Efficiency of Ontario primary care physicians across payment models : a stochastic frontier analysis

Objective The study examines the relationship between the primary care model that a physician belongs to and the efficiency of the primary care physician in Ontario, Canada. Methods Survey data were collected from 183 self-selected physicians and linked to administrative databases to capture the provision of services to the patients served for the 12 month period ending June 30, 2013, and the characteristics of the patients at the beginning of the study period. Two stochastic frontier regression models were used to estimate efficiency scores and parameters for two separate outputs: the number of distinct patients seen and the number of visits. Results Because of missing data, only 165 physicians were included in the analyses. The average efficiency was 0.72 for both outputs with scores varying from 4 % to 93 % for the visits and 5 % to 94 % for the number of patients seen. We observed that there were both very low and very high efficiency scores within each model. These variations were larger than variations in average scores across models

Analogue Patients

Abstract Analogue patients (APs) are individuals instructed for research purposes to imagine themselves in the position of a patient as portrayed in a written or recorded medical interaction. Subsequently, their experience or evaluation of and/or response to the interaction is assessed. Well thought‐out use of APs in patient–clinician communication research may enlighten the mechanisms underlying medical interactions, and thereby increase our ability to improve these interactions to the benefit of patients, their informal caregivers, and clinicians. Commonly, APs participate in experimental studies in which they are randomized to evaluate scripted variants of a medical interaction, so‐called vignettes. Sometimes, APs are involved to observe recordings of actual consultations. Involving APs rather than real patients allows for systematically testing the effect of variations in healthcare clinicians' communicative behavior, which may be unethical in real clinical practice. Moreover, researchers may use APs for practical (e.g., easier recruitment) or methodological (e.g., less socially desirable answers) reasons. A point of consideration is that the use of APs reduces ecological validity of the study. That is, findings cannot straightaway be extrapolated to real clinical consultations. Ecological validity will depend on APs' ability to engage with a vignette. Hence, attention to procedures to assess and enhance APs' level of engagement is necessary. Further research is needed to fully understand how APs' engagement, and thus the validity of using APs, can be improved