Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Master of Science

Program

Epidemiology and Biostatistics

Supervisor

Mathews, Maria

Abstract

Comprehensiveness represents medical care provided across settings and services that meets patients’ needs across life stages and clinical presentations. Yet, comprehensiveness has declined over time as family physicians (FPs) narrow their scopes of practice. This thesis aims to describe comprehensiveness among FPs examining changes over time and physician-and clinic-related predictors of comprehensiveness. Cross-sectional and longitudinal analyses were conducted on the 2009, 2014, and 2020 waves of the Western Family Medicine Resident Follow-Up Survey. Based on an OfficeCare+ definition of comprehensiveness, an average 76% of FPs practiced comprehensively across surveys and stayed comprehensive. FPs who had completed a PGY3 program were less likely to be comprehensive than FPs who had not. FPs in capitation-based funding models were more likely to be comprehensive than FPs in fee-for-service funding models. Stratification by urban and rural practice location uncovered differences in comprehensiveness. Findings provide insight on health system management and physician workforce planning.

Summary for Lay Audience

In Canada, family physicians are the leading providers of primary care. They are the first point-of-contact for health services, accountable for the needs of the people they serve. Their practices center around four core principles: first contact access, continuity, coordination, and comprehensiveness. Yet, of these, comprehensiveness is the least studied and prioritized. Comprehensiveness represents medical care for people across all ages, life stages, and presentations of disease. It can be measured as the range of services and sites where services are provided in primary care. Generally, comprehensiveness means meeting the majority of people’s needs. However, comprehensiveness is declining as many family physicians choose to narrow the services and settings in which they provide services.

This thesis aims to describe comprehensiveness among family physicians and how comprehensiveness has changed over time. Moreover, this thesis explores physician and clinic-related factors that contribute to comprehensive practices. Surveys were mailed out to family physicians who had completed their family medicine residency training at Western between 1985­–2017, including international medical graduates and those completing a third year. We conducted secondary analyses on the 2009, 2014, and 2020 waves of the Western Family Medicine Resident Follow-Up Survey.

Based on an OfficeCare+ definition of comprehensiveness, most Western family physicians practiced comprehensively across surveys and stayed comprehensive over time. Family physicians who completed a PGY3 program, an extra year of specialized family medicine residency training, were less likely to be comprehensive family physicians than those who had not completed a PGY3 program. Moreover, the ways family physicians were paid influenced comprehensiveness. Family physicians in capitation-based funding models were more likely to be comprehensive than family physicians in fee-for-service funding models. When we separated family physicians by urban and rural practice location, we also found differences in comprehensiveness.

Comprehensiveness matters for patients and health services to achieve high value care. Comprehensiveness is associated with decreases in the fragmentation and costs of care, producing better health and improved equity. This study provides insight on health system management and physician workforce planning.

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

Available for download on Wednesday, January 01, 2025

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