A Population-Wide Evaluation of Comprehensive Annual Care Plans by Physicians and Pharmacists in Alberta

• Author / Creator

  Necyk, Candace M.

• Background: Chronic diseases are growing in prevalence worldwide and are the largest drivers of healthcare costs due to physician visits, emergency department (ED) visits and hospital admissions. In 2009 and 2012, the Government of Alberta introduced a remuneration model for physicians and pharmacists, respectively, to develop a comprehensive annual care plan (CACP) for patients with complex needs.
  Objectives: 1) Characterize the population of patients in Alberta who received: a) physician-billed CACPs since 2009 and b) pharmacist-billed CACPs since 2012; 2) Evaluate changes in healthcare utilization, including all-cause and ambulatory care sensitive condition (ACSC)-related hospital admissions, ED visits, and physician visits in the above populations; and 3) Explore the impact of the CACP programs on patient perceptions of quality of chronic illness care provided by their physicians and pharmacists.
  Methods: To evaluate changes in healthcare utilization resulting from the CACP program, administrative health data were used to identify all individuals in Alberta who received a physician-billed CACP between 2009 to 2015 and a pharmacist-billed CACP between 2012 to 2015. Up to two control patients were matched to each CACP patient based on age, sex, provider, date of service and qualifying medical conditions. Controlled interrupted time series analyses were used to evaluate changes in physician visits, all-cause and ACSC-related hospitalizations and ED visits in the 12 months before and after a CACP in the physician group and the pharmacist group. To explore the impact of the CACP program on patient perception of chronic illness care, individuals and up to two matched controls (matched on the same criteria as above) who received a physician-billed or pharmacist-billed CACP in the previous 3 months were invited to complete an online questionnaire consisting of the 11-item Patient Assessment of Chronic Illness Care (PACIC) tool, with 3 additional questions added to further examine chronic illness and collaborative care. Health status, health literacy and demographics were also explored.
  Results: Between 2009 to 2015, 308,717 patients who received a physician-billed CACP were identified along with 549,479 matched controls. Likewise, 137,178 patients who received a pharmacist-billed CACP between 2012 to 2015 were matched to 241,658 control patients. In the physician CACP group, an overall increase in all-cause hospitalizations, ACSC-related hospitalizations, all-cause ED visits, and ACSC-related ED visits by 429.6 (95% CI: 337.1 to 522.1; p0.05) visits per 10,000 people in CACP patients vs. controls was also noted. In the pharmacy CACP group, CACP implementation was associated with an overall decrease in 180.5 (95% CI: -205.1 to 1-155.8; p0.05) and 8.0 (95% CI: 0.3 to 15.7; p<0.05) visits per 10,000 people in all-cause ED visits and ACSC-related hospitalizations (p<0.05), respectively, in those who received a pharmacist-billed CACP were also noted. With respect to patient perspectives on chronic illness care, few statistically significant differences were noted across all areas of care in those who received a physician billed CACP compared to controls. Few differences in care were noted between those who received a pharmacist-billed CACP compared to controls, with controls reporting statistically higher PACIC scores than CACP patients across 4 of the 14 questions. Sensitivity analyses in both the physician and pharmacy groups suggest that increased patient engagement in the CACP process leads to improved perceptions of chronic illness care.
  Conclusion: Overall, the physician and pharmacist CACP programs in Alberta have demonstrated minimal impact on perceived chronic illness care by patients as well as on healthcare utilization at an individual level; effect on healthcare utilization from a health system level may be interpreted as more meaningful. Improved design and implementation of these remuneration models, including required patient follow-up, are needed to better realize the long-term goals of improved chronic disease management.

• Subjects / Keywords

  • Chronic disease management
  • pharmacy practice
  • comprehensive annual care plan
  • physician practice

• Graduation date

  Fall 2020

• Type of Item

  Thesis

• Degree

  Doctor of Philosophy

• DOI

  https://doi.org/10.7939/r3-qeme-yr15

• License

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