Academic family health teams: Part 1: patient perceptions of core primary care domains

Article Figures & Data

Table 1.

The PCAT definitions of domains of primary health care

PRIMARY CARE DOMAIN	PCAT DEFINITION	NO. OF PCAT QUESTIONS
Accessibility	First-contact care Care is first sought from the primary care provider for a new health or medical need Usual entry point into the health care system Includes -accessibility -utilization	Access: 12 Utilization: 3
Continuity of care Relational or clinician continuity Informational or record continuity	Continuous (ongoing) care Longitudinal use of regular source of care Relationship over time between providers and patient	15
Coordination of care	Linking of health care visits and services for appropriate care for all health problems	Coordination of care: 9 Information systems: 3
Comprehensiveness of care	Range of services available and services provided	Services available: 25 Services provided: 13

PCAT—Primary Care Assessment Tool Adult Expanded Version.
Data from Johns Hopkins Primary Care Policy Center.²¹

Table 2.

Characteristics of family health team patient participants: N = 1026; mean (range) age of patients was 49.6 (18–90) years.

CHARACTERISTIC	n/N (%)^*
Age group, y
• ≤ 39	292/953 (30.6)
• 40–64	471/953 (49.4)
• ≥ 65	190/953 (19.9)
Female	686/958 (71.6)
English spoken at home	860/917 (93.8)
Recent immigrant (in Canada ≤ 10 y)	46/918 (5.0)
Marital status
• Single	215/941 (22.8)
• Married or common law	566/941 (60.1)
• Separated, divorced, or widowed	160/941 (17.0)
Employment
• Employed	540/916 (59.0)
• Not employed (not employed, student, or retired)	376/916 (41.0)
Education
• High school or less	196/956 (20.5)
• More than high school	760/956 (79.5)
Household income
• ≤ $35 000	189/908 (20.8)
• $36 000–$75 000	251/908 (27.6)
• > $75 000	377/908 (41.5)
• Not sure or declined to answer	91/908 (10.0)
Perception of health as excellent, very good, or good	794/936 (84.8)

Table 3.

Characteristics of participating academic FHTs

SITE	*LENGTH OF OPERATION,^{^} MO**	NO. OF FHT SITES	DEGREE OF IMPLEMENTATION OF FHT PLAN (SCALE 1–10)^†	NO. OF ROSTERED PATIENTS	NO. OF FAMILY DOCTORS^‡	NO. OF FAMILY MEDICINE RESIDENTS^‡	NO. OF OTHER HEALTH CARE PROFESSIONALS^‡	EMR
1	15	1	8	12 000	11	20	14	Yes
2	18	1	5	8000	14	26	8	Yes
3	19	2	9	6000	4	15	6	Yes
4	16	> 1	5	About 50 000	NA^§	NA^§	NA	Yes
5	NA^§	2	7	About 3300	17	20	10	No
6	14	1	7	9600	20	20	6	No

EMR—electronic medical record, FHT—family health team, NA—not available.
↵* Length of operation was calculated as the time between the date funding was received and the end date of the study.
↵† Scale ranged from 1 = none to 10 = full implementation.
↵‡ Doctors, residents, and health care professionals includes full-time and part-time practitioners.
↵§ Information was not provided by FHT managers.

Table 4.

The PCAT scores

PCAT DOMAIN	*N^{^}**	MEAN (SD) SCORE	PATIENTS RATING < 3.0, %
First-contact utilization	1005	3.70 (0.43)	4.2
First-contact accessibility	909	2.28 (0.36)	96.5
Continuous (ongoing) care	865	3.31 (0.50)	24.2
Coordination of care	680	3.35 (0.61)	22.5
Coordination of information systems	928	2.67 (0.62)	63.0
Comprehensiveness of services available	727	2.83 (0.50)	61.3
Comprehensiveness of services provided	787	2.36 (0.98)	65.1
Overall primary care score^†	418	2.92 (0.34)	NA

NA—not applicable, PCAT—Primary Care Assessment Tool Adult Expanded Version.
↵* Responses were included if answers were provided for at least 50% of items in a scale.
↵† Includes patients who completed at least 50% of items in all scales.

Table 5.

Significant predictors of scores ≥ 3.0 on primary care domains: There were no significant predictors for first-contact access.

DOMAIN	RR	95% CI	P VALUE
First-contact utilization
• Age group: ≥ 65 y vs < 65 y	1.06	1.01–1.12	.01
• Marital status: married or common law vs single	1.04	1.01–1.08	.02
• Marital status: separated, divorced, or widowed vs single	1.06	1.01–1.10	.015
• Employed vs not employed	1.04	1.01–1.07	.034
Continuous (ongoing) care
• Age group: 40–64 y vs < 40 y and ≥ 65 y	1.18	1.07–1.31	.001
• Health is excellent, very good, or good vs fair or poor	1.26	1.10–1.44	< .001
• Lived in Canada ≤ 10 y vs > 10 y	0.65	0.51–0.84	< .001
• Employed vs not employed	0.84	0.76–0.94	.001
Coordination of care
• Age group: 40–64 y vs < 40 y and ≥ 65 y	1.18	1.04–1.32	.008
• Age group: ≥ 65 y vs < 65 y	1.25	1.06–1.48	.01
• More than high school education vs high school education or less	0.83	0.70–0.98	.03
Coordination of information systems
• Age group: 40–64 y vs < 40 y and ≥ 65 y	1.48	1.15–1.91	.002
• Age group: ≥ 65 y vs < 65 y	1.65	1.17–2.33	.004
• Employed vs not employed	0.74	0.59–0.94	.01
Comprehensiveness of services available
• Distributed site vs not a distributed site	0.60	0.39–0.94	.02
• Mental health worker in FHT vs no mental health worker	2.14	1.25–3.67	.006
• Income $36 000–$75 000 vs ≤ $35 000 and > $75 000	0.65	0.49–0.88	.005
• Income > $75 000 vs ≤ $75 000	0.73	0.54–0.99	.04
Comprehensiveness of services provided
• Income > $75 000 vs ≤ $75 000	0.71	0.52–0.98	.03

Table 6.

Comprehensiveness of selected services: Overall comprehensiveness score (mean of services available) was 67.8%.

PRIMARY CARE SERVICE	PATIENTS WHO INDICATED THAT THE SERVICE WAS PROBABLY OR DEFINITELY AVAILABLE AT THEIR FHTS, N/N (%)
Women’s health
• Antenatal care	664/862 (77.0)
• Papanicolaou test	761/895 (85.0)
• Family planning or birth control	631/873 (72.3)
Procedural
• Suturing	491/896 (54.8)
• Allergy shots	648/895 (72.4)
• Wart treatment	595/884 (67.3)
• Splinting for a sprained ankle	481/886 (54.3)
• Removal of an ingrown toenail	484/878 (55.1)
Counseling
• Nutrition	817/942 (86.7)
• Alcohol or drug abuse	506/885 (57.2)
• Mental health	573/893 (64.2)