Advancing team-based primary health care: a comparative analysis of policies in western Canada

Abstract

BackgroundWe analyzed and compared primary health care (PHC) policies in British Columbia, Alberta and Saskatchewan to understand how they inform the design and implementation of team-based primary health care service delivery. The goal was to develop policy imperatives that can advance team-based PHC in Canada.MethodsWe conducted comparative case studies (n = 3). The policy analysis included: Context review: We reviewed relevant information (2007 to 2014) from databases and websites. Policy review and comparative analysis: We compared and contrasted publically available PHC policies. Key informant interviews: Key informants (n = 30) validated narratives prepared from the comparative analysis by offering contextual information on potential policy imperatives. Advisory group and roundtable: An expert advisory group guided this work and a key stakeholder roundtable event guided prioritization of policy imperatives.ResultsThe concept of team-based PHC varies widely across and within the three provinces. We noted policy gaps related to team configuration, leadership, scope of practice, role clarity and financing of team-based care; few policies speak explicitly to monitoring and evaluation of team-based PHC. We prioritized four policy imperatives: (1) alignment of goals and policies at different system levels; (2) investment of resources for system change; (3) compensation models for all members of the team; and (4) accountability through collaborative practice metrics.ConclusionsPolicies supporting team-based PHC have been slow to emerge, lacking a systematic and coordinated approach. Greater alignment with specific consideration of financing, reimbursement, implementation mechanisms and performance monitoring could accelerate systemic transformation by removing some well-known barriers to team-based care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2439-1) contains supplementary material, which is available to authorized users.

Integrating nurse practitioners into primary care: policy considerations from a Canadian province

“…It has also been suggested that the integration of NPs into communitybased care delivery is critical to accomplishing the transformation of primary care into primary health care (PHC) [3,4] -a transformation that has itself been linked to improved care, improved outcomes, and lowered costs [5][6][7][8]. The shift to PHC is one towards prevention, health, wellness and the successful management of chronic disease [9][10][11][12][13][14], accomplished through team-based care [15]. The integration of NPs into PHC-focused teams, and their integration into healthcare systems more broadly has been advocated for in a range of policy environments, including both Canada and the United States [16][17][18][19].…”

“…The NPSP positions Alberta's PCNs as the primary support and implementation mechanism for achieving NP integration into primary care, as part of a broader western Canadian objective of delivering team-based primary care [15]. In light of the province's relatively low rate of NP uptake in primary care, the NPSP aims to incentivize PCNs to hire more NPs in Alberta and to increase NP integration into primary care teams and achieve primary healthcare transformation [17].…”

Access to Primary Care and Internet Searches for Walk-In Clinics and Emergency Departments in Canada: Observational Study Using Google Trends and Population Health Survey Data

“…Western provinces and Quebec have implemented different organizational reforms, including family medicine groups, local services networks, medical homes, and primary care networks [14-17]. The proportion of clinical payments through capitated and salaried payment models is higher in Ontario, eastern provinces, and the territories, whereas the western provinces and Quebec have a higher proportion of fee-for-service payments [14,15,18]. Walk-in clinic practice may be more common under a fee-for-service model as physicians are paid per service without ongoing responsibility for specific patients.…”

“…Provinces also have varying mechanisms for after-hours coverage. Most have a toll-free number that connects patients to a registered nurse who can provide advice and direct patients to after-hours care [10,14]. Under capitated models, physicians may receive negation if their patients access services from another primary care provider, including walk-in clinics.…”

Regional variation in primary care improvement strategies and policy: case studies that consider qualitative contextual data for performance measurement in three Canadian provinces

“…For example, in the UK, national reports of patients’ experience of PC are adjusted for with important case-mix variables 9. Although health system context at the level of regional management areas within provinces and territories is identified as important in several performance measurement frameworks,10–13 few PC performance measurement studies collect contextual data at the regional level 14…”