Diabetes is a major cause of myocardial infarction, stroke, blindness and kidney failure, and accounts for nearly 15% of total health care expenditures.1,2
Its management is time-consuming and challenging, requires an individualized approach, and is usually coordinated by primary care physicians. Although safe, efficacious and cost-effective interventions for diabetes are available, studies suggest that patients are often not receiving these treatments.3,4
As such, programs that aim to improve the care of patients with chronic diseases, such as diabetes, must support providers of primary care, typically by coordinating teams of allied health providers. Although such comprehensive care can improve clinical outcomes,5
it is difficult to deliver and is optimized by programs that focus on the multidisciplinary management of chronic disease.6
Primary care networks were implemented in Alberta, Canada, in 2005 and are a potential strategy for improving care for patients with diabetes.7
A primary care network consists of primary care physicians and other health care providers working together to provide care to patients. In addition to typical physician services paid for on a fee-for-service basis, $50 per patient per year is provided to networks to support activities that fall outside of this model. Although networks may vary in size, the first 18 networks each provided care to nearly 90 000 patients and included an average of 75 primary care physicians (including groups of physicians from different practices). The objectives guiding all primary care networks are similar; they include increasing access to primary care, increasing emphasis on care for patients with chronic diseases and improving the coordination of primary health services with specialist care (Box 1
). Caring for patients with diabetes was identified as a priority for 17 of the original 18 networks.7,8
Box 1: Objectives of Alberta’s primary care networks7
- Increasing the number of residents with access to primary care services
- Managing access to appropriate around-the-clock primary care services
- Emphasizing the promotion of health, prevention of disease and injury, and care of patients with medically complex problems or chronic disease
- Improving the coordination of primary health services with hospitals and services providing long-term and specialty care
- Fostering a team approach to providing primary health care
There is considerable flexibility in how networks may operate, and the additional funds may be used either to hire allied health care professionals or for other initiatives. The types of programs offered by primary care networks for patients with diabetes vary substantially across networks.8
Generally, most offer programs for the education of patients, and about one-third either offer case management or employ members of the multidisciplinary team, other than the primary physician, who have the authority to provide alternative prescriptions.
Although Alberta’s primary care networks have some unique features, they are similar to Ontario’s family health teams9,10
and patient-centered Medical homes in the United States.11
Each of these approaches seeks to improve access to and coordination of care.
We sought to determine the impact of Alberta’s primary care networks on measures of processes, including the provision of guideline-recommended laboratory testing, appropriate use of medications, glycemic control and outcomes relevant to patients with diabetes (admissions to hospital or visits to emergency departments for diabetes-specific ambulatory care sensitive conditions [hypoglycemia, hyperglycemia]12,13
that might be partially prevented by appropriate outpatient care).