What are the Critical Attributes and Benefits of a High-quality Primary Healthcare System?

Dale McMurchy
January 2009 (released January 2010)

Full report (514 KB)

This paper summarizes the key attributes and benefits of high-quality primary healthcare systems. It covers factors such as orientation and design, organization and process, effective governance, physician supply and the critical features unique to primary care delivery.

Main Messages

Canada has not yet achieved a national primary care orientation in the sense of providing high quality patient-centred, comprehensive care – although there is evidence from other jurisdictions that this is achievable with demonstrable benefits.
Primary care practices that provide comprehensive and coordinated care confer the most benefits to patients. What characterizes these practices is that they: have a sound knowledge of their patients and community; use clinical guidelines and provide evidence-based care; provide collaborative team-based care; use and share information through electronic medical records; and have effective patient flow processes.
The factors that facilitate the delivery of comprehensive and coordinated care are: governance and organizational effectiveness including a clear mission and vision, strong leadership and change management strategies; accountability supported by a culture of continuous quality improvement and ongoing performance measurement; and patient empowerment through education, shared decision making, access to their medical records, and improved access for at-risk patients.
Future research efforts to support the delivery of high quality, comprehensive and coordinated primary care should focus on : 1) effective organizational, funding and administrative models; 2) methods for determining the appropriate mix of health professionals; 3) models for improving the coordination of care within primary care and with the rest of the health system; 4) the delivery of comprehensive, person-focused primary care, including chronic disease prevention and management, mental health and addictions services, rehabilitation, etc.; 5) improved care for under-serviced areas and at-risk populations; 6) the use of information technology to improve quality and reduce costs; and 7) methods to ensure quality and performance at the service and patient level.
Better co-ordination is required among the various groups that undertake primary care research and between researchers and decision makers seeking high performing primary care in Canada.
Primary care research conducted to date in Canada has not been fully exploited. More effort is required to promote the uptake and dissemination of existing research, including the preparation of syntheses of the published and grey literature for clinicians, managers and regional, provincial, territorial and federal policy makers.
There should be further investment to support change within the context of research and evaluation, including the development of management tools that support healthcare providers, managers, patients and decision makers in implementing change and improving quality.

Related reports

» The Health and Economic Consequences of Achieving a High-quality Primary Healthcare System in Canada – “Applying What Works in Canada: Closing the Gap”

» A Structure for Co-ordinating Canadian Primary Healthcare Research