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Impact of a chronic disease self-management program on healthcare utilization in rural communities: a retrospective cohort study using linked administrative data


Background — Internationally, chronic disease self-management programs (CDSMPs) have been widely promoted with the assumption that confident, knowledgeable patients practicing self-management behavior will experience improved health and utilize fewer healthcare resources. However, there is a paucity of published data supporting this claim and the majority of the evidence is based on self-report.

Methods — The authors used a retrospective cohort study using linked administrative health data. Data from 104 tele-CDSMP participants from 13 rural and remote communities in the province of Ontario, Canada were linked to administrative databases containing emergency department (ED) and physician visits and hospitalizations. Patterns of healthcare utilization prior to and after participation in the tele-CDSMP were compared. Poisson Generalized Estimating Equations regression was used to examine the impact of the tele-CDSMP on healthcare utilization after adjusting for covariates.

Results — There were no differences in patterns of healthcare utilization before and after participating in the tele-CDSMP. Among participants ≤ 66 years, however, there was a 34% increase in physician visits in the 12 months following the program (OR = 1.34, 95% CI 1.11-1.61) and a trend for decreased ED visits in those >66 years (OR = 0.59, 95% CI 0.33-1.06).

Conclusions — This is the first study to examine healthcare use following participation in the CDSMP in a Canadian population and to use administrative data to measure healthcare utilization. Similar to other studies that used self-report measures to evaluate healthcare use we found no differences in healthcare utilization before and after participation in the CDSMP. Future research needs to confirm our findings and examine the impact of the CDSMP on healthcare utilization in different age groups to help to determine whether these interventions are more effective with select population groups.



Jaglal SB, Guilcher SJ, Hawker G, Lou W, Salbach NM, Manno M, Zwarenstein M. BMC Health Serv Res. 2014; 14:198. Epub 2014 May 1.

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