Authors: Richard Lewanczuk
Treating cardiometabolic disease is traditionally addressed at the individual patient level. However, population-based data can be highly instructive regarding the system considerations necessary to support the care of individuals.
Aberta Health Services (AHS) is the arm's length government organization charged with providing universal health care to the 3.6 million people of province of Alberta, Canada. As with all health care systems, AHS is under pressure to reduce costs and improve outcomes. With a history active engagement in chronic disease management, AHS and academic partners set out to collect data that would allow an understanding of the system issues and challenges that would aid in better prevention, treatment and control of cardiometabolic disease.
Methods: Accessing population-wide Alberta Health Services provincial databases, relationships between cost, outcomes, markers of chronic disease management and primary care were assessed.
Results: The end-stages of cardiometabolic disease (diabetes, hypertension, coronary artery disease, etcetera) were primary drivers of health care costs and adverse patient outcomes. However, regardless of complexity, attachment to a primary care provider improves quality of care, outcomes and reduces cost. Primary care principles of attachment, access and continuity were also highlighted by data as being paramount to cost-effective, quality care. On the other hand, while specialist involvement reduced hospitalizations for cardiometabolic disease, quality of care and effective medical management were not impacted. Finally, while primary care does a good job in cardiometabolic disease prevention, patient-related factors are primarily responsible for the challenges seen in adopting healthy lifestyles.
Conclusion: Efective strategies to prevent, effectively treat, and prevent end-stages of cardiometabolic disease require an integrated approach between the health care system, primary care providers and specialty care.