Primary Care Reform and Medication Appropriateness for Seniors: A Mixed Methods Study

Rudoler, D. & Allin, S., Grudniewicz, A., Martin, E. & Strumpf, E.


Abstract


Context:
Seniors are taking multiple medications and are at higher risk than the general population of inappropriate prescribing and potentially harmful medications. This may be linked to a lack of coordination in the delivery of care. Primary care reforms in Ontario and Quebec have sought to improve coordination, particularly through the implementation of team-based primary care. Yet, there is limited evidence on the effectiveness of teams in improving medication safety.
Objective: To evaluate how primary care teams conduct medication management, how the care they deliver is facilitated or hindered by regional and provincial policies, and whether they have been effective in improving process and outcome measures.
Study Design: Comparative, mixed-methods study using complimentary qualitative and quantitative analyses. Quantitative analysis will inform the recruitment for qualitative interviews with participants in selected primary care teams.
Setting and Dataset: Administrative health data from IC/ES in Ontario and l’Institut national d’excellence en santé et en services sociaux (INESSS) in Quebec. Qualitative data will be collected from individuals working as part of selected Ontario Family Health Teams and Quebec Family Medicine Groups.
Population Studied: Quantitative analyses will include adults over 65 years and older. Outcome Measures: Description of practice and patient characteristics associated with higher and lower rates of prescriptions, inappropriate prescriptions, and adverse drug reactions.
Results: To date, an environmental scan of provincial policies and programs has been completed. Descriptive analyses of administrative health data will be completed by Fall 2019. Qualitative interviews will be conducted with practices selected after descriptive analyses. Our mixed methods design is expected to provide insight into whether and why (or why not) team-based interventions have been effective in supporting medication management. Conclusions: The findings of this work will help inform system managers seeking to improve the design of team-based primary care in order to improve patient outcomes and reduce adverse events and resulting hospitalizations. It can also inspire further interventions to improve appropriate prescribing.

Poster designed by Monika Roerig

Poster available on ResearchGate