A Canadian first: Nationwide study shows primary care transformation is slow, incremental, fragmented
November 20, 2023
Prof. Monica Aggarwal brought a team in a decade study what you do observed and evaluated changes in the provision of primary care in 13 Canadian jurisdictions. The results show that progress was limited, slow, and sometimes lacking in many attributes of high-performance primary care in Canada’s shared system.
Despite significant efforts and investments, Canada’s primary care system is not meeting the standards of a high-performing system, says a new study. These standards are crucial to improving health outcomes and health equity, reducing mortality rates, and reducing costs. The researchers, including the lead author and principal investigator PHS Prof. Monica Aggarwal, co-authors IHPME Prof. Ross Baker and research assistant Reham Abdelhalim, and with the support and input from PHS Prof. Rick Glazierpublished the results of a 10-year review (2012-2021) of Canada’s primary care delivery in The Milbank Quarterly.
“The study found that Canada’s primary care transformation has been slow, piecemeal, and incremental, with changes limited to the overall organization and delivery of primary care,” says Aggarwal.
This study is the first in Canada to compare and evaluate the transformation of primary care in all Canadian provinces and territories. The researchers conducted qualitative interviews with experts in each jurisdiction and a literature review of each region’s policies and innovations. The data was then analyzed and evaluated using the characteristics of high performance systems, originally identified by Prof Aggarwal and Dr Brian Hutchison. in 2012.
Aggarwal says challenges to transformation include country”Decentralized health systems, pre-existing political legacies, inadequate investment in primary care innovations, resistance to change among health care providers, limited evidence on the impetus for change, and insufficient performance measurement and accountability.
Based on the assessment of key features, the authors noted 10 areas that require significant reflection and action.
- Explicit political direction – Most jurisdictions have defined explicit policy direction for primary care, but the goals and approaches of reform initiatives differ across jurisdictions.
- Mechanisms of governance – More jurisdictions have developed governance mechanisms with structures and processes that oversee primary care at local levels over the past decade, but overall, change has been slow.
- patient registration – Various initiatives have been implemented to link a patient to a primary care provider or team, but formal patient enrollment is limited.
- Patient engagement – Actively involving patients in decisions about their health care and planning health services is an area that requires significant improvement across Canada.
- Financing and supplier payment arrangements – More jurisdictions have experimented with the implementation of financing and provider payment agreements that support the goals of the health system, but a widespread change has not occurred.
- Ongoing Performance Measurement – Ongoing performance measurement that allows accountability at multiple levels to inform and assess the impact of health service planning, management and improvement activities has been slow across Canada, and no jurisdiction monitors performance at all levels.
- Leadership Development – Investments in leadership development in primary care have been minimal across Canada.
- Coordination, integration and partnerships – Few jurisdictions have developed initiatives to allow collaboration with other health care and social services.
- Systematic Evaluation – Investments in the systematic evaluation of new approaches and innovations have been limited in all jurisdictions.
- search ability – Building research capacity and productivity in primary care remains an area of underinvestment across Canada.
While the researchers found that progress was slow in many areas, some areas showed improvements over the course of the decade.
- Health Information Technology – The adoption of electronic medical records is where Canada has made the most significant change. However, the shift towards integrated health records remains slow.
- Quality improvement training and support – Significant progress has been made through investments in quality improvement training and support for primary care providers.
- Interprofessional teams – More jurisdictions have launched inter-professional teams or networks; however, the degree of diffusion is variable.
Although these improvements should be celebrated, the results of the study show that the country still has a lot of work to do to build high performance systems.. The authors suggest that to accelerate transformation in Canada and abroad, a national strategy and performance measurement framework based on meaningful engagement of patients and other stakeholders is needed. This must be accompanied by targeted funding investments and building a strong data infrastructure for performance measurement to support rigorous research. Considering the current primary care crisis, Aggarwal says, “Canada and the world have waited long enough for high-performance primary care.” She calls on national and international leaders to “walk the talk”.
“The benefit of our study is the first to collect data on the the degree of progress on the key characteristics of high performance primary care systems in the last decade. This information will allow us to continue to track progress over the coming years,” says Aggarwal. “I I plan to identify best practices and lessons learned in Canada and internationally and hope to create forums through which this knowledge can be made available to policy makers so that leaders across the country can learn from one another. other and work together to build high-performing primary care systems in Canada. today and in the future.”
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