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Table 2 Outline of a policy brief about improving access to high quality primary healthcare in Canada

From: SUPPORT Tools for evidence-informed health Policymaking (STP) 13: Preparing and using policy briefs to support evidence-informed policymaking

What problem has been identified?

• The problem is limited or inequitable access to sustainable, high-quality community-based primary healthcare in federal, provincial, and territorial publicly-funded health systems in Canada. Key characteristics of the problem include:

   • Chronic diseases represent a significant share of the common conditions that must be prevented or treated by the primary healthcare system

   • Access to cost-effective programmes, services and drugs in Canada is not ideal. This is the case both when Canadians identify their own care needs or (more proactively on the part of healthcare providers) when they have an indication (or need) for prevention or treatment, particularly for chronic disease prevention and treatment

   • Health system arrangements have not always supported the provision of cost-effective programmes, services and drugs. Many Canadians do not:

1. Have a regular physician or place of care

2. Receive effective chronic-disease management services, or

3. Receive care in a primary healthcare practice that uses an electronic health record, faces any financial incentive for quality, or provides nursing services

What is more difficult to determine is the proportion of physicians who receive effective continuing professional development for chronic disease management and the proportion of primary healthcare practices that:

1. Are periodically audited for their performance in chronic disease management

2. Employ physician-led or collaborative practice models, and

3. Adhere to a holistic primary healthcare model's (the Chronic Care Model's) key features [21]

What information do systematic reviews provide about three viable options to address the problem?

• Each of the following three options was assessed in terms of its likely benefits, harms, costs (and cost-effectiveness), its key elements if it had been tried elsewhere, and stakeholder views about and experiences with it:

   • Support the expansion of chronic disease management in physician-led care through a combination of electronic health records, target payments, continuing professional development, and auditing of their primary healthcare practices

   • Support the targeted expansion of inter-professional, collaborative practice primary healthcare

   • Support the use of the Chronic Care Model in primary healthcare settings. This model entails the combination of self-management support, decision support, delivery system design, clinical information systems, health system, and community

• Important uncertainties about each option's benefits and potential harms were flagged. This was done in order to give these issues particular attention within any monitoring and evaluation plan put into place

What key implementation considerations need to be borne in mind?

• Little empirical research evidence could be identified about implementation barriers and strategies. Four of the implementation barriers identified were:

1. Initial wariness amongst some patients of potential disruptions to their relationship with their primary healthcare physician

2. Wariness on the part of physicians (particularly older physicians) of potential infringements on their professional and commercial autonomy

3. The organisational scale required for some of the options is not viable in many rural and remote communities, and

4. Hesitancy on the part of governments about broadening the breadth and depth of public payment for primary healthcare, particularly during a recession

Notes about the supporting evidence base:

• Dozens of relevant systematic reviews were identified, some of which addressed an option directly and others of which addressed elements of one or more options [14]