What we need to learn from each other in primary care

is Senior Scientist at the Institute for Clinical Evaluative Sciences, Family Physician and Scientist at St. Michael’s Hospital, and Professor of Family and Community Medicine at the University of Toronto. He is currently serving as President of the North American Primary Care Research Group ()


I see patients in a setting where there is an inter-professional team, electronic medical records, patient reminders for cancer screening, physician payment through capitation incentives, and after-hours coverage. These changes have all occurred in the past few years and they have been very costly to the provincial health system.

Most primary care settings in the developed world have undergone similar changes, or want to have them. Like my setting, very few places are able to say whether these changes have made patient care better, improved health, or reduced costs. Sure, we all know of success stories: a plan that has reduced emergency department visits; a group that has improved immunization coverage. But are these successes sustained over time and when they are successful do they spread elsewhere? The evidence from somewhere else, produced about a decade ago, suggest that these types of changes produce better health and better equity at lower costs. But what about right now, where I practice? Sadly, not much is known.

We live in a world that has started to recognize the promise of primary care to support health systems in a way that makes them effective, equitable and affordable. But few places have been able to back up that promise with results. Partly, our measurement systems are weak or non-existent. And in some places our primary care systems are thin on the ground and information technologies have not evolved far enough. The primary care systems with the best results have been innovating for many years. They are largely located outside of North America and they have surprisingly few commonalities in how they are organized.

So what do we need to learn from each other? A new initiative called has set out to improve access to primary care, be accountable for cost and quality, reduce health care disparities, move to comprehensive payment and away from fee-for-service, transform training, implement technology to support effective care, improve the research that underpins primary care, and actively engage patients, policy makers, and payers. Surely the U.S. health system is a unique case, so what can the rest of the world learn from this initiative? I will argue that although our health systems are vastly different, we all need to know what policies produce these sorts of changes, how they can be effectively organized and implemented and how we can tell if they are working or not.

An evidence base is needed so that all health care settings can realize the full value of primary care. The U.S. family of Family Medicine organizations has recognized the need for a robust research strategy into what works. So has the Canadian Institutes for Health Research and so have some other international funders.

There are many ways and many places that we can learn from each other. Still, it’s rare to have face-to-face opportunities to meet and speak with primary care clinicians, patients, policy-makers and researchers. has helped to foster a number of these opportunities, including interest groups, committees, working groups, pre-conferences and embassy conversations. , about to start in Times Square New York, is a unique venue with more than a thousand attendees from many places across the globe, all eager to learn about primary care from each other. I don’t think that NAPCRG or its annual meeting will solve the world’s health system problems. But I can’t think of a better place to start.

This blog is part of a series on global primary care research hosted on CMAJBlogs.com to coincide with NAPCRG's  Annual Meeting (2014), whichNAPCRG 2014a-630 begins this weekend