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CMAJ . Characteristics of primary care practices by proportion of patients unvaccinated against SARS-CoV-2: a cross-sectional cohort study

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  • CMAJ . Characteristics of primary care practices by proportion of patients unvaccinated against SARS-CoV-2: a cross-sectional cohort study

    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 1 , Michael E Green 2 , Tara Kiran 2 , Shahriar Khan 2 , Eliot Frymire 2 , Rahim Moineddin 2 , Meghan Kerr 2 , Mina Tadrous 2 , Dominik Alex Nowak 2 , Jeffrey C Kwong 2 , Jia Hu 2 , Holly O Witteman 2 , Bryn Hamilton 2 , Isaac Bogoch 2 , Lydia-Joy Marshall 2 , Sophia Ikura 2 , Stacey Bar-Ziv 2 , David Kaplan 2 , Noah Ivers 2



    AffiliationsAbstract

    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.


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