National Health Leadership Survey on Ambulatory and Community Care

Conducted by PricewaterhouseCoopers for the Canadian Health Services Research Foundation

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Canada’s healthcare system faces mounting pressure as the population ages and the prevalence of chronic conditions continues to rise.  The traditional focus on providing complex and chronic disease care within the acute setting is contributing to already existing pressures on wait times, alternate level of care days, and patient access and flow.  In response to these challenges, and the recognition that the acute setting may not be optimal for providing patient-focused chronic care, many provincial health ministries and healthcare organizations are launching initiatives to better manage complex chronic conditions in the community and improve the patient care experience.

Recognizing the need to address this issue, the Canadian Health Services Research Foundation (CHSRF) engaged PricewaterhouseCoopers LLP (PwC) to conduct a National Health Leadership Survey on Ambulatory and Community Care to:

  • Continue to help establish a channel for engagement with Health Leaders;
  • Identify leaders and leading practices in ambulatory and community care;
  • Identify integrated care interventions to improve care for patients with complex needs; and
  • Gather insights for use in CHSRF’s programs and events.

In total, 53 health leaders, including general internal medicine practitioners, general practitioners and administrators representing all of the provinces and the combined territories responded and participated in the study. Numerous themes emanated throughout the health leader interviews, with consistency generally found across regions and roles (e.g., general internal medicine, general practitioner, executive).  An overview of the themes is provided below.

Interprofessional Teams Working to Full Scope of Practice

  • Need to transition from siloed, hierarchical care to interprofessional team-based care
  • Non-physician providers should be leveraged
  • Interprofessional team members should be used to their full scope of practice

Locally Accessible Integrated Care

  • Care should be available at the local level where feasible
  • Strategies to improve access to care include
    o    Co-located services / one-stop shop
    o    Innovative use of technology 

Primary and Secondary Prevention

  • Complex chronic disease care needs to begin with prevention and carry across the continuum
  • Ongoing and proactive  secondary management is required to avoid the need for acute care

Patient Centred Self-Management

  • Information and tools should be provided to patients to enable them to take an active role in their care
  • Providers need to provide patient-centred services that listen to the experience of their patients, and engage the appropriate support systems

Coordinated Patient-Focused Care Across the Continuum

  • Linkages between acute and community care providers need to be strengthened
  • Technology should be used to enhance linkages and coordination e.g. electronic medical record, data repositories
  • Care coordination should be provided by the most responsible provider with consideration for the utilization of patient navigators for more complex patients

Evidence-Based Practice

  • Models of care need to be evidence-based
    Outcome metrics should inform decision making and funding of quality care
    Evidenced based care pathways support adherence to best practice