Do family physicians with focused practice or Care of the Elderly training practice differently than others? A population-based, propensity score-matched cohort study

RESEARCH ARTICLE Do family physicians with focused practice or Care of the Elderly training practice differently than others? A population-based, propensity score-matched cohort study Rebecca H. Correia 1,2*, David Kirkwood3, Aaron Jones1,3, Henry Yu-Hin Siu4, Meredith Vanstone 4, Steve Slade5, Andrew P. Costa1,6 1 Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada,‌‌ 2 Department of Family Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada, 3 ICES, McMaster University, Hamilton, Ontario, Canada, 4 Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada, 5 College of Family Physicians of Canada, Mississauga, Ontario, Canada, 6 Centre for Integrated Care, St. Joseph’s Health System, Hamilton, Ontario, Canada * Abstract OPEN ACCESS Citation: Correia RH, Kirkwood D, Jones A, Siu HY-H, Vanstone M, Slade S, et al. (2026) Do family physicians with focused practice or Care of the Elderly training practice differently than others? A population-based, propensity score-matched cohort study. PLoS One 21(5): e0347828. https://doi.org/10.1371/journal. pone.0347828 Editor: Marianne Clemence, Public Library of Science, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND Received: July 9, 2025 Accepted: May 8, 2026 Published: May 27, 2026 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal. pone.0347828 Copyright: © 2026 Correia et al. This is an open access article distributed under the terms of Background Family physicians play a key role in the care of older adults, yet the impact of additional geriatric training or focused practice remains unclear. Objective We compared performance on established clinical practice measures among family physicians with/without evidence of elderly-focused practice or training. Methods We used linked administrative data to conduct a population-based, propensity scorematched cohort study. Participants included family physicians in Ontario, Canada with rostered patients in 2019. Using logistic regression, we established propensity scores to match physicians with a focused alternative funding plan and/or a Certificate of Added Competence in ‘Care of the Elderly’ at a 1:4 ratio to a control group without focused practices or added competence certificates. We compared 11 practice-based measures endorsed by Canadian clinicians and researchers, adjusting for physician factors, medical practice characteristics, and primary care activities. Results We identified 232 family physicians with elderly-focused practices or training and 928 comparable controls. While differences in study group clinical practices were not statistically significant for most processes, they were in three areas. More physicians PLOS One | https://doi.org/10.1371/journal.pone.0347828 May 27, 2026 1 / 12 the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data availability statement: The dataset from this study is held securely in coded form at ICES. While legal data sharing agreements between ICES and data providers (e.g., healthcare organizations and government) prohibit ICES from making the dataset publicly available, access may be granted to those who meet pre-specified criteria for confidential access, available at www.ices.on.ca/DAS (email: das@ ices.on.ca). Please note that the computer programs may rely on coding templates or macros that are unique to ICES and are therefore either inaccessible or may require modification. As a Prescribed Entity under Ontario’s Personal Health Information Protection Act (PHIPA) and the Coroners Act, ICES has the authority to collect and use personal health information for specific purposes. PHIPA Section 45 provides Prescribed Entities with the authority to collect and use data to assist the government in the planning and management of the health system, and PHIPA section 44 provides Prescribed Entities with the authority to disclose data to third-party researchers. Therefore, ICES is bound by contracts, data sharing agreements, and research ethics standards, limiting the full dataset creation plan and underlying analytic code to only be available by contacting www. ices.on.ca/DAS (email: ). More information on data privacy in general can be found on the ICES website (https://www.ices. on.ca/data-privacy/). Funding: RHC was supported by a Canadian Institutes of Health Research Canada Graduate Scholarship (funding reference #181540). MV is supported by a Canada Research Chair (Tier 2) in Ethical Complexity in Primary Care and APC is supported by a Canada Research Chair (Tier 2) in Integrated Care for Seniors. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. with elderly-focused practice or training conducted testing aligned with the most recent Canadian Consensus on Dementia and were more likely to prescribe potentially inappropriate medications and antipsychotics to older attached patients. Conclusions We observed limited to no differences in clinical practice measures between family physicians with ‘Care of the Elderly’ focused practice or certification to those without. The lack of differences may reflect true performance, the effect of uniform constraints of primary care practice, or inherent limitations of objective performance measurement. Introduction Primary care of older adults is complex due to multimorbidity, chronicity, polypharmacy, and the need for care integration across settings and multiple providers. [1–3] In Canada, older adults constitute a large proportion of family physicians’ (FPs) overall medical practice and, compared to specialists, FPs provide the majority of older adult care. [4–6] Older adults’ use of primary care services is expected to increase given demographic shifts, [7] but FPs vary in their confidence and skillset to care for older patients. [8–10] Physicians report interpersonal challenges, administrative burdens, inadequate time and remuneration, and gaps in knowledge of community resources/services as barriers to caring for older adults [4,10,11].‌‌ Family medicine is faced with adapting to the changing needs of aging populations, but FPs often struggle to deliver comprehensive, continuous, and coordinated care to older patients. [12,13] While all FPs achieve foundational knowledge and clinical skills to care for older adults, [14] some pursue additional training to hone geriatric competencies [15,16 (...truncated)