Implementing Team-Based Innovation in Primary Health Care in British Columbia

Improving health services integration for patients with complex needs is a national priority in Canada. Health systems in all provinces grapple with the rising complexity of patients and the services they need. Team-based primary health care (PHC) models have been implemented in diverse ways to improve patients' experiences, increase the coordination of care, improve population health and reduce costs. While some provinces have more than two decades of experience with PHC teams, others such as British Colombia (BC) have made changes more recently. We conducted an in-depth analysis of 12 provincial policy documents produced since 2011 to study the evolution of interprofessional models in PHC. BC has integrated team-based care through overarching policy support and funding from the provincial government. Structural practice changes to support team-based care, such as Primary Care Networks (PCNs), were designed to address the quadruple aim, a framework designed to improve health system performance through integrated primary care. Policies have addressed the vision and goals of team-based care, but discussion of processes that support teams, such as a strategy for capitation-based funding and team composition, were non-specific. Finally, there is a significant need for a provincial strategy for continuous quality improvement and evaluation of reforms. Améliorer l'intégration des services de santé pour les patients ayant des besoins complexes est une priorité au Canada. Les systèmes de santé de toutes les provinces sont aux prises avec une augmentation du nombre des patients qui nécessitant des services complexes. Différents modèles variés de services de première ligne ont été mis en œuvre afin d'améliorer l'expérience des patients améliorer la coordination des services, améliorer la santé de la population ainsi que de  réduire les coûts. Si certaines provinces ont plus de vingt ans d'expérience dans la mise en place d'équipes de première ligne interdisciplinaires, d'autres provinces comme la Colombie-Britannique (CB) n'innovent que depuis peu. Nous avons mené une analyse approfondie de 12 politiques provinciales mise en place depuis 2011 pour étudier l'évolution des modèles interprofessionnels de première ligne. La CB a intégré des équipes de première ligne interdisciplinaires grâce à des politiques et des financements du gouvernement provincial. Les changements structurels pour soutenir le travail en équipe, comme les Réseaux de soins primaires (PCN), ont été conçus pour répondre au « quadruple objectif », qui est un cadre conceptuel pour améliorer la performance des systèmes de santé, par le biais de services de première ligne intégrés. Les politiques ont détaillé  les visions et objectifs des équipes de première ligne, mais les discussions sur les processus qui soutiennent ces équipes comme les stratégies de financement par capitation et la composition des équipes n’ont pas été explicitées. Enfin, il existe un besoin important d'une stratégie provinciale pour l'amélioration continue de la qualité et l'évaluation des réformes

Patient, family member and caregiver engagement in shaping policy for primary health care teams in three Canadian Provinces

Abstract Introduction Improving health services integration through primary health care (PHC) teams for patients with chronic conditions is essential to address their complex health needs and facilitate better health outcomes. The objective of this study was to explore if and how patients, family members, and caregivers were engaged or wanted to be engaged in developing, implementing and evaluating health policies related to PHC teams. This patient‐oriented research was carried out in three provinces across Canada: British Columbia, Alberta and Ontario. Methods A total of 29 semi‐structured interviews with patients were conducted across the three provinces and data were analysed using thematic analysis. Results Three key themes were identified: motivation for policy engagement, experiences with policy engagement and barriers to engagement in policy. The majority of participants in the study wanted to be engaged in policy processes and advocate for integrated care through PHC teams. Barriers to patient engagement in policy, such as lack of opportunities for engagement, power imbalances, tokenism, lack of accessibility of engagement opportunities and experiences of racism and discrimination were also identified. Conclusion This study increases the understanding of patient, family member, and caregiver engagement in policy related to PHC team integration and the barriers that currently exist in this engagement process. This information can be used to guide decision‐makers on how to improve the delivery of integrated health services through PHC teams and enhance patient, family member, and caregiver engagement in PHC policy. Patient or Public Contribution We would like to acknowledge the contributions of our patient partners, Brenda Jagroop and Judy Birdsell, who assisted with developing and pilot testing the interview guide. Judy Birdsell also assisted with the preparation of this manuscript. This study also engaged patients, family members, and caregivers to share their experiences with engagement in PHC policy