Open Access Research article

Impact of a chronic disease self-management program on health care utilization in rural communities: a retrospective cohort study using linked administrative data

Susan B Jaglal12345*, Sara JT Guilcher16, Gillian Hawker1457, Wendy Lou8, Nancy M Salbach23, Michael Manno49 and Merrick Zwarenstein1045

Author Affiliations

1 Women’s College Research Institute, Toronto, Ontario, Canada

2 Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

3 Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada

4 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada

5 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

6 Centre for Research on Inner City Health, St. Michael’s Hospital, Toronto, Ontario, Canada

7 Department of Medicine, Women’s College Hospital, Toronto, Ontario, Canada

8 Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, Toronto, Ontario, Canada

9 The Ontario HIV Treatment Network, Toronto, Ontario, Canada

10 Centre for Studies in Family Medicine & Department of Family Medicine, Western University, London, Ontario, Canada

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BMC Health Services Research 2014, 14:198  doi:10.1186/1472-6963-14-198

Published: 1 May 2014



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.


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.


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).


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.