Primary care reform has been on the political agenda in Canada and many industrialized countries for several decades; it is widely seen as the foundation for broader health system transformation. Federal investments in primary care, including major cash transfers to provinces and territories as part of a 10-year health care funding agreement in 2004, triggered waves of primary care reform across Canada. Nevertheless, Commonwealth Fund surveys show, Canada continues to lag behind other industrialized nations with respect to timely access to care, electronic medical record use and audit and feedback for quality improvement in primary care. This paper evaluates the pace and direction of primary care reform as well as the extent of resulting change in the organization and delivery of primary care in Ontario, Canada’s most populous province. Qualitative and quantitative methods were used for this study. A literature review was conducted to analyze the core dimensions of primary care reform, the history of reform in Ontario, and the extent to which different dimensions are integrated into Ontario’s models. Quantitative data on the number of family physicians/general practitioners and patients enrolled in these models was examined over a 10-year period to determine the degree of change that has taken place in the organization and delivery of primary care in Ontario. There are 11 core reform dimensions that individually and collectively shift from conventional primary care toward the more expansive vision of primary health care. Assessment of Ontario’s models against these core dimensions demonstrate that there has been little substantive change in the organization and delivery of primary care over 10 years in Ontario. Primary care reform is a multi-dimensional construct with different reform models bundling core dimensions in different ways. This understanding is important to move beyond the rhetoric of “reform” and to critically assess the pace and direction of change in primary care in Ontario and in other jurisdictions. The conceptual framework developed in this paper can assist decision-makers, academics and health care providers in all jurisdictions in evaluating the pace of change in the primary care sector, as well as other sectors.

中文翻译：

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边缘修补：评估加拿大安大略省初级保健改革的步伐和方向

几十年来，初级保健改革一直被提上加拿大和许多工业化国家的政治议程；它被广泛视为更广泛的卫生系统转型的基础。联邦政府对初级保健的投资，包括作为 2004 年 10 年期医疗保健资助协议的一部分向各省和地区提供的大量现金转移，引发了加拿大各地的初级保健改革浪潮。尽管如此，联邦基金的调查显示，加拿大在及时获得护理、电子病历使用以及初级保健质量改进的审计和反馈方面仍然落后于其他工业化国家。本文评估了加拿大人口最多的省份安大略省初级保健改革的步伐和方向，以及由此产生的初级保健组织和提供变化的程度。本研究采用了定性和定量方法。通过文献综述来分析初级保健改革的核心维度、安大略省改革的历史以及不同维度融入安大略省模式的程度。对 10 年来参与这些模型的家庭医生/全科医生和患者数量的定量数据进行了检查，以确定安大略省初级保健的组织和提供发生的变化程度。有 11 个核心改革维度，分别或集体从传统的初级保健转向更广泛的初级卫生保健愿景。根据这些核心维度对安大略省模型的评估表明，十年来安大略省初级保健的组织和提供几乎没有发生实质性变化。初级保健改革是一个多维度的构建，不同的改革模式以不同的方式捆绑核心维度。这种理解对于超越“改革”的言辞并批判性地评估安大略省和其他司法管辖区初级保健变革的步伐和方向非常重要。本文开发的概念框架可以帮助所有司法管辖区的决策者、学者和医疗保健提供者评估初级保健部门以及其他部门的变革步伐。