Innovative and diverse strategies toward primary health care reform: lessons learned from the Canadian experience.

INTRODUCTION: In the last decade, Canadian provincial and territorial health systems have taken diverse approaches to strengthening primary care delivery. Although the Canadian and US systems differ in significant ways, important commonalities include the organization of care delivery, core principles guiding primary care reform, and some degree of provincial/state autonomy. This suggests that Canadian experiences, which employed a variety of tools, strategies, and policies, may be informative for US efforts to improve primary care. INNOVATIONS: The range of primary care reform initiatives implemented across Canada target organizational infrastructure, provider payment, health care workforce, and quality and safety. Primary care teams and networks in which multiple physicians work in concert with other providers have become widespread in some provinces; they vary on a number of dimensions, including physician payment, incorporation of other providers, and formal enrolment of patients. Family medicine is attracting more recent medical school graduates, a trend likely affected by new physician payment models, increases in the number of primary care providers, and efforts to better integrate nonphysician providers into clinical practice. Efforts to integrate electronic medical records into practice and pursue quality improvement strategies are gaining ground in some provinces. CONCLUSIONS: Canadian primary care reform initiatives rely on voluntary participation, incremental change, and diverse models, encouraging engagement and collaboration from a range of stakeholders including patients, providers, and policymakers. Cross-country collaboration in evaluating and translating Canada's primary care reform efforts are likely to yield important lessons for the US experience.

Reflections on Ontario's primary healthcare journey.

Despite the prevailing opinion and consensus around how primary healthcare systems should be changed, there is very little agreement on how this should happen and a surprising paucity of research and evaluative evidence related to both system organization and mechanisms for change. The authors reflect on Ontario's experience with primary healthcare renewal and provide insight into lessons learned.

The research collective: bridging the chasm.

Decision-makers in healthcare face many challenges in obtaining, analyzing and applying research results, including multiple priorities, competition among stakeholders and the time required to synthesize evidence. The research collective described by Pineault et al. appears to expedite access to information that can help inform policy decisions. It also challenges both researchers and decision-makers to better understand each other's context. Achieving such an understanding will require us all to step outside our traditional comfort zones, but this greater trust and flexibility stand to benefit all those who work in the healthcare system and those who rely upon it for care.