Looking Backward to Move Forward: A Synthesis of Primary Health Care Reform Evaluations in Canadian Provinces

Primary Health Care (PHC) reform is currently underway in various Canadian provinces. Emerging models and policies are at various levels of implementation across differing jurisdictions. While there have been some evaluations of the impact of these reforms, there have been few cross provincial analyses. The aim of this project is to better understand the impact of emerging models and to identify the factors that have been facilitating or hindering their implementation.

A review of grey and published literature on primary care organisational models in Canada was achieved to describe the reform process in five Canadian provinces and understand the various contexts of reforms. Experts were asked to review these case studies and generate hypotheses with regard to potential barriers and facilitators of these reforms. A one-day deliberative forum was held on November 3rd 2010, bringing together researchers (n=40) and decision-makers (n=20) from each province involved to look at these case studies and identify the main factors influencing the implementation of these reforms and their main impacts.

Despite a relative paucity of published evaluations, our results suggest that PHC reforms have varied with regard to the scope and levers employed to implement change. Some provinces used specific PHC model implementation, while other provinces designed overarching policies aiming at changing professional behaviours and practice. The main barriers to reform were the lack of financial investments in the reforms, resistance from professional associations, overly prescriptive approaches that lacked adaptability to local circumstances and an overly centralized governance model. The main facilitators were a strong financial commitment using various allocation and payments models, the involvement of professional associations throughout the process of reform, an incremental and strong decentralization of decisions and adaptation to local circumstances. Most benefits of the reforms so far seem to have occurred with regard to patients' experience of care and higher workforce satisfaction.

PHC reforms currently being implemented in other jurisdictions could be informed by factors identified as promoting or hindering change in the various provinces that have been most proactive. The cross-provincial view of recent reforms, presented during this panel, will highlight insights that go beyond the findings from individual provinces' evaluations in order to guide ongoing PHC reform.

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