Dataset Information

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

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.

SUBMITTER: Rudoler D

PROVIDER: S-EPMC10728440 | biostudies-literature | 2023 Dec

REPOSITORIES: biostudies-literature

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Publications

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

Rudoler David D Austin Nichole N Allin Sara S Bjerre Lise M LM Dolovich Lisa L Glazier Richard H RH Grudniewicz Agnes A Laporte Audrey A Martin Elisabeth E Schultz Sue S Sirois Caroline C Strumpf Erin E

Preventive medicine reports 20231110

<h4>Objective</h4>To evaluate if access to team-based primary care is related to medication management outcomes for older adults.<h4>Methods</h4>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 ...[more]

PMID: 38116285

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Project description:ImportanceTransient elevations of blood pressure (BP) are common in hospitalized older adults and frequently lead practitioners to prescribe more intensive antihypertensive regimens at hospital discharge than the patients were using before hospitalization.ObjectiveTo investigate the association between intensification of antihypertensive regimens at hospital discharge and clinical outcomes after discharge.Design, setting, and participantsIn this retrospective cohort study, patients 65 years and older with hypertension who were hospitalized in Veterans Health Administration national health system facilities from January 1, 2011, to December 31, 2013, for common noncardiac conditions were studied. Data analysis was performed from October 1, 2018, to March 10, 2019.ExposuresDischarge with antihypertensive intensification, defined as receiving a prescription at hospital discharge for a new or higher-dose antihypertensive than was being used before hospitalization. Propensity scores were used to construct a matched-pairs cohort of patients who did and did not receive antihypertensive intensifications at hospital discharge.Main outcomes and measuresThe primary outcomes of hospital readmission, serious adverse events, and cardiovascular events were assessed by competing risk analysis. The secondary outcome was the change in systolic BP within 1 year of hospital discharge.ResultsThe propensity-matched cohort included 4056 hospitalized older adults with hypertension (mean [SD] age, 77 [8] years; 3961 men [97.7%]), equally split between those who did vs did not receive antihypertensive intensifications at hospital discharge. Groups were well matched on all baseline covariates (all standardized mean differences <0.1). Within 30 days, patients receiving intensifications had a higher risk of readmission (hazard ratio [HR], 1.23; 95% CI, 1.07-1.42; number needed to harm [NNH], 27; 95% CI, 16-76) and serious adverse events (HR, 1.41; 95% CI, 1.06-1.88; NNH, 63; 95% CI, 34-370). At 1 year, no differences were found in cardiovascular events (HR, 1.18; 95% CI, 0.99-1.40) or change in systolic BP among those who did vs did not receive intensifications (mean BP, 134.7 vs 134.4; difference-in-differences estimate, 0.6 mm Hg; 95% CI, -2.4 to 3.7 mm Hg).Conclusions and relevanceAmong older adults hospitalized for noncardiac conditions, prescription of intensified antihypertensives at discharge was not associated with reduced cardiac events or improved BP control within 1 year but was associated with an increased risk of readmission and serious adverse events within 30 days.

Dataset Information

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

Objective

Methods

Results

Interpretation

Publications

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

Similar Datasets

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