Toronto clinicians identify global primary care priorities

New research led by Toronto clinicians has identified global priorities in primary care, which could lead to more strategic resource allocation in efforts to solve the world's most pressing and most common health care challenges.

The research, published in the October issue of PLOS | ONE, tracked the preferences of primary care stakeholders in 13 countries to pinpoint the top ten research priorities. The study is the first of its kind to involve front-line clinicians and patients as well as researchers from across the world. “We know countries around the world face similar challenges when caring for their populations,” says lead author Dr. Braden O'Neill, Family Physician at North York General Hospital, Assistant Professor at the University of Toronto, Department of Family and Community Medicine. “These results will better enable us to prioritize where resources are deployed to make a real difference both locally and globally.” 

In the past, funding allocation has faced several barriers including a focus on specific conditions rather than broader disciplines, as well as a lack of consultation with people who will use or benefit from the research. Feedback gleaned from international health care professionals identified the top ten primary care research priorities, which included enhancing the use of information and communication technology, improving integration of indigenous communities' knowledge in the design of primary care services, primary care staffing, finance, and workforce issues.

“We hope that by identifying what patients, clinicians, and researchers think are the most pressing issues, that research and quality improvement initiatives and funders will look at these issues and focus on them,” Dr. O'Neill says. “Too often, research is undertaken without trying to determine what the key issues really are for people for whom the research is actually being done — patients and clinicians — and we hope this study provides some guidance so that the right questions are being addressed.”

The study included an online survey, optimized for computers and mobiles to ensure ease of use. It was available in three languages (English, French and Spanish) for a year. Respondents identified themselves as clinicians, researchers or members of the public and suggested up to three important primary care research questions. The second step was an in-person priority setting exercise involving primary care stakeholders from 13 countries, held in conjunction with the Besrour Forum, an annual international family medicine conference 

According to Dr. O'Neill, the findings are already being dispersed globally. Dr. Katherine Rouleau, physician in the Department of Family and Community Medicine at St. Michael's Hospital, Vice-Chair, Global Health and Social Accountability Program in the Department of Family and Community Medicine at the University of Toronto and one of the authors of the study, presented their findings at the World Health Organization Global Conference on Primary Heath Care held in Astana, Kazakhstan. Next, the Toronto clinicians will work with their colleagues at the Besrour Centre to help build capability amongst stakeholders and to start expanding and explaining their study. 

“What I'd like to see is for my patients to be involved in research right from the beginning, helping to decide what is researched and how this is carried out,” says Dr. O'Neill. “If we are going to find ways to improve the health system, it's going to take all of us working together, and empowering patients to have a strong voice in the design and implementation of health services.” 

The study was funded by North York General's Exploration Fund, a competitive granting competition designed to provide initial funding for staff and physicians to develop new ideas for the delivery of care. 

North York General Hospital, affiliated with the University of Toronto, is one of Canada's leading community academic hospitals. We offer our culturally diverse community a wide range of acute care, ambulatory and long-term care services across multiple sites. Through partnerships, collaboration and academic endeavours, we seek to set new standards for patient- and family-centred care. Working together with our patients and their families, we are making a world of difference.

The University of Toronto Department of Family and Community Medicine is recognized internationally for its clinical, educational and research excellence. We are the home of the World Health Organization Collaborating Centre on Family Medicine and Primary Care, the first Centre of its kind to focus on family medicine. We teach, create and disseminate knowledge in primary care, advancing the discipline of family medicine and improving health for diverse and underserved communities locally and globally. Our faculty are clinical and academic leaders who are breaking new ground on issues ranging from inner city health, addiction medicine, global health, palliative care, immigrant and indigenous health, and far more. Encompassing more than 1,600 faculty across the province — from rural villages to urban centres — we are shaping the future of family medicine in Canada. 

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