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Periodic health visits by primary care practice model, a population-based study using health administrative data

机译：初级保健实践模型的定期健康访问，使用健康管理数据的基于人群的研究

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The general health check, which includes the periodic health visit and annual physical exam, is not recommended to maintain the health of asymptomatic adults with no risk factors. Different funding mechanisms for primary care may be associated with the provision of service delivery according to recommended guidelines. We sought to determine how use of the periodic health visit for healthy individuals without comorbidities, despite evidence against its use, differed by primary care model. Population-based cross-sectional study using linked health and administrative datasets in Ontario, Canada, where most residents are insured for physician services through Ontario’s single payer, provincially funded Ontario Health Insurance Plan. Participants included all living adults (?19?years) in Ontario on January 1st, 2014, eligible for the Ontario Health Insurance Plan. Primary care enrollment model was the main exposure and included traditional fee-for-service, enhanced fee-for-service, capitation, team-based care, other (including salaried), and unenrolled. The main outcome measure was receipt of a periodic health visit during 2014. Age-sex standardized rates of periodic health visits performed during the one-year study period were analyzed by number of comorbid conditions. Of 10,712,804 adults in Ontario, 2,350,386 (21.9%) had a periodic health visit in 2014. The age-sex standardized rate was 6.1% (95% confidence interval [CI] 6.0, 6.1%) for healthy individuals. In the traditional fee-for-service model, the periodic health visit was performed for 55.3% (95% CI 54.4, 56.3%) of healthy individuals versus 10.2% (95% CI 10.0, 10.3%) in team-based care. Periodic health visit rates varied by primary care provider models. Traditional and enhanced fee-for-service models had higher rates across all comorbidity groups. Patients whose primary care physicians are funded exclusively through fee-for-service had the highest rates of periodic health visits in healthy individuals. Primary care reform initiatives must consider the influence of remuneration on providing evidence-based primary care.
机译：包括定期卫生访问和年度体检的一般健康检查不建议维持无症状成年人的健康，没有风险因素。根据建议的准则，初级保健的不同资金机制可能与提供服务交付有关。尽管有证据表明，我们试图如何在没有合并的情况下，在没有合并的情况下，如何使用定期的健康访问如何使用初级保健模式。基于人口的横断面研究，使用加拿大安大略省联合的健康和行政数据集，大多数居民通过安大略省单一付款人投保了医生服务，省份了安大略省的安大略省健康保险计划。参与者包括2014年1月1日在安大略省的所有生活成年人（> 19？年），有资格获得安大略省健康保险计划。初级保健入学型号是主要曝光，包括传统的服务费，加强的服务费用，行为，基于团队的护理，其他（包括薪水）和未注册。主要结果措施是在2014年收到定期卫生访问。通过合并条件的数量分析了一年的研究期间在一年的研究期间进行的时期性标准化的定期卫生访问率。在安大略省的10,712,804名成人中，2,350,386（21.9％）于2014年进行了定期的卫生访问。健康个体的年龄性标准化率为6.1％（95％的置信区间[CI] 6.0，6.1％）。在传统的服务费用模型中，定期卫生访问进行了55.3％（95％CI 54.4,56.3％）的健康个体，而在基于团队的护理中的10.2％（95％CI 10.0,10.3％）。定期健康访问税率因初级保健提供商模型而异。传统和增强的服务费用模型伴随着所有合并症的速率较高。初级保健医生专门通过用于服务费用的患者，在健康个人中具有最高的定期卫生率。初级保健改革举措必须考虑报酬对提供循证级别保健的影响。

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