How do Policy and Institutional Settings Shape Opportunities for Community-Based Primary Health Care? A Comparison of Ontario, Québec and New Zealand

Tenbensel, Tim; Miller, Fiona A.; Bréton, Mylaine; Couturier, Yves; Morton-Chang, Frances; Ashton, Toni; Sheridan, Nicolette; Peckham, Allie; Williams, A. Paul; Kenealy, Tim; Wodchis, Walter P.

doi:10.5334/ijic.2514

Cited by 28 publications

(22 citation statements)

References 25 publications

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“…In-depth descriptions of all nine cases and three jurisdictional policy environments are available through other iCOACH publications [ 44 , 45 ]. This section offers a brief summary of key contextual factors relevant to our analysis with additional data presented in Table 3 .…”

Section: Methodsmentioning

confidence: 99%

Using information communication technology in models of integrated community-based primary health care: learning from the iCOACH case studies

et al. 2018

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BackgroundInformation communication technology (ICT) is a critical enabler of integrated models of community-based primary health care; however, little is known about how existing technologies have been used to support new models of integrated care. To address this gap, we draw on data from an international study of integrated models, exploring how ICT is used to support activities of integrated care and the organizational and environmental barriers and enablers to its adoption.MethodsWe take an embedded comparative multiple-case study approach using data from a study of implementation of nine models of integrated community-based primary health care, the Implementing Integrated Care for Older Adults with Complex Health Needs (iCOACH) study. Six cases from Canada, three each in Ontario and Quebec, and three in New Zealand, were studied. As part of the case studies, interviews were conducted with managers and front-line health care providers from February 2015 to March 2017. A qualitative descriptive approach was used to code data from 137 interviews and generate word tables to guide analysis.ResultsDespite different models and contexts, we found strikingly similar accounts of the types of activities supported through ICT systems in each of the cases. ICT systems were used most frequently to support activities like care coordination by inter-professional teams through information sharing. However, providers were limited in their ability to efficiently share patient data due to data access issues across organizational and professional boundaries and due to system functionality limitations, such as a lack of interoperability.ConclusionsEven in innovative models of care, managers and providers in our cases mainly use technology to enable traditional ways of working. Technology limitations prevent more innovative uses of technology that could support disruption necessary to improve care delivery. We argue the barriers to more innovative use of technology are linked to three factors: (1) information access barriers, (2) limited functionality of available technology, and (3) organizational and provider inertia.

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Section: Methodsmentioning

confidence: 99%

Using information communication technology in models of integrated community-based primary health care: learning from the iCOACH case studies

et al. 2018

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“…On both dimensions, the New Zealand environment appears to offer the largest scope, with Ontario’s environment significantly less conducive, and Québec situated in between. Nevertheless, in each jurisdiction there remain important institutional barriers to the implementation of policies that promote ICBPHC (see Tenbensel et al, 2017) [35]. …”

Section: Phase One: Describe Models and Contextmentioning

confidence: 99%

A Research Program on Implementing Integrated Care for Older Adults with Complex Health Needs (iCOACH): An International Collaboration

Wodchis

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Baker

et al. 2018

International Journal of Integrated Care

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Health and social care systems across western developed nations are being challenged to meet the needs of an increasing number of people aging with multiple complex health and social needs. Community based primary health care (CBPHC) has been associated with more equitable access to services, better population level outcomes and lower system level costs. Itmay be well suited to the increasingly complex needs of populations; however the implementation of CBPHC models of care faces many challenges. This paper describes a program of research by an international, multi-university, multidisciplinary research team who are seeking to understand how to scale up and spread models of Integrated CBPHC (ICBPHC). The key question being addressed is “What are the steps to implementing innovative integrated community-based primary health care models that address the health and social needs of older adults with complex care needs?” and will be answered in three phases. In the first phase we identify and describe exemplar models of ICBPHC and their context in relation to relevant policies and performance across the three jurisdictions (New Zealand, Ontario and Québec, Canada). The second phase involves a series of theory-informed, mixed methods case studies from which we shall develop a conceptual framework that captures not only the attributes of successful innovative ICBPHC models, but also how these models are being implemented. In the third phase, we aim to translate our research into practice by identifying emerging models of ICBPHC in advance, and working alongside policymakers to inform the development and implementation of these models in each jurisdiction. The final output of the program will be a comprehensive guide to the design, implementation and scaling-up of innovative models of ICBPHC.

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“…European comparative studies add further evidence that the development of new skills can strengthen primary and chronic care reforms [30], while a feasibility study undertaken by the OECD explored indicators for an integrated team-based workforce development across countries [39]. However, primary care is still often organised in professional 'silos' and medical dominance is widespread [26,40,41]. The effects of teamwork and task shifting as well as the patient experience may therefore vary when assessed in different contexts.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Primary care workforce development in Europe: An overview of health system responses and stakeholder views

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Better primary care has become a key strategy for reforming health systems to respond effectively to increases in non-communicable diseases and changing population needs, yet the primary care workforce has received very little attention. This article aligns primary care policy and workforce development in European countries. The aim is to provide a comparative overview of the governance of workforce innovation and the views of the main stakeholders. Cross-country comparisons and an explorative case study design are applied. We combine material from different European projects to analyse health system responses to changing primary care workforce needs, transformations in the general practitioner workforce and patient views on workforce changes. The results reveal a lack of alignment between primary care reform policies and workforce policies and high variation in the governance of primary care workforce innovation. Transformations in the general practitioner workforce only partly follow changing population needs; countries vary considerably in supporting and achieving the goals of integration and community orientation. Yet patients who have experienced task shifting in their care express overall positive views on new models. In conclusion, synthesising available evidence from different projects contributes new knowledge on policy levers and reveals an urgent need for health system leadership in developing an integrated people-centred primary care workforce.

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How do Policy and Institutional Settings Shape Opportunities for Community-Based Primary Health Care? A Comparison of Ontario, Québec and New Zealand

Cited by 28 publications

References 25 publications

Using information communication technology in models of integrated community-based primary health care: learning from the iCOACH case studies

Using information communication technology in models of integrated community-based primary health care: learning from the iCOACH case studies

A Research Program on Implementing Integrated Care for Older Adults with Complex Health Needs (iCOACH): An International Collaboration

Primary care workforce development in Europe: An overview of health system responses and stakeholder views

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