Background: Emerging evidence that meaningful relationships with knowledge users are a key predictor of research use has led to promotion of partnership approaches to health research. However, little is known about health system experiences of collaborations with university-based researchers, particularly with research partnerships in the area of health system design and health service organization. The purpose of the study was to explore the experience and perspectives of senior health managers in health service organizations, with health organization-university research partnerships.Methods: In-depth, semi-structured interviews (n = 25) were conducted with senior health personnel across Canada to explore their perspectives on health system research; experiences with health organization-university research partnerships; challenges to partnership research; and suggested actions for improving engagement with knowledge users and promoting research utilization. Participants, recruited from organizations with regional responsibilities, were responsible for system-wide planning and support functions.Results: Research is often experienced as unhelpful or irrelevant to decision-making by many within the system. Research, quality improvement (QI) and evaluation are often viewed as separate activities and coordinated by different responsibility areas. Perspectives of senior managers on barriers to partnership differed from those identified in the literature: organizational stress and restructuring, and limitations in readiness of researchers to work in the fast-paced healthcare environment, were identified as major barriers. Although the need for strong executive leadership was emphasized, "multi-system action" is needed for effective partnerships.Conclusion: Common approaches to research and knowledge translation are often not appropriate for addressing issues of health service design and health services organization. Nor is the research community providing expertise to many important activities that the healthcare system is taking to improve health services. A radical rethinking of how we prepare health service researchers; position research within the health system; and fund research activities and infrastructure is needed if the potential benefits of research are to be achieved. Lack of response to health system needs may contribute to research and ‘evidence-informed’ practice being further marginalized from healthcare operations. Interventions to address barriers must respond to the perspectives and experience of health leadership.

BackgroundPatient-centred care emerged in the late 1960s as a framework to guide providers and decision-makers towards the provision of more effective health care and better outcomes. An important body of literature has since emerged, reporting mixed results in terms of outcomes. To date, assessments of the effectiveness of patient-centred approaches have focused one-on-one consultations. The purpose of this article is to explore dimensions identified as key in the patient-centred literature in the context of primary health care services delivered in a group setting. Group Medical Visits (GMVs) offer a novel format for the delivery of patient-centred primary health care services, especially for patients living with complex morbidities.MethodsDrawing on a large study of GMVs, we report on key format and process-oriented elements identified in GMVs, and on their link to improved outcomes. For the purpose of this study, we interviewed 34 providers and 29 patients who have been engaged in GMVs, delivered in rural, northern and First Nation communities in British Columbia, Canada.ResultsOur analysis shows that the delivery of PHC in a group format results in a shift in the role of the provider, from that of an adjudicator involved in imparting norms of self-care, to that of a facilitator who assists the group in defining norms of self-care that are based on medical knowledge but also on the broader context of patients’ lived experience and on their pragmatic experience. In a group process, peer-patients take on the role of promoting these norms to other patients. This results in a significant shift in the role of the provider, increased trust, increased knowledge for the providers and the patients and better patient self-management. Our results also show increase satisfaction for patients and providers.ConclusionsGMVs offer an alternative format for the provision of PHC that brings together the benefit of a group process and of a clinical encounter. This format can successfully deliver on the promises of patient-centred care.

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Objective: Group medical visits (Gmvs) have been touted as an innovation to effectively and efficiently provide primary healthcare (PHC) services. The purpose of this paper is to report whether Gmvs have tangible benefits for providers and patients. Methods: This descriptive study included in-depth interviews with patients attending and providers facilitating Gmvs and direct observation. five primary care practices in rural towns and four first Nations communities participated. This paper reports on an analysis of interviews and observations. Results: Thirty-four providers and 29 patients were interviewed. Patient participants were an average of 62 years old, mostly female and married. The three most common chronic conditions reported by patients were diabetes (n = 9), high blood pressure (n = 8) and arthritis (n = 7). Three themes illustrated how Gmvs: (1) can foster access to needed health services; (2) expand opportunities for collaboration and team-based care; and (3) improve patient and provider experiences. A fourth theme captured structural challenges in delivering Gmvs. Discussion: There are tangible benefits in delivering Gmvs in PHC. While whole patient panels can benefit from the integration of Gmvs into practice, those who could gain the most are patients with complex medical and social needs. Gmvs provide an opportunity to enhance PHC, strengthening the system particularly for patients with chronic conditions. Résumé Objectif : Les visites médicales de groupe (vmG) sont considérées comme des innovations pour la prestation efficace et efficiente de soins de santé primaires (ssP). Le but de cette étude est de voir si effectivement les vmG offrent des avantages pour les prestataires et pour les patients. Méthodes : Cette étude descriptive comprenait des entrevues en profondeur auprès de patients qui participent à des vmG et auprès des prestataires de soins qui les animent, ainsi que des observations directes. Cinq cliniques de soins primaires dans des petites villes rurales et quatre communautés autochtones y ont participé. L' article fait état d'une analyse des entrevues et des observations. Résultats : Trente-quatre prestataires de soins et vingt-neuf patients ont été interviewés. L' âge moyen des patients participants était de 62 ans, la plupart étant des femmes mariées. Les trois états chroniques les plus fréquemment rapportés par les patients étaient le diabète (n=9), l'hypertension artérielle (n=8) et l' arthrite (n=7). Trois volets montrent comment les vmG peuvent (1) favoriser l' accès aux services de santé requis, (2) accroître les chances de collaboration et les soins en équipe et (3) améliorer l' expérience des patients et des prestataires. un quatrième volet a trait aux défis structurels liés aux vmG. Discussion : Les vmG dans le cadre des ssP présentent de réels avantages. Bien que tous les patients d'un groupe puissent tirer avantage de l'intégration des vmG à la pratique, ceux qui en bénéficient le plus sont les patients qui présentent une complexité de besoins médicaux et sociaux. Les vm...