Sandra Peterson - Academia.edu (original) (raw)

Papers by Sandra Peterson

Research paper thumbnail of SARS-CoV-2 testing and COVID-19 related primary care use among people with citizenship, permanent residency, and temporary immigration status in British Columbia: Cross-sectional analysis of population-based administrative data

medRxiv (Cold Spring Harbor Laboratory), Nov 9, 2021

doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by pee... more doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. Acknowledgements: We wish to acknowledge community partners who have provided advice on the project and to thank Dawn Mooney for preparation of Figures 1 and 2. Availability of data and materials The data that support the findings of this study are approved for use by data stewards and accessed through a process managed by Population Data BC. The data sets used for this study will be archived, and requests for access to them in the context of verification of study findings can be made to PopData (https://www.popdata.bc.ca/data_access). We are not permitted to share the research extract used in this analysis with other researchers.

Research paper thumbnail of Understanding British Columbians’ experiences with primary health care : developing a sector-specific survey

This work is part of a series of activities that researchers at CHSPR undertook to support the Br... more This work is part of a series of activities that researchers at CHSPR undertook to support the British Columbia Ministry of Health and the province's health authorities in renewing PHC. At the time this work received funding, it was recognized that a PHC sector survey would be designed to reflect the features of PHC that are important to British Columbians, and be validated for use in the province.

Research paper thumbnail of Do changes in primary care service use over time differ by neighbourhood income? Population-based longitudinal study in British Columbia, Canada

International Journal for Equity in Health, Jun 7, 2022

Background: Strong primary care systems have been associated with improved health equity. Primary... more Background: Strong primary care systems have been associated with improved health equity. Primary care system reforms in Canada may have had equity implications, but these have not been evaluated. We sought to determine if changes in primary care service use between 1999/2000 and 2017/2018 differ by neighbourhood income in British Columbia. Methods: We used linked administrative databases to track annual primary care visits, continuity of care, emergency department (ED) visits, specialist referrals, and prescriptions dispensed over time. We use generalized estimating equations to examine differences in the magnitude of change by neighbourhood income quintile, adjusting for age, sex/ gender, and comorbidity, and stratified by urban/rural location of residence. We also compared the characteristics of physicians providing care to people living in low-and high-income neighbourhoods at two points in time. Results: Between 1999/2000 and 2017/8 the average number of primary care visits per person, specialist referrals, and continuity of care fell in both urban and rural settings, while ED visits and prescriptions dispensed increased. Over this period in urban settings, primary care visits, continuity, and specialist referrals fell more rapidly in low vs. high income neighbourhoods (relative change in primary care visits: Incidence Rate Ratio (IRR) 0.881, 95% CI: 0.872, 0.890; continuity: partial regression coefficient-0.92, 95% CI:-1.18,-0.66; specialist referrals: IRR 0.711, 95%CI: 0.696, 0.726), while ED visits increased more rapidly (IRR 1.06, 95% CI: 1.03, 1.09). The percentage of physicians who provide the majority of visits to patients in neighbourhoods in the lower two income quintiles declined from 30.6% to 26.3%. Conclusion: Results raise concerns that equity in access to primary care has deteriorated in BC. Reforms to primary care that fail to attend to the multidimensional needs of low-income communities may entrench existing inequities. Policies that tailor patterns of funding and allocation of resources in accordance with population needs, and that align accountability measures with equity objectives are needed as part of further reform efforts.

Research paper thumbnail of Differences in Mode Preferences, Response Rates, and Mode Effect Between Automated Email and Phone Survey Systems for Patients of Primary Care Practices: Cross-Sectional Study (Preprint)

Background: A growing number of health care practices are adopting software systems that link wit... more Background: A growing number of health care practices are adopting software systems that link with their existing electronic medical records to generate outgoing phone calls, emails, or text notifications to patients for appointment reminders or practice updates. While practices are adopting this software technology for service notifications to patients, its use for collection of patient-reported measures is still nascent. Objective: This study assessed the mode preferences, response rates, and mode effect for a practice-based automated patient survey using phone and email modalities to patients of primary care practices. Methods: This cross-sectional study analyzed responses and respondent demographics for a short, fully automated, telephone or email patient survey sent to individuals within 72 hours of a visit to their regular primary care practice. Each survey consisted of 5 questions drawn from a larger study's patient survey that all respondents completed in the waiting room at the time of their visit. Automated patient survey responses were linked to self-reported sociodemographic information provided on the waiting room survey including age, sex, reported income, and health status. Results: A total of 871 patients from 87 primary care practices in British Columbia, Ontario, and Nova Scotia, Canada, agreed to the automated patient survey and 470 patients (45.2%) completed all 5 questions on the automated survey. Email administration of the follow-up survey was preferred over phone-based administration, except among patients aged 75 years and older (P<.001). Overall, response rates for those who selected an emailed survey (369/606, 60.9%) were higher (P<.001) than those who selected the phone survey (101/265, 38.1%). This held true irrespective of age, sex, or chronic disease status of individuals. Response rates were also higher for email (range 57.4% [58/101] to 66.3% [108/163]) compared with phone surveys (range 36% [23/64] to 43% [10/23]) for all income groups except the lowest income quintile, which had similar response rates (email: 29/63, 46%; phone: 23/50, 46%) for phone and email modes. We observed moderate (range 64.6% [62/96] to 78.8% [282/358]) agreement between waiting room survey responses and those obtained in the follow-up automated survey. However, overall agreement in responses was poor (range 45.3% [43/95] to 46.2% [43/93]) for 2 questions relating to care coordination. Conclusions: An automated practice-based patient experience survey achieved significantly different response rates between phone and email and increased response rates for email as income group rose. Potential mode effects for the different survey modalities may limit multimodal survey approaches. An automated minimal burden patient survey could facilitate the integration of patient-reported outcomes into care planning and service organization, supporting the move of our primary care practices toward a more responsive, patient-centered, continual learning system. However, practices must be attentive to furthering inequities

Research paper thumbnail of Changes over time in patient visits and continuity of care among graduating cohorts of family physicians in 4 Canadian provinces

Canadian Medical Association Journal, Dec 11, 2022

Access to primary care services in Canada falls short of comparable countries. 1 Despite increasi... more Access to primary care services in Canada falls short of comparable countries. 1 Despite increasing absolute numbers of family phys icians, 2 evidence suggests that the volume of patient contacts and practice sizes are in decline, 3,4 and that practising family physicians are less likely to provide comprehensive care than in the past. 5 This has led to concerns that family physicians' practice has changed over time, with adverse effects on patients' access to care. Some have argued that recently trained physicians think more about work-life balance, are less career motivated and are less likely to engage in comprehensive and continuous family practice. 6-10 The implication is that younger family physicians work less and are less likely to be providing accessible, compre hensive care than their older colleagues. 11 We sought to measure changes in family physician practice volume and continuity of care between 1997 and 2018 using a method that considers the separate effects on service provision of individual, cohort and contextual factors. Methods Study design and setting We completed a longitudinal study of family physician practice patterns as part of a larger mixedmethods workforce study of earlycareer family physicians. 12,13 This study uses administrative health data for 4 provinces:

Research paper thumbnail of Pan-Canadian study of psychiatric care (PCPC): protocol for a mixed-methods study

BMJ Open, Jul 1, 2023

Introduction The Canadian population has poor and inequitable access to psychiatric care despite ... more Introduction The Canadian population has poor and inequitable access to psychiatric care despite a steady per-capita supply of psychiatrists in most provinces. There is some quantitative evidence that practice style and characteristics vary substantially among psychiatrists. However, how this compares across jurisdictions and implications for workforce planning require further study. A qualitative exploration of psychiatrists' preferences for practice style and the practice choices that result is also lacking. The goal of this study is to inform psychiatrist workforce planning to improve access to psychiatric care by: (1) developing and evaluating comparable indicators of supply of psychiatric care across provinces, (2) analysing variations and changes in the characteristics of the psychiatrist workforce, including demographics and practice style and (3) studying psychiatrist practice choices and intentions, and the factors that lead to these choices. Methods and analysis A cross-provincial mixedmethods study will be conducted in the Canadian provinces of British Columbia, Manitoba, Ontario and Nova Scotia. We will analyse linked-health administrative data within three of the four provinces to develop comparable indicators of supply and characterise psychiatric services at the regional level within provinces. We will use latent profile analysis to estimate the probability that a psychiatrist is in a particular practice style and map the geographical distribution of psychiatrist practices overlayed with measures of need for psychiatric care. We will also conduct in-depth, semistructured qualitative interviews with psychiatrists in each province to explore their preferences and practice choices and to inform workforce planning. Ethics and dissemination This study was approved by Ontario Tech University Research Ethics Board (16637 and 16795) and institutions affiliated with the study team. We built a team comprising experienced researchers, psychiatrists, medical educators and policymakers in mental health services and workforce planning to disseminate knowledge that will support effective human resource policies to improve access to psychiatric care in Canada.

Research paper thumbnail of Engaging im/migrant communities in cross-sectoral health and immigration data linkage research

International Journal for Population Data Science, Aug 25, 2022

Research paper thumbnail of Growing inequities by immigration group among older adults: Population-based analysis of access to primary care and return to in-person visits during the COVID-19 pandemic in British Columbia, Canada

BackgroundThe onset of the COVID-19 pandemic drove a rapid and widespread shift to virtual care, ... more BackgroundThe onset of the COVID-19 pandemic drove a rapid and widespread shift to virtual care, followed by a gradual return to in-person visits. Virtual visits may offer more convenient access to care for some, but others may experience challenges accessing care virtually, and some medical needs must be met in-person. Experiences of the shift to virtual care and benefits of in-person care may vary by immigration experience (immigration status and duration), official language level, and age. We examined use of virtual care and return to in-person visits in the Canadian province of British Columbia (BC), comparing patterns by age and across immigration groups, including length of time in Canada and language level (English) at time of arrival.MethodsWe used linked administrative health and immigration data to examine total primary care visits (virtual or in-person) and return to in-person visits during the COVID-19 pandemic (2019/20-2021/2) in BC. We examined the proportion of people...

Research paper thumbnail of Changes in comprehensiveness of services delivered by Canadian family physicians

Canadian Family Physician, Aug 1, 2023

Objective To describe changes in the comprehensiveness of services delivered by family physicians... more Objective To describe changes in the comprehensiveness of services delivered by family physicians across service settings and service areas in 4 Canadian provinces, to identify which settings and areas have changed the most, and to compare the magnitude of changes by physician characteristics. Design Descriptive analysis of province-wide, population-based billing data linked to population and physician registries.

Research paper thumbnail of Primary care for individuals with serious mental illness (PriSMI): protocol for a convergent mixed methods study

BMJ Open

IntroductionPeople with serious mental illness (SMI) have poor health outcomes, in part because o... more IntroductionPeople with serious mental illness (SMI) have poor health outcomes, in part because of inequitable access to quality health services. Primary care is well suited to coordinate and manage care for this population; however, providers may feel ill-equipped to do so and patients may not have the support and resources required to coordinate their care. We lack a strong understanding of prevention and management of chronic disease in primary care among people with SMI as well as the context-specific barriers that exist at the patient, provider and system levels. This mixed methods study will answer three research questions: (1) How do primary care services received by people living with SMI differ from those received by the general population? (2) What are the experiences of people with SMI in accessing and receiving chronic disease prevention and management in primary care? (3) What are the experiences of primary care providers in caring for individuals with SMI?Methods and a...

Research paper thumbnail of Patient characteristics associated with enrolment under voluntary programs implemented within fee-for-service systems in British Columbia and Quebec: a cross-sectional study

CMAJ Open, 2022

Background: There is a paucity of information on patient characteristics associated with enrolmen... more Background: There is a paucity of information on patient characteristics associated with enrolment under voluntary programs (e.g. incentive payments) implemented within fee-for-service systems. We explored patient characteristics associated with enrolment under these programs in British Columbia and Quebec. Methods: We used linked administrative data and a cross-sectional design to compare people aged 40 years or more enrolled under voluntary programs to those who were eligible but not enrolled. We examined 2 programs in Quebec (enrolment of vulnerable patients with qualifying conditions [implemented in 2003] and enrolment of the general population [2009]) and 3 in BC (Chronic disease incentive [2003], Complex care incentive [2007] and enrolment of the general population [A GP for Me, 2013]). We used logistic regression to estimate the odds of enrolment by neighbourhood income, rural versus urban residence, previous treatment for mental illness, previous treatment for substance use disorder and use of health care services before program implementation, controlling for characteristics linked to program eligibility. Results: In Quebec, we identified 1 569 010 people eligible for the vulnerable enrolment program (of whom 505 869 [32.2%] were enrolled within the first 2 yr of program implementation) and 2 394 923 for the general enrolment program (of whom 352 380 [14.7%] were enrolled within the first 2 yr). In BC, we identified 133 589 people eligible for the Chronic disease incentive, 47 619 for the Complex care incentive and 1 349 428 for A GP for Me; of these, 60 764 (45.5%), 28 273 (59.4%) and 1 066 714 (79.0%), respectively, were enrolled within the first 2 years. The odds of enrolment were higher in higher-income neighbourhoods for programs without enrolment criteria (adjusted odds ratio [OR] comparing highest to lowest quintiles 1.21 [95% confidence interval (CI) 1.20-1.23] in Quebec and 1.67 [95% CI 1.64-1.69] in BC) but were similar across neighbourhood income quintiles for programs with health-related eligibility criteria. The odds of enrolment by urban versus rural location varied by program. People treated for substance use disorders had lower odds of enrolment in all programs (adjusted OR 0.60-0.72). Compared to people eligible but not enrolled, those enrolled had similar or higher numbers of primary care visits and longitudinal continuity of care in the year before enrolment. Interpretation: People living in lower-income neighbourhoods and those treated for substance use disorders were less likely than people in higher-income neighbourhoods and those not treated for such disorders to be enrolled in programs without health-related eligibility criteria. Other strategies are needed to promote equitable access to primary care.

Research paper thumbnail of Advancing virtual primary care for people with opioid use disorder (VPC OUD): a mixed-methods study protocol

BMJ Open, Sep 1, 2022

Introduction The emergence of COVID-19 introduced a dual public health emergency in British Colum... more Introduction The emergence of COVID-19 introduced a dual public health emergency in British Columbia, which was already in the fourth year of its opioid-related overdose crisis. The public health response to COVID-19 must explicitly consider the unique needs of, and impacts on, communities experiencing marginalisation including people with opioid use disorder (PWOUD). The broad move to virtual forms of primary care, for example, may result in changes to healthcare access, delivery of opioid agonist therapies or fluctuations in co-occurring health problems that are prevalent in this population. The goal of this mixed-methods study is to characterise changes to primary care access and patient outcomes following the rapid introduction of virtual care for PWOUD. Methods and analysis We will use a fully integrated mixed-methods design comprised of three components: (a) qualitative interviews with family physicians and PWOUD to document experiences with delivering and accessing virtual visits, respectively; (b) quantitative analysis of linked, population-based administrative data to describe the uptake of virtual care, its impact on access to services and downstream outcomes for PWOUD; and (c) facilitated deliberative dialogues to co-create educational resources for family physicians, PWOUD and policymakers that promote equitable access to high-quality virtual primary care for this population. Ethics and dissemination Approval for this study has been granted by Research Ethics British Columbia. We will convene PWOUD and family physicians for deliberative dialogues to co-create educational materials and policy recommendations based on our findings. We will also disseminate findings via traditional academic outputs such as conferences and peer-reviewed publications.

Research paper thumbnail of Changing Practice Patterns Among Canadian Primary Care Physicians: Cross-Provincial Analysis of Linked Health Data

International Journal of Population Data Science

IntroductionCanadians report persistent problems accessing primary care despite an increasing per... more IntroductionCanadians report persistent problems accessing primary care despite an increasing per-capita supply of primary care physicians (PCPs). There is speculation that PCPs, especially those early in their careers, may be working less and/or choosing to practice in focused clinical areas rather than comprehensive family medicine. Objectives and ApproachOur objectives were to compare practice patterns among early-career (<10 years in practice) and established (10+ years) PCPs and to determine if any changes over time reflect cohort effects (attributes unique to recent cohorts of PCPs), or period effects (changes over time across all PCPs). We accessed linked population and physician registry data, physician billing data, hospital discharge records, and vital statistics in each of three Canadian provinces from 1996/7 to 2017/8. Physician fee schedules are negotiated separately by province which means that while fields capturing service dates, dollars billed, and diagnosis code...

Research paper thumbnail of Patient experiences with outpatient cancer care in British Columbia, 2012/13

Research paper thumbnail of SARS-CoV-2 testing and COVID-19–related primary care use among people with citizenship, permanent residency, and temporary immigration status: an analysis of population-based administrative data in British Columbia

Canadian Journal of Public Health

Objectives Having temporary immigration status affords limited rights, workplace protections, and... more Objectives Having temporary immigration status affords limited rights, workplace protections, and access to services. There is not yet research data on impacts of the COVID-19 pandemic for people with temporary immigration status in Canada. Methods We use linked administrative data to describe SARS-CoV-2 testing, positive tests, and COVID-19 primary care service use in British Columbia from January 1, 2020 to July 31, 2021, stratified by immigration status (citizen, permanent resident, temporary resident). We plot the rates of people tested and confirmed positive for COVID-19 by week from April 19, 2020 to July 31, 2021 across immigration groups. We use logistic regression to estimate adjusted odds ratios of a positive SARS-CoV-2 test, access to testing, and primary care among people with temporary status or permanent residency, compared with people who hold citizenship. Results A total of 4,146,593 people with citizenship, 914,089 people with permanent residency, and 212,215 people...

Research paper thumbnail of Patient experiences with ambulatory cancer care in British Columbia, 2005/06

Columbia (BC), a Patient Satisfaction Steering Committee has undertaken to learn and share inform... more Columbia (BC), a Patient Satisfaction Steering Committee has undertaken to learn and share information about the experiences that BC residents have with health care they receive in the province. In late 2006, that Steering Committee engaged our team to: (a) assist them in portraying the results of their work in the area of ambulatory cancer care, and (b) conduct work in 2007 to glean additional insights from survey data collected under a contract with NRC+Picker (www.nrcpicker.com).

Research paper thumbnail of Development and evaluation of comparable primary care indicators from administrative health data across three Canadian provinces

International Journal of Population Data Science, 2020

Introduction Across the world, data sources to support learning in primary care (PC) lag far behi... more Introduction Across the world, data sources to support learning in primary care (PC) lag far behind that of acute care. Having comparable data sources across jurisdictions is essential for scaling and spreading healthcare learnings. Objectives The purpose of this work was to 1) identify and develop indicators of PC performance using administrative data and 2) examine the comparability of indicator definitions across three Canadian provinces (Nova Scotia, Ontario, British Columbia). This work is valuable for demonstrating how to arrive at comparable administrative data indicators across jurisdictions with different care patterns. Methods The TRANSFORMATION study is a multi-province Canadian study of PC that aims to improve PC performance measurement reporting. We initially compiled a list of PC performance indicators that had been used with existing administrative data. We followed and documented an iterative process to achieve comparable indicator operationalizations across the thre...

Research paper thumbnail of Use of pharmaceuticals by inflammatory bowel disease patients: a population-based study

The American Journal of Gastroenterology, 2001

In 1996 we created the population-based University of Manitoba Inflammatory Bowel Disease (IBD) D... more In 1996 we created the population-based University of Manitoba Inflammatory Bowel Disease (IBD) Database. In 1994, Manitoba Health established the Drug Program Information Network (DPIN), which identified all ambulatory prescription drugs dispensed to each individual resident of the province. All residents have a personal health identification number, and use of this number allowed linkage of the IBD database with the DPIN database. Our aim was to use the linkage of these databases to describe prescription drug use by patients with IBD in Manitoba in 1997. METHODS: We analyzed all prescriptions and costs for fiscal year 1997, and stratified our analysis by age, sex, urban versus nonurban residence, income, and disease (Crohn's disease vs ulcerative colitis). We also extracted all subjects diagnosed with IBD in 1984-1987 and those diagnosed in 1994-97 and compared any differences in prescribing patterns in 1997 for these two cohorts. RESULTS: A total of 87.5% of IBD subjects received prescriptions in 1997. There was a direct, significant relationship between increasing age and number of different prescriptions per IBD drug user and total prescription costs per IBD drug user (in adults only), particularly for alimentary drugs. Female patients used a greater number of different prescriptions, but there was no difference between sexes in costs per user. Only 7.8% of patients used immunomodulatory drugs, but these accounted for the greatest cost ($1404) per user. Patients whose disease was diagnosed in 1994-1997 were significantly more likely to be prescribed oral or rectal 5-aminosalicylic acid and steroids than were those whose disease was diagnosed in 1984-1987. In addition, prescriptions for rectal 5-aminosalicylic acid were significantly increased in those patients whose diagnoses were made later over those whose diagnoses were made earlier. Male patients and Crohn's disease patients were more likely to use oral steroids and immunomodulatory medications. Based on the decade of diagnosis, there was no difference in prescribing patterns for immunomodulatory medications. CONCLUSIONS: The linkage of the University of Manitoba IBD Database and the Manitoba DPIN Database allowed a description of patterns of prescription use in a populationbased sample of IBD patients. Among the important findings are the lack of effect of gender and urban residence on prescription use in IBD patients; however the decade of diagnosis did affect prescribing patterns. Furthermore, only 7.8% overall receive immunomodulatory medications, but this was independent of the decade of diagnosis.

Research paper thumbnail of Assessing the Extent to Which Hospitals Are Used for Acute Care Purposes

Medical Care, 1999

The degree to which Manitobans were appropriately hospitalized for medical conditions was assesse... more The degree to which Manitobans were appropriately hospitalized for medical conditions was assessed using a retrospective chart review of a sample of patients in 26 hospitals. A standardized set of object-based, nondiagnostic criteria (Inter-Qual) was used by trained abstractors to assess the patient at admission and for each day of stay. A high percentage of admissions and days of care were inappropriate. Overall, 49.5% of medical patients were acute at the time of admission, 1.6% required no health care services, and 48.9% could have received care through alternate methods or facilities. Only 33.4% of the subsequent days of stay were appropriate. For patients assessed as acute at the time of admission, by the 8th day of stay, only 47% were still acute and by day 30, only 27% were acute. Patients aged 75 years or older were just as likely to be acute at the time of admission as were younger patients; however, they accounted for 54% of the days in the study, and fewer than 30% of these days were acute. Our data suggest that despite their high use of hospitals, disadvantaged groups (the poor, aboriginal Manitobans), have the same levels of appropriateness as others. We conclude that alternatives to hospital care must first be established and made known and available before a shift in health care resources can occur.

Research paper thumbnail of Using Population-Based Data to Enhance Clinical Practice Guideline Development

Medical Care, 1999

Working with the College of Physicians and Surgeons of Manitoba, and using tonsillectomies as a b... more Working with the College of Physicians and Surgeons of Manitoba, and using tonsillectomies as a basis of inquiry, MCHPE examined surgical rates and patterns of practice. This project had three major aims: to review whether current patterns of delivery provide optimal care; to enhance the development of clinical guidelines; and to inform and influence physician practice. Both a population-based method of inquiry (which permits comparisons across population groups) and a provider-based approach (which offers insights into differences in the nature of care offered by different types of hospitals and physicians) were used. Synergies between these two approaches offered useful insight into aspects of quality and efficiency of care. Consistent with other jurisdictions, there was a high degree of variability across regions. However, there were also a number of surprising findings, including high rates of surgery in females, in older children, and among residents of rural areas. Data analysis raised a number of quality-of-care issues related to small caseload volumes, performance of procedures in very young children, and patterns of postoperative care in rural hospitals. The analyses provided impetus for addressing these issues in the guideline and suggested that the target audience for intervention should be rural physicians rather than urban specialists. This project demonstrated that data analysis can provide a powerful adjunct to the development and implementation of clinical practice guidelines.

Research paper thumbnail of SARS-CoV-2 testing and COVID-19 related primary care use among people with citizenship, permanent residency, and temporary immigration status in British Columbia: Cross-sectional analysis of population-based administrative data

medRxiv (Cold Spring Harbor Laboratory), Nov 9, 2021

doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by pee... more doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. Acknowledgements: We wish to acknowledge community partners who have provided advice on the project and to thank Dawn Mooney for preparation of Figures 1 and 2. Availability of data and materials The data that support the findings of this study are approved for use by data stewards and accessed through a process managed by Population Data BC. The data sets used for this study will be archived, and requests for access to them in the context of verification of study findings can be made to PopData (https://www.popdata.bc.ca/data_access). We are not permitted to share the research extract used in this analysis with other researchers.

Research paper thumbnail of Understanding British Columbians’ experiences with primary health care : developing a sector-specific survey

This work is part of a series of activities that researchers at CHSPR undertook to support the Br... more This work is part of a series of activities that researchers at CHSPR undertook to support the British Columbia Ministry of Health and the province's health authorities in renewing PHC. At the time this work received funding, it was recognized that a PHC sector survey would be designed to reflect the features of PHC that are important to British Columbians, and be validated for use in the province.

Research paper thumbnail of Do changes in primary care service use over time differ by neighbourhood income? Population-based longitudinal study in British Columbia, Canada

International Journal for Equity in Health, Jun 7, 2022

Background: Strong primary care systems have been associated with improved health equity. Primary... more Background: Strong primary care systems have been associated with improved health equity. Primary care system reforms in Canada may have had equity implications, but these have not been evaluated. We sought to determine if changes in primary care service use between 1999/2000 and 2017/2018 differ by neighbourhood income in British Columbia. Methods: We used linked administrative databases to track annual primary care visits, continuity of care, emergency department (ED) visits, specialist referrals, and prescriptions dispensed over time. We use generalized estimating equations to examine differences in the magnitude of change by neighbourhood income quintile, adjusting for age, sex/ gender, and comorbidity, and stratified by urban/rural location of residence. We also compared the characteristics of physicians providing care to people living in low-and high-income neighbourhoods at two points in time. Results: Between 1999/2000 and 2017/8 the average number of primary care visits per person, specialist referrals, and continuity of care fell in both urban and rural settings, while ED visits and prescriptions dispensed increased. Over this period in urban settings, primary care visits, continuity, and specialist referrals fell more rapidly in low vs. high income neighbourhoods (relative change in primary care visits: Incidence Rate Ratio (IRR) 0.881, 95% CI: 0.872, 0.890; continuity: partial regression coefficient-0.92, 95% CI:-1.18,-0.66; specialist referrals: IRR 0.711, 95%CI: 0.696, 0.726), while ED visits increased more rapidly (IRR 1.06, 95% CI: 1.03, 1.09). The percentage of physicians who provide the majority of visits to patients in neighbourhoods in the lower two income quintiles declined from 30.6% to 26.3%. Conclusion: Results raise concerns that equity in access to primary care has deteriorated in BC. Reforms to primary care that fail to attend to the multidimensional needs of low-income communities may entrench existing inequities. Policies that tailor patterns of funding and allocation of resources in accordance with population needs, and that align accountability measures with equity objectives are needed as part of further reform efforts.

Research paper thumbnail of Differences in Mode Preferences, Response Rates, and Mode Effect Between Automated Email and Phone Survey Systems for Patients of Primary Care Practices: Cross-Sectional Study (Preprint)

Background: A growing number of health care practices are adopting software systems that link wit... more Background: A growing number of health care practices are adopting software systems that link with their existing electronic medical records to generate outgoing phone calls, emails, or text notifications to patients for appointment reminders or practice updates. While practices are adopting this software technology for service notifications to patients, its use for collection of patient-reported measures is still nascent. Objective: This study assessed the mode preferences, response rates, and mode effect for a practice-based automated patient survey using phone and email modalities to patients of primary care practices. Methods: This cross-sectional study analyzed responses and respondent demographics for a short, fully automated, telephone or email patient survey sent to individuals within 72 hours of a visit to their regular primary care practice. Each survey consisted of 5 questions drawn from a larger study's patient survey that all respondents completed in the waiting room at the time of their visit. Automated patient survey responses were linked to self-reported sociodemographic information provided on the waiting room survey including age, sex, reported income, and health status. Results: A total of 871 patients from 87 primary care practices in British Columbia, Ontario, and Nova Scotia, Canada, agreed to the automated patient survey and 470 patients (45.2%) completed all 5 questions on the automated survey. Email administration of the follow-up survey was preferred over phone-based administration, except among patients aged 75 years and older (P<.001). Overall, response rates for those who selected an emailed survey (369/606, 60.9%) were higher (P<.001) than those who selected the phone survey (101/265, 38.1%). This held true irrespective of age, sex, or chronic disease status of individuals. Response rates were also higher for email (range 57.4% [58/101] to 66.3% [108/163]) compared with phone surveys (range 36% [23/64] to 43% [10/23]) for all income groups except the lowest income quintile, which had similar response rates (email: 29/63, 46%; phone: 23/50, 46%) for phone and email modes. We observed moderate (range 64.6% [62/96] to 78.8% [282/358]) agreement between waiting room survey responses and those obtained in the follow-up automated survey. However, overall agreement in responses was poor (range 45.3% [43/95] to 46.2% [43/93]) for 2 questions relating to care coordination. Conclusions: An automated practice-based patient experience survey achieved significantly different response rates between phone and email and increased response rates for email as income group rose. Potential mode effects for the different survey modalities may limit multimodal survey approaches. An automated minimal burden patient survey could facilitate the integration of patient-reported outcomes into care planning and service organization, supporting the move of our primary care practices toward a more responsive, patient-centered, continual learning system. However, practices must be attentive to furthering inequities

Research paper thumbnail of Changes over time in patient visits and continuity of care among graduating cohorts of family physicians in 4 Canadian provinces

Canadian Medical Association Journal, Dec 11, 2022

Access to primary care services in Canada falls short of comparable countries. 1 Despite increasi... more Access to primary care services in Canada falls short of comparable countries. 1 Despite increasing absolute numbers of family phys icians, 2 evidence suggests that the volume of patient contacts and practice sizes are in decline, 3,4 and that practising family physicians are less likely to provide comprehensive care than in the past. 5 This has led to concerns that family physicians' practice has changed over time, with adverse effects on patients' access to care. Some have argued that recently trained physicians think more about work-life balance, are less career motivated and are less likely to engage in comprehensive and continuous family practice. 6-10 The implication is that younger family physicians work less and are less likely to be providing accessible, compre hensive care than their older colleagues. 11 We sought to measure changes in family physician practice volume and continuity of care between 1997 and 2018 using a method that considers the separate effects on service provision of individual, cohort and contextual factors. Methods Study design and setting We completed a longitudinal study of family physician practice patterns as part of a larger mixedmethods workforce study of earlycareer family physicians. 12,13 This study uses administrative health data for 4 provinces:

Research paper thumbnail of Pan-Canadian study of psychiatric care (PCPC): protocol for a mixed-methods study

BMJ Open, Jul 1, 2023

Introduction The Canadian population has poor and inequitable access to psychiatric care despite ... more Introduction The Canadian population has poor and inequitable access to psychiatric care despite a steady per-capita supply of psychiatrists in most provinces. There is some quantitative evidence that practice style and characteristics vary substantially among psychiatrists. However, how this compares across jurisdictions and implications for workforce planning require further study. A qualitative exploration of psychiatrists' preferences for practice style and the practice choices that result is also lacking. The goal of this study is to inform psychiatrist workforce planning to improve access to psychiatric care by: (1) developing and evaluating comparable indicators of supply of psychiatric care across provinces, (2) analysing variations and changes in the characteristics of the psychiatrist workforce, including demographics and practice style and (3) studying psychiatrist practice choices and intentions, and the factors that lead to these choices. Methods and analysis A cross-provincial mixedmethods study will be conducted in the Canadian provinces of British Columbia, Manitoba, Ontario and Nova Scotia. We will analyse linked-health administrative data within three of the four provinces to develop comparable indicators of supply and characterise psychiatric services at the regional level within provinces. We will use latent profile analysis to estimate the probability that a psychiatrist is in a particular practice style and map the geographical distribution of psychiatrist practices overlayed with measures of need for psychiatric care. We will also conduct in-depth, semistructured qualitative interviews with psychiatrists in each province to explore their preferences and practice choices and to inform workforce planning. Ethics and dissemination This study was approved by Ontario Tech University Research Ethics Board (16637 and 16795) and institutions affiliated with the study team. We built a team comprising experienced researchers, psychiatrists, medical educators and policymakers in mental health services and workforce planning to disseminate knowledge that will support effective human resource policies to improve access to psychiatric care in Canada.

Research paper thumbnail of Engaging im/migrant communities in cross-sectoral health and immigration data linkage research

International Journal for Population Data Science, Aug 25, 2022

Research paper thumbnail of Growing inequities by immigration group among older adults: Population-based analysis of access to primary care and return to in-person visits during the COVID-19 pandemic in British Columbia, Canada

BackgroundThe onset of the COVID-19 pandemic drove a rapid and widespread shift to virtual care, ... more BackgroundThe onset of the COVID-19 pandemic drove a rapid and widespread shift to virtual care, followed by a gradual return to in-person visits. Virtual visits may offer more convenient access to care for some, but others may experience challenges accessing care virtually, and some medical needs must be met in-person. Experiences of the shift to virtual care and benefits of in-person care may vary by immigration experience (immigration status and duration), official language level, and age. We examined use of virtual care and return to in-person visits in the Canadian province of British Columbia (BC), comparing patterns by age and across immigration groups, including length of time in Canada and language level (English) at time of arrival.MethodsWe used linked administrative health and immigration data to examine total primary care visits (virtual or in-person) and return to in-person visits during the COVID-19 pandemic (2019/20-2021/2) in BC. We examined the proportion of people...

Research paper thumbnail of Changes in comprehensiveness of services delivered by Canadian family physicians

Canadian Family Physician, Aug 1, 2023

Objective To describe changes in the comprehensiveness of services delivered by family physicians... more Objective To describe changes in the comprehensiveness of services delivered by family physicians across service settings and service areas in 4 Canadian provinces, to identify which settings and areas have changed the most, and to compare the magnitude of changes by physician characteristics. Design Descriptive analysis of province-wide, population-based billing data linked to population and physician registries.

Research paper thumbnail of Primary care for individuals with serious mental illness (PriSMI): protocol for a convergent mixed methods study

BMJ Open

IntroductionPeople with serious mental illness (SMI) have poor health outcomes, in part because o... more IntroductionPeople with serious mental illness (SMI) have poor health outcomes, in part because of inequitable access to quality health services. Primary care is well suited to coordinate and manage care for this population; however, providers may feel ill-equipped to do so and patients may not have the support and resources required to coordinate their care. We lack a strong understanding of prevention and management of chronic disease in primary care among people with SMI as well as the context-specific barriers that exist at the patient, provider and system levels. This mixed methods study will answer three research questions: (1) How do primary care services received by people living with SMI differ from those received by the general population? (2) What are the experiences of people with SMI in accessing and receiving chronic disease prevention and management in primary care? (3) What are the experiences of primary care providers in caring for individuals with SMI?Methods and a...

Research paper thumbnail of Patient characteristics associated with enrolment under voluntary programs implemented within fee-for-service systems in British Columbia and Quebec: a cross-sectional study

CMAJ Open, 2022

Background: There is a paucity of information on patient characteristics associated with enrolmen... more Background: There is a paucity of information on patient characteristics associated with enrolment under voluntary programs (e.g. incentive payments) implemented within fee-for-service systems. We explored patient characteristics associated with enrolment under these programs in British Columbia and Quebec. Methods: We used linked administrative data and a cross-sectional design to compare people aged 40 years or more enrolled under voluntary programs to those who were eligible but not enrolled. We examined 2 programs in Quebec (enrolment of vulnerable patients with qualifying conditions [implemented in 2003] and enrolment of the general population [2009]) and 3 in BC (Chronic disease incentive [2003], Complex care incentive [2007] and enrolment of the general population [A GP for Me, 2013]). We used logistic regression to estimate the odds of enrolment by neighbourhood income, rural versus urban residence, previous treatment for mental illness, previous treatment for substance use disorder and use of health care services before program implementation, controlling for characteristics linked to program eligibility. Results: In Quebec, we identified 1 569 010 people eligible for the vulnerable enrolment program (of whom 505 869 [32.2%] were enrolled within the first 2 yr of program implementation) and 2 394 923 for the general enrolment program (of whom 352 380 [14.7%] were enrolled within the first 2 yr). In BC, we identified 133 589 people eligible for the Chronic disease incentive, 47 619 for the Complex care incentive and 1 349 428 for A GP for Me; of these, 60 764 (45.5%), 28 273 (59.4%) and 1 066 714 (79.0%), respectively, were enrolled within the first 2 years. The odds of enrolment were higher in higher-income neighbourhoods for programs without enrolment criteria (adjusted odds ratio [OR] comparing highest to lowest quintiles 1.21 [95% confidence interval (CI) 1.20-1.23] in Quebec and 1.67 [95% CI 1.64-1.69] in BC) but were similar across neighbourhood income quintiles for programs with health-related eligibility criteria. The odds of enrolment by urban versus rural location varied by program. People treated for substance use disorders had lower odds of enrolment in all programs (adjusted OR 0.60-0.72). Compared to people eligible but not enrolled, those enrolled had similar or higher numbers of primary care visits and longitudinal continuity of care in the year before enrolment. Interpretation: People living in lower-income neighbourhoods and those treated for substance use disorders were less likely than people in higher-income neighbourhoods and those not treated for such disorders to be enrolled in programs without health-related eligibility criteria. Other strategies are needed to promote equitable access to primary care.

Research paper thumbnail of Advancing virtual primary care for people with opioid use disorder (VPC OUD): a mixed-methods study protocol

BMJ Open, Sep 1, 2022

Introduction The emergence of COVID-19 introduced a dual public health emergency in British Colum... more Introduction The emergence of COVID-19 introduced a dual public health emergency in British Columbia, which was already in the fourth year of its opioid-related overdose crisis. The public health response to COVID-19 must explicitly consider the unique needs of, and impacts on, communities experiencing marginalisation including people with opioid use disorder (PWOUD). The broad move to virtual forms of primary care, for example, may result in changes to healthcare access, delivery of opioid agonist therapies or fluctuations in co-occurring health problems that are prevalent in this population. The goal of this mixed-methods study is to characterise changes to primary care access and patient outcomes following the rapid introduction of virtual care for PWOUD. Methods and analysis We will use a fully integrated mixed-methods design comprised of three components: (a) qualitative interviews with family physicians and PWOUD to document experiences with delivering and accessing virtual visits, respectively; (b) quantitative analysis of linked, population-based administrative data to describe the uptake of virtual care, its impact on access to services and downstream outcomes for PWOUD; and (c) facilitated deliberative dialogues to co-create educational resources for family physicians, PWOUD and policymakers that promote equitable access to high-quality virtual primary care for this population. Ethics and dissemination Approval for this study has been granted by Research Ethics British Columbia. We will convene PWOUD and family physicians for deliberative dialogues to co-create educational materials and policy recommendations based on our findings. We will also disseminate findings via traditional academic outputs such as conferences and peer-reviewed publications.

Research paper thumbnail of Changing Practice Patterns Among Canadian Primary Care Physicians: Cross-Provincial Analysis of Linked Health Data

International Journal of Population Data Science

IntroductionCanadians report persistent problems accessing primary care despite an increasing per... more IntroductionCanadians report persistent problems accessing primary care despite an increasing per-capita supply of primary care physicians (PCPs). There is speculation that PCPs, especially those early in their careers, may be working less and/or choosing to practice in focused clinical areas rather than comprehensive family medicine. Objectives and ApproachOur objectives were to compare practice patterns among early-career (<10 years in practice) and established (10+ years) PCPs and to determine if any changes over time reflect cohort effects (attributes unique to recent cohorts of PCPs), or period effects (changes over time across all PCPs). We accessed linked population and physician registry data, physician billing data, hospital discharge records, and vital statistics in each of three Canadian provinces from 1996/7 to 2017/8. Physician fee schedules are negotiated separately by province which means that while fields capturing service dates, dollars billed, and diagnosis code...

Research paper thumbnail of Patient experiences with outpatient cancer care in British Columbia, 2012/13

Research paper thumbnail of SARS-CoV-2 testing and COVID-19–related primary care use among people with citizenship, permanent residency, and temporary immigration status: an analysis of population-based administrative data in British Columbia

Canadian Journal of Public Health

Objectives Having temporary immigration status affords limited rights, workplace protections, and... more Objectives Having temporary immigration status affords limited rights, workplace protections, and access to services. There is not yet research data on impacts of the COVID-19 pandemic for people with temporary immigration status in Canada. Methods We use linked administrative data to describe SARS-CoV-2 testing, positive tests, and COVID-19 primary care service use in British Columbia from January 1, 2020 to July 31, 2021, stratified by immigration status (citizen, permanent resident, temporary resident). We plot the rates of people tested and confirmed positive for COVID-19 by week from April 19, 2020 to July 31, 2021 across immigration groups. We use logistic regression to estimate adjusted odds ratios of a positive SARS-CoV-2 test, access to testing, and primary care among people with temporary status or permanent residency, compared with people who hold citizenship. Results A total of 4,146,593 people with citizenship, 914,089 people with permanent residency, and 212,215 people...

Research paper thumbnail of Patient experiences with ambulatory cancer care in British Columbia, 2005/06

Columbia (BC), a Patient Satisfaction Steering Committee has undertaken to learn and share inform... more Columbia (BC), a Patient Satisfaction Steering Committee has undertaken to learn and share information about the experiences that BC residents have with health care they receive in the province. In late 2006, that Steering Committee engaged our team to: (a) assist them in portraying the results of their work in the area of ambulatory cancer care, and (b) conduct work in 2007 to glean additional insights from survey data collected under a contract with NRC+Picker (www.nrcpicker.com).

Research paper thumbnail of Development and evaluation of comparable primary care indicators from administrative health data across three Canadian provinces

International Journal of Population Data Science, 2020

Introduction Across the world, data sources to support learning in primary care (PC) lag far behi... more Introduction Across the world, data sources to support learning in primary care (PC) lag far behind that of acute care. Having comparable data sources across jurisdictions is essential for scaling and spreading healthcare learnings. Objectives The purpose of this work was to 1) identify and develop indicators of PC performance using administrative data and 2) examine the comparability of indicator definitions across three Canadian provinces (Nova Scotia, Ontario, British Columbia). This work is valuable for demonstrating how to arrive at comparable administrative data indicators across jurisdictions with different care patterns. Methods The TRANSFORMATION study is a multi-province Canadian study of PC that aims to improve PC performance measurement reporting. We initially compiled a list of PC performance indicators that had been used with existing administrative data. We followed and documented an iterative process to achieve comparable indicator operationalizations across the thre...

Research paper thumbnail of Use of pharmaceuticals by inflammatory bowel disease patients: a population-based study

The American Journal of Gastroenterology, 2001

In 1996 we created the population-based University of Manitoba Inflammatory Bowel Disease (IBD) D... more In 1996 we created the population-based University of Manitoba Inflammatory Bowel Disease (IBD) Database. In 1994, Manitoba Health established the Drug Program Information Network (DPIN), which identified all ambulatory prescription drugs dispensed to each individual resident of the province. All residents have a personal health identification number, and use of this number allowed linkage of the IBD database with the DPIN database. Our aim was to use the linkage of these databases to describe prescription drug use by patients with IBD in Manitoba in 1997. METHODS: We analyzed all prescriptions and costs for fiscal year 1997, and stratified our analysis by age, sex, urban versus nonurban residence, income, and disease (Crohn's disease vs ulcerative colitis). We also extracted all subjects diagnosed with IBD in 1984-1987 and those diagnosed in 1994-97 and compared any differences in prescribing patterns in 1997 for these two cohorts. RESULTS: A total of 87.5% of IBD subjects received prescriptions in 1997. There was a direct, significant relationship between increasing age and number of different prescriptions per IBD drug user and total prescription costs per IBD drug user (in adults only), particularly for alimentary drugs. Female patients used a greater number of different prescriptions, but there was no difference between sexes in costs per user. Only 7.8% of patients used immunomodulatory drugs, but these accounted for the greatest cost ($1404) per user. Patients whose disease was diagnosed in 1994-1997 were significantly more likely to be prescribed oral or rectal 5-aminosalicylic acid and steroids than were those whose disease was diagnosed in 1984-1987. In addition, prescriptions for rectal 5-aminosalicylic acid were significantly increased in those patients whose diagnoses were made later over those whose diagnoses were made earlier. Male patients and Crohn's disease patients were more likely to use oral steroids and immunomodulatory medications. Based on the decade of diagnosis, there was no difference in prescribing patterns for immunomodulatory medications. CONCLUSIONS: The linkage of the University of Manitoba IBD Database and the Manitoba DPIN Database allowed a description of patterns of prescription use in a populationbased sample of IBD patients. Among the important findings are the lack of effect of gender and urban residence on prescription use in IBD patients; however the decade of diagnosis did affect prescribing patterns. Furthermore, only 7.8% overall receive immunomodulatory medications, but this was independent of the decade of diagnosis.

Research paper thumbnail of Assessing the Extent to Which Hospitals Are Used for Acute Care Purposes

Medical Care, 1999

The degree to which Manitobans were appropriately hospitalized for medical conditions was assesse... more The degree to which Manitobans were appropriately hospitalized for medical conditions was assessed using a retrospective chart review of a sample of patients in 26 hospitals. A standardized set of object-based, nondiagnostic criteria (Inter-Qual) was used by trained abstractors to assess the patient at admission and for each day of stay. A high percentage of admissions and days of care were inappropriate. Overall, 49.5% of medical patients were acute at the time of admission, 1.6% required no health care services, and 48.9% could have received care through alternate methods or facilities. Only 33.4% of the subsequent days of stay were appropriate. For patients assessed as acute at the time of admission, by the 8th day of stay, only 47% were still acute and by day 30, only 27% were acute. Patients aged 75 years or older were just as likely to be acute at the time of admission as were younger patients; however, they accounted for 54% of the days in the study, and fewer than 30% of these days were acute. Our data suggest that despite their high use of hospitals, disadvantaged groups (the poor, aboriginal Manitobans), have the same levels of appropriateness as others. We conclude that alternatives to hospital care must first be established and made known and available before a shift in health care resources can occur.

Research paper thumbnail of Using Population-Based Data to Enhance Clinical Practice Guideline Development

Medical Care, 1999

Working with the College of Physicians and Surgeons of Manitoba, and using tonsillectomies as a b... more Working with the College of Physicians and Surgeons of Manitoba, and using tonsillectomies as a basis of inquiry, MCHPE examined surgical rates and patterns of practice. This project had three major aims: to review whether current patterns of delivery provide optimal care; to enhance the development of clinical guidelines; and to inform and influence physician practice. Both a population-based method of inquiry (which permits comparisons across population groups) and a provider-based approach (which offers insights into differences in the nature of care offered by different types of hospitals and physicians) were used. Synergies between these two approaches offered useful insight into aspects of quality and efficiency of care. Consistent with other jurisdictions, there was a high degree of variability across regions. However, there were also a number of surprising findings, including high rates of surgery in females, in older children, and among residents of rural areas. Data analysis raised a number of quality-of-care issues related to small caseload volumes, performance of procedures in very young children, and patterns of postoperative care in rural hospitals. The analyses provided impetus for addressing these issues in the guideline and suggested that the target audience for intervention should be rural physicians rather than urban specialists. This project demonstrated that data analysis can provide a powerful adjunct to the development and implementation of clinical practice guidelines.