tetano
Editor, Senior Moderator
CMAJ
. 2024 Apr 7;196(13):E432-E440.
doi: 10.1503/cmaj.230816. Characteristics of primary care practices by proportion of patients unvaccinated against SARS-CoV-2: a cross-sectional cohort study
Jennifer Shuldiner[SUP] 1 [/SUP], Michael E Green[SUP] 2 [/SUP], Tara Kiran[SUP] 2 [/SUP], Shahriar Khan[SUP] 2 [/SUP], Eliot Frymire[SUP] 2 [/SUP], Rahim Moineddin[SUP] 2 [/SUP], Meghan Kerr[SUP] 2 [/SUP], Mina Tadrous[SUP] 2 [/SUP], Dominik Alex Nowak[SUP] 2 [/SUP], Jeffrey C Kwong[SUP] 2 [/SUP], Jia Hu[SUP] 2 [/SUP], Holly O Witteman[SUP] 2 [/SUP], Bryn Hamilton[SUP] 2 [/SUP], Isaac Bogoch[SUP] 2 [/SUP], Lydia-Joy Marshall[SUP] 2 [/SUP], Sophia Ikura[SUP] 2 [/SUP], Stacey Bar-Ziv[SUP] 2 [/SUP], David Kaplan[SUP] 2 [/SUP], Noah Ivers[SUP] 2 [/SUP]
Affiliations
Background: Variations in primary care practices may explain some differences in health outcomes during the COVID-19 pandemic. We sought to evaluate the characteristics of primary care practices by the proportion of patients unvaccinated against SARS-CoV-2.
Methods: We conducted a population-based, cross-sectional cohort study using linked administrative data sets in Ontario, Canada. We calculated the percentage of patients unvaccinated against SARS-CoV-2 enrolled with each comprehensive-care family physician, ranked physicians according to the proportion of patients unvaccinated, and identified physicians in the top 10% (v. the other 90%). We compared characteristics of family physicians and their patients in these 2 groups using standardized differences.
Results: We analyzed 9060 family physicians with 10 837 909 enrolled patients. Family physicians with the largest proportion (top 10%) of unvaccinated patients (n = 906) were more likely to be male, to have trained outside of Canada, to be older, and to work in an enhanced fee-for-service model than those in the remaining 90%. Vaccine coverage (≥ 2 doses of SARS-CoV-2 vaccine) was 74% among patients of physicians with the largest proportion of unvaccinated patients, compared with 87% in the remaining patient population. Patients in the top 10% group tended to be younger and live in areas with higher levels of ethnic diversity and immigration and lower incomes.
Interpretation: Primary care practices with the largest proportion of patients unvaccinated against SARS-CoV-2 served marginalized communities and were less likely to use team-based care models. These findings can guide resource planning and help tailor interventions to integrate public health priorities within primary care practices.
. 2024 Apr 7;196(13):E432-E440.
doi: 10.1503/cmaj.230816. Characteristics of primary care practices by proportion of patients unvaccinated against SARS-CoV-2: a cross-sectional cohort study
Jennifer Shuldiner[SUP] 1 [/SUP], Michael E Green[SUP] 2 [/SUP], Tara Kiran[SUP] 2 [/SUP], Shahriar Khan[SUP] 2 [/SUP], Eliot Frymire[SUP] 2 [/SUP], Rahim Moineddin[SUP] 2 [/SUP], Meghan Kerr[SUP] 2 [/SUP], Mina Tadrous[SUP] 2 [/SUP], Dominik Alex Nowak[SUP] 2 [/SUP], Jeffrey C Kwong[SUP] 2 [/SUP], Jia Hu[SUP] 2 [/SUP], Holly O Witteman[SUP] 2 [/SUP], Bryn Hamilton[SUP] 2 [/SUP], Isaac Bogoch[SUP] 2 [/SUP], Lydia-Joy Marshall[SUP] 2 [/SUP], Sophia Ikura[SUP] 2 [/SUP], Stacey Bar-Ziv[SUP] 2 [/SUP], David Kaplan[SUP] 2 [/SUP], Noah Ivers[SUP] 2 [/SUP]
Affiliations
- PMID: 38589026
- PMCID: PMC11001391
- DOI: 10.1503/cmaj.230816
Background: Variations in primary care practices may explain some differences in health outcomes during the COVID-19 pandemic. We sought to evaluate the characteristics of primary care practices by the proportion of patients unvaccinated against SARS-CoV-2.
Methods: We conducted a population-based, cross-sectional cohort study using linked administrative data sets in Ontario, Canada. We calculated the percentage of patients unvaccinated against SARS-CoV-2 enrolled with each comprehensive-care family physician, ranked physicians according to the proportion of patients unvaccinated, and identified physicians in the top 10% (v. the other 90%). We compared characteristics of family physicians and their patients in these 2 groups using standardized differences.
Results: We analyzed 9060 family physicians with 10 837 909 enrolled patients. Family physicians with the largest proportion (top 10%) of unvaccinated patients (n = 906) were more likely to be male, to have trained outside of Canada, to be older, and to work in an enhanced fee-for-service model than those in the remaining 90%. Vaccine coverage (≥ 2 doses of SARS-CoV-2 vaccine) was 74% among patients of physicians with the largest proportion of unvaccinated patients, compared with 87% in the remaining patient population. Patients in the top 10% group tended to be younger and live in areas with higher levels of ethnic diversity and immigration and lower incomes.
Interpretation: Primary care practices with the largest proportion of patients unvaccinated against SARS-CoV-2 served marginalized communities and were less likely to use team-based care models. These findings can guide resource planning and help tailor interventions to integrate public health priorities within primary care practices.