Abstract
Background: Promoting government efforts to transition to team-based care models in Canada is essential; it aligns with the imperative of ensuring health equity within primary healthcare (PHC) settings. By addressing the fundamental principle of fairness and striving to mitigate disparities in access, quality, and outcomes, these team-based care initiatives can foster a more inclusive and effective healthcare system. This study, part of a larger study, examines health equity initiatives within team-based primary healthcare (TBPHC) policies in British Columbia (BC), Ontario (ON), and Nova Scotia (NS), highlighting key policies, strategies, and challenges faced in fostering equitable care along with implementation and sustainment of TBPHC.
Approach:This longitudinal case study used mixed-methods to analyze 3 ON, 7 BC and 7 NS PHC policies from 202 onward. Data sources include provincial and local level policies including strategic direction documents and white papers. The analysis employs the Input-Mediators-Outcome (IMO) framework to systematically direct these major components, alongside the policy triangle that considers the content, process, actors, and context integral for policy formulation, implementation and evaluation. Moreover, the policy analysis is facilitated by the conceptual framework meticulously developed by the TBPHC research team, concentrating on critical areas such as patient engagement, alignment of patient needs, structure of PHC teams, and fostering collaboration among both internal and external shareholders. To enrich this analytical process, interviews will be conducted with patients, providers, and policymakers.
Results:Preliminary analyses showed: In BC, a notable shift towards prioritizing health equity in PHC delivery has been observed, particularly through initiatives focusing on Indigenous communities and equity-deserving groups. The emphasis on expanding Community Health Centres, especially those governed by First Nations, demonstrates a targeted approach to address the healthcare needs of equity-deserving groups. However, challenges remain, including workforce diversity and access to digital health resources. In NS, a strong commitment to community-based care and social determinants of health underscores the province's focus on promoting health equity. Despite this commitment, challenges persist, such as limited workforce capacity (e.g., shortage of family physicians) in collaborative practice teams. ON's adoption of transformative PHC models, like Family Health Teams and Nurse Practitioner-Led Clinics, target equity-deserving groups and aims to address systemic disparities in access to care. These models have shown tangible benefits, including reduced emergency room visits and improved care transitions. However, barriers such as limited access to healthcare for uninsured individuals and gaps in care coordination persist. Across all provinces, significant strides are being made to fortify the alignment between PHC and its dedicated teams. PHC teams facilitate integrated health services delivery by coordinating care, serving as care navigators, ensuring continuity, managing population health, fostering collaboration, and leveraging health information systems. Further in-depth analysis will be included in the presentation.
Implications:This study underscores the critical need for targeted interventions aimed at addressing inequities in healthcare access and outcomes among equity-deserving groups. The findings suggest that policymakers and healthcare decision-makers must prioritize initiatives that address workforce shortages crucial for fulfilling commitments to patient-centered care, promoting health equity, and overcoming barriers to equitable healthcare delivery.