Skip navigation
  • Home
  • Browse
    • Communities
      & Collections
    • Browse Items by:
    • Publication Date
    • Author
    • Title
    • Subject
    • Department
  • Sign on to:
    • My MacSphere
    • Receive email
      updates
    • Edit Profile


McMaster University Home Page
  1. MacSphere
  2. Open Access Dissertations and Theses Community
  3. Open Access Dissertations and Theses
Please use this identifier to cite or link to this item: http://hdl.handle.net/11375/32515
Full metadata record
DC FieldValueLanguage
dc.contributor.advisorCosta, Andrew-
dc.contributor.authorDash, Darly-
dc.date.accessioned2025-10-15T13:00:57Z-
dc.date.available2025-10-15T13:00:57Z-
dc.date.issued2025-11-
dc.identifier.urihttp://hdl.handle.net/11375/32515-
dc.description.abstractBackground: Family physicians deliver medical care for long-term care residents in Canada. These physicians provide care with varying levels of commitment, but there are knowledge gaps concerning the relationship between physician practice and care quality. No consensus exists on how to define and measure physician commitment in long-term care. Objectives: This thesis examined: (1) How does physician commitment to long- term care influence resident care quality? (2) What are the relevant and feasible expectations for physician commitment in long-term care? (3) How does the long-term care practice environment influence medication prescribing patterns? Methods: This thesis comprised a retrospective cross-sectional study, a modified e-Delphi study, and a retrospective cohort study. Using health administrative data, the commitment of long-term care physicians was described and examined in relation to resident outcomes. Expert physicians rated statements to define expectations of commitment. A multi-level cohort study analyzed electronic medical records of long-term care residents to examine prescribing variation at the resident, unit, home, and organizational levels. Results: Only 114 (8.3%) physicians had a practice commitment of 80% or higher, which was associated with 10% fewer emergency department visits, but showed inconsistent relationships with other outcomes in administrative data. The consensus study established that commitment is multidimensional, encompassing 21 statements that define commitment. Lastly, this work examined the long-term care practice environment in a multi-level analysis and found substantial prescribing variation across psychotropic and non-psychotropic medications, with home variation consistently exceeding unit variation. Conclusion: This thesis provides the first comprehensive understanding of physician practice in Canadian long-term care homes. The studies developed an approach to measure commitment within health administrative data and demonstrated that commitment is multidimensional, with care quality resulting from complex interactions between physician characteristics and organizational contexts. This thesis provides support for evidence-based guidance for medical education, workforce planning, and quality improvement initiatives.en_US
dc.language.isoenen_US
dc.subjectlong term careen_US
dc.subjectnursing homesen_US
dc.subjectfamily physicianen_US
dc.subjectagingen_US
dc.subjectphysician practiceen_US
dc.subjectcare qualityen_US
dc.titlePHYSICIAN PRACTICE PATTERNS IN CANADIAN LONG-TERM CARE SETTINGS: DEFINING, MEASURING, AND EVALUATING IMPACT ON CARE QUALITYen_US
dc.title.alternativePHYSICIAN PRACTICE IN CANADIAN LONG-TERM CARE SETTINGSen_US
dc.typeThesisen_US
dc.contributor.departmentHealth Research Methodologyen_US
dc.description.degreetypeDissertationen_US
dc.description.degreeDoctor of Philosophy (PhD)en_US
dc.description.layabstractAs Canada's population ages, long-term care homes care for complex residents who require skilled medical care. Family physicians provide this medical care, but their practice patterns vary greatly. Some doctors dedicate most of their practice to long-term care, while others visit only occasionally. There is a research gap in understanding how physician practice impacts the care that long-term care residents receive. This thesis studied physicians working in long-term care to see how their level of commitment and the long-term care setting affect resident care. Experienced physicians were consulted to determine what defines commitment to long-term care practice that is most relevant and feasible. The research involved analyzing health records, consulting expert physicians across Canada, and examining medication prescribing patterns in long-term care homes. Findings showed some practice differences between committed long-term care physicians, but the relationship with care quality was complex. Experienced physicians agreed that commitment involves more than the number of residents cared for or the time spent with them. This research suggests that physicians impact the care quality long-term care residents receive, but the relationship is complex. Other factors beyond the individual physician, such as culture, staff, and policies, also impact care quality.en_US
Appears in Collections:Open Access Dissertations and Theses

Files in This Item:
File Description SizeFormat 
Dash_Darly_202510_PhD.pdf
Open Access
11.13 MBAdobe PDFView/Open
Show simple item record Statistics


Items in MacSphere are protected by copyright, with all rights reserved, unless otherwise indicated.

Sherman Centre for Digital Scholarship     McMaster University Libraries
©2022 McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8 | 905-525-9140 | Contact Us | Terms of Use & Privacy Policy | Feedback

Report Accessibility Issue