Can we improve patient reported accessibility with Integrated Primary Care Teams?

Arnaud Duhoux

Background:
Integrated Primary Care Teams (IPCTs) have four key characteristics (intensive interdisciplinary practice; advanced nursing practice with an expanded role; group practice; increased proximity and availability) aimed at strengthening primary care in Quebec, Canada.
Patient Reported Experience Measures (PREM) provide patient-centered measures that allow for the capture of quality dimensions that are important to patients but that are not captured by other data sources usually used in health services research such as administrative data.

Research questions:
Does the patient reported accessibility increase over time for patients who have an IPCT as their primary source of care?
What are the site and patients' characteristics associated with an increase in reported accessibility?

Method:
We used a quasi-experimental longitudinal design based on a pre-and-post administered survey at a 2-year interval. Patients who used an IPCT as their primary source of care were recruited during a consultation received in one a the participating IPCT. They completed a self-administered questionnaire at inception and two years later. We measured 5 PREM including 5 dimensions of patient-reported accessibility.

Results:
A total of 1473 patients completed both the pre- and post-surveys. Results showed that patients who were newly registered with an IPCT had a significant increase in reported accessibility, whereas patients who have been registered with an IPCT for 2 years prior to the first round of data collection had already high reported accessibility that was maintained over time. Moreover, linear regression models showed statistically significant different increases in accessibility by site and patients’ characteristics.

Conclusions:
Our results suggest that the IPCT model is tailored to the needs of its target populations, resulting in improved PREM. These results imply that broader implementation of innovative and flexible community-based care models should be considered by policymakers.

Points for discussion:
What are the characteristics of the IPCT?

What are the other dimensions of experience of care that IPCT can improve?

Could accessibility be measured by other methods?