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Best practice: Quality assessment outcomes of the Practice Enhancement Program among family physicians in Saskatchewan, Canada.
Abstract
Increased family physician workloads have strained primary care. The objective of this study was to describe the frequency and types of quality concerns identified among Saskatchewan's family physicians, changes in these concerns over time, associated physician characteristics, and recommendations made for improvement. In this repeated cross-sectional study (1997 to 2020), we examined family physician assessment reports from the Saskatchewan Practice Enhancement Program, a mandatory practice review strategy, for quality concerns on three outcomes: care, medical record, and facility. We recorded demographic and practice characteristics, the presence or absence of quality concerns, and the type of recommendations made. Concern incidence was calculated both overall and across sub-periods, and three outcome-specific multiple logistic regression models were developed. Recommendations made were quantified and their nature evaluated using thematic analysis. Among 824 assessments, 20.8% identified concerns, with a statistically significant increase in 2015 to 2020 over earlier years (14.2% versus 43.4%, P < 0.001). Corresponding proportions also significantly increased within each quality outcome (6.0% to 37.1%, P < 0.001 for care concerns; 12.7% to 19.6%, P = 0.03 for medical record concerns; 3.9% to 21.0%, P < 0.001 for facility concerns). We found statistically significant adjusted associations between care concerns and both urban location (OR: 2.2; 95% CI: 1.30, 3.8) and international medical training (OR: 2.4; 95% CI: 1.34, 4.2); facility concerns and solo practice (OR: 2.5 95% CI: 1.10, 5.7); and medical record concerns and male gender (OR: 1.88; 95% CI: 1.09, 3.3), solo practice (OR: 1.67; 95% CI: 1.01, 2.7), and increased age. Reflecting a statistically significant interaction found between age as a continuous covariate and time period, older physicians were more likely to have a medical record concern in later years (OR: 1.072; 95% CI: 1.026, 1.120) compa red to earlier ones (OR: 1.021; 95% CI: 1.001, 1.043). Among physicians where a concern was identified, recommendations most frequently pertained to documentation (91.2%), chronic disease management (78.2%), cumulative patient profiles (62.9%), lab investigations (53.5%), medications (51.8%), and emergency preparedness (51.2%). A concerning and increasing proportion of family physicians have quality gaps, with identifiable factors and recurring recommendations. These findings provide direction for strategic support development.
Authors (3) : James Macaskill, Rhonda Bryce, Andries Muller
Source : International journal for quality in health care : journal of the International Society for Quality in Health Care
Article Information
| Year | 2023 |
| Type | Journal Article |
| DOI | 10.1093/intqhc/mzad108 |
| ISSN | 1464-3677 |
| Volume |
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