title: Why Is Bigger Not Always Better in Primary Health Care Practices? The Role of Mediating Organizational Factors.
abstract: Size of primary health care (PHC) practices is often used as a proxy for various organizational characteristics related to provision of care. The objective of this article is to identify some of these organizational characteristics and to determine the extent to which they mediate the relationship between size of PHC practice and patients' experience of care, preventive services, and unmet needs. In 2010, we conducted population and organization surveys in 2 regions of the province of Quebec. We carried out multilevel linear and logistic regression analyses, adjusting for respondents' individual characteristics. Size of PHC practice was associated with organizational characteristics and resources, patients' experience of care, unmet needs, and preventive services. Overall, the larger the size of a practice, the higher the accessibility, but the lower the continuity. However, these associations faded away when organizational variables were introduced in the analysis model. This result supports the hypothesized mediating effect of organizational characteristics on relationships between practice size and patients' experience of care, preventive services, and unmet needs. Our results indicate that size does not add much information to organizational characteristics. Using size as a proxy for organizational characteristics can even be misleading because its relationships with different outcomes are highly variable.
authors.affiliation: Centre de recherche du Centre hospitalier de l'Université de Montréal, Québec, Canada Institut national de santé publique du Québec, Montréal, Canada Institut de recherche en santé publique de l'Université de Montréal, Québec, Canada Direction de santé publique du CIUSS du Centre-Est-de-l'Île-de-Montréal, Québec, Canada raynald.pineault@umontreal.ca.
authors.forename: Raynald
authors.initials: R
authors.lastname: Pineault
authors.affiliation: Centre de recherche du Centre hospitalier de l'Université de Montréal, Québec, Canada Institut de recherche en santé publique de l'Université de Montréal, Québec, Canada Direction de santé publique du CIUSS du Centre-Est-de-l'Île-de-Montréal, Québec, Canada.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Provost
authors.affiliation: Centre de recherche du Centre hospitalier de l'Université de Montréal, Québec, Canada Institut de recherche en santé publique de l'Université de Montréal, Québec, Canada Faculté des sciences infirmières de l'Université de Montréal, Québec, Canada.
authors.forename: Roxane
authors.initials: R
authors.lastname: Borgès Da Silva
authors.affiliation: Centre de recherche de l'Hôpital Charles-Lemoyne, Longueuil, Québec, Canada Département des sciences de la santé communautaire de l'Université de Sherbrooke, Québec, Canada.
authors.forename: Mylaine
authors.initials: M
authors.lastname: Breton
authors.affiliation: University of New South Wales, Sydney, Australia Bureau of Health Information, Sydney, NSW, Australia.
authors.forename: Jean-Frédéric
authors.initials: JF
authors.lastname: Levesque
mesh_terms: D039602:After-Hours Care; D003266:Continuity of Patient Care; D003299:Cooperative Behavior; D019937:Diagnostic Techniques and Procedures; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D007256:Information Systems; D008511:Medicine; D009740:Nursing Staff / Q000458:organization & administration; D017060:Patient Satisfaction; D011314:Preventive Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D011364:Professional Practice / Q000458:organization & administration / Q000706:statistics & numerical data*; D011792:Quebec; D012959:Socioeconomic Factors
keywords: experience of care; organizational characteristics; preventive care; primary care; size of PHC practice; unmet needs
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