title: Impact of a chronic disease self-management program on health care utilization in rural communities: a retrospective cohort study using linked administrative data.
abstract: BACKGROUND
  Internationally, chronic disease self-management programs (CDSMPs) have been widely promoted with the assumption that confident, knowledgeable patients practicing self-management behavior will experience improved health and utilize fewer healthcare resources. However, there is a paucity of published data supporting this claim and the majority of the evidence is based on self-report.
  
  
  METHODS
  We used a retrospective cohort study using linked administrative health data. Data from 104 tele-CDSMP participants from 13 rural and remote communities in the province of Ontario, Canada were linked to administrative databases containing emergency department (ED) and physician visits and hospitalizations. Patterns of health care utilization prior to and after participation in the tele-CDSMP were compared. Poisson Generalized Estimating Equations regression was used to examine the impact of the tele-CDSMP on health care utilization after adjusting for covariates.
  
  
  RESULTS
  There were no differences in patterns of health care utilization before and after participating in the tele-CDSMP. Among participants ≤ 66 years, however, there was a 34% increase in physician visits in the 12 months following the program (OR = 1.34, 95% CI 1.11-1.61) and a trend for decreased ED visits in those >66 years (OR = 0.59, 95% CI 0.33-1.06).
  
  
  CONCLUSIONS
  This is the first study to examine health care use following participation in the CDSMP in a Canadian population and to use administrative data to measure health care utilization. Similar to other studies that used self-report measures to evaluate health care use we found no differences in health care utilization before and after participation in the CDSMP. Future research needs to confirm our findings and examine the impact of the CDSMP on health care utilization in different age groups to help to determine whether these interventions are more effective with select population groups.
authors.affiliation: Women's College Research Institute, Toronto, Ontario, Canada. susan.jaglal@utoronto.ca.
authors.forename: Susan B
authors.initials: SB
authors.lastname: Jaglal
authors.forename: Sara J T
authors.initials: SJ
authors.lastname: Guilcher
authors.forename: Gillian
authors.initials: G
authors.lastname: Hawker
authors.forename: Wendy
authors.initials: W
authors.lastname: Lou
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Salbach
authors.forename: Michael
authors.initials: M
authors.lastname: Manno
authors.forename: Merrick
authors.initials: M
authors.lastname: Zwarenstein
mesh_terms: D000368:Aged; D002908:Chronic Disease / Q000628:therapy*; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009864:Ontario; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D019035:Rural Health Services; D012648:Self Care; D057566:Self Report