Barriers and Facilitators for Primary Care Reform in Canada: Results from a Deliberative Synthesis across Five Provinces

Abstract

Introduction: since 2000, primary care (PC) reforms have been implemented in various Canadian provinces. Emerging organizational models and policies are at various levels of implementation across jurisdictions. few cross-provincial analyses of these reforms have been realized. The aim of this study is to identify the factors that have facilitated or hindered implementation of reforms in Canadian provinces between 2000 and 2010. Methods: A literature and policy scan identified evaluation studies across Canadian jurisdictions. Experts from British Columbia, manitoba, Nova scotia, Ontario and quebec were asked to review the scope of published evaluations and draft provincial case descriptions. A one-day deliberative forum was held, bringing together researchers (n = 40) and decisionmakers (n = 20) from all the participating provinces. Results: despite a relative lack of published evaluations, our results suggest that PC reform has varied with regard to the scope and the policy levers used to implement change. some provinces implemented specific PC models, while other provinces designed overarching policies aiming at changing professional behaviour and practice. The main perceived barriers to reform were the lack of financial investment, resistance from professional associations, too overtly prescriptive approaches lacking adaptability and an overly centralized governance model. The main perceived facilitators were a strong financial commitment using various allocation and payment approaches, the cooperation of professional associations and an incremental emergent change philosophy based on a strong decentralization of decisions allowing adaptation to local circumstances. so far the most beneficial results of the reforms seem to be an increase in patients' affiliation with a usual source of care, improved experience of care by patients and a higher workforce satisfaction. Conclusion: PC reforms currently under consideration in other jurisdictions could learn from the factors identified as promoting or hindering change in the provinces that have been most proactive.

Barriers and facilitators for implementation of family medicine–oriented model of primary care in Bosnia and Herzegovina: A qualitative study

“…The centralized policy model, lack of stakeholders' interest in reform, resistance from professional associations, and the lack of financial investment were identified as the main hindering factors to implementation, while the main facilitators were perceived to be the collaborative design, a strong financial plan with multifarious apportionment and payment approaches and strong, decentralized, locally adapted decision-making processes. 24,25 The current study corroborates the previous findings that the lack of coordination between primary and secondary health care represents a barrier to supporting the implementation function. 26,27 According to a statement of the European Working Party on Quality in Family Practice, developing a positive working cooperative relationship requires guidelines which would include a process combining the patient's perspective and a description of task distribution between FPs and hospitalists.…”

“…Other authors have stated that primary health reform varies regarding the sphere and the policy instruments used to implement the change. The centralized policy model, lack of stakeholders' interest in reform, resistance from professional associations, and the lack of financial investment were identified as the main hindering factors to implementation, while the main facilitators were perceived to be the collaborative design, a strong financial plan with multifarious apportionment and payment approaches and strong, decentralized, locally adapted decision‐making processes …”

Offering Patients a Medical Home – Not a Hallway – and a Stronger Health System

“…Adhering to these principles not only improves patient experience, health outcomes and provider satisfaction, but care within a Patient's Medical Home also leads to fewer unnecessary hospital admissions and ER visits -system savings and better use of public resources. It creates the conditions for health system reform success (Levesque et al 2015;Sikka et al 2015;Starfield et al 2005). That success is inextricably tied to a strong primary care sector, appropriately funded, equipped and governed, in which teams built on trust deliver both high-quality care to patients and savings to the system.…”

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

“…Anticipating a large range of PC improvement strategies considered in the three regions, our multi-stakeholder group agreed that to identify the priority strategies for the case study we would conduct an initial review of Canadian papers that address PC reforms to identify improvement strategies with significant provincial financial investments and legislative or regulatory policy change 3 19–21. We sought those strategies which were most likely to be priorities across all three regions or within at least one.…”