The impact of team-based primary care on medication-related outcomes in older adults: A comparative analysis of two Canadian provinces

David Rudoler; Nichole Austin; Sara Allin; Lise M Bjerre; Lisa Dolovich; Richard H Glazier; Agnes Grudniewicz; Audrey Laporte; Elisabeth Martin; Sue Schultz; Caroline Sirois; Erin Strumpf

doi:10.1016/j.pmedr.2023.102512

The impact of team-based primary care on medication-related outcomes in older adults: A comparative analysis of two Canadian provinces

Prev Med Rep. 2023 Nov 10:36:102512. doi: 10.1016/j.pmedr.2023.102512. eCollection 2023 Dec.

Authors

David Rudoler^{1

2

3}, Nichole Austin⁴, Sara Allin⁵, Lise M Bjerre⁶, Lisa Dolovich⁷, Richard H Glazier^{3

5

8}, Agnes Grudniewicz⁹, Audrey Laporte^{3

5

10}, Elisabeth Martin¹¹, Sue Schultz³, Caroline Sirois¹², Erin Strumpf^{10

13

14}

Affiliations

¹ Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada.
² Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada.
³ ICES, Toronto, Ontario, Canada.
⁴ School of Health Administration, Dalhousie University, Halifax, Canada.
⁵ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁶ Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁷ Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
⁸ Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada.
⁹ Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada.
¹⁰ Canadian Centre for Health Economics, University of Toronto, Toronto, Ontario, Canada.
¹¹ Faculty of Nursing Sciences, Université Laval, Québec City, Québec, Canada.
¹² Faculty of Pharmacy, Université Laval, Québec, Québec, Canada.
¹³ Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.
¹⁴ Department of Economics, McGill University, Montréal, Québec, Canada.

Abstract

Objective: To evaluate if access to team-based primary care is related to medication management outcomes for older adults.

Methods: We completed two retrospective cohort studies using administrative health data for older adults (66+) in Ontario (n = 428,852) and Québec (n = 310,198) who were rostered with a family physician (FP) between the 2001/02 and 2017/18 fiscal years. We generated matched comparison groups of older adults rostered to an FP practicing in a team-based model, and older adults rostered to an FP in a non-team model. We compared the following outcomes between these groups: any adverse drug reactions (ADRs), any potentially inappropriate prescription (PIP), and polypharmacy. Average treatment effects of access to team-based care were estimated using a difference-in-differences estimator.

Results: The risk of an ADR was 22 % higher (RR = 1.22, 95 % CI = 1.18, 1.26) for older adults rostered to a team-based FP in Québec and 6 % lower (RR = 0.943, 95 % CI = 0.907, 0.978) in Ontario. However, absolute risk differences were less than 0.5 %. Differences in the risk of polypharmacy were small in Québec (RR = 1.005, 95 % CI = 1.001, 1.009) and Ontario (RR = 1.004, 95 % CI = 1.001, 1.007) and had absolute risk differences of less than 1 % in both provinces. Effects on PIP were not statistically or clinically significant in adjusted models.

Interpretation: We did not find evidence that access to team-based primary care in Ontario or Québec meaningfully improved medication management outcomes for older adults.

Keywords: Administrative health data; Comparative study; Medication management; Primary care; Team-based care.