Full-service family practice in British Columbia: policy interventions and trends in practice, 1991-2010

British Columbia's primary care reform (initiated in 2002) aims to promote "full-service family practice" through incentive payments and other practice support programs. Despite attention to policy, no longitudinal analysis has been conducted of the activities of BC primary care physicians.

This study employed linked administrative health data from 1991/92 through 2009/10 to describe dimensions of care from the definition of "full-service family practice" used in BC reform, grouped into four categories: access, continuity, coordination and comprehensiveness.

Access, continuity and coordination of care fell over the study period (p < 0.001). Some dimensions reflecting comprehensiveness of care declined (obstetrics and geriatric care), though the remainder did not change significantly. Overall declining trends were consistent across physician characteristics and remained significant when accounting for shifts to non- fee-for-service payment.

Findings suggest efforts are not achieving their intended aims. Rigorous evaluation of individual components of reform is needed.