Canadian first. Nationwide Study Finds Primary Care Transformation Slow, Incremental, Fragmented – Dalla Lana School of Public Health

Canadian first. A nationwide study shows that transformation in primary care is slow, incremental, and fragmented

November 20/2023

Professor Monica Agisto be done was guided a team a decade study that notice and appreciated changes in primary care delivery 13 in Canada powers. The results show that progress has been limited, slow, and sometimes non-existent in many of the attributes of high-performing primary care in Canada’s fractured system.

Despite significant efforts and investments, Canada’s primary care system is not meeting the standards of a high-performing system, a new study says. These measures are critical to improving health outcomes and health equity, reducing mortality, and reducing costs. The researchers, including lead author and principal investigator PHS Prof. Monika Aggarwal, co-authors IHPME prof. Ross Baker and Research Assistant Reham Abdelhalim, and with support and input from PHS Prof. Rick Glaserpublished the results of a 10-year review (2012-2021) of Canadian primary care performance The Milbank Quarterly.

“The study found that the transformation of primary care in Canada has been slow, piecemeal and incremental, with limited changes to the overall organization and delivery of primary care,” says Aggarwal.

This study is the first in Canada to compare and evaluate primary care transformation across all Canadian provinces and territories. The researchers conducted qualitative interviews with experts in each jurisdiction and a literature review of policies and innovations in each region. The data was then analyzed and evaluated using the characteristics of high performance systems originally identified by Professor Aggarwal and Dr Brian Hutchison. in 2012.

Aggarwal says the challenges of transformation include the country’s “decentralized health systems, legacies of pre-existing policies, insufficiently accountable investment in primary care innovation, resistance to change among health care providers, limited evidence for driving change, and inadequate performance measurement and accountability”.

Based on an assessment of key features, the authors identified 10 areas that require significant reflection and action.

1. A clear policy direction – More jurisdictions have set a clear policy direction for primary care, but the goals and approaches to reform initiatives vary across jurisdictions.
2. Management mechanisms – More jurisdictions have developed governance mechanisms in the past decade, with structures and processes that oversee primary care at local levels, but overall, change has been slow.
3. Patient registration – Various initiatives have been implemented to connect the patient to a primary care provider or team, but formal patient enrollment is limited.
4. Patient involvement – Actively involving patients in their health care and health service planning decisions is an area that requires significant improvement in Canada.
5. Financing and Supplier Payment Arrangements – More jurisdictions have experimented with implementing financing and provider payment mechanisms that support health system goals, but widespread change has not occurred.
6. Continuous Performance Measurement – Continuous performance measurement, which enables accountability at multiple levels to inform and evaluate the impact of health service planning, management and improvement actions, has been slow in Canada, and no jurisdiction monitors performance at all levels.
7. Leadership Development – Investments in leadership development in primary care have been minimal in Canada.
8. Coordination, integration and partnership – Few jurisdictions have developed initiatives to enable collaboration with other health and social services.
9. Systematic assessment – Investments in systematic evaluation of new approaches and innovations have been limited across jurisdictions.
10. Research skills – Building research capacity and productivity in primary care remains an area of ​​underinvestment across Canada.

Although the researchers found that progress has been slow in many areas, there have been improvements in some areas over the decade.

1. Health information technology – The adoption of electronic medical records is where Canada has made the most significant change. However, the shift to integrated health records remains slow.
2. Quality improvement training and support – Significant progress has been made through investments in quality improvement training and support for primary care providers.
3. Interprofessional teams – More jurisdictions have established interprofessional teams or networks. however, the degree of spread is variable.

While these improvements should be noted, the study’s findings show that the country still has a lot of work to do to create high-performance systems.. The authors suggest that a national strategy and performance measurement framework based on meaningful engagement of patients and other stakeholders is needed to accelerate transformation in Canada and abroad. This must be accompanied by targeted funding investments and the building of a robust data infrastructure for performance measurement to support rigorous research. Given the current crisis in primary care, Aggarwal says, “Canada and the world have waited long enough for high performance primary care.” He calls on national and international leaders to “continue negotiations”.

“The benefit of our liedy is that it is the first to collect data the extent of progress over the past decade on key features of high-performance primary care systems. This information will allow us to continue to monitor progress for years to come,” says Aggarwal. “Me plan to identify best practices and lessons learned in Canada and internationally and hope to create forums through which this knowledge will be made available to policy makers so that country leaders can learn from each other and work together to build high performance primary care systems in Canada. today and in the future.”