The impact of primary care reform on health system performance in Canada: a systematic review.

Renee Carter,Geneviève Gariepy,Amélie Quesnel-Vallée,Bruno Riverin,Jean-Frédéric Levesque

doi:10.1186/s12913-016-1571-7

Abstract

BackgroundWe aimed to synthesize the evidence of a causal effect and draw inferences about whether Canadian primary care reforms improved health system performance based on measures of health service utilization, processes of care, and physician productivity.MethodsWe searched the Embase, PubMed and Web of Science databases for records from 2000 to September 2015. We based our risk of bias assessment on the Grading of Recommendations Assessment, Development and Evaluation guidelines. Full-text studies were synthesized and organized according to the three outcome categories: health service utilization, processes of care, and physician costs and productivity.ResultsWe found moderate quality evidence that team-based models of care led to reductions in emergency department use, but the evidence was mixed for hospital admissions. We also found low quality evidence that team-based models, blended capitation models and pay-for-performance incentives led to small and sometimes non-significant improvements in processes of care. Studies examining new payment models on physician costs and productivity were of high methodological quality and provided a coherent body of evidence assessing enhanced fee-for-service and blended capitation payment models.ConclusionA small number of studies suggested that team-based models contributed to reductions in emergency department use in Quebec and Alberta. Regarding processes of diabetes care, studies found higher rates of testing for blood glucose levels, retinopathy and cholesterol in Alberta’s team-based primary care model and in practices eligible for pay-for-performance incentives in Ontario. However pay-for-performance in Ontario was found to have null to moderate effects on other prevention and screening activities. Although blended capitation payment in Ontario contributed to decreases in the number of services delivered and patients seen per day, the number of enrolled patients and number of days worked in a year was similar to that of enhanced fee-for-service practices.

Highlights

We aimed to synthesize the evidence of a causal effect and draw inferences about whether Canadian primary care reforms improved health system performance based on measures of health service utilization, processes of care, and physician productivity
We aimed to synthesize the evidence of effects and draw inferences about whether Canadian primary care reforms improved health system performance based on measures of health service utilization, processes of care, and physician productivity
Of the 14 studies, 2 assessed independent associations between several predictors and health system performance outcomes, and 12 assessed the causal effect of defined interventions compared to a control group

Summary

Introduction

We aimed to synthesize the evidence of a causal effect and draw inferences about whether Canadian primary care reforms improved health system performance based on measures of health service utilization, processes of care, and physician productivity. Between 2000 and 2006 the Primary Health Care Transition Fund (PHCTF) contributed $800 million towards reforming primary care in Canadian provinces and territories. This effort was aimed to address the health service needs of the country’s ageing population and growing burden of chronic disease [1]. We aimed to synthesize the evidence of effects and draw inferences about whether Canadian primary care reforms improved health system performance based on measures of health service utilization, processes of care, and physician productivity

Objectives

Methods

Results

Discussion

Conclusion