Arlene Bierman is the Director of Center for Evidence and Practice Improvement (CEPI) at the United States Agency for Healthcare Research and Quality (AHRQ)
Rick Glazier is a Family Physician and Senior Scientist and Program Lead of Primary Care and Population Health at the Institute for Clinical Evaluative Sciences (ICES) in Toronto, Canada
Primary care is foundational to optimizing individual and population health. Health systems based upon primary care provide better access to care while improving health equity and outcomes and reducing costs. Effective models of primary care can greatly enhance the value of increasingly constrained health care spending. Despite large investments on primary care transformation in the US and Canada, primary care has yet to achieve its full promise in either country. Sharing successes and failures from attempts at innovation on both sides of the border can help each country accelerate improvement.
Despite very different health systems, primary care practices in both countries encounter remarkably similar challenges in delivering care. At the point of care, patients’ needs are similar and their experiences too often suboptimal. ...continue reading →
Yehuda Berg, an American author and spiritual leader, was probably talking about individual level transformation when he said “We need to realize that our path to transformation is through our mistakes. We're meant to make mistakes, recognize them, and move on to become unlimited.” But the statement has a lot of validity even applied to system level transformation.
Canada and the United States share the dubious honor of ranking near the top of OECD nations for total healthcare costs and near the bottom for health outcomes, whether measured in terms of individual health or health system performance. But it is through the recognition of these mistakes that both countries have embarked on a path toward transformation.
While differences between the two systems of health care delivery are frequently emphasized, we actually face some common challenges to primary care transformation ...continue reading →
Domhnall MacAuleyis a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK
The concept of the “Salon” is based on the tradition of European intellectual gatherings that led to the great literary, artistic and political movements of our time. At a recent meeting of primary care researchers in Colorado Springs, Frank deGruy gathered a group of colleagues in this way together to create discussion, debate and perhaps generate ideas. Such gatherings might take place with any group and in any context - in a department, region or nationally. On this occasion, Frank attracted a group of about twenty delegates of the NAPCRG meeting from various international and professional backgrounds and I was fortunate enough to be included. ...continue reading →
The High Plains of eastern Colorado have been referred to as a dwindling remnant of the “worst hard time”, reminding us of a not too distant past that included the dust bowl and westward out-migration to the West Coast. Rural Colorado has become mostly a crop-circle curiosity or a time to “put your seat into the upright and locked position” for the thousands of travelers that fly over at 30,000 feet. The small town of Last Chance, Colorado sits at the junction of 2 blue highways. It is home to just 22 residents.
Last Chance once had a Dairy King and 2 gas stations, and was for many, the last chance for food and fuel before heading east into the vast open plains of eastern Colorado. ...continue reading →
Kevin Pottie is Associate Professor of Family Medicine and Epi & Community Medicine at the University of Ottawa, as well as co-Chair of the Canadian Collaboration for Immigrant and Refugee Health, and a family physician at the Immigrant Health Clinic of Ottawa, which he helped to found. Dr Pottie will be speaking at the forthcoming North American Primary Care Research Group (NAPCRG) annual meeting.
My residency training in Ottawa began with a wave of refugees from El Salvador and Guatemala. Most conflict-affected refugees - Somali, Sudanese, Congolese, Karen, Bhutanese, Colombian - come quietly and settle rapidly in our communities. And, even in instances when the media cover the arrival of large waves of refugees, such as the Vietnamese boat people or the recent Syrian war victims, the refugees themselves settle quietly in our communities.
In the early 1990s, it felt almost revolutionary to care for refugees. There were few primary care practitioners trained and ready to lead ...continue reading →
Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy
Some of the fundamental principles of our health-care system — universal access to a comprehensive range of services in a system that is publicly administered — are threatened by the court challenge being mounted by Dr. Brian Day. But there is no smoke without fire.
Back in the 1990s, I organized study tours for Swedish health-care managers interested in learning from Canada’s health-care system. In introducing them to the system, I would point out that we do not have a national health-care system, as they do in Sweden, the U.K. or many other places.
Liz Sturgiss is a lecturer at the Academic Unit of General Practice of the Australian National University
I faced attending PHCRIS this year with some trepidation. I'll admit that, as a (very) early career GP researcher, the recent months of de-funding announcements have filled me with disappointment. Have I chosen a career path worth pursuing? Is this a valuable way to spend the next 30 years of my working life?
I'm pleased to say I've been left with a feeling of great hope having been inspired by my primary healthcare research mentors and leaders.
Grant Russell, newly elected for a second term as President of the Australasia Association of Academic Primary Care (AAAPC) was upbeat in his introduction to the second day of the meeting. He reminded us how the Canadian academic, Martin Bass, had warned against learned helplessness and he pointed out that primary care has much more influence than we give ourselves credit for.
Claire Jackson, one of Australia’s leading primary care researchers was introduced at her plenary lecture as “an eternal optimist”. True to form, she told us that there has never been a more exciting time to be in primary care research. She listed the national primary health care strategy, the primary care framework, and the 31 primary health networks. While there have been numerous health care reforms, each one has primary care at its centre and there is growing government awareness of the need to address complex chronic illness in community. ...continue reading →
Domhnall MacAuleyis a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK. He is currently attending the 2016 Primary Health Care Research Conference in Canberra, Australia
“This is the time to be in general practice...This is the time to be in general practice research,” said Steve Hambleton, former chair of the Primary Health Care Advisory Group, a body created to look at options to reform care for people with complex and chronic illness. Steve gave the opening conference address. He spoke about the advisory group's work, their wide ranging membership including family doctors, other providers and consumers, and he outlined three areas that would be major challenges in the future: chronic care, obesity, and preventable disease. Steve also reminded us that those patients with the greatest number of diseases see the greatest number of doctors. The final report, delivered on ...continue reading →