Background
Methods
Results
British Columbia |
BC1: British Columbia Ministry of Health. (2007). Primary Health Care Charter: A Collaborative Approach. Victoria, BC: British Columbia Ministry of Health. http://www.health.gov.bc.ca/library/publications/year/2007/phc_charter.pdf
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BC2: British Columbia Government, British Columbia Medical Association & Medical Services Commission (2012). Physician Master Agreement. Retrieved from: http://www2.gov.bc.ca/assets/gov/health/practitioner-pro/medical-services-plan/pma-2012-consolidated-amendment-7.pdf
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BC3: British Columbia Ministry of Health. (2013). Health Professions Act. Victoria, BC: British Columbia Queen’s Printer. http://www.bclaws.ca/Recon/document/ID/freeside/00_96183_01
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BC4: British Columbia Ministry of Health. (2011). Bill 10–2011 Nurse Practitioners Statutes Amendment Act. Victoria, BC: British Columbia Ministry of Health. https://www.leg.bc.ca/39th4th/3rd_read/gov10-3.htm
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Alberta |
AB1: Alberta Health. (2014). Alberta’s Primary Health Care Strategy. Edmonton, AB: Alberta Health. http://www.health.alberta.ca/documents/Primary-Health-Care-Strategy-2014.pdf
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AB2: Alberta Health. (2013a). Family Care Clinic Reference Manual. Edmonton, AB: Alberta Health. https://open.alberta.ca/publications/6859089
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AB3: Alberta Health. (2013b). Family Care Clinic Governance and Accountability Guidelines. Edmonton, AB: Alberta Health. https://open.alberta.ca/publications/family-care-clinic-governance-and-accountability-guidelines
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AB4: Alberta Health and Wellness, Alberta Medical Association Alberta Health Services (2008). Primary Care Initiative Policy Manual 10.1. Edmonton: Alberta Health and Wellness. Available at: https://www.pcnpmo.ca/access/Documents/PCN%20Policy%20Manual.pdf
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AB5: Alberta Health and Alberta Health Services (2010). Becoming the Best: Alberta’s 5-Year Health Action Plan. Edmonton, AB: Alberta Health. https://open.alberta.ca/publications/9780778582861
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Saskatchewan |
SK1: Saskatchewan Ministry of Health. (2012). Patient Centred Community Designed Team Delivered: A Framework for Achieving a High Performing Primary Health Care System in Saskatchewan. Regina, SK: Saskatchewan Ministry of Health. https://www.saskatchewan.ca/~/media/files/health/additional%20reports/other%20ministry%20plans%20and%20reports/primary%20health%20care.pdf
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SK2: Regina Qu’Appelle Health Region. (2008). Primary Health Care Strategic Plan 2008–2013. Regina, SK: Regina Qu’Appelle Health Region http://www.rqhealth.ca/programs/primary_healthcare/pdf_files/strategic_plan.pdf
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SK3: Regina Qu’Appelle Health Region. (2013). Strategy for Touchwood Primary Health Care Collaborative. Regina, SK: Regina Qu’Appelle Health Region. http://www.rqhealth.ca/service-lines/master/files/rqhr_primary_care_strategy_touchwood.pdf
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SK4: Government of Saskatchewan (2014). The Pharmacy and Pharmacy Disciplines Act. Chapter P-9.1 of the Statutes of Saskatchewan, 1996 (effective January 1, 1998). Regina: Queen’s Printer. |
SK5: Government of Saskatchewan (2007) The Midwifery Act being Chapter M-14.1 of the Statutes of Saskatchewan, 1999 (effective February 23, 2007. Regina: Queen’s Printer. |
Policies shaping team-based care: Development processes and stakeholder involvement
The conceptualization and composition of primary health care teams
Policy tools to advance the implementation of team-based primary health care policies
Stakeholder feedback
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It was noted that there are many good examples of team-based care but that there was a lack of ways to share these examples; many commented on the limited operational guidance or practice resources to support implementation of team-based care.
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Almost every key informant raised concerns about the distribution and control of funding streams, which may hinder progressive policy development. They argued that it is essential to finding better ways to remunerate all the members of primary health care teams and fund team development.
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Stakeholders stressed the importance of moving beyond collaborative practice as a strategic goal and the need for appropriate investment in change management to overcome years of inertia. The need for infrastructure (collaborative space, IT) and education for collaborative practice was a recurrent theme.
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Informants gave illustrations of the ways in which poor alignment of policies and practices across the health system impedes the development of team-based care.
Advisory group and roundtable feedback
Policy imperative #1: To align health system goals, policies, workforce and structures |
The lack of system alignment between the ministries of health, regional health authorities and private practices’ priorities and agendas impedes team-based care. To align health system goals, policies, workforce and structures requires a shared vision on team-based care, resource sharing and inclusion of the broader community in policy deliberation and implementation. We urge leaders to stay the course for team-based primary health care as it is foundational to health care reform in Canada. |
Policy imperative #2: To invest adequate resources to support system change structures |
Provinces need to invest adequate resources to support system change to foster team-based primary health care. This requires that provinces provide sustainable funding for team-based care and invest in proper infrastructure, adequate technology and change management plans. Improved evidence is required to guide decisions on resource assignment. |
Policy imperative #3: To develop appropriate and sustainable compensation models |
Existing compensation models can negatively impact team-based service delivery. The third policy imperative is therefore to develop appropriate and sustainable compensation models. This imperative is not directed solely at physician remuneration; we need to consider compensation models for a wider range of team members including those in the community. |
Policy imperative #4: To integrate collaborative practice metrics in primary health care monitoring and evaluation structures |
The fourth policy imperative, integrate collaborative practice metrics in primary health care monitoring and evaluation, will improve accountability for team-based service provision. Investments need to be made in shared data elements and indicators so we can learn from successes and failures, target our investments and disinvest in initiatives that do not yield the desired outcomes. |
Discussion
The policy landscape
Policy imperatives
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To align health system goals, policies, workforce and structures,
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To invest adequate resources to support system change structures,
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To develop appropriate and sustainable compensation models,
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To integrate collaborative practice metrics in primary health care monitoring and evaluation structures.