REFERRAL PATTERNS OF PRIMARY CARE PRACTICES IN ONTARIO

Abstract

Background: Primary care physicians (PCPs) are critical to Ontario’s health care system, acting as the first point of contact for patients with the system. They play a critical role in facilitating referrals to specialists and laboratory services, as part of clinical decision-making to address patients’ health care needs. However, there is limited understanding of how different primary care practice models impact different aspects of referrals, such as rate of referrals to specialists, communication with specialists about their referrals, and rate of referrals to laboratory medicine services, particularly within the context of Ontario’s primary care reform. This thesis aimed to comprehensively study primary care physician referrals to specialists and laboratory services and examine the association between their practice model and referral rates to specialist services and laboratory medicine. Methods: This thesis includes three independent studies using quantitative observational research methods. Primary care physicians practicing comprehensive care were identified from health administrative databases, and their data was linked to physicians’ billing data (Ontario Health Insurance Plan), population-level patient experience survey data (Health Care Experience Survey) and other health administrative databases. Statistical analyses were conducted to examine the association between primary care physician’s practice models and referral rates to specialist and laboratory medicine services, adjusted for other physician, patient and practice-level factors. Results: The first study showed that primary care physician referrals to specialists vary by practice model and sex. Those in predominantly fee-for-service models referred fewer patients to specialists than those in Family Health Teams (FHTs), Ontario's largest team-based care model. The second study showed that while patients generally across all models reported a high level of information coordination between their primary care physician and specialist, patients rostered to predominantly fee-for-service models were more likely to report that the specialist did not receive the necessary medical information from their primary care physician. The third study found that primary care physicians in FHTs had a lower rate of referrals to laboratory services than those in other primary care practice models. Conclusion: Primary care physician practice models significantly influenced rates of referrals to specialists and laboratory medicine services. Primary care physicians in FHTs had lower referral rates for laboratory services and higher coordination of information with specialists, they had a higher referral rate to specialists and to different subspecialties. These findings emphasize the importance of considering the impact changes to primary care practice models could have on the utilization of specialist and laboratory medicine services as Ontario continues to reform the primary care system and expand team-based care models such as FHTs