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INTERNATIONAL COLLABORATION IN INNOVATING HEALTH SYSTEMS

Chris van Weel, Deborah Turnbull, Emma Whitehead, Andrew Bazemore, Felicity Goodyear-Smith, Claire Jackson, Cindy L. K. Lam, Barbara A. van der Linden, David Meyers, Maria van den Muijsenbergh, Robert Phillips, Jose M. Ramirez-Aranda, Robyn Tamblyn and Evalyn van Weel-Baumgarten
The Annals of Family Medicine January 2015, 13 (1) 86-87; DOI: https://doi.org/10.1370/afm.1751

Aim and Background

Strong primary health care is critical to secure sustainable health care.1 The International Implementation Research Network in Primary Care (IIRNPC) was founded to facilitate exchanges of experiences between countries in primary health care implementation.2,3 Involvement of all stakeholders, and focus on local conditions to approach health problems in a broad social, economic, political and cultural context4 are core components.

Based on these principles, a pre-conference was organized at the 2014 North American Primary Care Research Group (NAPCRG) conference to explore international aspects of innovating health systems to:

  • Come to a better understanding of health systems, and their needs and potential for change

  • Review models of success in changing health systems

  • Analyze the role of research funding agencies in international comparisons to inform systems’ change

A full report is available on NAPCRG’s website at http://www.napcrg.org.

Methods and Findings

Health care systems from Mexico5–7 and Hong Kong8–10 served as case studies for critical appraisal, using the World Organization of Family Doctors (WONCA) instrument.11 In both populations the available capacity of primary health care is limited, and policy makers are uncertain of health care consequences. Advocacy of primary health care policy and research were identified as a priorities for instigating and supporting change.

Three innovative international approaches were shared:

  • The Embassy Conversations organized in Washington, DC, allowed policy makers to learn from health care reform in Australia, Denmark, and The Netherlands. Experts from these countries spoke in their US embassies so that they could be recognized as experts by their home governments. Clinical and policy reactors provided US and Canadian context.

  • An Australian community-based team of family physicians and endocrinologists applied a co-creation approach, involving highest-need patients in their own health care, resulting in better outcome of diabetes care and risk reduction,12 and lower hospitalizations,13 with higher patient satisfaction and lower costs14 compared with usual care.

  • The EU RESTORE project addressed how improved communication with migrants in primary health care can overcome lingual and cultural challenges. Through Participatory Learning and Action, contemporary social theory methods,1,5 and implementation of communication guidelines and training initiatives, the most vulnerable and difficult-to-reach populations were engaged.16,17

The shift to primary health care asks for a redirection of research towards the community setting. Four funding agencies: the US Agency for Healthcare Research and Quality (AHRQ),18 the Australian Primary Health Care Research Institute (APHCRI),19 the Canadian Institutes of Health Research (CIHR),20,21 and the Netherlands Organization of Health Research and Development (ZonMw)22,23 presented their approaches towards innovation and translation support.

All 4 commission funding to establish partnerships beyond the research community to other stakeholders, in order to guide change. Innovative approaches included trained implementation experts who serve as change agents.

Bi-national collaborative funding between APHCRI and CIHR24 was highlighted, exploring the variation between countries as a natural research experiment. International comparison-of-care outcomes were seen as powerful support for health systems innovation and change, but funding agencies are often restricted in funding to their national jurisdictions. The most efficient way to obtain transnational comparisons is for researchers to collectively apply to their national agencies. Comparisons would benefit from a standardization of outcome measures.

Conclusions and Actions

On the basis of these findings, the IIRNPC decided to pursue the following next steps:

  • Inform Mexican leaders about effective primary health care policy and implementation practices via a preconference at the 2015 NAPCRG annual meeting in Cancun, Mexico

  • Review the systems of Japan, the Republic of South Korea, Hong Kong, Taiwan, and Singapore at a workshop at the WONCA Asia Pacific Conference in 2015 in Taipei11,25

  • The Embassy Conversations model will be promoted as a promising approach for engaging policy makers and lawmakers in health systems innovation

  • Promote participatory research methodology as a meaningful tool for engagement with stakeholders

  • Promote the value of international comparative outcome research for health systems’ innovation:

    • The 4 funding agencies have committed to ongoing informal discussions to consider opportunities for collaboration over shared areas of interest

    • Pursue the development of a standardized set of primary health care-sensitive outcome measures.