years as the reference period. Outcome measures were number of primary care visits and Bice-Boxerman Concentration of Care Index at the physician and practice level (for patients with ≥2 visits in a given period). We included age, sex, region remoteness, medical vulnerability, and Charlson Comorbidity Index as covariates in regression models fitted with generalized estimating equations.
Results:
The number of primary care visits increased by 103% in the first post attachment year and 29% in the second year (p < 0.001). The odds of having all primary care visits concentrated with a single physician increased by 53% in the first year and 22% (p < 0.001) in the second year after attachment. At the practice level, the odds of perfect concentration of care increased by 19% (p < 0.001) and 15% (p < 0.001) respectively, in first and second year after attachment.
Conclusion:
Our results show an increase in patients' number of primary care visits and concentration of care at the family physician and practice level after attachment to a family physician. This suggests that attachment may help improve access to and continuity of primary care.
