CRITICAL ENGAGEMENT

By Alisa Kim

OurCare Initiative Brings the Public’s Voice to the Dialogue on the Future of Primary Care in Canada.

The issues besetting primary care in Canada are immense and predate the COVID-19 pandemic. For one, it is very difficult for people without a family doctor to find one—particularly those in rural and remote areas. The problem will only get worse as family doctors retire in the coming years with fewer medical students choosing to specialize in family medicine to take their place. As decisionmakers try to address these matters and reform primary care in Canada, a key voice is missing—that of patients and the public.

Dr. Tara Kiran, Vice-Chair of Quality and Innovation at the Department of Family and Community Medicine (DFCM), is correcting that omission. She is spearheading a bold national initiative called OurCare that engages patients and the public in reimagining the future of primary care in Canada. The goal is to enable the average person living in Canada to have a say in developing a primary care system that is more accessible, equitable and sustainable, and to bring that feedback to policy makers.

As a scientist and family physician, Dr. Kiran understands the imperative need for users of the primary care system to be part of any reforms. “Primary care is in crisis right now. Far too many people don’t have a family doctor; those who do can’t get seen in a timely way. There have been lots of changes in primary care and the health care system including the introduction of virtual care and increased footprint of corporations. All of these things together make it the right time to have dialogue around what the system of the future should look like,” she says.

The first phase of OurCare launched in September 2022 with a national online survey that asked about people’s experiences with primary care and what they valued most in primary care. More than 9,000 people completed the survey which, among other things, inquired about whether people had a primary care provider, if they had used a walk-in clinic in the past year, how they access their medical information, and the importance of having a primary care provider or team. Results of the survey are posted online, where anyone can interact with the data and see how different groups responded to the questions.

The second phase of the project engages patients and the public via reference panels. In Ontario, more than 1,200 people volunteered to participate; 36 people representing the demographics of Ontario were randomly selected. The panel met to learn about primary care and put forward recommendations for a better system. There will also be reference panels in British Columbia, Quebec, Nova Scotia and one territory.

It is a priority to discuss the future of primary care in a way that is inclusive and equitable, says Dr. Kiran, who notes the team is engaging with members of the public who may not have a regular care provider. “When we think about patient engagement, we think about people who are actually taken care of. Primary care is something that should be available for everyone so we want to have that broad conversation with members of the public whether or not they have a family doctor,” she says.

The third phase is a series of community round tables to hear from people who are underserved by primary care systems in Canada. The OurCare team is collaborating with local organizations to understand who it should be engaging, and to rely on the groups’ relationships and expertise to bring people together. “[The round tables] are designed to focus on equity issues and bring voice to marginalized communities and their specific needs and priorities,” says Dr. Kiran.

After each phase, the researchers will produce a report about the findings. The reports will be shared with the public and a long list of stakeholders including government and health care organizations—all of whom are deeply interested in the public’s perception about the current state and future of primary care in Canada. “I don’t think there is any government that isn’t interested in what the public has to say about what the future of primary care should be. I think often they don’t have a direct vehicle to converse with the public to understand the perspective,” says Dr. Kiran.

OurCare reflects the priorities of DFCM through its work in the Quality and Innovation program, which, in 2022, established a Family Medicine Patient Advisory Committee. The committee is comprised of 16 patient partners who receive care at one of DFCM’s clinics. Its members come from a variety of backgrounds to form a diverse and inclusive group.

When the call for patient partners was made, there was a strong response, notes Dana Arafeh, DFCM’s first Patient and Family Engagement Specialist. “We had 150 apply for the role. From there, we selected 16. We wanted representation from all of the clinics and looked at sociodemographic information and the type of connection patients might have to a primary care clinic. There is definitely a diverse range of perspectives,” she says.

The Patient Advisory Committee, which meets bi-monthly, advises DFCM on a variety of topics related to improving the quality of care delivered in family medicine. It helps the department form questions for its patient experience survey, assists in interpreting results of the survey and gives feedback on new projects aimed at improving care. The group will also provide advice on the education of family medicine residents by helping the department communicate the role of residents to patients, and will provide input on curriculum and advice on how to give feedback to residents. “We are getting the patient perspective on what’s missing at our clinics, how can we start communicating better about what we do, what a teaching clinic looks like, and what people can expect from a resident,” says Ms. Arafeh.

Engaging patients to try and improve the health care system is critical, says Dr. Kiran. “I’ve learned over the years how important it is to hear directly from the people using the system how we should design it. Each time I’ve done it, I’ve learned a lot. The public and patients provided stakeholders with important insights we wouldn’t have gotten otherwise that helped shed light on what the priorities are and how we should move forward.”

Some Recommendations from the Ontario OurCare Priorities Panel:

• Expand team-based care to every resident

• Ensure patient access to personal health data

• Legislate and enforce interoperability data standards

• Invest a greater proportion of total health care funding in primary care

• Strengthen links between primary care practitioners and community agencies