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Research ArticleResearch

Patient poverty and workload in primary care

Study of prescription drug benefit recipients in community health centres

Laura Muldoon, Jennifer Rayner and Simone Dahrouge
Canadian Family Physician April 2013; 59 (4) 384-390;
Laura Muldoon
Affiliated with the C.T. Lamont Primary Health Care Research Centre of the Bruyère Research Institute, Lecturer in the Department of Family Medicine at the University of Ottawa, and a clinician at the Somerset West Community Health Centre in Ottawa, Ont.
MD MPH FCFP
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  • For correspondence: lmuldoon@swchc.on.ca
Jennifer Rayner
MSc PhD
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Simone Dahrouge
MSc PhD
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Article Figures & Data

Tables

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    Table 1

    Ontario Drug Benefit recipients

    PROGRAMCHARACTERISTICS OF RECIPIENTSANNUAL INCOME, 2009PERCENT OF LICO*
    Ontario WorksYounger than 65 y with temporary financial need$7501 for a single employable person40.7%
    Ontario Disability Support ProgramPersons with disabilities who are in financial need$12 905 for a single person70.1%
    Ontario Drug Benefit for low-income seniorsOlder than 65 y; meeting financial requirements< $16 018 (single); < $24 175 (couple)Varies
    • LICO—low income cutoff.

    • ↵* Percent of the annual before-tax income at the LICO ($18 421) for a single person living in an urban area with population > 500 000 in 2009.26 Below the LICO, households spend at least 20% more of their income than the average household on food, shelter, and clothing. The LICO is adjusted for family size and degree of urbanization.27

    • Data from the Ontario Ministry of Community and Social Services28 and the Ontario Ministry of Health and Long-Term Care.29

    • View popup
    Table 2

    Sociodemographic characteristics of patients in CHCs: N = 63 CHCs.

    CHARACTERISTICMEAN (SD)MAXIMUMMINIMUM
    Proportion of female patients59.8 (9.2)96.845.3
    Age, y
      • < 1824.5 (8.6)45.32.2
      • 19–4435.9 (12.9)45.38.3
      • 45–6425.3 (8.4)39.70.0
      • ≥ 6513.1 (10.2)63.20.0
    Proportion of total ODB*21.8 (13.1)66.43.7
    Proportion of patients on Ontario Works8.9 (6.9)25.90.3
    Proportion of patients on ODSP9.6 (7.4)38.81.4
    Proportion of patients on ODB for low-income seniors3.3 (2.5)14.50.0
    Income quintile
      • 1 (lowest)34.8 (17.8)72.33.9
      • 220.3 (6.8)41.71.6
      • 316.7 (6.9)35.27.0
      • 414.2 (7.4)32.62.2
      • 5 (highest)11.6 (9.4)49.21.1
    • CHC—community health centre, ODB—Ontario Drug Benefits, ODSP—Ontario Disability Support Program.

    • ↵* Total ODB is the total proportion of clients on Ontario Works, ODSP, and ODB for low-income seniors.

    • View popup
    Table 3

    Organizational characteristics of CHCs: N = 63 CHCs.

    CHARACTERISTICMEAN (SD)MAXIMUMMINIMUM
    FP FTEs2.7 (1.6)7.40.0
    NP FTEs2.8 (1.5)7.50.0
    Clinical support1.1 (0.5)2.60.2
    Social support0.42 (0.3)1.70.0
    Rooms per PCP1.6 (0.8)3.80.6
    Panel size per PCP444.9 (187.3)1035.2127.3
    • CHC—community health centre, FTE—full-time equivalent, NP—nurse practitioner, PCP—primary care provider.

    • View popup
    Table 4

    Bivariate results for poverty and panel size

    POVERTY MEASUREβP VALUE
    Income quintiles 1 and 2−0.101.430
    Total ODB−0.221.072
    Ontario Works−0.111.386
    ODSP−0.275.029
    ODB for low-income seniors−0.061.637
    • ODB—Ontario Drug Benefits, ODSP—Ontario Disability Support Program.

    • View popup
    Table 5

    Multiple linear regression models (β coefficients) for poverty and panel size

    FACTORMODEL 1*MODEL 2†MODEL 3‡MODEL 4 (FULL MODEL)
    Total ODB§−0.221||−0.230||−0.034−0.072
    Examination rooms per PCP0.280¶0.096
    Support staff per PCP0.0550.170
    SAMI#−0.368¶−0.291¶
    • ACG—Adjusted Clinical Groups, CHC—community health centre, ODB—Ontario Drug Benefits, ODSP—Ontario Disability Support Program, PCP—primary care provider, SAMI—Standardized ACG Morbidity Index.

    • ↵* Adjusted for poverty.

    • ↵† Adjusted for organization factors (examination rooms and support staff).

    • ↵‡ Adjusted for medical comorbidities.

    • ↵§ Total ODB is the total proportion of clients on Ontario Works, ODSP, and ODB for low-income seniors.

    • ↵|| P ≤ .01.

    • ↵¶ P ≤ .05.

    • ↵# Average SAMI for the CHC.

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Canadian Family Physician: 59 (4)
Canadian Family Physician
Vol. 59, Issue 4
1 Apr 2013
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Patient poverty and workload in primary care
Laura Muldoon, Jennifer Rayner, Simone Dahrouge
Canadian Family Physician Apr 2013, 59 (4) 384-390;

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Laura Muldoon, Jennifer Rayner, Simone Dahrouge
Canadian Family Physician Apr 2013, 59 (4) 384-390;
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