Optimizing health care investments

Why one Canada Research Chair believes an Ontario diabetes support program may hold the key to a new standard of care

Date published: 2023-11-14 10:00:00

Nurse administering a glucose blood test on her senior patient, during a home visit.

Photo: iStock.com/vitapix

It’s been called the silent epidemic. Diabetes impacts nearly 12 million Canadians and costs the healthcare system a staggering $50 million dollars daily in Canada.

“Diabetes is a crushing chronic illness in Canada, and it’s only getting worse,” says Dr. Maria Mathews, Canada Research Chair in Primary Health Care and Health Equity and Professor in the Department of Family Medicine at the Schulich School of Medicine and Dentistry at Western University.

For most diabetics, their bodies are unable to produce insulin, the hormone that regulates glucose (sugar) in the blood. For others, their bodies can’t properly use the insulin produced. Diabetes can cause a range of severe and life-threatening complications including kidney disease, blindness, heart attack and even amputation. Complications, Mathews understands far too well.

A personal journey into health care and research

“I come from a family where just about everyone is diabetic or pre-diabetic,” says Mathews. “One of my first memories as a child growing up in India is helping to give my grandmother insulin. I lost her relatively early because of the disease. Diabetes really hits home for me.”

Mathews’ training is in health care administration, and she developed a broader interest in how health care systems work, the importance of investing in primary care and the most efficient use of funds to achieve the best return on investment. Now Mathews is heading up a new study with her interdisciplinary team of researchers and undergraduate and graduate students that will allow her to pair her passion for primary care policy with her drive to create better outcomes for diabetic patients.

“Keeping people out of hospital is a huge cost savings,” Mathews explains. “When I met Dr. Stewart Harris, a family physician here in London who specializes in diabetes care, and he told me about a program he has developed, I knew it was something I needed to explore further.”

Holistic approach: A unique model for diabetes care

It’s called the Primary Care Diabetes Support Program (PCDSP) at St. Joseph’s Health Care in London. Founded by Dr. Harris in 2007, PCDSP is an integrated team-based diabetes clinic that has family physicians working alongside registered nurses, nurse practitioners and social workers to help diabetes patients, most with complex medical and social needs, manage their illness.

“The patients in this program may be at higher risk for life-altering complications like losing a leg or developing kidney disease. They may have low income, have trouble managing their prescription drugs or depend on food banks. They may be new immigrants who are unfamiliar with the Canadian health care system or perhaps they don’t have a family doctor. The idea is to not only manage their medical needs but also help them navigate government support programs. It’s a unique and holistic approach to health care,” says Mathews.

All in the numbers: Evaluating PCDSP's effectiveness and cost efficiency

Mathews says since PCDSP launched, Harris and his team have seen positive clinical outcomes, from improvement in controlling blood sugar levels to anecdotal accounts of improved quality of life, but Mathews and her research team, as part of her Canada Research Chairs research program, wanted to dig deeper. Funded through the Canadian Institutes of Health Research Transitions in Care initiative, the study called The Primary Care Diabetes Support Program: Addressing Transitions in Care for Medically Complex, Unattached, and Socially Complex Patients with Diabetes will evaluate the effectiveness of Harris’ diabetes program. Over the next four years, the researchers will interview patients and analyze clinic, hospital, physician, pharmaceutical and billing data for diabetic patients within the PCDSP. Mathews will then compare that information with province-wide data to see if patients who had access to PCDSP were able to stay out of hospital longer and have better outcomes than other diabetic patients receiving standard care across Ontario.

“The final step is to take that data and convert it into costs,” Mathews says. “If we take the cost of providing this model of care and look at the cost of hospitalizations and we add and subtract it will help us determine if we actually save money. If our research shows clinics like this one in London have the ability to keep people out of the hospital and prevent premature death, then we could demonstrate that this should be a new model of health care not just in Ontario, but across the country.”

Beyond diabetes: PCDSP as a blueprint for chronic illness care

Mathews says if their research shows PCDSP to be cost-efficient, this model of care could expand beyond diabetes and serve as a template for other chronic illnesses.

“Policy-makers, politicians and health care providers understand money, they understand investment and they understand savings,” adds Mathews. “If we can do an economic evaluation and show that this is a good way to spend health care dollars, then we can show that this team-based clinical model of care can be applied to other chronic illnesses like chronic obstructive pulmonary disease or congestive heart disease. That could be a great investment for all Canadians.”

Investment in research is an investment in Canadians

The study is slated for completion in 2027, although the team is expecting early results to be released in 2024. Mathews believes studies like this one are important to ensure all Canadians can benefit from clinical innovations in the most efficient way.

“We invest a lot in health care; we just don’t manage those investments well. That’s why investing in this kind of research is crucial,” says Mathews. “Ensuring primary care is working well means fewer people require surgeries and fewer people find themselves in hospital. That is a huge return on investment.”

Want to learn more?

Explore Maria Mathews’s ongoing research projects and take a closer look at the Primary Care Diabetes Support Program (PCDSP) in London, Ontario.