Predictors of Up-to-Date Colorectal Cancer Screening and Patient-Centred Care in Family Health Team Primary Care Practices
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Introduction: The Family Health Team (FHT) is an Ontario-based initiative that aims to provide primary care through multidisciplinary teams of healthcare professionals. Little is known about variability between and within teams, and whether certain organizational characteristics are associated with quality of patient care. Objectives: (1) To describe FHT-level organizational characteristics for seven FHTs in Southeastern Ontario. (2) To examine the role of physician-level organizational characteristics in predicting: (a) Up-to-date colorectal cancer screening and (b) episodic patient-centredness for patients within seven FHTs in Southeastern Ontario. Methods: This study employed linked datasets obtained from surveys of seven FHTs, 115 health care providers (including 41 family physicians) and 998 patients, as well as a chart abstraction. Statistical analyses included performing subject-specific multilevel multivariate modeling. Results: (1) FHTs varied on characteristics including length of time of practice operation, number of patients, existence of personnel policies, team makeup and team climate. (2) (a) Patient uptake of colorectal cancer screening was associated with average duration of regular routine visit OR=0.88 per minute (95% CI 0.83-0.94), patient gender male OR=2.00 (95% CI 1.22-3.28), general checkup in past 2 years OR=9.03 (95% CI 5.18-15.73), travel time less than or equal to 20 minutes OR=1.53 (95% CI 0.94-2.48), and usually see regular provider OR=0.40 (95% CI 0.19–0.87). Patient uptake or physician recommendation of colorectal cancer screening demonstrated similar associations, with the absence of travel time and the addition of team climate (family physician and nurses) OR=5.88 (95% CI 0.98-35.24), patient occupational status employed vs. retired OR=0.49 (95% CI 0.23–1.02), patient occupational status not employed vs. retired OR=0.42 (95% CI 0.16–1.13), and patient smoking status never vs. ever OR=0.59 (95% CI 0.37–0.96). (b) Episodic patient-centredness was associated with patient born in Canada 0.1119 (95% CI -0.0040-0.2278), seeing regular healthcare provider today 0.1449 (95% CI 0.0426-0.2472), physician-patient gender concordance 0.1019 (95% CI 0.0128-0.1910), and appointment length 0.006929 (95% CI 0.003554-0.010304). Discussion: Further research is needed to examine predictors of the quality of patient care at the practice, physician and patient levels.