LESSONS LEARNED FROM REBUILDING A PRIMARY CARE INFRASTRUCTURE: A CANADIAN PERSPECTIVE

1. Don’t Think Your System is Always the Best

Policy-makers and the health care establishment were inattentive to the weakening of the Canadian primary care infrastructure. Physicians in training were increasingly choosing specialties over family practice to be able to pay off their student loans.¹ As a result, first contact with the medical system for many patients became emergency departments and walk-in clinics since many Canadians could not find a family doctor. Our specialist colleagues were being asked by patients to do the job of family doctors. These were just a few symptoms of a sick system that needed some serious attention.

2. The Solution of Simply Spending More Money is Unsustainable

Despite huge amounts of money being thrown at the Canadian system, international reports indicated that Canada was losing ground among industrialized nations in terms of the quality of primary care. Countries that had invested in their primary care systems were well ahead of Canada—even after spending fewer resources.^2,3

3. Spending the Majority of Resources on Health Systems, Hospitals, and Specialties is Not the Answer

Provincial governments expanded emergency rooms and funded more specialists, while primary care slowly continued to crumble. Quadrupling the size of emergency departments and not spending any money on the primary care sector did not solve the problem. The cost of caring for patients in the emergency departments far exceeded the cost of delivering primary care yet the quality of care was inferior.

4. Establish Measures of Performance for the Primary Care Sector

The quality of care in hospitals was the focus of public debate since there were few decent measures of performance of the primary care sector.

5. Fix Primary Care First; Then Put Money Into the Rest of the System

International research shows that countries that invest in primary care as the foundation of their health care system have better outcomes: their citizens live longer and have a better quality of life.⁴

6. The System Needs to Be in Balance

Primary care physicians need to be the cornerstone of the health care system. They need to care for the whole patient, not just a single condition. Specialists cannot be specialists without this balance. The other components of the health care system depend on a solid and stable primary care foundation.

7. Significant Investment in Reforming the Primary Care Sector is Necessary

In the past 10 years, Canada has spent hundreds of millions of dollars to reform the primary care sector, including: electronic health records (EHRs), blended systems of remuneration for family doctors, multidisciplinary teams, and requirements for accountability.

8. Research Ensures the Money Has Been Well Spent

We must study the effects of our financial investments, compare results among communities, and examine the data on patient outcomes.⁵

The Canadian Institutes of Health Research (CIHR) convened a 2-day summit in 2010 with key stakeholders to discuss the state of primary care research nationally and internationally, and to explore new applications for Canada. In 2011, CIHR initiated a 10-year research plan that can not only support the delivery of high-quality, community-based, primary health care across Canada, but also build a strong, evidence-based research capacity and infrastructure.⁶

Canadian PHC researchers have come together to form the Canadian Primary Health Care Research Network that will coordinate Canadian research efforts and work toward enhancing the quality, access and cost-effectiveness of Canada’s health care system.

9. Technology and Innovation Are Keys to Success

Modern information technology tools and new analytical techniques will unlock our understanding of what makes primary health care effective and inform us of what is needed to improve the quality and cost effectiveness of the entire health care system.