Innovative and Diverse Strategies Toward Primary Health Care Reform: Lessons Learned from the Canadian Experience

Abstract

Introduction:In the last decade, Canadian provincial and territorial health systems have taken diverse approaches to strengthening primary care delivery. Although the Canadian and US systems differ in significant ways, important commonalities include the organization of care delivery, core principles guiding primary care reform, and some degree of provincial/state autonomy. This suggests that Canadian experiences, which employed a variety of tools, strategies, and policies, may be informative for US efforts to improve primary care.Innovations: The range of primary care reform initiatives implemented across Canada target organizational infrastructure, provider payment, health care workforce, and quality and safety. Primary care teams and networks in which multiple physicians work in concert with other providers have become widespread in some provinces; they vary on a number of dimensions, including physician payment, incorporation of other providers, and formal enrolment of patients. Family medicine is attracting more recent medical school graduates, a trend likely affected by new physician payment models, increases in the number of primary care providers, and efforts to better integrate nonphysician providers into clinical practice. Efforts to integrate electronic medical records into practice and pursue quality improvement strategies are gaining ground in some provinces.Conclusions: Canadian primary care reform initiatives rely on voluntary participation, incremental change, and diverse models, encouraging engagement and collaboration from a range of stakeholders including patients, providers, and policymakers. Cross-country collaboration in evaluating and translating Canada's primary care reform efforts are likely to yield important lessons for the US experience.

Ontario’s Family Health Teams

“…The PHCTF provided the economic means for PHC pilot projects that eventually led to the FHTs. More importantly, PHCTF was a signal to Ontario and the rest of Canada that primary care was to shift towards greater inclusion of PHC (Strumpf et al, 2012;Hutchison, Levesque, Strumpf, & Coyle, 2011).…”

“…Ontario has been a leader in Canada's PHC reform, and a range of models now exist (Glazier, Kopp, Schultz, Kiran, & Henry, 2012;Strumpf et al, 2012). Different models of PHC are intended to serve different patient populations, community health needs, and provider preferences (Cook & Kachala, 2004;Glazier, Zogorski, & Rayner, 2012).…”

International Learning on Increasing the Value and Effectiveness of Primary Care (I LIVE PC)

“…Canada organizes its health care at the provincial level and therefore has a natural, ongoing experiment in new models of care. 4 One of the more consistent changes has been development of multidisciplinary, interprofessional primary health care teams. Danish GPs have comparatively smaller practices with panels averaging fewer than 1600 patients per GP and, like the Dutch, are creating shared after-hours care models.…”

“…2 Canada has generally approached quality improvement by successful formation of learning collaboratives based on the Institute for Health Care Improvement's Breakthrough Series model and in partnership with provincial government and medical associations. 4 In this regard, Canada may be educating the United States about the potential role of a USbased organization in improving primary care, but with enhanced facilitation and buy-in from the payer.…”

“…Although there is variation across Canadian provinces, there is a general move toward blended payment models that favor capitation over fee for service. 4 Strumpf et al 4 say that "successful introduction of new models of physician payment relies on some combination of rostering patients, identifiable electronic medical record data, and support of the provincial medical associations." One of Canada's more potent lessons may be that the success of payment changes is tied to a move toward population health management, which requires some external support or facilitation.…”