Characteristics of family physicians delivering home visits: a Canadian retrospective cohort study

Introduction — Home visits have become increasingly uncommon although evidence suggests they improve healthcare quality and reduce overall expenditures. This study identifies the primary care physicians delivering home visits at patients’ end of life in Ontario, Canada, describes characteristics of primary care physicians delivering end-of-life home visits, and explores associations with delivery.

Methods — A retrospective cohort design using population-level health administrative data housed at ICES. The cohort was composed of primary care physicians in Ontario, Canada between April 1, 2014-March 31, 2019, who were registered in the College of Physicians and Surgeons of Ontario database (CPSO) dataset on or after January 1, 1990 and as of March 31, 2016.

Results — A total of 9,884 physicians were identified, of which 2,568 (25.7%) delivered at least one end-of-life home visit. Physician characteristics showing increased odds ratio (OR) of home visit delivery were older age (OR 1.01 [95% Confidence Interval (CI): 1.00-1.02]) international training (OR 1.28 [95% CI:1.04-1.59]), previous home visit experience (OR 1.02 [95% CI: 1.01-1.02]), capitation models of remuneration; namely enhanced fee-for-service models (OR 1.5 [95%CI: 1.17-2.00]) and mainly capitation model (OR 1.4 [95% CI:1.11-1.79]), and population size of practice location with highest odds in small rural or remote areas (<9,000 residents) (OR 1.38 [95%CI: 1.02-1.88]) and the largest metropolitan areas (OR 1.84 [95%CI: 1.46-2.57]).

Conclusions — This research confirms previous evidence and identifies novel primary care physicians’ characteristics associated with home visit practice patterns. Furthermore, it highlights characteristics amenable to policy or system-level changes (e.g. remuneration model, training, and experience) that could increase the provision of home visits which may greatly improve the dying experience of Canadians.