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General practice / Family practice
Original research
Regional variation in primary care improvement strategies and policy: case studies that consider qualitative contextual data for performance measurement in three Canadian provinces
  1. Ruth Martin-Misener, Professor and Director1,
  2. Sabrina T Wong2,
  3. Sharon Johnston3,
  4. Stephanie Blackman4,
  5. Catherine Scott5,
  6. William Hogg6,7,
  7. Fred Burge4,
  8. Anne M Grool8,
  9. John L Campbell9,
  10. Sara Wuite4
  1. 1 School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
  2. 2 School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
  3. 3 Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
  4. 4 Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
  5. 5 PolicyWise for Children & Families, Calgary, Alberta, Canada
  6. 6 Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
  7. 7 Montfort Hospital Research Institute, Ottawa, Ontario, Canada
  8. 8 Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
  9. 9 Peninsula Medical School, University of Exeter, Exeter, United Kingdom
  1. Correspondence to Dr Ruth Martin-Misener; ruth.martin-misener{at}dal.ca

Abstract

Objective To explore regional primary care improvement strategies that are potentially determinants of primary care performance.

Design Multiple comparative embedded case study.

Setting Three regions in Canada: Fraser East, British Columbia; Eastern Ontario Health Unit, Ontario; Central Zone, Nova Scotia.

Data sources (1) In-depth interviews with purposively selected key informants (eg, primary care decision-makers, physician leads, regulatory agencies) and focus groups with patients and clinicians (n=68 participants) and (2) published and grey literature (n=205 documents).

Outcome measures Variations in spread and uptake of primary care improvement strategies across the three study regions. NVivo (V.11) was used to manage data and perform content analysis to identify categories within and across cases. The coding structure was developed by researchers through iterative collaboration, using inductive and deductive processes.

Results Six overarching primary care improvement strategies, differing in focus and spread, were implemented across the three study regions: interprofessional team-based approaches, provider skill mix expansion, physician groups and networks, information systems, remuneration and performance measurement and reporting infrastructure.

Conclusion The addition of information on regional improvement strategies to primary care performance reports could add important contextual insights into primary care performance results. This could help identify possible drivers of reported performance outcomes and levers for change in practice, regional and system-level settings.

  • primary health care
  • quality of health care
  • qualitative research

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2019-029622

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    Footnotes

    • Twitter @MisenerRuth, @profjcampbell

    • Contributors All authors have made substantial contributions to the conception or design of the work (RMM, STW, SJ, SB, CS, WH, FB, JC) or the acquisition, analysis or interpretation of data for the work (RMM, STW, SJ, SB, CS, WH, FB, AMG, JC, SW) AND drafting the work (RMM, STW, SJ, SB, CS, SW) or revising it critically for important intellectual content (RMM, STW, SJ, SB, CS, WH, FB, AMG, JC, SW); AND final approval of the version to be published (RMM, STW, SJ, SB, CS, WH, FB, AMG, JC, SW) AND are in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding This work was supported by the Canadian Institutes of Health Research (grant number TTF-128265) and the Michael Smith Foundation for Health Research (grant number PT-CPH-00001-134).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Procedures were approved by the Research Ethics Boards at Fraser Health, University of British Columbia, Ottawa Health Science Network, Bruyère Continuing Care and the Nova Scotia Health Authority.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.