Characteristics of Family Physicians Delivering Home Visits: A Canadian Retrospective Cohort Study |
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| Institution: | 1. Bruyere Research Institute (M.M.S., S.R.I., A.T.H., D.G.M., P.T.), Ottawa, Ontario, Canada;2. Department of Medicine (M.M.S., T.R., D.G.M., P.T.), School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada;3. Department of Medicine (S.R.I.), University of Ottawa, Ottawa, Ontario, Canada;4. ICES uOttawa (H.I., M.P., A.T.H., D.G.M., P.T.), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada;5. Department of Clinical Epidemiology, The Ottawa Hospital Research Institute (T.R., A.T.H., D.G.M., P.T.), Ottawa Methods Centre, Ottawa, Ontario, Canada;6. Department of Family Medicine (H.S.), McMaster University, Hamilton, Ontario, Canada;1. Department of Pediatrics (P .D.), Medical College of Wisconsin, Milwaukee, Wisconsin;2. Department of Internal Medicine (M. M.), University of Utah School of Medicine, Salt Lake City, Utah;3. Department of Family Medicine (L. O.), University of Utah School of Medicine, Salt Lake City, Utah;4. Department of Pediatrics (N, M., D. M.), University of Utah School of Medicine, Capecchi Drive SLC Utah;1. Brookdale Department of Geriatrics and Palliative Medicine (M.B., K.M., L.P.G., N.E.G.), Icahn School of Medicine at Mount Sinai, New York, New York, USA;2. Department of Internal Medicine/Cardiology (M.B.), Charité–Universitätsmedizin Berlin, Berlin, Germany;3. James J. Peters Veterans Affairs Medical Center (L.P.G.), Geriatric Research Education and Clinical Center (GRECC), Bronx, New York, USA;4. University of Chicago Medicine (S.P.P.), Chicago, Illinois, USA;2. VA Greater Los Angeles Health System (A.W.), Los Angeles, California;1. Department of Medicine (A.W.), University of California, Los Angeles, California;3. RAND Health Care (A.W., J.H., S.A.), Santa Monica, California;4. American Academy of Hospice and Palliative Medicine (K.A.,J.R.), Chicago, Illinois;5. Department of Health Policy and Management (S.D.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;6. Department of Veterans Affairs (M.E.), Philadelphia, Pennsylvania;7. University of Pennsylvania Schools of Nursing and Medicine (M.E.), Philadelphia, Pennsylvania;8. Division of Geriatric Medicine and Palliative Care Program (L.H.), University of North Carolina School of Medicine, Chapel Hill, North Carolina;9. Duke University School of Medicine (A.K.), Durham, North Carolina;10. The Mongan Institute and the Division of Palliative Care and Geriatric Medicine ( C.R.), Massachusetts General Hospital, Boston, Massachusetts;11. Oregon Health and Science University School of Medicine (J.T.), Portland, Oregon;12. Stanford University School of Medicine (V.P.),Stanford, California;13. VA Palo Alto Health Care System (V.P.), Livemore, California, USA |
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| Abstract: | ContextHome visits have become increasingly uncommon although evidence suggests they improve healthcare quality and reduce overall expenditures. This study identifies the primary care physicians delivering home visits at patients’ end of life in Ontario, Canada, describes characteristics of primary care physicians delivering end-of-life home visits, and explores associations with delivery.ObjectivesIdentify the primary care physicians delivering home visits at patients' end of life in Ontario, Canada, describe characteristics of primary care physicians delivering end-of-life home visits, and explore associations with delivery.MethodsA retrospective cohort design using population-level health administrative data housed at ICES. The cohort was composed of primary care physicians in Ontario, Canada between April 1, 2014 and March 31, 2019, who were registered in the College of Physicians and Surgeons of Ontario database dataset on or after January 1, 1990 and as of March 31, 2016.ResultsA total of 9884 physicians were identified, of which 2568 (25.7%) delivered at least one end-of-life home visit. Physician characteristics showing increased odds ratio (OR) of home visit delivery were older age (OR 1.01 95% Confidence Interval (CI): 1.00–1.02]) international training (OR 1.28 95% CI:1.04–1.59]), previous home visit experience (OR 1.02 95% CI: 1.01–1.02]), capitation models of remuneration; namely enhanced fee-for-service models (OR 1.5 95%CI: 1.17–2.00]) and mainly capitation model (OR 1.4 95% CI:1.11–1.79]), and population size of practice location with highest odds in small rural or remote areas (<9000 residents) (OR 1.38 95%CI: 1.02–1.88]) and large metropolitan areas (OR 1.84 95%CI: 1.46–2.57]).ConclusionThis research confirms previous evidence and identifies novel primary care physicians’ characteristics associated with home visit practice patterns. Furthermore, it highlights characteristics amenable to policy or system-level changes (e.g., remuneration model, training, and experience) that could increase the provision of home visits which may greatly improve the dying experience of Canadians. |
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