Models of Primary Health Care Delivery in Northern, Rural or Remote Settings
E. Neufeld, J. Bickford, S. Lacarte, and K. Viau
This report used a focused literature search and review, coupled with key informant interviews to explore how the delivery of primary healthcare could be reorganized in order to better meet the needs of northern, rural or remote (NRoR) populations in Canada, including Aboriginal populations. This report provides an analysis and synthesis of findings from over 100 articles and reports, plus interviews with five key informants. A central limitation to the synthesis is the short timeframe within which articles were located.
The context in which primary healthcare is delivered in NRoR settings is initially described. This includes a discussion regarding the challenges of recruiting and retaining healthcare providers to NRoR and that this health human resource shortage impedes access to care. Alternative payment plans (APP) were identified as a means for recruiting and retaining healthcare professionals to NRoR settings; however, key informants identified that APPs were physician-centric and excluded allied health.
The literature review identified four models of interprofessional primary healthcare delivery that could be adapted and/or replicated in NRoR communities: Integrated Care; Comprehensive Primary Healthcare; Outreach; and Telehealth, Telemedicine and Virtual Outreach. Within comprehensive primary healthcare, the patient-centered medical home model, the group medical visit model and the interdisciplinary expanded care model were also identified. The models identified are organized from rural (larger, more closely settled communities) to remote (smaller populations dispersed over vast areas).
Within each of these models, practice examples are provided including how the success of these models is measured, and the degree to which they address components of the Triple Aim (TA) framework. Many of the examples within these model types were echoed in the key informant interviews, highlighting areas where potential reorganization within the system is occurring (or could occur in the future) to best meet the needs of NRoR populations. Key findings and recommendations for the reorganization of primary healthcare delivery are based on this combination of literature and key informant interviews.
Each of these models offer features of primary healthcare organization or care delivery that could be replicated in NRoR settings. As key informants noted, communities in NRoR settings, particularly remote communities, are more willing to push the boundaries on traditional primary care delivery because they recognize that it is necessary. Of notable interest was the number of key informants who identified a lack of evaluative research regarding Canadian primary healthcare models. However, key informants equally discussed forthcoming personal research projects that appear will fill this gap in Canadian research literature in the near future.
(funded by the Canadian Foundation for Healthcare Improvement (CFHI))
[Started in February 2014; Completed in July 2014]
Link to final report forthcoming from CFHI website
(Names in bold denote CRaNHR investigators and research staff.)