Abstract
Background: Close to 20% of Canadians lack a family physician - a number that continues to rise annually. Canada has had universal health care coverage for medically necessary services provided on the basis of need, rather than the ability to pay for decades. With complexities including variability in provincial governance, multiple health and social care agencies, siloed funding and care delivery, integration of health and social care services could be transformational in solving the country’s primary care access crisis.
Family physicians and health system leaders from coast to coast have been implementing various integrated care initiatives over the past couple of years. Learning from these initiatives using a standard framework could help advance health system integration across the country.
Approach: This oral presentation explores the application of the Integrated People-Centred Health System Standard (IPCHS) in three initiatives from the west coast to the east of Canada, on how to improve access to primary care in settings outside of the traditional family physicians’ offices, through family physician leadership, robust health systems partnerships and community engagement. These 3 initiatives include:
(1) North York Toronto Health Partners Community Health and Information Fairs (CHIFs) were designed by partnering organizations to increase low barrier access to cancer screening and testing for chronic diseases in communities with lack of access to primary care providers.
(2) Vancouver Island Health, as the regional health authority, in 2019, started integrating primary care by overseeing Urgent and Primary Care Centres (UPCC) to increase access to primary care in Victoria, capital of British Columbia, where close to 100,000 residents lack a family physician. Patients attending for urgent medical needs are also offered nurse-lead cancer and cardiovascular screening/follow up for abnormal tests, and in partnership with the provincial cancer agency, people without a family doctor can be redirected to the UPCCs for cancer screening. In response to seasonal peaks in emergency departments (ED), the UPCCs partnered with EDs and diverted less emergent patients to the UPCCs.
(3) East Toronto Health Partners Initiative focuses on increasing access to local social services and primary care for specific equity deserving populations and neighbourhoods presenting to the local emergency departments for non-emergent care.
Results: All three initiatives benefited from the use of integrated care design principles in the co-design and implementation of various aspects of the programs. Health system leaders, providers, patients, families and caregivers utilized elements of the 10 design principles, when collaborating on and problem-solving in areas of differences across agencies, as we try to solve our primary care access crisis together. Using a developmental evaluation approach, integration challenges were mapped to the standards. Future advocacy and actions were then identified, ensuring continued incremental progress in these integration initiatives.
Implications: The existence of standardized frameworks that are evidence-based and widely accepted, could help advance health system integration. Primary care organizations and leaders in particular, can be better equipped, when working with funders, policy makers and acute care partners, through a developmental evaluation approach guided by standards that help frame future approaches.