Why Is Bigger Not Always Better in Primary Health Care Practices? The Role of Mediating Organizational Factors

The objective of this article is to identify some of these organizational characteristics and to determine the extent to which they mediate the relationship between size of PHC practice and patients’ experience of care, preventive services, and unmet needs. In 2010, we conducted population and organization surveys in 2 regions of the province of Quebec. We carried out multilevel linear and logistic regression analyses, adjusting for respondents’ individual characteristics. Size of PHC practice was associated with organizational characteristics and resources, patients’ experience of care, unmet needs, and preventive services. Overall, the larger the size of a practice, the higher the accessibility, but the lower the continuity. However, these associations faded away when organizational variables were introduced in the analysis model. This result supports the hypothesized mediating effect of organizational characteristics on relationships between practice size and patients’ experience of care, preventive services, and unmet needs. Our results indicate that size does not add much information to organizational characteristics. Using size as a proxy for organizational characteristics can even be misleading because its relationships with different outcomes are highly variable.

Source: Inquiry: The Journal of Health Care Organization, Provision, and Financing - January 31, 2016 Category: Health Management Authors: Pineault, R., Provost, S., Borges Da Silva, R., Breton, M., Levesque, J.-F. Tags: Original Research Source Type: research