Making It Happen

Barış, Enis; Silverman, Rachel; Zhao, Feng; Pate, Muhammad Ali

doi:10.1596/978-1-4648-1768-7_ch4

Cited by 5 publications

(9 citation statements)

References 188 publications

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“…Canada and the world have waited long enough for high‐performing PC. It is time for national and international leaders to “walk the talk.” 27 …”

Section: Discussionmentioning

confidence: 99%

“…Specifically, Canada lags behind in access to regular doctors or places of care, timely access to care, the ability of a patient to communicate electronically with PC providers, the development of interprofessional teams, and communication across health care settings 24–26 . The COVID‐19 pandemic has shed light worldwide on the impact of weak PC systems 27 . Nearly half a century after the Alma Ata Conference, the World Bank has noted it is time for countries to not just “talk” about PC but to “walk the talk.” 27 Thus, Canada's PC performance calls for a thoughtful and determined approach to system transformation.…”

Section: Figurementioning

confidence: 99%

“…[24][25][26] The COVID-19 pandemic has shed light worldwide on the impact of weak PC systems. 27 Nearly half a century after the Alma Ata Conference, the World Bank has noted it is time for countries to not just "talk" about PC but to "walk the talk." 27 Thus, Canada's PC performance calls for a thoughtful and determined approach to system transformation.…”

mentioning

confidence: 99%

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Building High‐Performing Primary Care Systems: After a Decade of Policy Change, Is Canada “Walking the Talk?”

AGGARWAL,

HUTCHISON,

ABDELHALIM

et al. 2023

Milbank Quarterly

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Policy Points Considerable investments have been made to build high‐performing primary care systems in Canada. However, little is known about the extent to which change has occurred over the last decade with implementing programs and policies across all 13 provincial and territorial jurisdictions. There is significant variation in the degree of implementation of structural features of high‐performing primary care systems across Canada. This study provides evidence on the state of primary care reform in Canada and offers insights into the opportunities based on changes that governments elsewhere have made to advance primary care transformation. ContextDespite significant investments to transform primary care, Canada lags behind its peers in providing timely access to regular doctors or places of care, timely access to care, developing interprofessional teams, and communication across health care settings. This study examines changes over the last decade (2012 to 2021) in policies across 13 provincial and territorial jurisdictions that address the structural features of high‐performing primary care systems.MethodsA multiple comparative case study approach was used to explore changes in primary care delivery across 13 Canadian jurisdictions. Each case consisted of (1) qualitative interviews with academics, provincial health care leaders, and health care professionals and (2) a literature review of policies and innovations. Data for each case were thematically analyzed within and across cases, using 12 structural features of high‐performing primary care systems to describe each case and assess changes over time.FindingsThe most significant changes include adopting electronic medical records, investments in quality improvement training and support, and developing interprofessional teams. Progress was more limited in implementing primary care governance mechanisms, system coordination, patient enrollment, and payment models. The rate of change was slowest for patient engagement, leadership development, performance measurement, research capacity, and systematic evaluation of innovation.ConclusionsProgress toward building high‐performing primary care systems in Canada has been slow and variable, with limited change in the organization and delivery of primary care. Canada's experience can inform innovation internationally by demonstrating how preexisting policy legacies constrain the possibilities for widespread primary care reform, with progress less pronounced in the attributes that impact physician autonomy. To accelerate primary care transformation in Canada and abroad, a national strategy and performance measurement framework is needed based on meaningful engagement of patients and other stakeholders. This must be accompanied by targeted funding investments and building strong data infrastructure for performance measurement to support rigorous research.

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“…Canada and the world have waited long enough for high‐performing PC. It is time for national and international leaders to “walk the talk.” 27 …”

Section: Discussionmentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

See 1 more Smart Citation

Building High‐Performing Primary Care Systems: After a Decade of Policy Change, Is Canada “Walking the Talk?”

AGGARWAL,

HUTCHISON,

ABDELHALIM

et al. 2023

Milbank Quarterly

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“…As the world passes the halfway mark towards the sustainable development goals, many low-and middle-income countries (LMICs) are not on track to achieve universal health coverage (UHC) [1]. This is partly blamed on failure to ensure that health systems deliver high-quality care [2].…”

Section: Introductionmentioning

confidence: 99%

Barriers to and enablers of quality improvement in primary health care in low- and middle-income countries: A systematic review

Odhus,

Kapanga,

Oele

2024

PLOS Glob Public Health

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The quality of health care remains generally poor across primary health care settings, especially in low- and middle-income countries where tertiary care tends to take up much of the limited resources despite primary health care being the first (and often the only) point of contact with the health system for nearly 80 per cent of people in these countries. Evidence is needed on barriers and enablers of quality improvement initiatives. This systematic review sought to answer the question: What are the enablers of and barriers to quality improvement in primary health care in low- and middle-income countries? It adopted an integrative review approach with narrative evidence synthesis, which combined qualitative and mixed methods research studies systematically. Using a customized geographic search filter for LMICs developed by the Cochrane Collaboration, Scopus, Academic Search Ultimate, MEDLINE, CINAHL, PSYCHINFO, EMBASE, ProQuest Dissertations and Overton.io (a new database for LMIC literature) were searched in January and February 2023, as were selected websites and journals. 7,077 reports were retrieved. After removing duplicates, reviewers independently screened titles, abstracts and full texts, performed quality appraisal and data extraction, followed by analysis and synthesis. 50 reports from 47 studies were included, covering 52 LMIC settings. Six themes related to barriers and enablers of quality improvement were identified and organized using the model for understanding success in quality (MUSIQ) and the consolidated framework for implementation research (CFIR). These were: microsystem of quality improvement, intervention attributes, implementing organization and team, health systems support and capacity, external environment and structural factors, and execution. Decision makers, practitioners, funders, implementers, and other stakeholders can use the evidence from this systematic review to minimize barriers and amplify enablers to better the chances that quality improvement initiatives will be successful in resource-limited settings. PROSPERO registration: CRD42023395166.

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“…1 As most health interactions take place in primary care, there is growing interest in understanding and tackling barriers to accessing these community-based services. [2][3][4] Previous research has demonstrated the ubiquity, inequity and impact of poor access to health care across numerous settings and service domains. [5][6][7] The ascendant principles of Primary Health Care (PHC) have focused attention on equitable access to community-based health services, based on community engagement and empowerment.…”

Section: Introductionmentioning

confidence: 99%

Rapid methods for identifying barriers and solutions to improve access to community health services: a scoping review

Allen

Azab

Jonga³

et al. 2023

BJGP Open

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BackgroundThe advancement of Universal Health Coverage is largely based on identifying and addressing barriers to accessing community health services. Traditional qualitative research approaches provide excellent insights but have unfeasibly high resource requirements for most care providers.AimTo identify, categorise, and evaluate methods that have been used to identify barriers and/or solutions for improving access to community-based health services, grounded in engagement with affected communities, excluding approaches that take >14 days.Design & settingScoping review.MethodFollowing Joanna Briggs Institute guidelines, we searched the Cochrane Library, MEDLINE Ovid, Embase Ovid, Global Health Ovid, and Google Scholar using a search designed by an information specialist. We used dual independent review and data charting.ResultsForty-four studies were included from 28 countries, reporting on 18 different clinical services. Thirty studies used self-described ‘rapid’ approaches, however the majority of these did not justify what they mean by this term. Half of the studies used mixed- or multi-methods and triangulation to verify early findings. All of the qualitative studies used interviews and/or focus groups, often supplemented with observations, document review and mapping activities. The use of in-situ snowball and convenience sampling; community members as data collectors and cultural guides; collaborative summarisation, review of findings with community members and end-users; and deductive framework analysis expedited the research processes. There were no data on costs.ConclusionThere are a wide range of different methods that can be used to deliver timely information about barriers to access. These tend to use traditional data collection approaches in innovative ways.

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Making It Happen

Cited by 5 publications

References 188 publications

Building High‐Performing Primary Care Systems: After a Decade of Policy Change, Is Canada “Walking the Talk?”

Building High‐Performing Primary Care Systems: After a Decade of Policy Change, Is Canada “Walking the Talk?”

Barriers to and enablers of quality improvement in primary health care in low- and middle-income countries: A systematic review

Rapid methods for identifying barriers and solutions to improve access to community health services: a scoping review

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