Project

MAAP: Models and Access Atlas of Primary Care

Goal: MAAP will create a database of all family physicians and primary healthcare nurse practitioners, including information about accessibility and the model of care in which they practice, and will link the survey data to administrative health databases. This will allow for exploration of research issues such as: the association of models of primary care with chronic disease prevention and management; accessibility of primary care with patient use of emergency departments; and walk-in clinic utilisation and preventive and screening services. This research will: (1) identify areas of primary health care requiring enhancement, such as where gaps exist in accessibility (eg, geographical location, time of day and availability of specific primary care services); (2) provide a baseline for evaluating future innovations and (3) create new knowledge about the current landscape of PHC access, models of care being offered and their impacts on utilisation.

Updates
0 new
0
Recommendations
0 new
0
Followers
0 new
5
Reads
0 new
86

Project log

Emily G Marshall
added a research item
Abstract Objective: To understand physician acceptance of new patients, specifically the use of “meet and greets”; and to explore FPs’ rationale, beliefs, and processes regarding these appointments. Design Exploratory qualitative interviews. Setting: Nova Scotia. Participants: A purposive sample of 12 FPs who had previously participated in the Models and Access to Primary Care Providers in Nova Scotia study. Methods: In-depth, semistructured, 1-on-1 qualitative interviews. Interview transcripts were coded using Atlas.ti and analyzed for typologies and common themes regarding accepting practices. Main findings: Four typologies of accepting practices emerged: no form of meet and greet; nonscreening meet and greet to gather a history; meet and greet to assess alignment of patient needs and provider scope; and meet and greet to screen out undesirable patients. Typology 1 was subdivided: accepting first-come, first-served and accepting with previous patient knowledge. Rationale for each varied. Family physicians employing typologies 1 and 2 emphasized the importance of equitable access to primary care. Family physicians employing typologies 3 and 4 highlighted the challenges of meeting the needs of specific populations within the context of professional and systemic constraints. Conclusion: Meet and greets before accepting new patients are purposed differently across providers. Some FPs incorporate these meetings ethically; others present challenges to the principles of equity and nondiscrimination. Policy implications exist for how providers admit new patients and what resources might support more equitable access.
Emily G Marshall
added a research item
Background.: Family physicians (FPs) are expected to take on new patients fairly and equitably and to not discriminate based on medical or social history. 'Meet and greet' appointments are initial meetings between physicians and prospective patients to establish fit between patient needs and provider scope of practice. The public often views these appointments as discriminatory; however, there is no empirical evidence regarding their prevalence or outcomes. Objectives.: To determine the proportion of FPs conducting 'meet and greets' and their outcomes. Methods: . Study design and setting: Census telephone survey of all FP practices in Nova Scotia (NS). Participants: Person who answers the FP office telephone. Main Outcomes: Proportion of FPs holding 'meet and greets'; proportion of FPs conducting 'meet and greets' who have ever decided not to continue seeing a patient after the meeting. Results.: 9.2% of FPs accept new patients unconditionally; 51.1% accept new patients under certain conditions. Of those accepting patients unconditionally or with conditions, 46.9% require a 'meet and greet'; 41.8% have a first-come, first-serve policy. Among FPs who require a 'meet and greet', 44.0% decided, at least once, not to continue seeing a patient after the first meeting. Conclusion.: 'Meet and greets' are common among FPs in NS and result in some patients not being accepted into practice. More research is needed to understand the intentions, processes, and outcomes of 'meet and greets'. We recommend that practice scope be made clear to prospective patients before their first visit, which may eliminate the need for 'meet and greets'.
Emily G Marshall
added a research item
The addition of nurse practitioners (NPs) in primary healthcare (PHC) is intended to improve accessibility. This study compared access to NP services in consultative, dyad and multiprofessional team structures in Nova Scotia. Accessibility indicators included NP appointment wait times, after-hours coverage and acceptance of new patients. Secondary analysis of province-wide survey data from PHC providers showed multiprofessional structures had shorter median NP appointment wait times: 0.5 days for urgent appointments versus 6.5 days (dyad, p= 0.004) and 4.5 days (consultative, p= 0.003), 4 days for non-urgent appointments versus 15 days (dyad, p= 0.020) and 4.5 days (consultative, p> 0.05). Only NPs in the multiprofessional structure provided after-hours coverage and over half the NPs in each structure were accepting new patients. These results support the use of team-based care and should be considered along with local needs and resources when planning team structures.
Emily G Marshall
added a project goal
MAAP will create a database of all family physicians and primary healthcare nurse practitioners, including information about accessibility and the model of care in which they practice, and will link the survey data to administrative health databases. This will allow for exploration of research issues such as: the association of models of primary care with chronic disease prevention and management; accessibility of primary care with patient use of emergency departments; and walk-in clinic utilisation and preventive and screening services. This research will: (1) identify areas of primary health care requiring enhancement, such as where gaps exist in accessibility (eg, geographical location, time of day and availability of specific primary care services); (2) provide a baseline for evaluating future innovations and (3) create new knowledge about the current landscape of PHC access, models of care being offered and their impacts on utilisation.
 
Emily G Marshall
added a research item
Introduction There is little evidence on how primary care providers (PCPs) model their practices in Nova Scotia (NS), Canada, what services they offer or what accessibility is like for the average patient. This study will create a database of all family physicians and primary healthcare nurse practitioners in NS, including information about accessibility and the model of care in which they practice, and will link the survey data to administrative health databases. Methods and analysis 3 census surveys of all family physicians, primary care nurse practitioners (ie, PCPs) and their practices in NS will be conducted. The first will be a telephone survey conducted during typical daytime business hours. At each practice, the person answering the telephone will be asked questions about the practice's accessibility and model of care. The second will be a telephone survey conducted after typical daytime business hours to determine what out-of-office services PCP practices offer their patients. The final will be a tailored fax survey that will collect information that could not be obtained in the first 2 surveys plus new information on scope of practice, practice model and willingness to participate in research. Survey data will be linked with billing data from administrative health databases. Multivariate regression analysis will be employed to assess whether access and availability outcome variables are associated with PCP and model of practice characteristics. Negative binomial regression analysis will be employed to assess the association between independent variables from the survey data and health system use outcomes from administrative data. Ethics and dissemination This study has received ethical approval from the Nova Scotia Health Authority and the Health Data Nova Scotia Data Access Committee. Dissemination approached will include stakeholder engagement at local and national levels, conference presentations, peer-reviewed publications and a public website.