The ecology of medical care for adults in Alberta, 2002/03 to 2016/17: a retrospective cohort study

Finlay A. McAlister; Marcello Tonelli; Natasha Wiebe; Meng Lin; Lawrence W. Svenson; Stafford Dean

doi:10.9778/cmajo.20190188

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Figure 1:
Proportions of community-dwelling adult Albertans who saw a primary care physician, saw a specialist, visited an emergency department and were admitted to hospital in 2002/03, 2009/10 and 2006/17.
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Figure 2:
Proportions of community-dwelling adults with and without at least 1 ambulatory-care–sensitive condition (ACSC) who visited an outpatient clinic in 2002/03, 2009/10 and 2006/17. Note: PCP = primary care physician.
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Figure 3:
The ecology of medical care for community-dwelling adults in Alberta, 2016/17. The sets of patients are not necessarily nested within each other.

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Table 1:

Use of health care services by adults in Alberta, 2002/03

Variable	Community-dwelling, no. (%)^*										Long-term care residents, no. (%)^* n = 25 853

	Overall n = 2 660 947	Residence		Age, yr			Sex		No. of ACSCs

		Urban n = 2 206 514	Rural n = 295 685	18–40 n = 1 251 465	41–65 n = 1 086 555	> 65 n = 322 927	Male n = 1 353 551	Female n = 1 307 396	0 n = 2 113 374	≥ 1 n = 547 573
Age, yr, median (IQR)	41 (29–53)	41 (29–53)	43 (31–56)	28 (23–34)	49 (44–55)	73 (69–79)	40 (29–52)	41 (29–54)	37 (27–47)	60 (48–71)	82 (73–88)

Female sex	1 307 396 (49.1)	1 099 863 (49.8)	142 766 (48.3)	601 486 (48.1)	529 133 (48.7)	176 777 (54.7)	0 (0.0)	1 307 396 (100.0)	1 020 754 (48.3)	286 642 (52.3)	16 743 (64.8)

No. of comorbidities, median (IQR)	0 (0–1)	0 (0–1)	1 (0–1)	0 (0–1)	1 (0–1)	2 (1–3)	0 (0–1)	0 (0–1)	0 (0–1)	2 (1–3)	4 (3–6)

Urban residence^†	2 206 514 (88.2)	2 206 514 (100.0)	0 (0.0)	1 024 656 (89.1)	911 686 (87.6)	270 172 (87.0)	1 106 651 (87.9)	1 099 863 (88.5)	1 736 468 (88.6)	470 046 (86.8)	23 338 (90.9)

Saw primary care physician in office setting	1 883 353 (70.8)	1 661 432 (75.3)	215 357 (72.8)	796 915 (63.7)	807 792 (74.3)	278 646 (86.3)	833 798 (61.6)	1 049 555 (80.3)	1 377 949 (65.2)	505 404 (92.3)	11 452 (44.3)

Saw salaried specialist as outpatient	58 979 (2.2)	52 898 (2.4)	5914 (2.0)	15 459 (1.2)	26 622 (2.5)	16 898 (5.2)	26 204 (1.9)	32 775 (2.5)	29 217 (1.4)	29 762 (5.4)	1069 (4.1)

Saw FFS specialist as outpatient	838 916 (31.5)	759 658 (34.4)	77 230 (26.1)	268 626 (21.5)	384 902 (35.4)	185 388 (57.4)	344 465 (25.4)	494 451 (37.8)	529 599 (25.1)	309 317 (56.5)	10 780 (41.7)

Saw any specialist as outpatient	849 668 (31.9)	768 955 (34.8)	78 584 (26.6)	272 436 (21.8)	389 988 (35.9)	187 244 (58.0)	350 055 (25.9)	499 613 (38.2)	536 064 (25.4)	313 604 (57.3)	10 917 (42.2)

Had at least 1 emergency department visit	549 039 (20.6)	450 325 (20.4)	97 354 (32.9)	259 600 (20.7)	199 755 (18.4)	89 684 (27.8)	273 085 (20.2)	275 954 (21.1)	375 784 (17.8)	173 255 (31.6)	11 586 (44.8)

Had at least 1 hospital admission^‡	173 179 (6.5)	144 560 (6.6)	28 436 (9.6)	70 102 (5.6)	54 580 (5.0)	48 497 (15.0)	64 116 (4.7)	109 063 (8.3)	92 465 (4.4)	80 714 (14.7)	9127 (35.3)

Note: ACSC = ambulatory care sensitive condition, FFS = fee-for-service, IQR = interquartile range.
↵* Except where noted otherwise.
↵† Data on patient residence (rural or urban) were missing for 6.0% of respondents.
↵‡ In 2003/04, the administrative database did not include type of hospital.

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Table 2:

Use of health care services by adults in Alberta, 2009/10

Variable	Community-dwelling, no. (%)^*										Long-term care residents, no. (%)^* n = 34 121

	Overall n = 3 261 459	Residence		Age, yr			Sex		No. of ACSCs

		Urban n = 2 731 980	Rural n = 339 996	18–40 n = 1 492 764	41–65 n = 1 369 231	> 65 n = 399 464	Male n = 1 672 187	Female n = 1 589 272	0 n = 2 458 843	≥ 1 n = 802 616
Age, yr, median (IQR)	42 (29–55)	42 (29–55)	44 (29–57)	28 (23–34)	50 (45–56)	73 (68–79)	41 (29–54)	42 (29–55)	37 (27–48)	59 (49–70)	82 (71–88)

Female sex	1 589 272 (48.7)	1 346 267 (49.3)	165 347 (48.6)	715 257 (47.9)	660 282 (48.2)	213 733 (53.5)	0 (0.0)	1 589 272 (100.0)	1 182 963 (48.1)	406 309 (50.6)	21 164 (62.0)

No. of comorbidities, median (IQR)	0 (0–1)	0 (0–2)	1 (0–2)	0 (0–1)	1 (0–2)	3 (1–4)	0 (0–1)	1 (0–2)	0 (0–1)	2 (2–4)	6 (4–7)

Urban residence^†	2 731 980 (88.9)	2 731 980 (100.0)	0 (0.0)	1 246 856 (89.7)	1 154 496 (88.8)	330 628 (86.5)	1 385 713 (88.8)	1 346 267 (89.1)	2 036 905 (89.5)	695 075 (87.4)	30 109 (88.8)

Saw primary care physician in office setting	2 213 242 (67.9)	1 966 992 (72.0)	242 026 (71.2)	888 408 (59.5)	985 739 (72.0)	339 095 (84.9)	985 842 (59.0)	1 227 400 (77.2)	1 486 193 (60.4)	727 049 (90.6)	26 655 (78.1)

Saw salaried specialist as outpatient	34 357 (1.1)	30 910 (1.1)	3337 (1.0)	8639 (0.6)	15 261 (1.1)	10 457 (2.6)	14 521 (0.9)	19 836 (1.2)	16 766 (0.7)	17 591 (2.2)	705 (2.1)

Saw FFS specialist as outpatient	998 159 (30.6)	902 039 (33.0)	94 234 (27.7)	301 515 (20.2)	470 601 (34.4)	226 043 (56.6)	419 346 (25.1)	578 813 (36.4)	560 979 (22.8)	437 180 (54.5)	15 796 (46.3)

Saw any specialist as outpatient	999 737 (30.7)	903 392 (33.1)	94 421 (27.8)	302 290 (20.3)	471 294 (34.4)	226 153 (56.6)	420 266 (25.1)	579 471 (36.5)	562 203 (22.9)	437 534 (54.5)	15 808 (46.3)

Had at least 1 medication dispensation	1 789 513 (54.9)	1 575 859 (57.7)	212 030 (62.4)	675 570 (45.3)	797 895 (58.3)	316 048 (79.1)	769 355 (46.0)	1 020 158 (64.2)	1 123 292 (45.7)	666 221 (83.0)	23 983 (70.3)

Had at least 1 emergency department visit	644 247 (19.8)	526 163 (19.3)	116 673 (34.3)	295 663 (19.8)	243 185 (17.8)	105 399 (26.4)	314 769 (18.8)	329 478 (20.7)	409 589 (16.7)	234 658 (29.2)	16 268 (47.7)

Had at least 1 hospital admission	192 409 (5.9)	163 362 (6.0)	28 886 (8.5)	79 556 (5.3)	61 568 (4.5)	51 285 (12.8)	69 420 (4.2)	122 989 (7.7)	98 222 (4.0)	94 187 (11.7)	12 308 (36.1)

Admitted to academic centre	40 686 (1.2)	37 000 (1.4)	3650 (1.1)	12 251 (0.8)	15 742 (1.1)	12 693 (3.2)	19 200 (1.1)	21 486 (1.4)	16 855 (0.7)	23 831 (3.0)	3289 (9.6)

Note: ACSC = ambulatory-care–sensitive condition, FFS = fee-for-service, IQR = interquartile range.
↵* Except where noted otherwise.
↵† Data on patient residence (rural or urban) were missing for 5.8% of respondents.

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Table 3:

Use of health care services by adults in Alberta, 2016/17

Variable	Community-dwelling, no. (%)^*										Long-term care residents n = 44 199

	Overall n = 3 840 527	Residence		Age, yr			Sex		No. of ACSCs

		Urban n = 3 264 235	Rural n = 377 048	18–40 n = 1 664 530	41–65 n = 1 617 231	> 65 n = 558 766	Male n = 1 961 342	Female n = 1 879 185	0 n = 2 774 814	≥ 1 n = 1 065 713
Age, yr, median (IQR)	43 (31–57)	43 (31–57)	45 (30–60)	30 (24–34)	51 (45–57)	72 (68–79)	43 (31–57)	43 (31–58)	37 (28–49)	60 (49–70)	79 (62–88)

Female sex	1 879 185 (48.9)	1 611 933 (49.4)	184 876 (49.0)	812 923 (48.8)	775 091 (47.9)	291 171 (52.1)	0 (0.0)	1 879 185 (100.0)	1 355 404 (48.8)	523 781 (49.1)	25 357 (57.4)

No. of comorbidities, median (IQR)	0 (0–2)	1 (0–2)	1 (0–2)	0 (0–1)	1 (0–2)	3 (1–4)	0 (0–2)	1 (0–2)	0 (0–1)	3 (2–4)	6 (4–8)

Urban residence^†	3 264 235 (89.6)	3 264 235 (100.0)	0 (0.0)	1 428 028 (89.9)	1 371 563 (90.2)	464 644 (87.4)	1 652 302 (89.6)	1 611 933 (89.7)	2 330 393 (90.2)	933 842 (88.3)	38 674 (88.0)

Saw primary care physician in office setting	2 620 547 (68.2)	2 354 013 (72.1)	264 572 (70.2)	1 032 584 (62.0)	1 136 067 (70.2)	451 896 (80.9)	1 199 365 (61.2)	1 421 182 (75.6)	1 684 849 (60.7)	935 698 (87.8)	33 037 (74.7)

Saw salaried specialist as outpatient	173 541 (4.5)	158 633 (4.9)	14 878 (3.9)	46 302 (2.8)	77 135 (4.8)	50 104 (9.0)	75 608 (3.9)	97 933 (5.2)	71 407 (2.6)	102 134 (9.6)	5447 (12.3)

Saw FFS specialist as outpatient	1 221 966 (31.8)	1 108 923 (34.0)	112 086 (29.7)	371 194 (22.3)	546 251 (33.8)	304 521 (54.5)	534 034 (27.2)	687 932 (36.6)	655 537 (23.6)	566 429 (53.2)	20 704 (46.8)

Saw any specialist as outpatient	1 273 175 (33.2)	1 154 894 (35.4)	117 310 (31.1)	389 028 (23.4)	570 256 (35.3)	313 891 (56.2)	557 575 (28.4)	715 600 (38.1)	683 110 (24.6)	590 065 (55.4)	22 082 (50.0)

Had at least 1 medication dispensation	2 313 406 (60.2)	2 058 693 (63.1)	252 755 (67.0)	820 186 (49.3)	1 047 437 (64.8)	445 783 (79.8)	1 047 875 (53.4)	1 265 531 (67.3)	1 388 384 (50.0)	925 022 (86.8)	36 653 (82.9)

Had at least 1 emergency department visit	735 973 (19.2)	613 342 (18.8)	121 334 (32.2)	313 954 (18.9)	278 553 (17.2)	143 466 (25.7)	353 512 (18.0)	382 461 (20.4)	432 441 (15.6)	303 532 (28.5)	21 678 (49.0)

Had at least 1 hospital admission	215 148 (5.6)	184 571 (5.7)	30 288 (8.0)	83 562 (5.0)	66 848 (4.1)	64 738 (11.6)	80 152 (4.1)	134 996 (7.2)	101 565 (3.7)	113 583 (10.7)	15 744 (35.6)

Admitted to academic centre	47 642 (1.2)	43 213 (1.3)	4 354 (1.2)	13 120 (0.8)	18 020 (1.1)	16 502 (3.0)	22 828 (1.2)	24 814 (1.3)	17 975 (0.6)	29 667 (2.8)	4248 (9.6)

Pharmacist-delivered patient counselling or prescription modification	169 243 (3.7)	127 315 (3.5)	41 928 (4.4)	36 917 (2.4)	65 716 (4.4)	48 645 (8.5)	73 820 (3.2)	95 423 (4.2)	167 894 (3.7)	1349 (13.7)	NA

Note: ACSC = ambulatory-care–sensitive condition, FFS = fee-for-service, IQR = interquartile range, NA = not applicable.
↵* Except where noted otherwise.
↵† Data on patient residence (rural or urban) were missing for 5.2% of respondents.