Effect of family medicine groups on visits to the emergency department among diabetic patients in Quebec between 2000 and 2011: a population-based segmented regression analysis

Renee Carter, Amélie Quesnel-Vallée, Céline Plante, Philippe Gamache, Jean-Frédéric Lévesque

Family Medicine Groups (FMG) were introduced in Quebec in 2002 to re-organize primary care practices and encourage inter-professional service delivery. We measured visits to the emergency department (ED) for acute complications related to diabetes as a proxy for access to and quality of primary care, before and after the reform using an open cohort of individuals diagnosed with type 1 and type 2 diabetes. The weekly rate of ED visits between April 1, 2000 and March 31, 2012 were derived from administrative databases. We performed an interrupted segmented regression analysis to obtain the estimated and predicted rates of visits in the years following the introduction of the reform. An outcome control series of diabetic patients visiting the ED to treat appendicitis was incorporated to strengthen the study's internal validity. After 9 years of reform implementation, we observed a statistically significant absolute decrease of 2.12 and 2.25 ED visits per 10,000 diabetic patients per week to treat acute diabetes-related complications in urban and rural areas, respectively. However, the magnitude of the changes between the estimated and predicted rates did not differ significantly over time. No statistically significant change in the rate of ED visits for appendicitis was observed. Our findings suggest that the introduction of the FMG model produced reductions in the weekly rate of avoidable visits to the ED. Our results also imply that despite a greater proportion of the diabetes population being enrolled with FMG physicians across the province over time, the added benefit may be minimal. More studies examining this issue are needed to inform future policy.