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Related Experiment Videos

The declining comprehensiveness of primary care.

Benjamin T B Chan1

  • 1Institute for Clinical Evaluative Sciences, and Department of Health Policy, Evaluation and Management, University of Toronto, Ont. ben@ices.on.ca

CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne
|March 6, 2002
PubMed
Summary

The number of primary care physicians providing comprehensive services in Ontario has significantly decreased over a decade. This trend affects all physician demographics and practice locations, indicating a broad decline in accessible, holistic patient care.

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Area of Science:

  • Health Services Research
  • Primary Care Medicine
  • Physician Practice Patterns

Background:

  • Primary care comprehensiveness has shown a steady decline over the past decade.
  • This study investigates the participation rates of general practitioners and family physicians in non-office settings in Ontario.

Purpose of the Study:

  • To track physician participation in 6 non-office settings from 1989/90 to 1999/2000.
  • To identify physician characteristics associated with a decline in comprehensive care provision.

Main Methods:

  • Billing records analyzed for fee-for-service general practitioners and family physicians.
  • Proportions of physicians providing emergency, inpatient, nursing home, house call, anesthesia, or obstetrical services were determined.
  • Multivariate analysis examined physician characteristics related to comprehensiveness in 1999/2000.

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Main Results:

  • The proportion of "office-only" physicians increased from 14% to 24% between 1989/90 and 1999/2000.
  • This increase was observed across all physician ages, sexes, and practice locations.
  • Recent graduates showed higher emergency medicine participation, while older physicians were more involved in nursing home visits and house calls. "Office-only" physicians were more likely to be female, recent graduates, older, or practicing in urban areas.

Conclusions:

  • A significant decline in comprehensive care provision by Ontario's general practitioners and family physicians has been documented.
  • This decline is widespread, affecting physicians of all ages and genders, and is present in both rural and urban settings.