title: 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.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, 1020 Pine Avenue West, Montreal, Quebec, Canada. renee.carter@mail.mcgill.ca.|Institut National de Santé Publique du Québec, 945 Avenue Wolfe, Ste-Foy, Québec, Canada. renee.carter@mail.mcgill.ca.
authors.forename: Renee
authors.initials: R
authors.lastname: Carter
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, 1020 Pine Avenue West, Montreal, Quebec, Canada. amelie.quesnelvallee@mcgill.ca.|Department of Sociology, Faculty of Arts, McGill University, 855 Sherbrooke Street West, Montreal, Quebec, Canada. amelie.quesnelvallee@mcgill.ca.
authors.forename: Amélie
authors.initials: A
authors.lastname: Quesnel-Vallée
authors.affiliation: Institut National de Santé Publique du Québec, 945 Avenue Wolfe, Ste-Foy, Québec, Canada. celine.plante@inspq.qc.ca.
authors.forename: Céline
authors.initials: C
authors.lastname: Plante
authors.affiliation: Institut National de Santé Publique du Québec, 945 Avenue Wolfe, Ste-Foy, Québec, Canada. philippe.gamache@inspq.qc.ca.
authors.forename: Philippe
authors.initials: P
authors.lastname: Gamache
authors.affiliation: Bureau of Health Information, Level 11 Sage Building, 67 Albert Avenue, Chastwood, NSW, Australia. jeanfrederic.levesque@health.nsw.gov.au.|Centre for Primary Health Care and Equity, University of New South Wales, Level 3, AGSM Building, Botany Street Gate 11, Sydney, NSW, 2052, Australia. jeanfrederic.levesque@health.nsw.gov.au.
authors.forename: Jean-Frédéric
authors.initials: JF
authors.lastname: Lévesque
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data* / Q000639:trends; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D018166:Health Care Reform / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration*; D011787:Quality of Health Care; D011792:Quebec; D012044:Regression Analysis; D012189:Retrospective Studies