The impact of team-based primary care on medication-related outcomes in older adults: a comparative analysis of two Canadian provinces

Objective — To evaluate if access to team-based primary care is related to medication management outcomes for older adults.

Methods — We completed two retrospective cohort studies using administrative health data for older adults (66+) in Ontario (n = 428,852) and Québec (n = 310,198) who were rostered with a family physician (FP) between the 2001/02 and 2017/18 fiscal years. We generated matched comparison groups of older adults rostered to an FP practicing in a team-based model, and older adults rostered to an FP in a non-team model. We compared the following outcomes between these groups: any adverse drug reactions (ADRs), any potentially inappropriate prescription (PIP), and polypharmacy. Average treatment effects of access to team-based care were estimated using a difference-in-differences estimator.

Results — The risk of an ADR was 22% higher (RR = 1.22, 95% CI = 1.18, 1.26) for older adults rostered to a team-based FP in Québec and 6% lower (RR = .943, 95% CI = .907, .978) in Ontario. However, absolute risk differences were less than 0.5%. Differences in the risk of polypharmacy were small in Québec (RR = 1.005, 95% CI = 1.001, 1.009) and Ontario (RR = 1.004, 95% CI = 1.001, 1.007) and had absolute risk differences of less than 1% in both provinces. Effects on PIP were not statistically or clinically significant in adjusted models.

Interpretation — We did not find evidence that access to team-based primary care in Ontario or Québec meaningfully improved medication management outcomes for older adults.