Grant: Project Grant

In Canada, seniors are not only taking multiple medications -- on average seven unique drugs per year -- but they are also at higher risk than the general population for being prescribed inappropriate medications that are potentially harmful and/or unnecessary. Inappropriate prescribing may be linked to a lack of coordination in the delivery of care, particularly for seniors who have multiple points of contact with the healthcare system. Inappropriate medications can lead to poor health outcomes, like hospitalization, and place a cost burden on health systems. Over the last 15 years, primary care reforms in Ontario and Quebec have sought to improve coordination of care, particularly through the implementation of team-based interprofessional care. However, there is limited evidence regarding the effectiveness fo such teams in improving the coordination and management of medications. In this study, we investigate whether primary care reforms in Ontario and Quebec have improved medication management and health outcomes for seniors. We use administrative health data to investigate the effects of primary care reforms, particularly team-based Interprofessional care, on the number of unique prescription drugs taken by seniors, the number of inappropriate medications taken, and hospitalizations resulting from inappropriate medication use. We will also interview primary care teams in both provinces to determine how teams -- including physicians, pharmacists, nurses, and others -- work together to manage seniors with multiple medications. The concurrent analysis of administrative data and interviews with teams should provide unique perspectives on the impact of primary care reform on medication safety for seniors. 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.