Canada’s primary care transformation slow, fragmented, study finds

Canada’s primary care system is falling short of high performance standards despite significant investments to transform the sector, according to a study led by Monica Agarwal, assistant professor at the Dalla Lana School of Public Health at the University of Toronto. .

In a 10-year review of Canada’s primary care performance. was announced on milbank quarterly magazineResearchers found that Canada lags in providing timely access to doctors and care, developing interprofessional teams, and communicating across health care settings.

Researchers including Professor G. Ross Baker and research assistant Reham Abdelhalim of the Dalla Lana Institute for Health Policy, Management and Evaluation (IHPME) say these standards will improve health outcomes and health equity, and reduce mortality. It is said that this is extremely important for lowering costs and reducing costs. Professor Brian Hutchison of McMaster University collaborated with support and input from Professor Rick Glazier of Dalla Lana University and the Department of Family and Community Medicine, Temerty School of Medicine.

“This study finds that the transformation of primary care in Canada is occurring slowly, piecemeal and incrementally, with limited changes to the overall organization and delivery of primary care,” said Agarwal. says.

This study examines policy changes from 2012 to 2021 and is the first to compare and evaluate primary care transformation across all Canadian provinces and territories.

The researchers conducted qualitative interviews with experts in each jurisdiction and conducted a literature review on policy and innovation in each region. The data was then analyzed and evaluated using the capabilities of a high-performance system first identified by Aggarwal and Hutchison in 2012.

Agarwal said challenges to change include Canada’s “decentralized health care system, legacy of existing policies, insufficient accountable investment in primary care innovation, resistance to change among health care providers; These include limited evidence on the drivers of change, and insufficient performance measurement and accountability.”

Based on their assessment of key features, the authors noted 10 areas that require significant reflection and action. These include reforms with policy orientations that vary by jurisdiction and reforms to governance structures that take time to bring about change.

Despite efforts to connect patients with primary care providers and teams, formal patient registration was found to be limited. The researchers also noted that significant improvements are needed in terms of patient involvement in decision-making regarding the planning of care and health services.

Far-reaching changes have also yet to occur in the implementation of funding and provider payment arrangements to support health system goals.

Building research capacity and productivity in primary care is also an area that remains under-invested across Canada.

Other areas of interest include performance measurement, systematic evaluation of new approaches and innovations, leadership development, and coordination and partnerships between primary care and other health and social services.

Although progress in these areas has been slow, researchers have identified areas where improvements have been made over the decade.

Although the transition to integrated health records remains slow, the introduction of electronic health records was noted as a major change. Significant progress has also been made in quality improvement training and support for primary care providers. It is also believed that an increasing number of jurisdictions are establishing interprofessional teams and networks, although the extent of this is varying.

To accelerate change in Canada and abroad, the authors call for a national strategy and performance measurement framework based on meaningful engagement of patients and other stakeholders. This needs to be accompanied by targeted investments and the creation of a strong data infrastructure to measure performance and support research, they say.

The findings show that Canada has a long way to go to build a high-performing primary care system.

“Canada and the world have waited long enough for high-quality primary care,” Agarwal said, calling on national and international leaders to “walk the talk.”

She said this data will allow her and her fellow researchers to continue monitoring progress for years to come.

“I intend to identify best practices and lessons learned in Canada and internationally, and create a forum where this knowledge is available to policymakers so that leaders across the country can learn from each other and collaborate to build high-performing primary schools.” We want to be able to build a system of care.” Now and in the future, I’m in Canada. ”