Grant: Operating Grant - PA: Regional Partnership Program - Newfoundland and Labrador

A patient's first contact with the healthcare system is usually with a primary healthcare provider, often a family physician. A reform of primary healthcare is proceeding in Canada and other countries under the assumption that changing the delivery of care at this level will translate into improved public health. Although this implied overall benefit to public health is logical, it is important to both research and policy that the reforms are evaluated with regard to their relative strength to improve medical outcomes. The usage of healthcare services and the success of policy reforms are influenced by a complex set of non-medical variables (e.g., socioeconomic and geographic) at various levels of organization (e.g., hospital and bureaucracy). Some reforms will thus be more effective than others and some anticipated health benefits might conceivably not actualize post-implementation. However, very few studies have examined the effects of the proposed reforms on health outcomes. Changes in health resulting from interventions at the primary healthcare level are generally not observed in a population for many years after implementation. Thus, studies of recent changes to the primary care system have focused on economic feasibility or patient and physician satisfaction rather than their effect on the diagnosis or prevention of disease. However, some changes to primary care have now been in effect for sufficient time to observe whether there have been improvements in related hospital outcomes. We will gather pre-existing data about physician reimbursement models, geographic accessibility, clinical setting, patient education, wealth, and prior health in Newfoundland and Labrador. We will develop a multilevel statistical model that can be used to determine which primary care reforms help prevent important patient outcomes such as hospitalizations. We will also examine the feasibility of a nation-wide study that will use a similar method.