How does enrollment with a GP impact care?
Data access has been approved for a project to investigate whether, and how, patient enrolment with a General Practitioner (GP) may improve patient experiences, continuity and quality of care, and policy-relevant health care system outcomes.
The enrolment of patients with individual GPs or primary care practices is an important aspect of integrated primary health care (PHC) delivery models. In Canada, patient enrolment (i.e., rostering, registration) is pursued in several provinces in more and less formal ways, ranging from a signed contract between a patient and their GP, to additional fees billable by the GP, to default enrolment based on where patients seek care. Some financial incentives exist for physicians based on patients’ share of visits with “their” GP, but patients remain free to choose their physician and there are no financial penalties for patients if they seek care elsewhere.
“The quality of the patient-provider relationship is crucial to many processes and outcomes across the continuum of care”, says project lead, Dr. Kimberlyn McGrail, Associate Professor at the Centre for Health Services and Policy Research in the University of British Columbia’s School of Population and Public Health. “Enrolment has the potential to directly or indirectly improve the Triple Aim outcomes: health of populations, experience of care, and per-capita costs.”
Provincial-level Ministry officials, responsible for the development of effective and responsive PHC systems, have expressed that, having based their policies on evidence of the benefits of patient enrolment from other jurisdictions, they have little information on the impacts of enrolment in Canada, where physicians are autonomous professionals. Says McGrail, “In short, they ask whether and how patient enrolment with a primary care provider improves patient experiences, continuity and quality of care and health outcomes, and whether the kinds of enrolment policies used in some provinces are more effective than those used elsewhere.”
The study will compare practices in British Columbia with those in Quebec. Quebec uses an explicit, contract-based approach to patient enrolment, with specific targets laid out by the Ministry, while British Columbia relies on physician incentives via billing codes to increase patient attachment.
“We will assess whether enrolment impacts patient experiences, continuity and quality of care, and policy-relevant health care system outcomes, particularly among more vulnerable patient groups: high users of health care and social services and patients with lower socioeconomic status,” says McGrail.
She hopes the findings will produce new knowledge informing patient-oriented best practices to optimize service integration across the continuum of care, with special attention to the experiences of patients with complex or chronic health needs.
PopData will link 8 data sets from the BC Ministry of Health and BC Vital Statistics Agency for the project.