Team-based primary care: Improving the healthcare system for Canadians living with dementia

The following is a guest post by Nadia Sourial, a CCNA trainee working under the supervision of Dr. Isabelle Vedel.

 

As Canada’s population ages, the number of people living with Alzheimer’s disease (AD) will double to 1.1 million over the next 20 years. The impact on those living with AD, their care providers, families, the healthcare system, and the broader economy will be tremendous, with a projected health care cost of over $150 billion.

 

During the 2015 global meeting on dementia, former World Health Organization (WHO) Director-General, Dr. Margaret Chan said she could “think of no other disease where innovation, including breakthrough discoveries to develop a cure, is so badly needed.” Dementia has since been recognized by the WHO as one of the major global public health crises of the 21st century.

 

Responding to the WHO’s call to action, Canadian provincial governments implemented reforms with the goal of providing better care to people living with AD and other complex diseases. Essentially, these reforms have enabled and empowered family doctors to diagnose, treat, and manage AD. The hope is that these practice improvements will also reduce the burden of disease on Canada’s healthcare system by having fewer people with AD in emergency rooms, hospital wards, and long-term care.

 

Despite the fact that these publicly-financed reforms have been in place for over 10 years in several provinces, we still don’t know whether these changes to the health system have been useful in accomplishing these goals.

 

Our study, which takes place within the Canadian Consortium on Neurodegeneration in Aging, will provide this much needed information. We’re examining the impact of these reforms by analyzing government health data from the past 15 years on all patients with AD in the provinces of Ontario, Quebec, and New Brunswick. Because these ‘big data’ sources account for more than two-thirds of the Canadian population with AD, they will allow us to study the trends in care and use of health services before and after the reforms were introduced at a broad, population level.

 

To measure these trends, our team has developed a list of almost 60 performance indicators, including the number of patients with access to a family doctor, number of hospital readmissions within 30 days of hospital discharge, number of patients who have been prescribed Alzheimer’s medications by a family doctor, as well as access to home care and dying at home. These indicators were assessed based on the literature and feedback we received from several of our stakeholders, such as the Alzheimer Society of Canada, government representatives, managers, and clinicians.

 

Beyond describing these trends, we will use innovative statistical models to examine whether more people with AD are being diagnosed and regularly followed by family doctors. In turn, this will show whether primary care really is taking charge of more Alzheimer’s patients since the reforms were implemented. We will also determine whether the reforms have decreased the number of emergency visits, hospital stays, and other health services needed for people living with AD.

 

Taken together, the results of our study will give provincial health officials, researchers, and Alzheimer’s advisory groups data on what parts of the reforms are working, and what still needs to be improved. Our study will help Quebec, Ontario, New Brunswick, and ultimately the rest of Canada, achieve a sustainable and effective healthcare system – a system capable of meeting the needs of people and families affected by AD, eventuating in better quality of life, services, and care.

 

To learn more about this work, please visit the recently launched Team 19 webpage or contact Nadia directly at nadia.sourial@mail.mcgill.ca.

 

The views and opinions expressed in this guest blog are those of the authors (individual CCNA scientists) and do not necessarily reflect the views of the Canadian Consortium on Neurodegeneration in Aging and its partner organizations.