全部 标题 作者
关键词 摘要

OALib Journal期刊
ISSN: 2333-9721
费用:99美元

查看量下载量

相关文章

更多...

Primary Healthcare Solo Practices: Homogeneous or Heterogeneous?

DOI: 10.1155/2014/373725

Full-Text   Cite this paper   Add to My Lib

Abstract:

Introduction. Solo practices have generally been viewed as forming a homogeneous group. However, they may differ on many characteristics. The objective of this paper is to identify different forms of solo practice and to determine the extent to which they are associated with patient experience of care. Methods. Two surveys were carried out in two regions of Quebec in 2010: a telephone survey of 9180 respondents from the general population and a postal survey of 606 primary healthcare (PHC) practices. Data from the two surveys were linked through the respondent’s usual source of care. A taxonomy of solo practices was constructed ( ), using cluster analysis techniques. Bivariate and multilevel analyses were used to determine the relationship of the taxonomy with patient experience of care. Results. Four models were derived from the taxonomy. Practices in the “resourceful networked” model contrast with those of the “resourceless isolated” model to the extent that the experience of care reported by their patients is more favorable. Conclusion. Solo practice is not a homogeneous group. The four models identified have different organizational features and their patients’ experience of care also differs. Some models seem to offer a better organizational potential in the context of current reforms. 1. Introduction Recent reforms in healthcare delivery have greatly modified primary care medical practice, by fostering the grouping of physicians into more complex and large organizations [1]. Consequently, the number of solo practices has decreased considerably. In Canada, the percentage of physicians in solo practice was estimated at 51.8% in 1986-1987 [2]. In 1997, this figure had decreased to 31.3% and in 2010 to only 22.3%. Male and older physicians were proportionally overrepresented in this mode of practice [2–5]. This trend has also been observed in other countries, namely, in The Netherlands where the percentage of solo practitioners decreased from 67.4% in 1990 to 39.1% in 2010, while group practice increased proportionally [6, 7]. A decrease in small practices has also been reported in the UK [8]. Echoing this trend, solo medical practice has been considered obsolete [9]. However, analysts are not unanimous, as many contend that small practices, including solo practices, must be maintained [10]. Solo practice is cherished by many doctors, because it fosters greater professional autonomy, a core value of the medical profession [1, 11]. Networking, either through formal collaborative agreement or patients’ referral and affiliation with other practice

References

[1]  P. C. Alguire, “Types of practices,” American College of Physician, 2013, http://www.acponline.org/residents_fellows/career_counseling/types.htm.
[2]  A. P. Williams, E. Vayda, H. M. Stevenson, M. Burke, and K. D. Pierre, “A typology of medical practice organization in Canada. Data from a national survey of physicians,” Medical Care, vol. 28, no. 11, pp. 995–1004, 1990.
[3]  A. Safarov, National Family Physician Workforce Survey: Summary Report 1997, College of Family Physicians of Canada, Mississauga, Canada, 2010.
[4]  N. P. S. Collaborative, National Physicians Survey 2010, Canadian Medical Association, The College of Family Physicians of Canada, The Royal College of Physicians of Canada, Mississauga, Canada, 2010.
[5]  I. Savard and J. Rodrigue, “La pratique professionnelle des médecins de famille au Québec et au Canada,” Le Médecin du Québec, vol. 36, no. 11, pp. 103–108, 2001.
[6]  M. Wensing, P. Vedsted, J. Kersnik et al., “Patient satisfaction with availability of general practice: an international comparison,” International Journal for Quality in Health Care, vol. 14, no. 2, pp. 111–118, 2002.
[7]  M. S. Faber, personal communication, 2013.
[8]  J. Smith, H. Holder, N. Edwards, et al., “Securing the future of general practice: new models of primary care,” Tech. Rep., The Nuffield trust and The King's Fund, London, UK, 2013.
[9]  J. Lubell, “Lawmakers warned of demise of solo medical practices,” American Medical News, 2012, http://www.amednews.com/article/20120730/government/307309948/6/.
[10]  L. Douglas, “Solo practice: the way of the future,” Family Practice Management, vol. 5, no. 2, pp. 16–23, 2003.
[11]  R. R. Bauman, “Better off alone? Why physicians don't merge,” Journal of Medical Practice Management, vol. 23, no. 2, pp. 75–79, 2007.
[12]  F. Goulet, E. Hudon, R. Gagnon, E. Gauvin, F. Lemire, and I. Arsenault, “Effect on continuing professional development on clinical performance: results of a study involving family practitioners in Quebec,” Canadian Family Physician, vol. 59, no. 5, pp. 518–525, 2013.
[13]  E. Vayda, “Physicians in health care management: 5. Payment of physicians and organization of medical services,” Canadian Medical Association Journal, vol. 150, no. 15, pp. 1583–1588, 1994.
[14]  C. Rivet, B. Ryan, and M. Stewart, “Hands on: is there an association between doing procedures and job satisfaction?” Canadian Family Physician Médecin de Famille Canadien, vol. 53, no. 1, pp. 92–93, 2007.
[15]  H. R. Rubin, B. Gandek, W. H. Rogers, M. Kosinski, C. A. McHorney, and J. E. Ware Jr., “Patients' ratings of outpatient visits in different practice settings: results from the medical outcomes study,” Journal of the American Medical Association, vol. 270, no. 7, pp. 835–840, 1993.
[16]  R. Pineault, J. F. Levesque, D. Roberge, M. Hamel, P. Lamarche, and J. Haggerty, “L’accessibilité et la continuité des services de santé: une étude sur la première ligne au Québec,” Research report presented to the Canadian Institutes of Health Reseach and the Canadian Health Services Research Foundation, Direction de santé publique de l'Agence de la santé et des services sociaux de Montréal, Institut national de santé publique, Centre de recherche de l'H?pital Charles LeMoyne, Montréal, Canada, 2008.
[17]  C. Bernard, “Pas d’agisme au Collège,” Le Collège, vol. 52, no. 3, p. 3, 2012.
[18]  J. Rodwell and A. Gulyas, “A taxonomy of primary health care practices: an avenue for informing management and policy implementation,” Australian Journal of Primary Health, vol. 19, no. 3, pp. 236–243, 2012.
[19]  P. A. Lamarche, R. Pineault, J. Haggerty, M. Hamel, J.-F. Levesque, and J. Gauthier, “The experience of primary health care users: a rural-urban paradox,” Canadian Journal of Rural Medicine, vol. 15, no. 2, pp. 61–66, 2010.
[20]  R. Geneau, P. Lehoux, R. Pineault, and P. A. Lamarche, “Primary care practice à la carte among GPs: using organizational diversity to increase job satisfaction,” Family Practice, vol. 24, no. 2, pp. 138–144, 2007.
[21]  J. F. Levesque, R. Pineault, S. Provost, et al., “Assessing the evolution of primary healthcare organizations and their performance (2005–2010) in two regions of Québec province: Montréal and Montérégie,” BMC Family Practice, vol. 1, no. 11, pp. 95–107, 2010.
[22]  O. Lemoine, B. Simard, S. Provost, J. F. Levesque, R. Pineault, and P. Tousignant, “Rapport méthodologique de l'enquête populationnelle sur l'expérience de soins à Montréal et en Montérégie,” Direction de santé publique de l’Agence de la santé et des services sociaux de Montréal, Institut national de santé publique du Québec/Direction de l'analyse et de l'évaluation des systèmes de soins et services, Montréal, Canada, 2011.
[23]  A. Prud’homme, R. Pineault, A. Couture, R. Borgès Da Silva, J. F. Levesque, and P. Tousignant, “Rapport méthodologique de l’enquête organisationnelle à Montréal et en Montérégie,” Direction de santé publique de l'Agence de la santé et des services sociaux de Montréal, Institut national de santé publique du Québec/Direction de l'analyse et de l'évaluation des systèmes de soins et services, Montréal, Canada, 2012.
[24]  D. Haziza, “Imputation and inference in the presence of missing data,” in Sample Surveys: Design, Methods and Applications, D. Pfeffermann and C. R. Rao, Eds., vol. 29 of Handbook of Statistics, North Holland, The Netherlands, 2009.
[25]  R. Pineault, J. F. Levesque, S. Provost, et al., “L’évolution de l’organisation et de la performance des services de première ligne (2005–2010) dans deux régions du Québec: montréal et Montérégie: population questionnaire,” Direction de santé publique de l’Agence de la santé et des services sociaux de Montréal, Institut national de santé publique du Québec/Direction de l'analyse et de l'évaluation des systèmes de soins et services, Montréal, Canada, 2010.
[26]  D. G. Safran, M. Kosinski, A. R. Tarlov et al., “The primary care assessment survey: tests of data quality and measurement performance,” Medical Care, vol. 36, no. 5, pp. 728–739, 1998.
[27]  L. Shi, B. Starfield, and J. Xu, “Validating the adult primary care assessment tool,” Journal of Family Practice, vol. 50, no. 2, pp. 161–175, 2001.
[28]  J. L. Haggerty, F. Burge, M.-D. Beaulieu et al., “Validation of instruments to evaluate primary healthcare from the patient perspective: overview of the method,” Healthcare Policy, vol. 7, pp. 31–46, 2011.
[29]  J. L. Haggerty, J.-F. Lévesque, D. A. Santor et al., “Accessibility from the patient perspective: comparison of primary healthcare evaluation instruments,” Healthcare Policy, vol. 7, pp. 94–107, 2011.
[30]  A. Dubé-Linteau, R. Pineault, J. F. Levesque, C. Lecours, and M. E. Tremblay, Enquête Québécoise Sur L'expérience de Soins 2010-2011. Le médecin De famille et L'endroit habituel de Soins: Regard Sur L'expérience Vécue Par Les Québécois, vol. 2, Institut de la statistique du Québec, Québec, Canada, 2013.
[31]  A. Diamantopoulos and H. M. Winklhofer, “Index construction with formative indicators: an alternative to scale development,” Journal of Marketing Research, vol. 38, no. 2, pp. 269–277, 2001.
[32]  K. A. Bollen and S. Bauldry, “Three Cs in measurement models: causal indicators, composite indicators, and covariates,” Psychological Methods, vol. 16, no. 3, pp. 265–284, 2011.
[33]  R. Pineault, J. F. Levesque, M. Hamel, et al., “L’évolution de l’organisation et de la performance des services de première ligne (2005–2010) dans deux régions du Québec: montréal et Montérégie: organizational questionnaire,” Direction de santé publique de l’Agence de la santé et des services sociaux de Montréal, Institut national de santé publique du Québec/Direction de l'analyse et de l'évaluation des systèmes de soins et services, Montréal, Canada, 2010.
[34]  J. Haggerty, R. Pineault, M. D. Beaulieu, et al., “Accessibility and continuity of primary care in Quebec,” Report to the Canadian Health Services Research Foundation, Ottawa, Canada, 2004.
[35]  A. Gauthier, évaluation de L’implantation et des Effets des Premiers Groupes de Médecine de Famille, Ministère de la Santé et des Services Sociaux du Québec, Québec, Canada, 2008.
[36]  M. D. Beaulieu, J. L. Denis, D. D’Amour, et al., Implementing Family Medicine Groups: The Challenge in the Reorganization of Practice and Interprofessional Collaboration-Case Study of Five FMGs in the First Wave of Québec FMGs, Doctor Sadok Besrour Chair, Université de Montréal, Québec, Canada, 2006.
[37]  CIHI, Organizational Attributes of Primary Health Care Survey, The Canadian Institute for Health Information, Ottawa, Canada, 2013.
[38]  L. Lebart, “Complementary use of correspondence analysis and cluster analysis,” in Correspondence Analysis in the Social Sciences, M. J. Greenacre and J. Blasius, Eds., Academic Press, San Diego, Calif, USA, 1994.
[39]  M. J. Greenacre and J. Blasius, “Multiple correspondence analysis,” in Multiple Correspondence Analysis and Related Methods Statistic in the Social and Behavioral Sciences Series, M. J. Greenacre and J. Blasius, Eds., Chapman & Hall/CRC, Boca Raton, Fla, USA, 2006.
[40]  R. Borgès Da Silva, R. Pineault, M. Hamel, J. F. Levesque, D. Roberge, and P. Lamarche, “Constructing taxonomies to identify distinctive forms of primary healthcare organizations,” ISRN Family Medicine, vol. 2013, 11 pages, 2013.
[41]  L. Lebart, A. Morineau, and M. Piron, “Analyse de correspondances multiples,” in Statistique Exploratoire Multidimensionnelle, Dunod, France, 3rd edition, 2000.
[42]  A. M. Liebetrau, in Cramer’s Contingency Coefficient Measures of Association, vol. 32, Sage, Thousand Oaks, Calif, USA, 1983.
[43]  B. Hutchison, J.-F. Levesque, E. Strumpf, and N. Coyle, “Primary health care in Canada: systems in motion,” Milbank Quarterly, vol. 89, no. 2, pp. 256–288, 2011.
[44]  M. P. Pomey, E. Martin, and P. G. Forest, “Quebec’s Family medicine groups: innovation and compromise in the reform of front-line care,” Canadian Political Science Review, vol. 3, no. 4, pp. 31–46, 2009.
[45]  A. Couture, R. Pineault, A. Prud’homme, et al., “Rapport descriptif de l’enquête organisationnelle pour la région de la Montérégie,” Direction de santé publique de l’Agence de la santé et des services sociaux de Montréal, Institut national de santé publique du Québec/Direction de l'analyse et de l'évaluation des systèmes de soins et services, Québec, Canada, 2012.
[46]  R. Pineault, A. Couture, A. Prud’homme, et al., “Rapport descriptif de l’enquête organisationnelle pour la région de Montréal,” Direction de santé publique de l’Agence de la santé et des services sociaux de Montréal, Institut national de santé publique du Québec/Direction de l'analyse et de l'évaluation des systèmes de soins et services, Montréal, Canada, 2012.

Full-Text

Contact Us

service@oalib.com

QQ:3279437679

WhatsApp +8615387084133