Factors associated with patient use of primary care outside of their capitated primary care enrolment group

OBJECTIVE: To determine which patient, physician, physician-group, and geographic factors influence the likelihood of health care visits to family physicians (FPs) outside of patients' enrolling physician groups. DESIGN: Cross-sectional analysis using administrative health data. A multilevel logistic regression model was used to determine the probability of outside use based on a set of observable factors at the patient and physician-group levels, accounting for the variation attributable to the patient, physician, physician-group, and geographic levels. SETTING: Ontario. PARTICIPANTS: Patients enrolled in family health organizations (FHOs) during the study period from April 1, 2018, to March 31, 2019. MAIN OUTCOME MEASURES: Outside use, defined as an encounter with an FP outside of the patient's enrolling physician group who submitted an Ontario Health Insurance Plan fee code in the FHO core primary care services. RESULTS: <.05) included Rurality Index for Ontario scores, group size, years of existence, proportion of female physicians, average age, and number of weekend and holiday days worked per patient. CONCLUSION: Physician- or physician-group-level policy options for effectively reducing outside use may include increasing group size to more than 5 and increasing weekend and holiday days worked per patient and after-hours care. However, because outside use is primarily explained by variations at the patient level, other innovative policy options may need to be implemented to improve care continuity.