Article Figures & Data
Tables
CHARACTERISTIC FAMILY PHYSICIANS
n (%), N = 208*PEDIATRICIANS
n (%), N = 68*MIDWIVES
n (%), N = 45TOTAL
n (%), N = 321*Practice setting • Academic† 8 (3.8) 4 (5.9) 0 (0.0) 12 (3.7) • Non-academic 200 (96.2) 64 (94.1) 45 (100.0) 309 (96.3) Practice type • Solo 40 (19.2) 41 (61.2) 1 (2.2) 82 (25.6) • Group‡ 168 (80.8) 26 (38.8) 44 (97.8) 238 (74.4) Method of reimbursement • Fee-for-service§ 62 (29.8) 62 (91.2) 0 (0.0) 124 (38.6) • Non–fee-for-service 146 (70.2) 6 (8.8) 45 (100.0) 197 (61.4) Practice location • Urban 123 (59.4) 58 (85.3) 33 (73.3) 214 (66.9) • Rural 84 (40.6) 10 (14.7) 12 (26.7) 106 (33.1) Years in practice • 0-15 83 (39.9) 26 (38.2) 40 (88.9) 149 (46.4) • ≥ 16 125 (60.1) 42 (61.8) 5 (11.1) 172 (53.6) Sex • Female 130 (62.8) 28 (41.2) 45 (100.0) 203 (63.4) • Male 77 (37.2) 40 (58.8) 0 (0.0) 117 (36.6) Practice-based exposure to … • CF 58 (28.0) 37 (54.4) 10 (22.7) 105 (32.9) • CF carrier 66 (32.2) 34 (52.3) 22 (51.2) 122 (39.0) • NBS results positive for CF 47 (22.7) 33 (50.0) 26 (59.1) 106 (33.4) • NBS results positive for another disorder 85 (41.1) 53 (80.3) 30 (69.8) 168 (53.2) CF—cystic fibrosis, NBS—newborn screening.
↵*Denominators vary owing to missing data.
↵†Includes providers who see any patients in academic health sciences centres.
↵‡Includes interprofessional practice as well as single-discipline group practice.
↵§Includes providers who reported any fee-for-service. Midwives in Ontario are publicly funded but not fee-for-service.
- Table 2.
Primary care providers’ perspectives on their role in caring for children who have positive screening results for CF
ROLES TOTAL
n (%), N = 321*FAMILY PHYSICIANS
n (%), N = 208*PEDIATRICIANS
n (%), N = 68*MIDWIVES
n (%), N = 45*P VALUE† What role would you have in providing routine WBC for ... Infants confirmed to have CF < .001 • Provide total WBC 73 (23.0) 35 (17.0) 37 (54.4) 1 (2.3) • Share WBC with specialist or subspecialist 216 (68.1) 152 (73.8) 30 (44.1) 34 (79.1) • Refer WBC to specialist or subspecialist 28 (8.8) 19 (9.2) 1 (1.5) 8 (18.6) Infants with an inconclusive diagnosis of CF < .001 • Provide total WBC 158 (49.5) 102 (49.5) 46 (67.6) 10 (22.2) • Share WBC with specialist or subspecialist 144 (45.1) 99 (48.1) 21 (30.9) 24 (53.3) • Refer WBC to specialist or subspecialist 17 (5.3) 5 (2.4) 1 (1.5) 11 (24.4) Infants who are CF carriers < .001 • Provide total WBC 284 (89.3) 196 (94.7) 61 (92.4) 27 (60.0) • Share WBC with specialist or subspecialist 27 (8.5) 11 (5.3) 1 (1.5) 15 (33.3) • Refer WBC to specialist or subspecialist 7 (2.2) 0 (0.0) 4 (6.1) 3 (6.7) What role would you have in providing care for minor acute illnesses for ... Infants confirmed to have CF < .001 • Provide total care for minor acute illnesses 171 (53.6) 112 (54.1) 57 (85.1) 2 (4.4) • Share care for minor illnesses with specialist or subspecialist 113 (35.4) 84 (40.6) 10 (14.9) 19 (42.2) • Refer care for minor illnesses to specialist or subspecialist 35 (11.0) 11 (5.3) 0 (0.0) 24 (53.3) Infants with an inconclusive diagnosis of CF < .001 • Provide total care for minor acute illnesses 214 (67.1) 154 (74.4) 58 (86.6) 2 (4.4) • Share care for minor illnesses with specialist or subspecialist 84 (26.3) 53 (25.6) 9 (13.4) 22 (48.9) • Refer care for minor illnesses to specialist or subspecialist 21 (6.6) 0 (0.0) 0 (0.0) 21 (46.7) Infants who are CF carriers < .001 • Provide total care for minor illnesses 265 (83.6) 200 (96.6) 61 (93.8) 4 (8.9) • Share care for minor illnesses with specialist or subspecialist 36 (11.4) 7 (3.4) 1 (1.5) 28 (62.2) • Refer care for minor illnesses to specialist or subspecialist 16 (5.0) 0 (0.0) 3 (4.6) 13 (28.9) - Table 3.
Primary care providers’ perspectives and confidence related to NBS and CF carrier status
FACTOR TOTAL
n (%), N = 321*FAMILY PHYSICIANS
n (%), N = 208*PEDIATRICIANS
n (%), N = 68*MIDWIVES
n (%), N = 45*P VALUE Up to date on NBS < .001† • Strongly agree or agree 182 (57.6) 90 (43.7) 57 (85.1) 35 (81.4) • Strongly disagree, disagree, or neutral 134 (42.4) 116 (56.3) 10 (14.9) 8 (18.6) Important role in NBS < .001† • Strongly agree or agree 256 (80.8) 153 (74.3) 59 (88.1) 44 (100.0) • Strongly disagree, disagree, or neutral 61 (19.2) 53 (25.7) 8 (11.9) 0 (0.0) Confidence in providing reassurance about health of CF carrier < .001† • Extremely or very confident 172 (53.9) 107 (51.7) 51 (76.1) 14 (31.1) • Moderately, not very, or not at all confident 147 (46.1) 100 (48.3) 16 (23.9) 31 (68.9) Within scope to provide reassurance about health of CF carrier .001† • Yes 268 (88.2) 176 (88.9) 60 (96.8) 32 (72.7) • No 36 (11.8) 22 (11.1) 2 (3.2) 12 (27.3) Confidence in explaining relevance of carrier status to family planning .009‡ • Extremely or very confident 187 (58.6) 112 (54.1) 52 (77.6) 23 (51.1) • Moderately confident 109 (34.2) 78 (37.7) 13 (19.4) 18 (40.0) • Not very or not at all confident 23 (7.2) 17 (8.2) 2 (3.0) 4 (8.9) Within scope to explain relevance of carrier status .39† • Yes 269 (84.6) 177 (85.9) 57 (85.1) 35 (77.8) • No 49 (15.4) 29 (14.1) 10 (14.9) 10 (22.2) Know how to order CF carrier testing for adults .006† • Yes 79 (24.9) 60 (29.4) 16 (23.5) 3 (6.7) • No 238 (75.1) 144 (70.6) 52 (76.5) 42 (93.3) Within scope to order CF carrier testing for adults <. 001† • Yes 150 (47.9) 132 (65.7) 15 (22.4) 3 (6.7) • No 163 (52.1) 69 (34.3) 52 (77.6) 42 (93.3) Know how to refer for prenatal diagnosis related to CF <. 001† • Yes 213 (67.0) 132 (64.4) 39 (57.4) 42 (93.3) • No 105 (33.0) 73 (35.6) 29 (42.6) 3 (6.7) Within scope to refer for prenatal diagnosis related to CF <. 001† • Yes 257 (81.1) 176 (85.9) 37 (55.2) 44 (97.8) • No 60 (18.9) 29 (14.1) 30 (44.8) 1 (2.2) FACTOR MODEL 1: PCP PROVIDING TOTAL* WBC FOR INFANTS WHO ARE CF CARRIERS, ADJUSTED RR (95% CI) MODEL 2: PCP PROVIDING TOTAL* ACUTE MINOR ILLNESS CARE FOR INFANTS WHO ARE CF CARRIERS, ADJUSTED RR (95% CI) MODEL 3: PCP PROVIDING TOTAL* WBC FOR INFANTS WHO HAVE AN INCONCLUSIVE DIAGNOSIS OF CF, ADJUSTED RR (95% CI) MODEL 4: PCP PROVIDING TOTAL* ACUTE MINOR ILLNESS CARE FOR INFANTS WHO HAVE AN INCONCLUSIVE DIAGNOSIS OF CF, ADJUSTED RR (95% CI) Extremely or very confident in reassuring about health of CF carrier vs not very or not at all confident 1.50 (1.14-1.97)† 1.21 (0.98-1.50) 3.30 (1.34-8.16)† 1.61 (1.03-2.52)† Moderately confident in reassuring about health of CF carrier vs not very or not at all confident 1.44 (1.10-1.90)† 1.26 (1.02-1.56)† 4.08 (1.68-9.92)† 1.89 (1.21-2.95)† Population served: urban vs rural 0.92 (0.86-0.99)† 0.95 (0.89-1.02) 0.93 (0.72-1.19) 0.94 (0.81-1.10) Female vs male 1.16 (1.07-1.26)† 1.08 (1.00-1.16)† 1.06 (0.84-1.33) 0.92 (0.80-1.06) Midwives vs family physicians and pediatricians‡ 0.72 (0.56-0.94)† 0.12 (0.05-0.31)§ 0.46 (0.22-0.98)† 0.08 (0.02-0.32)§ Within scope to provide reassurance about health of CF carrier: yes vs no 1.17 (0.94-1.47) 1.02 (0.90-1.14) 0.64 (0.43-0.97)† 0.89 (0.69-1.16) Child in practice with positive NBS result for CF: yes vs no 1.05 (0.95-1.17) 1.06 (0.97-1.15) 1.09 (0.82-1.44) 1.32 (1.12-1.55)† CF—cystic fibrosis, NBS—newborn screening, PCP—primary care provider, RR— risk ratio, WBC—well-baby care.
↵*Total care vs combined shared and referred care.
↵†P < .05.
↵‡Differences between family physicians vs midwives and pediatricians, and pediatricians vs midwives and family physicians were not significant.
↵§P < .01.