The following is a summary of “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,” published in the September 2023 issue of Primary Care by Sheng, et al.
Chronic obstructive pulmonary disease (COPD) is a common, long-lasting condition primarily managed in primary care settings. However, how different primary care approaches affect the outcomes of COPD patients remains uncertain. For a study, researchers sought to analyze and compare how various primary care models impact specific indicators of unplanned healthcare usage among newly diagnosed COPD patients in Ontario.
A retrospective cohort study utilized healthcare administrative data from the Institute for Clinical Evaluative Sciences. The study group consisted of individuals aged 35 and older who had received a COPD diagnosis from a physician between January 1, 2014, and December 31, 2019. These patients were divided into three categories based on the primary care models they received: team-based care, traditional care, and no enrollment in any specific care model. The study’s primary focus was unplanned healthcare utilization, specifically at emergency department (ED) visits and hospitalizations. To account for situations where zero values were observed, the study employed zero-inflated negative binomial (ZINB) models to assess the connection between different primary care models and unplanned healthcare usage.
Of the 57,145 individuals who met the study’s criteria, 55,994 were included in the analysis. Notably, 62.8% of patients were in the traditional care group, 30.3% received team-based care, and 6.9% were not enrolled in any specific care model. During the study period from 2014 to 2019, 70.7% of the cohort experienced at least one unplanned ED visit for any reason without being subsequently hospitalized. The adjusted ZINB models revealed no significant difference in the risk of experiencing unplanned healthcare utilization between the team-based and traditional care groups. However, patients not enrolled in any specific care model had a notably higher risk of unplanned ED visits without hospitalization, ED visits followed by hospitalization, and readmissions within 30 days, regardless of the cause.
The landscape of primary care models was multifaceted and shaped by factors such as payment systems and organizational structures. It highlighted the importance of further research to enhance our understanding of primary care reforms. Additionally, given the increasing shortage of primary care providers, individuals with COPD and other chronic illnesses are particularly at risk, emphasizing the need for special attention and interventions.