RT Journal Article
SR Electronic
T1 Which primary Care Physicians Deliver Home Visits to Their Dying Patients in Ontario? A Retrospective Cohort Study
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 3559
DO 10.1370/afm.21.s1.3559
VO 21
IS Supplement 1
A1 Scott, Mary
A1 Ponka, David
A1 Tanuseputro, Peter
A1 Pugliese, Michael
A1 Hsu, Amy
A1 Siu, Henry
A1 Isenberg, Sarina
A1 Imsirovic, Haris
YR 2023
UL http://www.annfammed.org/content/21/Supplement_1/3559.abstract
AB Context: Home visits have become increasingly uncommon although evidence suggests they improve healthcare quality and reduce overall expenditures.Objective: This study identifies the number of physicians delivering home visits at patients’ end of life, describes characteristics of primary care physicians delivering end-of-life home visits, and explores associations with delivery.Study Design and Analysis: A retrospective cohort design with descriptive analysis of association between primary care physician characteristics and the propensity to deliver home visits to patients at the end of life.Setting or Dataset: Ontario, Canada using population-level health administrative data housed at ICES.Population Studied: Primary care physicians in Ontario, Canada between April 1, 2014-March 31, 2019, who were registered in the College of Physicians and Surgeons of Ontario database (CPSO) dataset on or after January 1, 1990 and as of March 31, 2016.Intervention/Instrument: Patients who were in their last year of life.Outcome Measures: Home visits deliveredResults: A total of 9,884 physicians were identified, of which 2,568 (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 (<9,000 residents) (OR 1.38 [95%CI: 1.02-1.88]) and the largest metropolitan areas (OR 1.84 [95%CI: 1.46-2.57]).Conclusions: This research demonstrates primary care physicians’ characteristics influence home visit practice patterns. Furthermore, it highlights characteristics amenable to policy or system-level changes that could increase the provision of home visits. Increasing physician home services could greatly improve the dying experience of Canadians.