title: Barriers and Facilitators for Primary Care Reform in Canada: Results from a Deliberative Synthesis across Five Provinces.
abstract: BACKGROUND
  Since 2000, primary care (PC) reforms have been implemented in various Canadian provinces. Emerging organizational models and policies are at various levels of implementation across jurisdictions. Few cross-provincial analyses of these reforms have been realized. The aim of this study is to identify the factors that have facilitated or hindered implementation of reforms in Canadian provinces between 2000 and 2010.
  
  
  METHODS
  A literature and policy scan identified evaluation studies across Canadian jurisdictions. Experts from British Columbia, Manitoba, Nova Scotia, Ontario and Quebec were asked to review the scope of published evaluations and draft provincial case descriptions. A one-day deliberative forum was held, bringing together researchers (n = 40) and decision-makers (n = 20) from all the participating provinces.
  
  
  RESULTS
  Despite a relative lack of published evaluations, our results suggest that PC reform has varied with regard to the scope and the policy levers used to implement change. Some provinces implemented specific PC models, while other provinces designed overarching policies aiming at changing professional behaviour and practice. The main perceived barriers to reform were the lack of financial investment, resistance from professional associations, too overtly prescriptive approaches lacking adaptability and an overly centralized governance model. The main perceived facilitators were a strong financial commitment using various allocation and payment approaches, the cooperation of professional associations and an incremental emergent change philosophy based on a strong decentralization of decisions allowing adaptation to local circumstances. So far the most beneficial results of the reforms seem to be an increase in patients' affiliation with a usual source of care, improved experience of care by patients and a higher workforce satisfaction.
  
  
  CONCLUSIONS
  PC reforms currently under consideration in other jurisdictions could learn from the factors identified as promoting or hindering change in the provinces that have been most proactive.
authors.affiliation: Centre for Primary Health Care and Equity, University of New South Wales, Bureau of Health Information Sydney, Australia.
authors.forename: Jean-Frédéric
authors.initials: JF
authors.lastname: Levesque
authors.affiliation: Department of Family Medicine, McGill University, Montréal, QC.
authors.forename: Jeannie L
authors.initials: JL
authors.lastname: Haggerty
authors.affiliation: Department of Family Medicine, University of Ottawa, Ottawa, ON.
authors.forename: William
authors.initials: W
authors.lastname: Hogg
authors.affiliation: Department of Family Medicine, Dalhousie University, Halifax, NS.
authors.forename: Frederick
authors.initials: F
authors.lastname: Burge
authors.affiliation: School of Nursing Culture, Gender and Health Research Unit, Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC.
authors.forename: Sabrina T
authors.initials: ST
authors.lastname: Wong
authors.affiliation: Family Medicine and Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, MB.
authors.forename: Alan
authors.initials: A
authors.lastname: Katz
authors.affiliation: Direction de santé publique de l'Agence de la santé et des services sociaux de Montréal and Institut national de santé publique du Québec, Montréal, QC.
authors.forename: Dominique
authors.initials: D
authors.lastname: Grimard
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, The Netherlands.
authors.forename: Jan-Willem
authors.initials: JW
authors.lastname: Weenink
authors.affiliation: Direction de santé publique de l'Agence de la santé et des services sociaux de Montréal and Institut national de santé publique du Québec, Montréal, QC.
authors.forename: Raynald
authors.initials: R
authors.lastname: Pineault
mesh_terms: D001955:British Columbia; D018166:Health Care Reform / Q000331:legislation & jurisprudence* / Q000458:organization & administration*; D006801:Humans; D008350:Manitoba; D009674:Nova Scotia; D009864:Ontario; D009936:Organizational Innovation; D011320:Primary Health Care / Q000331:legislation & jurisprudence* / Q000458:organization & administration*; D011787:Quality of Health Care / Q000331:legislation & jurisprudence* / Q000458:organization & administration*; D011792:Quebec