Because of the key role it plays, primary health care (PHC) has long been the focus of renewal efforts, and has recently benefited from substantial government investment. Yet despite our recognition of the importance of PHC, and despite a long history of provincial and federal reform initiatives and investment, Canada lacks the most basic ability to measure and monitor our PHC system. We know little about how PHC systems are structured across and within Canadian provinces, how PHC services are delivered, and how effective those services are.
As much as we try to improve our PHC system, we won’t be able to determine if it is getting better (or worse) if we don’t measure key aspects of its performance. It is being increasingly recognized that investments in sophisticated new data collection strategies are required to make it possible to measure, monitor and manage PHC.
Researchers at the UBC Centre for Health Services and Policy Research have focused on determining which key aspects of PHC performance could be measured right now, given our existing data capabilities. Measuring the Performance of Primary Health Care looks at how we can better measure key aspects of PHC using data and information that already exist. The report also identifies gaps in the current data landscape that hinder system reporting, and recommends how these gaps might be filled. This new work builds on an earlier CHSPR report—A Results-Based Logic Model for Primary Health Care—that describes PHC as a configuration of linked parts and processes.
- From the perspective of PHC, the current collection of census, administrative and survey data available in Canada is a patchwork. It allows us to measure some indicators in isolated areas of importance to primary health care. These include demographic and contextual factors, the sector’s human, material and financial inputs, and to some degree, the actions and decisions of government, managers and providers and PHC outputs.
- Many available data sources are cross-sectional--available only at a single point in time. System evaluation requires consistent data collection over time. This is particularly true of any efforts to evaluate how well the PHC system is treating individuals with chronic conditions.
- Very little consistent data is collected regarding organizations delivering primary health care at the local level--we can’t compare PHC models across jurisdictions.
- Survey data availability tends to vary greatly by geographic area--some are available at the national or provincial level, but not at the health region, local or organizational level.
- Canada lacks the most basic information systems that would allow us to assess and monitor the immediate outcomes of the PHC system, particularly in reducing the risk and duration of illness, and improving knowledge about health and health care among the population.
- The use of a common, systematic evaluation framework and consensus process should guide Canadian efforts to develop a comprehensive, population-based data collection system and the next generation of PHC information systems.
- A comprehensive PHC data collection strategy would collect population-based, longitudinal data across every part of the primary health care system, making it possible to link individual patients to providers, clinics and organizations.