title: Is Team-Based Primary Care Associated with Less Access Problems and Self-Reported Unmet Need in Canada?
abstract: As in many jurisdictions, the delivery of primary care in Canada is being transformed from solo practice to team-based care. In Canada, team-based primary care involves general practitioners working with nurses or other health care providers, and it is expected to improve equity in access to care. This study examined whether team-based care is associated with fewer access problems and less unmet need and whether socioeconomic gradients in access problems and unmet need are smaller in team-based care than in non-team-based care. Data came from the 2008 Canadian Survey of Experiences with Primary Health Care (sample size: 10,858). We measured primary care type as team-based or non-team-based and socioeconomic status by income and education. We created four access problem variables and four unmet need variables (overall and three specific components). For each, we ran separate logistic regression models to examine their associations with primary care type. We examined socioeconomic gradients in access problems and unmet need stratified by primary care type. Primary care type had no statistically significant, independent associations with access problems or unmet need. Among those with non-team-based care, a statistically significant education gradient for overall access problems existed, whereas among those with team-based care, no statistically significant socioeconomic gradients existed.
authors.affiliation: 1 Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Austin
authors.initials: A
authors.lastname: Zygmunt
authors.affiliation: 2 Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Asada
authors.affiliation: 3 Department of Family Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Frederick
authors.initials: F
authors.lastname: Burge
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002170:Canada; D002908:Chronic Disease; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D057566:Self Report; D012737:Sex Factors; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Canada; access to care; team-based primary care; unmet need