Patient-reported access to primary care in Ontario: effect of organizational characteristics.
OBJECTIVE
To describe patient-reported access to primary health care across 4 organizational models of primary care in Ontario, and to explore how access is associated with patient, provider, and practice characteristics.


METHODS
Cross-sectional survey.


METHODS
One hundred thirty-seven randomly selected primary care practices in Ontario using 1 of 4 delivery models (fee for service, established capitation, reformed capitation, and community health centres).


METHODS
Patients included were at least 18 years of age, were not severely ill or cognitively impaired, were not known to the survey administrator, had consenting providers at 1 of the participating primary care practices, and were able to communicate in English or French either directly or through a translator.


METHODS
Patient-reported access was measured by a 4-item scale derived from the previously validated adult version of the Primary Care Assessment Tool. Questions were asked about physician availability during and outside of regular office hours and access to health information via telephone. Responses to the scale were normalized, with higher scores reflecting greater patient-reported access. Linear regressions were used to identify characteristics independently associated with access to care.


RESULTS
Established capitation model practices had the highest patient-reported access, although the difference in scores between models was small. Our multilevel regression model identified several patient factors that were significantly (P = .05) associated with higher patient-reported access, including older age, female sex, good-to-excellent self-reported health, less mental health disability, and not working. Provider experience (measured as years since graduation) was the only provider or practice characteristic independently associated with improved patient-reported access.


CONCLUSIONS
This study adds to what is known about access to primary care. The study found that established capitation models outperformed all the other organizational models, including reformed capitation models, independent of provider and practice variables save provider experience. This suggests that the capitation models might provide better access to care and that it might take time to realize the benefits of organizational reforms.
C.T. Lamont Primary Health Care Research Centre, Department of Family Medicine, University of Ottawa, 43 Bruyère St, Ottawa, ON K1N 5C8. emuggah@bruyere.org.
Elizabeth
E
Muggah
William
W
Hogg
Simone
S
Dahrouge
Grant
G
Russell
Elizabeth
E
Kristjansson
Laura
L
Muldoon
Rose Anne
RA
Devlin
D002204:Capitation Fee / Q000458:organization & administration; D003151:Community Health Centers / Q000458:organization & administration; D003430:Cross-Sectional Studies; D018588:Fee-for-Service Plans / Q000458:organization & administration; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D055361:Multilevel Analysis; D009864:Ontario; D011320:Primary Health Care / Q000458:organization & administration*; D011795:Surveys and Questionnaires