The Impact of Primary Care Practice Models on Indicators of Unplanned Health Care Utilization for Ontario Adults Newly Diagnosed with Chronic Obstructive Pulmonary Disease: A Retrospective Cohort Study
chronic obstructive pulmonary disease , health care utilization , hospitalizations , emergency department use , primary care
Background: Chronic obstructive pulmonary disease (COPD) is a highly prevalent chronic disease among Ontario’s general population. Most of the care for this population occurs within the primary care setting; however, the extent to which different primary care practice models influence the care and outcomes of patients with COPD is largely unknown. Objective: The overall aim of this study was to compare and explore the impact of different primary care practice models on indicators of unplanned health care utilization among adults newly diagnosed with COPD. Methods: We conducted a retrospective cohort study using health administrative datasets housed within the Institute for Clinical Evaluative Sciences (ICES). Our cohort consisted of Ontario individuals 35 years and older with physician-diagnosed COPD between January 1, 2014 and December 31, 2019. Individuals were assigned to the following cohorts: team-based (FHT), traditional (CCM, FHO, FHN, FHG), and no enrolment (walk-in clinics). The primary outcomes were indicators of unplanned health care utilization as defined by emergency department (ED) visits and hospitalizations. Adjusted logistic regression models were used to analyze the association between the different practice models and unplanned health care utilization while controlling for confounders. Results: In total, 57,145 individuals met the inclusion criteria and 55,994 were included in the regression analysis. 62.8% of patients were in the traditional group, 30.3% in the team-based group, and 6.9% in the no enrolment group. Between 2014-2019, 70.7% of the cohort had at least one all-cause ED visit without hospitalization. In the adjusted logistic regression models, patients in the traditional model had a lower risk of ED visit without hospitalization, regardless of cause [all-cause (AOR = 0.89; 95% CI = 0.85-0.94) or COPD-related (AOR = 0.90; 95% CI = 0.84-0.97)] in comparison to patients enrolled in team-based models. Conclusion: Amongst patients newly diagnosed with COPD, patients in team-based primary care models were more likely to have an ED visit without hospitalization when compared to patients in traditional primary care models. Primary care models are complex, with influence from remuneration and organizational structures, reinforcing the importance of continuing research efforts in this area to broaden the understanding of primary care reforms.