Contexts and Models in Primary Healthcare and their Impact on Interprofessional Relationships

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Key Messages

  • Nationally and internationally, the need to effectively coordinate provision of care to meet the needs of patients and to make optimal use of resources have been identified as health system priorities.
  • Effective Primary Health Care (PHC) systems can provide the foundation for comprehensive, coordinated health services delivery. Consideration of context matters in development of these PHC models.
  • In Alberta, Primary Healthcare Networks (PCNs) were designed to improve patient access, provide round-the-clock primary care services, increase emphasis on health promotion, disease and injury prevention, and care for patients with chronic diseases and medically complex problems, as well as to better coordinate care and to foster team approaches to primary health care delivery.
  • Commonalities within the contexts described across cases within this study as well as across studies reviewed for the comparative analysis:
  • In the changing policy context within Alberta, the influence of policy uncertainty had a negative impact on initial engagement of physicians within PCNs;
  • Strong leaders were able to both facilitate relationships and mobilize the resources required to effectively implement programs;
  • In all PCNs, interprofessioal relationships seemed to be facilitated by co-location but co-location in and of itself was not sufficient to foster good interprofessional working relationships.
  • Strong interprofessional relationships were required to allow quality improvement initiatives and other practice changes to proceed within the physicians’ offices. Challenges of bringing new professionals into physicians’ work environments included lack of training and work processes but these were successfully overcome when trusting relationships were built between individuals;
  • Communication within and across PCNs and with other organizations, greatly influenced implementation of programs; and
  • PHC initiatives across Canada are just beginning to measure outcomes using indicators developed from the Canadian Institute for Health Information (CIHI) Pan-Canadian Primary Heath Care Indicator Development Project.
  • Differences in geographic locations of the PCNs created different health needs and local PCN priorities because of population demographics (e.g. rapidly expanding urban communities underserved by primary care physicians, neighbouring communities such as First Nations reserves, or distance from specialty care in rural PCNs).
  • Resource shortages due to Alberta’s economic boom affected the resources available to the PCNs when they were forming. Although funding was available, other resources such as office space and staff were in short supply due to competition from the industry and other PCN partners.
  • Examination of the development of PCNs in Alberta yields important lessons that can inform the improvement of PHC systems in other parts of the country and other jurisdictions.