Who gets access to an interprofessional team-based primary care programme for patients with complex health and social needs? A cross-sectional analysis.

OBJECTIVES: To determine whether a voluntary referral-based interprofessional team-based primary care programme reached its target population and to assess the representativeness of referring primary care physicians. DESIGN: Cross-sectional analysis of administrative health data. SETTING: Ontario, Canada. INTERVENTION: TeamCare provides access to Community Health Centre services for patients of non-team physicians with complex health and social needs. PARTICIPANTS: All adult patients who participated in TeamCare between 1 April 2015 and 31 March 2017 (n=1148), and as comparators, all non-referred adult patients of the primary care providers who shared patients in TeamCare (n=546 989), and a 1% random sample of the adult Ontario population (n=117 753). RESULTS: TeamCare patients were more likely to live in lower income neighbourhoods with a higher degree of marginalisation relative to comparison groups. TeamCare patients had a higher mean number of diagnoses, higher prevalence of all chronic conditions and had more frequent encounters with the healthcare system in the year prior to participation. CONCLUSIONS: TeamCare reached a target population and fills an important gap in the Ontario primary care landscape, serving a population of patients with complex needs that did not previously have access to interprofessional team-based care. STRENGTHS AND LIMITATIONS: This study used population-level administrative health data. Data constraints limited the ability to identify patients referred to the programme but did not receive services, and data could not capture all relevant patient characteristics.

Comparing public policies impacting prescribing and medication management in primary care in two Canadian provinces.

The challenges of polypharmacy and inappropriate prescribing are recognized internationally. This study synthesizes and compares the policies related to these issues introduced in Canada's two most populous provinces - Ontario and Quebec - over the first two decades of the 21st century. Drawing on policy documents and consultations with experts, we found that while medication management to address polypharmacy and inappropriate prescribing has not been an explicit and consistent policy target in either province, some policy changes sought to directly or indirectly impact medication management. These changes include the introduction of primary care teams that include pharmacists, the introduction of a medication review performed by pharmacists (in Ontario), increased emphasis on quality improvement with some attention to potentially inappropriate medications (specifically opioids in Ontario), and investments in information technology to improve communication across providers and move toward electronic prescribing to improve medication safety and appropriateness. Despite growing evidence of the problem of polypharmacy and inappropriate prescribing, there has been limited policy attention targeting these problems directly, and policy changes with potential to improve prescribing and medication management may not have been fully realized. Further research to evaluate the impact of these changes on provider behaviours, and on patient outcomes, warrants attention.