Did the Implementation of Team-Based Primary Care Models in Ontario and Quebec, Canada, Impact Appropriate Prescribing?

Abstract

<h3>Context:</h3> Many older adults take multiple medications prescribed by a variety of providers, which leads to concerns about medication management, appropriateness, and adverse drug events. Interdisciplinary, team-based primary care models can improve coordination of health care services, which could translate to improved medication management and related outcomes. <h3>Objective:</h3> Evaluate the impact of interdisciplinary team-based primary care models implemented in two Canadian provinces — Ontario and Quebec — on outcomes related to medication use. <h3>Study Design and Analysis:</h3> Retrospective cohort analysis of population-level administrative health data. We used difference-in-differences analysis to compare older adults rostered to team-based primary care models, to older adults not rostered to team-based models. <h3>Dataset:</h3> Data housed at ICES in Ontario and the Institut national d’excellence en sante et services sociaux (INESSS) in Quebec. We focused on fiscal years 1999/00 to 2017/18. <h3>Population Studied:</h3> Eligible patients were between 66 and 104 years of age. We matched (1-to-1 propensity score matching without replacement) an exposure group of older adults who were rostered to a physician affiliated with a team-based primary care model to a comparison group of older adults rostered to non-team family physicians. <h3>Intervention:</h3> Quebec’s Family Medicine Groups (implemented in 2002) and Ontario’s Family Health Teams (implemented in 2005). <h3>Outcome Measures:</h3> Any adverse drug event resulting in hospitalization, polypharmacy (5+ medication classes), and any potentially inappropriate prescription (adapted from Beer’s and STOPP/START criteria). <h3>Results:</h3> Matched cohorts included 429,104 older adults in Ontario and 310,198 in Quebec. In the year before they rostered, 53% and 40% of older adults had a potentially inappropriate prescription in Ontario and Quebec, respectively. In both provinces, 1% had an adverse drug event. Quebec’s Family Medicine Groups were more likely to experience an adverse drug event (RR = 1.14; 95% CI: 1.10 - 1.17). We found no other differences between the exposure and comparison groups. <h3>Conclusions:</h3> The implementation of team-based primary care models in Ontario and Quebec was not associated with a variety of outcomes related to medication management. These results point to a need for further investigation of the composition and functioning of primary care teams to determine how they can support older adults with complex health needs