Chronic Disease Surveillance and Management in Alberta

Introduction

Chronic diseases are a significant concern for public health systems worldwide. In Alberta, several programs and initiatives are in place to aid in the surveillance and management of chronic diseases. This blog post explores these efforts, highlighting Alberta's unique health data ecosystem, technological advancements, and funding mechanisms.

Alberta's Unique Health Data Ecosystem

Alberta stands out with its unified health organization and comprehensive data set. The province maintains a mature data ecosystem with linkable data dating back over 30 years (Svenson, et.al., 2018). This extensive data collection makes Alberta a prime target for population-based research and provides valuable insights into various health-related topics, including chronic diseases.

The Interactive Health Data Application (IHDA) platform is a key tool in this ecosystem. It offers comprehensive health statistics on demographics, mortality, chronic and infectious diseases, and children's health. Users can interactively explore publicly available data through dashboards and export data for further analysis (Alberta Health Services, 2025). This accessibility makes Alberta's health data highly useful for researchers, policymakers, and the general public.

Technological Advancements in Chronic Disease Management

Alberta leverages technology to enhance chronic disease management. Virtual health coaching, remote monitoring services, and electronic medical records help patients stay connected with healthcare providers and manage their conditions more effectively (Centre for Active Living, 2025). Additionally, Alberta tech companies like AMII are involved in teaching computers how to read and analyze scans, contributing to advancements in chronic disease management and reducing the burden on physician and specialists time (Alberta Machine Intelligence Institute, 2025).

Alberta's Tomorrow Project (ATP) is another significant initiative. This longitudinal study tracks the health of 55,000 adults to investigate why some people develop cancer and chronic diseases while others do not. Launched in 2000, ATP aims to shape how these illnesses are detected, diagnosed, treated, and prevented (Alberta's Tomorrow Project, 2021).

Chronic Disease Management Programs

Alberta Health Services (AHS) offers various programs to help individuals manage chronic conditions like diabetes, hypertension, chronic obstructive pulmonary disease (COPD), and heart disease. Programs such as the Alberta Healthy Living Program, Better Choices, Better Health, Nutrition Services, and Weight Management services provide education, support, and resources to help patients maintain their health and improve their quality of life (Alberta Health Services, 2025).

AHS collaborates with community partners and family doctors to offer support groups, educational workshops, personalized care plans, and educational resources to help individuals manage their chronic conditions (Alberta Health Services, 2025).

Challenges and Opportunities

Despite these efforts, a report from the Office of the Auditor General concluded that while Alberta provides excellent care for individuals with chronic diseases, the care tends to be fragmented. No entity has overall responsibility for ensuring that all parts work together well, that all patients receive the same level of care, and that providers make good use of available resources to understand chronic diseases and manage patient care (Office of the Auditor General of Alberta, 2014). This fragmentation suggests the need for an umbrella agency within AHS to streamline chronic disease management.

Recently, a new tier within AHS, Acute Care Alberta, was announced to streamline access to high-quality care in emergencies and ongoing treatment (Acute Care Alberta, 2025). While this will impact those with chronic diseases, a dedicated tier for chronic disease management would be ideal to see proper management of specialized care.

Funding Mechanisms for Chronic Disease Management

Several funding options are available in Alberta to support chronic disease management:

• Patient/Care-Based Funding (PCBF): Implemented in 2010, this model allocates resources based on the specific needs of residents in long-term care, using an internationally recognized assessment tool (Alberta Health Services, n.d.).

• Pharmacy Claims: Albertans with chronic diseases are eligible for Comprehensive Annual Care Plans (CACPs) and follow-ups. In 2024, pharmacy claims for CACPs increased by 27%, reaching 482,089 (Welds, 2024).

• General Healthcare Funding: Chronic diseases account for a significant portion of healthcare costs in Alberta, including hospital inpatient days, physician visits, and emergency room visits (Office of the Auditor General of Alberta, 2014).

  
  

These funding mechanisms aim to ensure that individuals with chronic conditions receive the necessary care and support. Additionally, individuals with chronic diseases can join research studies to potentially receive experimental medications, with treatment and related care provided at the cost of the sponsor (entity [person or company] paying for the research).

Conclusion

While Alberta has made significant strides in chronic disease surveillance and management, there is still room for improvement. The province's unique health data ecosystem, technological advancements, and funding mechanisms provide a strong foundation, but efforts must continue to streamline care and ensure equitable access for all individuals with chronic conditions.

References

Acute Care Alberta. (2025). Home. Retrieved from https://acutecarealberta.ca/

Alberta Health Services. (2025). Chronic Disease Management. Alberta Health Services. https://www.albertahealthservices.ca/info/page11934.aspx

Alberta Health Services. (n.d.). Patient/Care-Based Funding. Retrieved from https://www.albertahealthservices.ca/cc/Page15503.aspx

Alberta Machine Intelligence Institute. (n.d.). J. Ross Mitchell. Retrieved from https://www.amii.ca/people/ross-mitchell

Alberta's Tomorrow Project. (2021). Home Page. Retrieved from https://myatp.ca/

Centre for Active Living. (2025). How Alberta's tech-driven health programs are changing chronic disease care. Retrieved from https://www.centre4activeliving.ca/how-albertas-tech-driven-health-programs-are-changing-chronic-disease-care/

Office of the Auditor General of Alberta. (2014). Report on chronic disease management. Retrieved from https://www.oag.ab.ca/reports/oag-health-report-chronic-disease-management-sept-2014/

Svenson, L., Simmonds, K., Perry, A., & Riemer, J. (2018). Alberta's data mobilization strategy: Leveraging linked data for innovation. International Journal of Population Data Science, 3(4). Retrieved from https://ijpds.org/article/view/1022

Welds, K. (2024). Service claims tell the story in Alberta. Canadian Foundation for Pharmacy. Retrieved from https://cfpnet.ca/service-claims-tell-the-story-in-alberta/.