Contextualized Health Research Synthesis Program (CHRSP)
Interprofessional Teams for Chronic Disease Management in NL
As in other parts of Canada and the world, the prevalence of chronic disease in Newfoundland and Labrador (NL) is growing due to the combined impact of our aging population, rising obesity rates, and other persistent lifestyle risk factors.
It has been argued that a team approach to chronic disease management may improve patient health outcomes and may also ease the financial burden on the health care system.
Adopting an interprofessional team-based approach to chronic disease management in NL would, however, require a rethinking of the current health care delivery system and would have implications for both patients and providers of health care in this province.
In order to justify the potential increments in human and financial resources associated with such a change, decision makers would, before making such significant investments, require reliable research-based evidence on whether team-based management of chronic disease works and, if so, how such teams are best designed, implemented and sustained.
Given the mounting health and economic burdens associated with chronic disease in this province, our decision-making partners in the provincial health system asked the Contextualized Health Research Synthesis Program (CHRSP) team to synthesize and contextualize the evidence on interprofessional teams for the management of chronic disease.
The research team chose to focus their study on the management of individuals with diabetes and chronic obstructive pulmonary disease (COPD) for several reasons:
- In 2006-7, NL had the highest age-standardized prevalence of diabetes of all provinces and territories in Canada (PHAC, 2009) and incidence rates are steadily increasing. The complications associated uncontrolled diabetes place a considerable burden on patients and the health care system.
- COPD is a chronic, debilitating disease and is the leading cause of hospital admissions and readmissions for chronic disease across Canada (Canadian Thoracic Society, 2010). If managed incorrectly, the disease affects the quality of life of patients, and places considerable burden on the health care system.
- Lastly, in keeping with CHRSP methodologies, the availability of systematic reviews and HTAs for these two chronic diseases was sufficient to support a synthesis of research evidence.
We have recruited an expert researcher, Dr. Anne Sales, Deputy Chief, VA Inpatient Evaluation Center (IPEC) and Canadian Research Chair in Interdisciplinary Healthcare Teams, as our Team Leader.
Dr. Daria O’Reilly of the PATH program at McMaster University will serve as our health economist.
Dr. Susan Gillam, CEO of Western Health, is our local health system partner, and we are also consulting with Linda Carter of the Department of Health and Community Services, Karen Oldford of Labrador-Grenfell RHA, and Karen Milley of Eastern Health.
Other local academic and clinical experts include Dr. Brendan Barrett, Dr. Nigel Duguid, Ms. Sandra Small, and Dr. Anne Kearney, all of Memorial University.
Is there reliable scientific evidence to support team-based management of chronic disease and, if so, given the NL context (in terms of geography, demography, fiscal resources and health system capacities) what is the most effective and efficient way to organize, implement, and sustain team-based care for individuals with diabetes and chronic obstructive pulmonary disease (COPD) so as to derive the best possible outcomes for patients, providers and the health system?