Interprofessional Teams in the Context of Primary Care Reform in Ontario, Canada: Selection Factors and Association with Access to Care and Health Services Utilization

Abstract

Background: Countries throughout the world have been exploring new models to deliver primary care. Ontario has undergone a primary care reform that includes the introduction of interprofessional teams. The purpose of this thesis was to investigate the association between receiving care from interprofessional versus non-interprofessional primary care teams and access to care and health services utilization. The first study investigated selection factors into interprofessional teams. The second and third studies compared interprofessional teams and non-interprofessional teams on access and health services utilization measures.Methods: The three studies linked provincial administrative datasets (second study included a provincial healthcare experience survey as well) to assess outcomes of interest over time. The first study was cross-sectional and the last two were retrospective cohort studies. Results: The first study identified that there are selection factors into interprofessional teams. The second study findings highlighted that as compared to Health Care Experience Survey respondents in non-interprofessional teams, respondents in interprofessional teams self-reported more timely access to care and less walk-in clinic use but no significant difference in self-reported access to after-hours care and emergency department use. The third study found that there was no difference in the change over time in Ambulatory Care Sensitive Conditions admissions and all cause hospital re-admission between interprofessional and non-interprofessional teams between the pre- and post-implementation periods. Conclusion: Ontario has made a major investment in interprofessional team-based care. The findings from this thesis indicate that there are selection factors into interprofessional teams. Interprofessional teams perform better than non-interprofessional teams on some but not all investigated processes and outcomes of care. Our findings can inform other jurisdictions aiming to expand voluntary participation in interprofessional primary care teams regarding expectations about the relationship between primary care policy, organization and delivery and patient experience and health services utilization.Ph.D