Primary Care Policy Research Articles

How to Build Local Governance in Child Care? Focusing on a Comparison of Primary Care Policy Cases

How to Build Local Governance in Child Care? Focusing on a Comparison of Primary Care Policy Cases

Profile of Primary Care Managers in A Municipality in Northern Brazil and their Leadership Styles

Objective: Know the profile and leadership style of managers of Basic Health Units (BHU). Theoretical Framework: The 2017 National Primary Care Policy (NPCP) suggested the inclusion of managers in BHU to perform technical-managerial functions, based on the manager's assessment and according to the needs of the territory and coverage of Basic Care (BC). Method: Descriptive, cross-sectional and quantitative research, carried out in the municipality of Barcarena, in the state of Pará. The sample was 22 AB managers, carried out from October 2022 to May 2023. The data obtained from a questionnaire with sociodemographic and of experiences in Primary Health Care (PHC) and another on leadership style, the Multifactorial Leadership Questionnaire (MLQ). Results and Discussion: Most BC managers are female (86.4%), aged 20 to 39 (54.5%), married (59.1%), with higher education (90.9%) in Nursing (59 .1%) and 50.0% have a postgraduate degree at Lato sensu level and have a temporary employment relationship (59.1%). They had previous experience in management (59.1%) and had experience in PHC (72.7%). Regarding leadership styles, transformational leadership was more self-perceived (m=3.33) and was statistically significant (p=0.020), as an attribute, motivational inspiration (m=3.67). Research Implications: This study is one of the few works involving research focused on the leadership profile of BC managers. Originality/Value: This study contributes to the literature by understanding the aspects associated with the leadership style of BC managers, and the relationship between leadership and the guidance suggested by the 2017 NPCP.

Approaching collaboration in primary care differently: Exploring boundaries and boundary objects.

In recent primary care policy, collaboration is often understood as an outcome, such as the delivery of team-based care or an integrated health system. This outcome-based understanding of collaboration in policy has proven challenging to achieve in practice. This article introduces the concepts of constructing boundaries and boundary objects used in other disciplines, to support our understanding of collaboration by observing the collaborative process. Multiple methods, such as semi-structured interviews, discourse analysis, and member-checking, were used to compare primary care collaborations across three distinct time periods during the onset of COVID-19 within Interior British Columbia. Data analysis revealed the changing nature of boundaries and boundary objects, providing insights into the collaborative process. Through the exploration of boundaries and boundary objects, this article provides a way to approach collaboration in practice differently. By better understanding the process of collaboration, this research could potentially improve collaborative outcomes.

Assessing the impact of Canadian primary care research and researchers: Citation analysis.

To describe the citation impact and characteristics of Canadian primary care researchers and research publications. Citation analysis. Canada. A total of 266 established Canadian primary care researchers. The 50 most cited primary care researchers in Canada were identified by analyzing data from the Scopus database. Various parameters, including the number of publications and citations, research themes, Scopus h index, content analysis, journal impact factors, and field-weighted citation impact for their publications, were assessed. Information about the characteristics of these researchers was collected using the Google search engine. On average, the 50 most cited primary care researchers produced 51.1 first-author publications (range 13 to 249) and were cited 1864.32 times (range 796 to 9081) over 29 years. Twenty-seven publications were cited more than 500 times. More than half of the researchers were men (60%). Most were clinician scientists (86%) with a primary academic appointment in family medicine (86%) and were affiliated with 5 universities (74%). Career duration was moderately associated with the number of first-author publications (0.35; P=.013). Most research focused on family practice, while some addressed health and health care issues (eg, continuing professional education, pharmaceutical policy). Canada is home to a cadre of primary care researchers who are highly cited in the medical literature, suggesting that their work is of high quality and relevance. Building on this foundation, further investments in primary care research could accelerate needed improvements in Canadian primary care policy and practice.

Development of a Core Outcome Set for Family and Community Nursing: Protocol for a Delphi Study.

Family and community nurses (FCNs) play a crucial role in delivering primary care to patients within their homes and communities. A key aspect of their role involves various health interventions, which are influenced by their unique competencies, such as health promotion, advanced clinical knowledge, and strong interpersonal skills. However, it is essential to understand which specific health outcomes these interventions impact to better understand the relationship between FCNs' skills and the health results. This study aims to outline the steps we will take to develop a set of core outcomes. These outcomes will be particularly sensitive to the health interventions carried out by FCNs, providing a clearer picture of their practice's impact. A Delphi survey will be used for this research, conducted from January to December 2024. The process will involve 5 steps and input from 3 stakeholder categories. These stakeholders will help identify a preliminary list of outcomes that will form the basis of our core outcome set (COS). This guideline will be beneficial for a wide range of stakeholders involved in COS development, including COS developers, trialists, systematic reviewers, journal editors, policy makers, and patient groups. As of January 2024, we have successfully completed the first stage of the study, with the stakeholder group approving the reported outcomes and assigning participant lists for each stakeholder group. This study will provide a roadmap for identifying the key health outcomes influenced by the interventions of FCNs. The multistakeholder, multiphase approach will ensure a comprehensive and inclusive process. Ultimately, the findings will enhance our understanding of FCNs' impact on health outcomes, leading to more effective primary care strategies and policies. PRR1-10.2196/51084.

How useful do communities find the health and wellness centres? A qualitative assessment of India’s new policy for primary health care

BackgroundThe policy attention to primary health care has seen a global upswing in recent years, including in India. Earlier assessments had shown that a very small proportion of Indian population used the government primary health facilities. Starting in 2018, Indian government has established more than 100,000 Health and Wellness Centres (HWCs) to increase rural population’s access to primary health care. It is crucial to know how useful people find the services of HWCs.MethodsA qualitative inquiry was made to understand the perceptions, experiences and expectations of the rural communities regarding HWCs in Chhattisgarh state. Fourteen focus group discussions were conducted with community members. The study areas were chosen to include both the central and remote districts of the state. The study used accessibility, availability, acceptability and quality (AAAQ) framework to assess HWCs.ResultsCommunity members felt that the most important change brought about by HWCs was to offer a wider range of curative services than previously available. Services for noncommunicable diseases such as hypertension and diabetes were seen as a key value addition of HWCs. People felt improvements in services for acute ailments also. The services people found missing in HWCs were for injuries, dental care and mental health. In people’s experience, the availability of essential medicines and point-of-care tests at HWCs was satisfactory and the treatment was effective. People appreciated the supportive behaviour of health workers in HWCs. They did not find the referrals from HWCs as excessive but often faced difficulties in receiving necessary services at higher facilities.ConclusionsThe assessment based on community perceptions showed that the services of HWCs matched well with people’s needs of curative primary care. It shows that people are willing to use the government facilities for primary health care if the services are relevant, adequately functional and accessible.

Policy Evaluation of Primary Care Doctor Practice Based on PCMH in Shenzhen

This work is to conduct a comprehensive policy evaluation of the Patient-Centered Medical Home (PCMH) in Shenzhen since the year of 2009. Main stakeholders of the primary care policy are community residents, government, general hospitals, health agencies, community service providers and medical insurance institutions, drug suppliers. Equity is improved through better community service coverage condition, increase of outpatients in community health service centers, decrease in medical expenditure and the implementation of zero price addition policy of drugs. Better performance in terms of public health cost saving upon primary care doctor policy based on PCMH in Shenzhen are reflected in the reduced proportion of government grant by 7.1%. Each community health service center provided medical services are increased from an average of 97.1 to 156.1 person-times per day, and every doctor servicing with an average of 27.1 to 53.2 person-times per day from 2009 to 2013. Every 1 million from government found brings 2.2 million in operational revenue in 2013, with ratio 1:2.2 compared to 1:1.6 in 2008. Based on the findings from this policy evaluations, it appears that the introduction of PCMH model in public health may improve health care equity, efficiency of community service utilization and cost saving in Shenzhen. However, the extent in which PCMH might be useful also depends on the stakeholders’ effort, as well as the validity of the data used in this evaluation report.

What factors are associated with the research productivity of primary care researchers in Canada? A qualitative study

BackgroundResearch evidence to inform primary care policy and practice is essential for building high-performing primary care systems. Nevertheless, research output relating to primary care remains low worldwide. This study describes the factors associated with the research productivity of primary care researchers.MethodsA qualitative, descriptive key informant study approach was used to conduct semi-structured interviews with twenty-three primary care researchers across Canada. Qualitative data were analyzed using reflexive thematic analysis.ResultsTwenty-three primary care researchers participated in the study. An interplay of personal (psychological characteristics, gender, race, parenthood, education, spousal occupation, and support), professional (mentorship before appointment, national collaborations, type of research, career length), institutional (leadership, culture, resources, protected time, mentorship, type), and system (funding, systematic bias, environment, international collaborations, research data infrastructure) factors were perceived to be associated with research productivity. Research institutes and mentors facilitated collaborations, and mentors and type of research enabled funding success. Jurisdictions with fewer primary care researchers had more national collaborations but fewer funding opportunities. The combination of institutional, professional, and system factors were barriers to the research productivity of female and/or racialized researchers.ConclusionsThis study illuminates the intersecting and multifaceted influences on the research productivity of primary care researchers. By exploring individual, professional, institutional, and systemic factors, we underscore the pivotal role of diverse elements in shaping RP. Understanding these intricate influencers is imperative for tailored, evidence-based interventions and policies at the level of academic institutions and funding agencies to optimize resources, promote fair evaluation metrics, and cultivate inclusive environments conducive to diverse research pursuits within the PC discipline in Canada.

Utilization of dental services by rural riverside populations covered by a Fluvial Family Health Team in Brazil.

Rural riverside populations of Brazil face several difficulties to access health services. The Brazilian National Primary Care Policy implemented the Fluvial Family Health Teams (FFHT), which is a specific primary care team arrangement for these territories. The aim of the study was to assess the use of dental services by adults living in rural riverside areas covered by a FFHT. A household-based cross-sectional survey was carried out with a rural riverside population of 38 localities on the left bank of the Rio Negro, Manaus, Amazonas, representative of the area covered by the FFHT. Stratified random sampling was calculated based on the number of adults and households in each riverside locality. An electronic questionnaire was used to obtain information on sociodemographic and oral health conditions, and the utilization of dental services. After descriptive analysis, logistic regression analyses were performed to estimate the odds ratios for the outcome 'use of dental health services over the past 12 months'. A total of 492 individuals, aged 18 years or more, from 38 rural riverside areas were assessed. The mean age of participants was 43.5 years (standard deviation 17.0), ranging from 18.0 to 90.7 years. Of these participants, 3.1% had never been to a dentist and 21.9% had been to a dentist more than 3 years ago. Among those who attended the dental service, 77.4% of appointments occurred in public health services. Dental pain over the previous 6 months (odds ratio (OR)=2.44; 95% confidence interval (CI) 1.51-3.96), higher education (OR=2.62; 95%CI 1.23-5.56), most recent appointment in public health services (OR=1.86; 95%CI 1.19-2.93), edentulism (OR=0.38; 95%CI 0.17-0.85) and dissatisfaction with oral health (OR=0.59; 95%CI 0.38-0.93) were associated with the dental services utilization. The study results revealed that approximately a quarter of the individuals did not use dental services over the previous 3 years or have never used them. Despite the increase in access provided by the FFHT, edentulous individuals, individuals dissatisfied with their oral health, and those with lower levels of education were less likely to use dental services, while individuals who experienced dental pain sought dental services more frequently. These findings suggest that the healthcare model offered to this population must be rearranged.

Evaluating engagement with equity in Canadian provincial and territorial primary care policies: Results of a jurisdictional scan

Equitable access to primary care is essential to achieving more equitable health outcomes, yet evidence suggests that structurally marginalized populations are less likely to have benefited from varied primary care reforms in Canada. Our objective is to determine how equity is incorporated in public primary care policy and strategy documents across Canada. We conducted string term and snowball searches for provincial/territorial primary care policy documents published between 01 January 2018 and 30 June 2022, extracted the policy objective, and applied a rubric to evaluate each document's engagement with equity. We performed content analysis of the documents which acknowledged inequities and articulated a related policy response. Of the 224 identified documents that discussed primary care policy: 63 (28 %) identified one or more structurally marginalized group(s) experiencing inequities related to primary care, 64 (29 %) identified a structurally marginalized group and articulated a policy response, and 16 (7 %) articulated a detailed policy response to address inequities. Even where policy responses were articulated, in most cases these did not directly address the acknowledged inequities. The absence of measurable goals, meaningful community consultation, and tenuous connections between the policy response and inequities mentioned may help explain persistent inequities in primary care across Canada.

Determining the feasibility of calculating pancreatic cancer risk scores for people with new-onset diabetes in primary care (DEFEND PRIME): study protocol

IntroductionWorldwide, pancreatic cancer has a poor prognosis. Early diagnosis may improve survival by enabling curative treatment. Statistical and machine learning diagnostic prediction models using risk factors such as patient demographics...

Putting patients’ goals first: strategies and challenges through the eyes of primary care stakeholders

Introduction: Primary care is in constant transformation to optimize integrated care delivery according the increase of people with multiple and long-term care needs. One of the suggested strategies is person centered integrated care (PC-IC). PC-IC has an explicit focus on patients’ personal goals. This should reorient care delivery from the focus on disease oriented quality indicators to outcomes that matter to people. To get this focus on patients goals implemented throughout the system, actions in practice, research, education and policy are required.
 Aim: This study aims to explore the experiences of primary care providers, scholars and policy makers towards putting patients’ goals first in primary care, the strategies they use, and challenges they encounter.
 Methods: Primary care stakeholders (n=41) - recruited via maximal variation purposive sampling- participated in six focus groups. Data were collected through a semi-structured interview guide, audio recorded, and analyzed following a phenomenological-hermeneutical philosophy of Lindseth and Norberg.
 Results: All participants emphasized their fundamental commitment in putting patients' goals first. Participants who were active in patient care discussed how they enabled patients to talk about their values and personal stories in order to elicit their personal goals. They also attempted to establish a balanced relationship by integrating their medical expertise with the goals of their patients. Participants stated that they listened to the goals of patients' significant others in order to gain common understanding on goals and recognize everyone's contribution to the care process. Finally, they used patients’ personal goals as a focus for guiding interprofessional collaboration. Both the clinicians and scholars stressed that (future) care providers need more training to develop the competencies necessary to discuss patients' personal goals and integrate them into care delivery. According to policy, all types of participants agreed that there’s challenges related to organizational constraints, such as time restrictions and a lack of registration systems.
 Discussion: The results of this study provide an integrated perspective on the strengths, weaknesses, opportunities and threats for adopting an explicit focus on patient goals throughout the system. In order to support primary care stakeholders to fully engage in the adoption of patients' personal goals in care delivery, the development of models of practice, training and policy plans from a person-centered integrated system approach are required.

Implementing integrated care in the daily practice of general practitioners in an urban setting: facilitating collaboration between health and welfare services.

Summary: Funded by the city of Antwerp, the 'ZIHP' project wants (1) to implement the existing elaborated Flemish vision on integrated care in the daily practice of general practitioners, (2) to strengthen the network around GP practices by facilitating concrete collaborations and (3) strengthen the network around the patient, ultimately improving the health and well-being of the most vulnerable population in Antwerp.
 Context and problem: Current pressure on primary care is driven by increasing complex and long-term care needs of patients and initiatives in health policy to move care from hospitals to the community. In Antwerp, specific areas contain a large number of inhabitants of diverse ethnicity and low socio-economic status. Given that these socioeconomic factors have a large impact on health outcomes, this poses an additional challenge on primary care. The interrelatedness of somatic conditions and psychosocial problems urges for a strong and structural collaboration between welfare and primary care services in these vulnerable neighborhoods. Because GP practices are seen as central hubs for care coordination, the ZIHP project focuses on the support of GP practices in vulnerable areas through the temporarily employment of a social nurse.
 Workshop: We choose for a workshop because we want to explain the functioning of the ZIHP project and subsequently invite professionals to reflect on their own role and act in the uptake of complex care, starting from the goals of the patients. We use casestudies to:
 
 identify the patients problems, viewed from the patients perspective;
 identify the role of each professional;
 identify the added value from each professional in relation to other professionals;
 search for connection and collaboration between the health and welfare sector.
 
 This workshop is relevant for primary care workers (welfare and medical services) and policy makers.
 Workshop details:
 
 20 min intro and presentation with the results of the ZIHP project
 30 min in different small groups – using the ‘Worldcafé methode’ and asking the groups 3 questions:
 
 oWhich problems do you determine in this case?
 oWhat do you expect from each care worker and the patient
 oWhat’s from the patients perspective the most important problem that should be addressed first
 
 10 min: oral summary of take home messages
 
 ofeedback of the most relevant insights of the groups
 osupplemented with insights from the project
 Engage with the audience: We use the ‘Worldcafé method’ which maximizes the exchange between participants. The group is divided into small groups and each group has a host who leads the discussion. After the group has reflected on the first question, the host moves on to the next group, taking the key messages with them, and the group can answer the second question with their own -and the other group's insights. This is repeated for the third question.
 Summarizing the take home messages: The hosts present orally the most relevant insights of the groups, alongside insights of the ZIHP project.

Disparities in access to primary care are growing wider in Canada.

Canadian provinces and territories have undertaken varied reforms to how primary care is funded, organized, and delivered, but equity impacts of reforms are unclear. We explore disparities in access to primary care by income, educational attainment, dwelling ownership, immigration, racialization, place of residence (metropolitan/non-metropolitan), and sex/gender, and how these have changed over time, using data from the Canadian Community Health Survey (2007/08 and 2015/16 or 2017/18). We observe disparities by income, educational attainment, dwelling ownership, recent immigration, immigration (regular place of care), racialization (regular place of care), and sex/gender. Disparities are persistent over time or increasing in the case of income and racialization (regular medical provider and consulted with a medical professional). Primary care policy decisions that do not explicitly consider existing inequities may continue to entrench them. Careful study of equity impacts of ongoing policy reforms is needed.

Suicide in veterinary medicine: A literature review.

Veterinarians are commonly exposed to occupational stressors, including excessive workload and financial constraints. These stressors can lead to psychological distress, which typically results in mental health disorders such as depression, anxiety, and burnout and can even culminate in suicide attempts or suicide deaths. Risk factors associated with poor mental health and high rates of suicide in veterinary practitioners include continuous exposure to challenging scenarios, such as interpersonal conflicts, performing euthanasia, and easy access to lethal means of suicide, such as opioids and anesthetics. The previous studies highlight the urgent need for a better understanding of predisposing factors, mental health-related improvements in the professional environment, and the subsequent establishment of primary mental health-related care policies. Effective ways to promote mental health and prevent suicide may include social support, resilience, developing coping skills, promoting a healthy work environment, and discouraging perfectionist behaviors. This review aimed to summarize findings in studies that have investigated mental health and suicide in veterinarians and veterinary students and highlight measures that could be implemented as options for mental health promotion and suicide prevention.

Strategies to support primary care involvement in the care of patients with a history of breast cancer: A Delphi study.

e24040 Background: Although healthcare leaders in the US support an active role for primary care (PC) in the care of patients with a history of breast cancer, the nature of this role remains unclear. Methods: We invited 40 innovators in breast cancer survivorship care to participate in a 4-round online Delphi panel to identify strategies for defining and fostering PC’s role in breast cancer survivorship. Innovators included primary care physicians, oncologists, researchers and policy makers from government and professional organizations participating in survivorship care programs in the US. Round 1 elicited strategies for improving PC’s role in survivorship care. To reduce the number of strategies and participant burden in subsequent rounds, Round 2 asked panelists to prioritize the top 10 strategies they perceived to be most crucial for implementation. Round 3 asked panelists to assess the importance and feasibility of the previously ranked strategies on a 1 -9 scale. In the final round, panelists were asked to review the group results (medians, IQRs) and reevaluate the importance and feasibility of each strategy in an effort to reach consensus. The RAND/UCLA Appropriateness Method determined the final group rating for each strategy. Results: Of the 40 invited, 23 responded to the email and were included. In Round 1, panelists (n = 23) collectively identified 31 unique strategies to support survivorship care. In Round 2, two of the 31 strategies were unranked by any of the 23 panelists and were eliminated from subsequent rounds. In Round 3, panelists’ (n = 15) evaluated importance and feasibility and revealed three strategies to be most important (scored 9) but with uncertain feasibility (scored 5 or 6). All three strategies emphasized the need to foster connections between primary care and oncology: (1) define clear roles and responsibilities for oncology and primary care, (2) train oncologists about how primary care can address survivorship care needs, (3) create clear pathways for communicating/sharing information with oncology. In Round 4, panelists (n = 20) confirmed the most important strategies and evaluated five strategies as both important and feasible, targeting a range of approaches including EHR-based strategies (e.g., enable screening reminders, monitoring alerts, automated messaging within EHRs in PC), patient education (e.g., educate patients on survivorship), and resource development/distribution (e.g., distribute accessible clinician reference guides detailing common breast cancer drugs and effects). Conclusions: Although innovators identified important and feasible strategic initiatives at various levels of implementation, they agreed that the most important strategies were those that clarified roles and improved communication between oncology and PC but these were not feasible, indicating the need to invest resources to build capacity between PC and oncology.

Quantitative and epidemiological analysis of measles cases in Macapá-AP from 2017 to 2021

Objective: To epidemiologically analyze measles cases in Macapá from 2017 to 2021, considering their sociodemographic and clinical aspects. Method: A descriptive study with a quantitative approach and analysis of secondary data was carried out. The population consisted of all notifications with suspected or confirmed measles in the Health Units of Macapá through the compulsory measles and rubella notification forms. Result: 788 suspected cases were registered in Macapá, with 576 confirmed cases in the period evaluated. The year 2021 was predominant in cases with n=407 (71%) confirmed notifications. It also demonstrates the profile of reported cases, the majority being children, with a slight predilection for males, coming mainly from the urban area. Conclusion: The data indicate an exponential growth of measles in the municipality studied, and vaccination coverage and health policies in primary care should be encouraged and reinforced.

Strategies on critical levels and nodes to improve self-management in people with cardiovascular risk factors in COVID-19 pandemic conditions

Chile faced the Sars-Cov-2 pandemic, which coexisted with food-nutritional problems related to non-communicable diseases (NCDs). Due to this context, individuals with chronic conditions had less chance to receive medical attention due to the restructuring of the public health system. The present study aimed to identify strategies that integrate the individual, community, and structural levels to improve health control in habitual and critical situations. The study included individuals attending the Cardiovascular Health Program (Programa de Salud Cardiovascular) at the primary care level in the capital city of Santiago during the COVID-19 pandemic. Nine hundred forty individuals attending the Cardiovascular Health Program answered a 40-question telephonic interview. With the results of the analysis (convergence analyses, the complement of quantitative and qualitative results), we performed a seminar with key stakeholders from the Ministry of Health and the primary care level. Our study describes integrative strategies that include the individual level, the community level, and structural aspects. These strategies may improve healthcare management among people with NCDs and could be helpful to face interruptions of health benefits and improve health control in everyday and critical situations. The strategies include three levels: 1) Cardiovascular Health Program redesign; 2) facing health attendance discontinuities, and 3) structural measures. It is necessary to re-evaluate primary care policies in light of these proposed strategies for sharing responsibility and empowering users about their abilities.

PHILIPPINE GUIDELINES ON PERIODIC HEALTH EXAMINATION: PEDIATRIC IMMUNIZATION

This Clinical Practice Guideline for the Periodic Health Examination (Pediatric Immunization) is an output from the joint undertaking of the Department of Health and National Institutes of Health-Institute of Clinical Epidemiology. This clinical practice guideline is a systematic synthesis of scientific evidence on immunization for the prevention of human papilloma virus (HPV) infection, influenza, typhoid fever, Japanese encephalitis, poliomyelitis, meningococcal infection, and Hepatitis A in the pediatric population. The CPG provides nine (9) recommendations on prioritized questions regarding the relevant vaccines for preventing these seven (7) diseases. Recommendations are based on the appraisal of the best available evidence on each of the eight identified clinical questions. The CPG is intended to be used by general practitioners and specialists in the primary care setting, policy makers, employers and administrators, allied health practitioners and even patients. The guideline development process followed the widely accepted Grading of Recommendations, Assessment, Development, and Evaluation or the GRADE approach including GRADE Adolopment, a systematic process of adapting evidence summaries and the GRADE Evidence to Decision (EtD) framework. , It includes 1) identification of critical questions and critical outcomes, 2) retrieval of current evidence, 3) assessment and synthesis of the evidence base for these critical questions, 4) formulation of draft recommendations, 5) convening of a multi­sectoral stakeholder panel to discuss values and preferences and assess the strength of the recommendations, and 6) planning for dissemination, implementation, impact evaluation and updating. The recommendations in this CPG shall hold and will be updated after 3 years or when new evidence arise.

The population effect of a national policy to incentivize chronic disease management in primary care in stroke: a population-based cohort study using an emulated target trial approach

Governments are investing in primary care policies that support chronic disease management. Large scale population-based evaluations are lacking. We aim to determine the effectiveness of government-funded chronic disease management policies to improve long-term outcomes (survival, hospital presentations, and preventive medication adherence) following stroke/Transient Ischemic Attack (TIA). Using a population-based cohort we utilized the target trial methodology. Participants were identified through the Australian Stroke Clinical Registry (January 2012-December 2016) from 42 hospitals in the states of Victoria and Queensland and linked with state and national hospital, primary care, pharmaceutical, aged care, and death datasets. Registrants living in the community, not receiving palliative care and who survived to 18 months following stroke/TIA were included. The comparison was a Medicare claim for policy-supported chronic disease management, 7-18 months following stroke/TIA versus usual care. Outcomes were modelled using multi-level, mixed-effects inverse probability of treatment weighted regression. 12,368 registrants were eligible (42% female, median age 70 years, 26% TIA), 45% had a chronic disease management claim. The difference in mean outcomes for participants with a claim, compared to those without, showed a 26% lesser mortality rate (adjusted hazard ratio [aHR]: 0.74, 95% confidence interval [CI]: 0.62, 0.87) and a greater adjusted Odds Ratio [aOR] of being adherent with preventive medications: antithrombotics (aOR: 1.16, 95% CI: 1.07, 1.26); lipid-lowering (aOR: 1.23, 95% CI: 1.13, 1.33). Impacts on hospital presentations were variable. Government policies that financially support primary care physicians to provide structured chronic disease management improve survival in the long-term following stroke/TIA. National Health and Medical Research Council Australia.