Health Research BC is providing match funds for this research project, which is funded by CIHR’s Strategy for Patient Oriented Research (SPOR) Primary and Integrated Health Care Innovations (PIHCI) Network – Comparative Program and Policy Analysis Grant.
Dr. Nelly Oelke is undertaking this pan-Canadian project across four provinces (BC, AB, ON, and QC) with a team of researchers including the following PIs: S. Montesanti (AB), S. Johnston (ON), and M. Breton (QC).
Primary health care (PHC) models in Canada continue to change. There are still many gaps in understanding what works and what doesn’t work for PHC teams, specifically, to promote integration and continuity of care for patients with complex needs (e.g. more than one chronic condition). The goal of this research is to study provincial and regional policy documents (guiding principles and courses of action) that support health services integration for patients with complex needs through PHC teams. Patient engagement in developing and applying policies will also be looked at.
This study will include three phases.
- Phase 1: Collecting and analyzing all policy documents from the four provinces. Individual case reports will be developed and then policies will be compared across provinces.
- Phase 2: Patient interviews from each province and then a disussion session with those patients to review the results and come up with an action plan.
- Phase 3: Feedback will be gathered through online and web-based discussions from a broad group of provincial and national stakeholders including patients. These stakeholders will be asked to develop recommendations and actions based on the research results.
The results of this study will provide a better understanding of BC’s current policies for PHC teams, and how these support or create barriers to integrated health services delivery. It will also provide a better understanding of how BC patients and caregivers are involved in developing and applying policies in this area. Given BC’s focus on primary health care transformation, these will be most beneficial in supporting change.
Finally, the study will provide a set of leading national practices for integrated health services delivery through PHC teams that will be helpful to all participating provinces, other provinces in Canada, and internationally.
End of Award Update: May 2022
Most exciting outputs
1. Primary Health Care (PHC) teams need to be integrated at the individual level (at the point of care to improve patient’s care), PHC teams also need to be integrated at the health system level to facilitate integrated health services delivery.
- Clearly defined roles for team members are needed for effective PHC teams.
- Strong support for co-located teams, but not always feasible given geography, and the increase in virtual care. More research is needed in comparing co-located and virtual teams, particularly in today’s context of increased virtual care delivery.
- Interoperability and access to electronic health records, impacts team functioning. An accessible and shared electronic health record is needed for teams to function effectively.
- Financial remuneration models continue to impact effective functioning of PHC teams.
- Limited structure and information exist on performance measurement in PHC teams and integrated health services delivery. More work is needed at both the clinical and health system levels in performance measurement.
2. Ontario was more advanced in terms of engaging patients in policy activities, however, patients, family members, and caregivers who were engaged had similar experiences in policy engagement across the provinces. Patients were more often engaged in the development of policy, but engagement throughout the policy process (development, implementation, and evaluation) was much less clear.
3. Three key themes were identified: motivation for policy engagement, experiences with policy engagement, and barriers to engagement in policy, such as opportunities for engagement, power imbalances, tokenism, bureaucracy, accessibility, racism, sexism, and ageism.
4. Training in policy for patients, family members, and caregivers is needed to be better engaged throughout the policy process.
5. Opportunities for patients, family, and caregivers to engage in policy should be increased to facilitate inclusiveness and increase the diversity of perspectives.
Impacts so far
Our policy analysis on PHC teams and integrated health services delivery in four provinces in Canada, is to our knowledge the first of its kind. Our research results have been shared and we have discussed the same with the Primary Care, BC Ministry of Health. We have also shared the results of patient engagement in PHC policy with various stakeholders via the Putting Patients First Conference and the Canadian Association for Health Services and Policy Research Conference. Policy analysis results were also shared with international audiences through conferences and publications.
Potential future influence
Our research results have the potential to improve integrated health services delivery through PHC teams and to increase patient, family member, and caregiver engagement in PHC policy. The findings of the study can be utilized by other projects investigating what really makes PHC teams work, and which also include a policy analysis as well.
Next steps
Knowledge translation: A virtual national knowledge translation event with patients, researchers, policymakers, decision-makers, and providers to share the results, as well as gather feedback on the findings. We will also share the results via plain language summary, infographics, and publications in academic journals.
Useful links
- Facilitating Integration Through Team-Based Primary Healthcare: A Cross-Case Policy Analysis of Four Canadian Provinces (International Journal of Integrated Care, November 2021)
- Shaping Primary Health Care Teams and Integrated Care in Québec: An Overview of Policies (2000-2020) (Health Reform Observer Journal, January 2022)
- Engaging Patients, Family Members, and Caregivers in Policy for Primary Health Care Teams Integration (Putting Patients First Conference, March 2022)