Community Based Primary Health Care Innovations 4th Annual Meeting

October 24-25th, 2016
Meeting Report

The Community Based Primary Health Care Innovations (CBPHC) 4th Annual Meeting was co-hosted by the CIHR Institutes of Population and Public Health (IPPH) and Health Services and Policy Research (IHSPR) in Ottawa, Ontario on October 24th and 25th, 2016. The meeting brought together CIHR funded CBPHC Innovation Teams, New Investigators and Applied Public Health Chairs, and other key stakeholders and partners in the initiative, including representatives from national health care organizations including CIHI, the Canadian Medical Association and the College of Family Physicians of Canada.

The objectives of the CBPHC 4th Annual Meeting were to:

  • Critically reflect on progress, achievements and impacts arising from Teams and awardees’ programs of research, capacity building and knowledge translation;
  • Provide a forum for knowledge exchange, critical debate and collaboration between Teams, salary awardees, decision-makers and partners about issues of common interest;
  • Foster linkages with other complementary CIHR initiatives; and
  • Facilitate the further implementation of the CBPHC common indicators project.

CBPHC at the Mid-Term

The Mid-Term Summary session largely focused on results captured by the Innovation Research Teams mid-term progress reports. The teams are interdisciplinary, multi-stakeholder and multi-jurisdictional in nature and much of the early efforts and progress made has been process-oriented. However, some great progress has also been made in advancing innovations that are impacting health and health systems and in building capacity via new collaborations and trainees. A brief summary of highlights from the mid-term reports is available.

The meeting co-Chairs, Drs. Robyn Tamblyn (IHSPR) and Steven Hoffman (IPPH), provided recommendations to for the Innovation Teams heading toward summative final reporting, encouraging them to:

  • Reduce variability in reporting nature and extent of outputs
  • Case study information requires action and improvement, ideally including stories tracing out research investment and real change that has occurred
  • Improve specificity in what has been achieved through funding
  • Plan for sustainability

CBPHC Highlights & Updates

In this session, the CBPHC Innovation Teams were required provide a highlight, and the other CBPHC-funded researchers were invited share any highlights as well. They were asked to highlight something interesting or significant that happened in relation their research in the past year and that it be something specifically related to one of the objectives of the CBPHC Signature Initiative, or to an immediate or intermediate outcome as outlined in Performance Measurement Framework.

Presenters were tasked with providing brief presentations of no more than 5 minutes, and to focus on what happened, why it was interesting or significant (i.e. how it related to the CBPHC objectives or Performance Measurement Framework), and how it was accomplished. Summaries of the highlights can be found in the profiles of the CBPHC teams and researchers.

Policy Response Panel – Considerations for Scale-up

A follow-up panel of decision makers engaged with different CBPHC initiatives provided a response to the highlights that were presented. The panel was moderated by Owen Adams of the Canadian Medical Association and the panelists included:

  • Anne Hayes, Director of the Research, Analysis and Evaluation Branch, Ontario Ministry of Health and Long Term Care
  • Paul Huras, CEO, Southeast Local Health Integration Network (ON)
  • Tara Sampalli, Director of Research and Innovation, Primary Health Care, Nova Scotia Health Authority
  • Carla Loepkky, Director and Lead Epidemiologist, Government of Manitoba, Public Health (Manitoba Health, Healthy Living and Seniors)
  • Renee Bowers, Chronic Disease Advisor, First Nations and Inuit Health Branch

Through the panel discussion the importance of building relationships with decision makers and community stakeholders was stressed because of the value in ensuring that relevant problems and solutions are define. It was also stressed that interventions must be simple and relevant, addressing a current issue, such as inequities in access to care, and that it is important to consider the patient’s journey through the health care system with the goal of providing patient centered care. Participants were also encouraged to seek learnings from other jurisdictions (such as the United States and Australia), which may elucidate some common challenges or successful interventions while being sure to take into account the Canadian context.

Following an open discussion, some key recommendations for researchers working with policy makers and aiming to impact on decision making included:

  • Tools such as Issue Briefs are helpful for policy makers who need evidence packaged to speak to problems and how they align with strategic priorities.
  • Be aware of meeting schedules and consider how to plan and coordinate an approach across the Ministry.
  • Civil servants (unlike politicians) do not change with politics and therefore is it beneficial to embed yourself in the systems that may be more sustainable.

Priorities for Primary Health Care Research, Implementation and Scale-up: Small Group Discussions

Following the highlights presentations and policy response panel, meeting participants broke off into small groups and were assigned 1 of 5 topics for discussion: chronic disease management, rural and remote access, measurement, vulnerable communities and patient/community engagement. The aim was to generate 2-3 priorities for research and 2-3 priorities for implementation and scale-up. These are summarized in Table 1.

Table 1. Summary of Research and Implementation Priorities
Theme Research Priorities Implementation and Scale-up Priorities
Chronic Disease Management
  1. Implement a research focus on “wellness”
  2. Work upstream
  3. To design research from a patient-centered perspective
  4. Focus on simple interventions for complex issues
  5. Improve collaboration between researchers and decision makers.
  1. Build relationships, partnerships and collaborations that include the right decision-makers and communities early in the process
  2. Create a culture of collaboration and relationship building
  3. Build interdisciplinarity into research
Measurement
  1. Embed research in policy
  2. Develop a common/ core set of primary health care indicators
  3. Leverage other/ new data sources (e.g. wearables)
  4. Invest in comprehensive info systems to monitor PHC
  5. Link data within provinces (admin and EMR and survey data)
  6. Embed researchers with decision-makers
  1. Invest in systematic data collection and coordinate leadership
  2. Link data within provinces – administrative and EMR data are available but this needs to be linked with survey data (e.g. patient, provider)
  3. Embed researchers with decision-makers
Rural and Remote Access
  1. Invest in IT structures
  2. Listen to communities
  1. Expand the BASE eConsult program
  2. Address difficulties with technology in rural/remote areas
  3. Ensure cultural context is addressed first
Vulnerable Communities
  1. Research must be strength-based and participatory
  2. Community and decision maker buy-in is necessary
  3. Must be context specific (local)
  4. What makes a community vulnerable and does research make this worse
    1. How do they define themselves
    2. Research needs
  1. Address health literacy
  2. Work with advocacy groups- researchers need to engage with advocacy groups
  3. Establish non-traditional roles in health for communities to be engaged and represented– KT, change management
  4. Create research networks and relationships b/w communities and decision-makers
  5. Develop funding mechanisms
  6. SPOR needs to be accessible to people who need support
Patient/Community Engagement
  1. Demonstrate measurable impact of patient engagement on research, research protocols, measurement
  2. Make patient engagement a component of health professional training/education (mandatory)
  1. This will follow organically if priority # above is addressed
  2. Embed policies that require patient engagement in research proposals (not just the research plan if/once funded) (i.e.via CIHR and universities

Rapid Fire Presentations: Embedded Clinician Researchers

In the Summer of 2016, 20 Embedded Clinician Researchers were funded through a new CBPHC salary award program designed to build capacity for, and support the creation of, Learning Health Systems – accountable healthcare organizations that mobilize research for transformation and impact, particularly to improve patient experience and outcomes, and quality of life for persons with chronic conditions. Six of the Embedded Clinician Researchers were able to attend the CBPHC Annual meeting, each of whom presented an overview of their research program during the rapid fire session. A profile of each of the presenters, as well as the other Embedded Clinician Researchers is available.

Canadian Primary Care Data Resources Panel

The purpose of this panel discussion, moderated by José Pereira from the College of Family Physicians of Canada, was to share information on relevant data resources that are available for research and to:

  • Provide an overview and characterization of relevant data holdings available to CBPHC researchers, and how they can be accessed;
  • Identify the opportunities presented by the primary care data available in Canada;
  • Reflect on how the CBPHC community can capitalize on the data and/or leverage the data to support the evidence base needed for broader implementation and scale-up on primary care innovations; and
  • Identify and reflect on the gaps in, or other challenges related to, the information available.

The panel included Dr. Richard Birtwhistle presenting on the Canadian Primary Care Senitinel Surveillance Network (CPCSSN), Caroline Heick speaking about data holdings relevant to primary care at the Canadian Institute for Health Information (CIHI), Alison Paprica, presenting on relevant data holdings at the Institute for Clinical and Evaluative Sciences (ICES) and the efforts to being led by the Pan-Canadian Real-World Health Data Network (PRDHN), and finally Dr. Robyn Tamblyn speaking about the Dynamic Cohort of High Systems Users established through a partnership between CIHR and CIHI.

The discussion following the panel presentations focused on the challenges often faced in accessing data. In some cases, permissions can take an excessive amount of time or the data may be rather sparse (i.e. only covering a few provinces). It was clear that there is a critical need to maximize data access and the datasets available across provinces, as well as to harmonize the processes for data access. Another key challenge noted was the different policies and procedures between universities, which creates difficulty with releasing data to researchers on multi-institute teams. Efforts are being made to create master agreements with universities. To conclude the discussion, it was agreed that there would be a benefit in creating a platform to have a discussion about data access and standardization.

SPOR Response Panel & Discussion

Chaired by Marie-Dominique Beaulieu of the QC SPOR SUPPORT Unit, the panel sought to support of the main meeting objectives, to foster linkages with other complementary CIHR Initiatives. The specific objectives of the panel were to:

  • Critically reflect on common priorities for primary care research, and the implementation and scale-up of innovative primary care interventions identified during the small group discussions and presented in the previous session (see Table 1)
  • Identify opportunities for collaboration or linkage between CBPHC and SPOR
  • Identify potential challenges to the implementation and scale-up of emerging primary care innovations, and strategies for addressing them

The panel consisted of representatives from different networks and components of SPOR, including Primary and Integrated Health Care Innovation networks, chronic disease networks, and SUPPORT Units, including:

  • Kris Aubrey-Brassler, Science Lead, PRIIME NL (NL SPOR PIHCI Network)
  • Fred Burge, Science Lead, BRIC-NS (NS SPOR PIHCI Network)
  • Vasanthi Srinivasan, Executive Director, Ontario SPOR SUPPORT Unit (TBC)
  • Gary Teare, CEO, Health Quality Saskatchewan and SK SPOR SUPPORT Unit
  • Cathy Whiteside, Executive Director, Diabetes Action Canada, SPOR Chronic Disease Network

The comments provided by respondents on the panel and the subsequent group discussions focused on key linkages and opportunities between CBPHC and SPOR, as well as potential challenges. CBPHC researchers and teams were encouraged to engage and work with other SPOR networks that have now been established and, to take advantage of the SUPPORT Units for new and effective ways of collaborating with decision makers, working with clinical teams to build from the ground up to include key interventions and outcomes, and engaging patients at the scientific level. Some key challenges discussed, that can and should be addressed through collaboration across the SPOR components, were data access, availability of data on social determinants of health, effective patient engagement strategies that avoid the potential for exhausting or overburdening patients, and change management strategies to support broader implementation and scale-up of effective interventions.

Date modified: