ArticleCanadian family physician Medecin de famille canadien2026
Factors associated with patient use of primary care outside of their capitated primary care enrolment group: Multilevel analysis.
Article in Canadian family physician Medecin de famille canadien, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo determine which patient, physician, physician-group, and geographic factors influence the likelihood of health care visits to family physicians (FPs) outside of patients' enrolling physician groups.
designCross-sectional analysis using administrative health data. A multilevel logistic regression model was used to determine the probability of outside use based on a set of observable factors at the patient and physician-group levels, accounting for the variation attributable to the patient, physician, physician-group, and geographic levels.
settingOntario.
participantsPatients enrolled in family health organizations (FHOs) during the study period from April 1, 2018, to March 31, 2019.
main outcome measuresOutside use, defined as an encounter with an FP outside of the patient's enrolling physician group who submitted an Ontario Health Insurance Plan fee code in the FHO core primary care services.
resultsPatient-level factors explained 83.7% of the variation in outside use probability. Physician- and physician-group-level variations each explained less than 2% of outside use probability, while 14.2% was explained at the physician-group geographic level. Patient-level factors associated with outside use included age (oldest versus [vs] youngest cohort, odds ratio [OR]=0.44, 95% confidence interval [CI] 0.42 to 0.45); female sex (OR=1.21, 95% CI 1.19 to 1.23); expected relative health care costs (highest vs lowest complexity score quintile, OR=3.65, 95% CI 3.53 to 3.79); distance from enrolled physician group (longest vs shortest travel time, OR=2.10, 95% CI 2.01 to 2.19); and FP to population need ratio (highest vs lowest quintile, OR=1.71, 95% CI 1.62 to 1.80). Statistically significant physician-group-level variables (
conclusionPhysician- or physician-group-level policy options for effectively reducing outside use may include increasing group size to more than 5 and increasing weekend and holiday days worked per patient and after-hours care. However, because outside use is primarily explained by variations at the patient level, other innovative policy options may need to be implemented to improve care continuity.
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