Association of physician financial incentives with primary care enrolment of adults with serious mental illnesses in Ontario: a retrospective observational population-based study.

CMAJ open Pub Date : 2023-01-01 DOI:10.9778/cmajo.20210190

Imaan Bayoumi, Marlo Whitehead, Wenbin Li, Paul Kurdyak, Richard H Glazier

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引用次数: 2

Abstract

Background: Financial incentives may improve primary care access for adults with schizophrenia or bipolar disorder (serious mental illness [SMI]). We studied the association between receipt of the SMI financial premium paid to primary care physicians and rostering of adults with SMI in different patient enrolment models (PEMs), including enhanced fee-for-service and capitation-based models with and without interdisciplinary team-based care.

Methods: We conducted a retrospective cohort study involving Ontario adults (≥18 yr) with SMI in PEM practices, in fiscal years 2016/17 and 2017/18. Using negative binomial models, we examined relations between rostering and the primary care model and the contribution of the incentive. Similar models were developed for adults with type 1 or 2 diabetes mellitus and the general population.

Results: Among 9730 physicians in PEM practices, 4866 (50.0%) received a premium and 448 319 (88.4%) people with SMI in PEMs were rostered. Compared with enhanced fee for service, the likelihood of rostering people with SMI was 3.0% higher for patients in capitation with team-based care (adjusted relative risk [RR] 1.03, 95% confidence interval [CI] 1.02-1.04), with similar results for capitation without team-based care (adjusted RR 1.00 95% CI 0.99-1.01). Rostering for people with diabetes was similar in team-based care (adjusted RR 1.02, 95% CI 1.02-1.03) but higher in capitation without team-based care (adjusted RR 1.03, 95% CI 1.02-1.03) and slightly higher for the Ontario population (team-based care 1.04, 95% CI 1.04-1.05, capitation without team-based care 1.03, 95% CI 1.03-1.04).

Interpretation: Rostering of people with SMI was lower than for the general population. Additional policy measures are needed to address persisting inequities and to promote rostering of this underserved population with complex needs.

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安大略省严重精神疾病成人初级保健登记与医生财务激励的关系:一项基于人群的回顾性观察性研究。

背景:经济激励可以改善成人精神分裂症或双相情感障碍(严重精神疾病[SMI])的初级保健可及性。我们研究了向初级保健医生支付的SMI财务保费与在不同患者登记模式(PEMs)中登记的SMI成人患者之间的关系，包括增强的服务收费和基于资本的模式，有无跨学科团队护理。方法:我们在2016/17和2017/18财政年度进行了一项回顾性队列研究，涉及安大略省成人(≥18岁)在PEM实践中患有SMI。使用负二项模型，我们检验了值勤和初级保健模式之间的关系以及激励的贡献。对1型或2型糖尿病成人和一般人群也建立了类似的模型。结果:在9730名PEM执业医师中，4866名(50.0%)获得了保费，448319名(88.4%)PEM的SMI患者被登记在册。与提高服务费用相比，采用团队为基础的治疗方案的患者出现重度精神障碍的可能性高出3.0%(调整相对风险[RR] 1.03, 95%可信区间[CI] 1.02-1.04)，而采用不采用团队为基础的治疗方案的患者出现类似结果(调整RR 1.00, 95% CI 0.99-1.01)。在以团队为基础的护理中，糖尿病患者的名单相似(调整后的RR为1.02,95% CI为1.02-1.03)，但在没有团队为基础的护理中，人数较多(调整后的RR为1.03,95% CI为1.02-1.03)，而在安大略省人口中，人数较多(团队为基础的护理为1.04,95% CI为1.04-1.05，人数较多，95% CI为1.03-1.04)。解释:重度精神障碍患者的登记人数低于一般人群。需要采取更多的政策措施来解决持续存在的不平等现象，并促进对这些需求复杂、服务不足的人口进行登记。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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CMAJ open

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