Cancer screening inequities in a time of primary care reform: a population-based longitudinal study in Ontario, Canada

被引:18
作者
Lofters, Aisha K. [1 ,2 ,3 ,4 ,5 ]
Mark, Amy [5 ]
Taljaard, Monica [5 ,6 ]
Green, Michael E. [5 ,7 ]
Glazier, Richard H. [1 ,2 ,3 ,4 ,5 ]
Dahrouge, Simone [5 ,8 ,9 ]
机构
[1] St Michaels Hosp, Dept Family & Community Med, 30 Bond St, Toronto, ON M5B 1W8, Canada
[2] Univ Toronto, Dept Family & Community Med, 500 Univ Ave 5th Floor, Toronto, ON M5G 1V7, Canada
[3] St Michaels Hosp, Li Ka Shing Knowledge Inst, Ctr Urban Hlth Solut, 30 Bond St, Toronto, ON M5B 1W8, Canada
[4] Univ Toronto, Dalla Lana Sch Publ Hlth, 155 Coll St 6th Floor, Toronto, ON M5T 3M7, Canada
[5] Inst Clin Evaluat Sci, G1 06,2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
[6] Ottawa Hosp, Res Inst, 501 Smyth Box 511, Ottawa, ON K1H 8L6, Canada
[7] Queens Univ, Dept Family Med, 220 Bagot St, Kingston, ON K7L 5E9, Canada
[8] Bruyere Res Inst, CT Lamont Primary Hlth Care Res Ctr, 43 Bruyere St, Ottawa, ON K1N 5C8, Canada
[9] Univ Ottawa, Dept Family Med, 600 Peter Morand Crescent Suite 201, Ottawa, ON K1G 5Z3, Canada
来源
BMC FAMILY PRACTICE | 2018年 / 19卷
关键词
Cancer screening; Primary care; Health equity; Primary care reform; Health disparities; CERVICAL-CANCER; BREAST-CANCER; URBAN IMMIGRANTS; DIABETES CARE; UNITED-STATES; MEDICAL HOME; DISPARITIES; PHYSICIAN; LEVEL; INCENTIVES;
D O I
10.1186/s12875-018-0827-1
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background: Primary care has been reformed in recent years in Ontario, Canada, with a move away from traditional fee-for-service to enhanced fee-for-service and capitation-based models. It is unclear how new models have affected disparities in cancer screening. We evaluated whether Ontario's enhanced fee-for-service model was associated with a change in the gaps in cancer screening for people living with low income and people who are foreign-born. Methods: We conducted a population-based longitudinal analysis from 2002 to 2013 of Ontario family physicians who transitioned from traditional fee-for-service to enhanced fee-for-service. The binary outcomes of interest were adherence to cervical, breast and colorectal cancer screening recommendations. Outcomes were analyzed using mixed-effects logistic regression. Analyses produced annual odds ratios comparing the odds of being up-to-date for screening among patients in enhanced fee-for-service versus patients in traditional fee-for-service for each social stratum separately. We calculated the ratios of stratum-specific odds ratios to assess whether the transition from traditional to enhanced fee-for-service was associated with a change in screening gaps between immigrants and long-term residents, and between people in the lowest and highest neighbourhood income quintiles. Results: Throughout the study period, cancer screening was consistently lower among immigrants and among people in the lowest income quintile. Transition to enhanced fee-for-service was generally associated with increased screening uptake for all, however for most years, ratios of ratios were significantly less than 1 for all three cancer screening types, indicating that there was a widening of the screening gap between immigrants and long-term residents and between people living in the lowest vs. highest income quintile associated with transitions. Conclusion: The transition to enhanced fee-for-service in Ontario was generally associated with a widening of screening inequities for foreign-born and low-income patients.
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页数:14
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