Of the 18 Primary Care Networks (PCNs) originally developed in Alberta, 17 explicitly identified care for patients with diabetes as a priority area. In their examination of PCNs, Manns et al. explore the impact of PCN enrolment on key process and outcome variables for patients with incident and prevalent diabetes. PCNs in Alberta demonstrate considerable flexibility in how they deliver services and how network funding is used for this patient group.

PCNs include Core Providers (often general or family medicine practitioners) responsible for “maintaining the ongoing relationship with a patient, for providing the range of Primary Care Network primary care services, and dedicating the majority of their work time to the Primary Care Network.”36(p44) Core Providers are supported by Associate Providers who agree to supply one or more of the required services.

While most PCNs use funds raised through the per-capita patient payment structure for supporting multi-disciplinary teams (e.g., practice nurses, allied health staff), other initiatives may be supported. For diabetes care, the majority of PCNs use per-capita PCN funding to provide enhanced diabetes services, including patient education and case-management, or as noted, a multidisciplinary team.

Key to these operations is the improved coordination between providers and improved access to care. Using administrative data from Alberta Health and Wellness, the authors compare differences in process and outcome between a cohort of patients with diabetes receiving care through a PCN and a cohort of patients not receiving care through a PCN.

Following a propensity score matching process, the authors describe small but significant advantages of PCN care compared to standard practice. For patients with prevalent diabetes, treatment in a PCN setting was found to be associated with a 19.4% relative reduction in admissions to hospital emergency departments, improved glycemic control, and greater application of guideline recommended laboratory and retinal screening.

While the authors suggest that a true randomized trial is required to determine the impact of PCNs on patient outcomes, results from this study are encouraging; the PCN approach may be an effective means for better coordinating and improving care for prevalent cases of diabetes.

Source. Manns et al.⁵⁶