Do interprofessional primary care teams provide equitable quality of care across social determinants of health?

Background: Interprofessional primary care teams serve populations of varying social determinants of health, which may drive health inequities. While such teams have the potential to deliver high-quality and equitable primary care, whether that is truly the case is not clear. Our objectives were to measure the association between patient attachment to a family physician practicing in an interprofessional primary care team and quality of care and to investigate whether this association differs according to social determinants of health.

 

Methods: This retrospective longitudinal cohort study used data from the TorSaDE cohort, which links the Canadian Community Health Survey (with self-reported sociodemographic and outcome information) and Quebec health administrative data (with doctor billing codes). Study participants were adult residents of Quebec, Canada, who were attached to a family physician, and who had responded to the 2015-2016 cycle of the Canadian Community Health Survey.

 

The exposure was patient attachment to a family physician practicing in an interprofessional primary care team (herein, attached to an interprofessional primary care team), measured one year prior to survey response compared to patients attached to a family physician not practicing in an interprofessional primary care team. Outcomes included self-reported data from patients regarding quality of primary care indicators (access, continuity, and coordination). The social determinants of health used in this study were chosen based on the PROGRESS-Plus framework (Place of residence, Race/ ethnicity/ culture/ language, Occupation, Gender/ sex, Religion, Education, Social status, Social capital,

 Plus (additional factors such as age). Inverse probability of treatment weighting was applied to balance the exposed and unexposed groups. Moderation analyses were conducted with multiply imputed weighted regression models.

 

Results: The cohort included 11,566 participants, and more than three fourths were attached to an interprofessional primary care team. We found no association between attachment to an interprofessional primary care team and access, continuity, or coordination. We also found no association across levels of each social determinant of health, except for education, where the odds of good continuity were 4.4% higher among the poorly educated attached to an interprofessional primary care team (P-value<0.05).

 

Implications: This research provides a thorough assessment of the equitable impact of interprofessional primary care teams on quality of care by incorporating multiple social determinants of health. Our results suggest that the quality of primary care received by patients attached to an interprofessional primary care team, while not superior to that of patients attached to a family physician not practicing in an interprofessional primary care team, was equitable. Findings are promising and have implications for practice and policy. Monitoring and further investigation (e.g., by means of qualitative studies) are necessary to confirm and enhance the equitable impact of team-based care.