Equity-focused global health partnerships can transform health systems (top score)

The University of Toronto’s Department of Family and Community Medicine and the Kwame Nkrumah University of Science and Technology’s School of Public Health in Kumasi, Ghana, are engaged in a transformative 10-year partnership. The focus of this collaboration is to cocreate and codeliver continuing education programs tailored to enhance the skills of primary care practitioners in Ghana, West Africa. These programs cover a wide range of topics, including palliative care, quality improvement for health professionals, prehospital emergency care, community emergency care, and emergency preparedness and response to epidemic-prone diseases.

After only 2 years, this ethical, equity-focused, and practical North-South partnership is driving sustainable change, accelerating achievement of the United Nations Sustainable Development Goals, and establishing platforms for health transformation in Africa. This model can be immediately replicated to harness the power of family medicine to promote global health equity. The goal of this partnership is to bring about transformative change across African health systems and improve global health equity. By building the competency of primary care practitioners in Ghana, this partnership aims to contribute to health systems that employ and retain the primary care workforce. Retention of a skilled primary care workforce in Ghana is critical to achieving Sustainable Development Goal 3, which aims to “ensure healthy lives and promote well-being for all at all ages.”¹

In addition, it is hypothesized that by intentionally building this North-South partnership on a solid ethical foundation of solidarity, humility, cultural sensitivity, respect, and shared accountability to guide partnership behaviour, this initiative holds potential to catalyze personal, professional, and institutional transformation. The partnership has a robust monitoring, evaluation, learning, and adaptation plan cocreated within a broader plan for the Africa Higher Education Health Collaborative. The replicable and adaptable evaluation methodologies encompass end-of-course evaluation surveys, teacher interviews, and learner focus group discussions within multimodule courses.

Unlimited refills

While unlimited refills are a truly terrible idea when it comes to soft drinks and fast food, apply it to medication prescriptions and it becomes an efficient way to save time for family physicians. Why is it prescriptions must have a set number of refills, or that pharmacies require a new prescription after a certain length of time? We know much of our work as family physicians involves managing chronic illness and many of those illnesses require medications that change very little from year to year. What if we could simply write “unlimited” in the refill section of the prescription for a cholesterol or antihypertensive medication, with the understanding the medication could be renewed indefinitely without further intervention by the prescriber?

It is clear implementing such a plan would eliminate a large number of prescriptions generated each year by family physicians, each of which consumes a discrete amount of office time each day. Benchmarks could be obtained for the average time taken to renew a prescription, which could be used to establish potential reductions in time. For physicians who use the opportunity of medication renewals to perform routine monitoring (eg, blood work), this change could provide the impetus to delegate these processes to administrative staff using automated reminders. Fewer routine prescriptions would mean more time for other, more valuable patient care activities.

Two-eyed seeing approach to relationship development

Health systems have multiple components including public health services and the role of family medicine in primary care. There continue to be challenges in advancing community-centred and culturally safe approaches in health systems that effectively meet the holistic health needs of First Nations, Inuit, and Métis (FNIM) populations.

While there are many efforts to address these challenges, there remain relatively few examples of a 2-eyed seeing approach applied to family medicine practice. To address this gap, the Indigenous Primary Health Care Council, with primary care and public health partners, developed a toolkit of resources to support FNIM and health teams in planning programs and services by, with, and for FNIM communities. Resources include: an engagement guide with a readiness model, pre- and postengagement checklists, and an FNIM community-driven survey; and a relationship agreement worksheet, checklist, and template. Examples from communities are embedded throughout to facilitate learning from practice.

We hypothesize the use of these resources will impact primary care and public health settings in Ontario and across Canada by influencing the approach to partnerships and service delivery. We plan to quantitatively assess the number of downloads and engagement gatherings working through these resources. We also plan to qualitatively consider the impacts on culture, shifts in practice, and unintended consequences. The roadmap to relationship development between FNIM communities and organizations and public health and family medicine partners focuses on shared discussions on the purpose of the partnership, relationship foundations, conflict resolution, fostering the relationship, resource sharing, information sharing, roles and responsibilities, communication, decision making, and cultural practices.

We believe implementing the engagement guide and relationship agreement template can lead to improved relationships between FNIM and public health and family medicine partners. Ultimately, more appropriate engagement in the public health and health care system can lead to improved health outcomes for FNIM people at the individual, community, and population levels in Canada.

Warp speed: accelerating innovation with digital health interoperability

Canadian primary care is in crisis. As patients live longer with multiple comorbidities, patient care is more complex. The introduction of digital systems helped in some ways, but high levels of stress among practitioners, associated with an increasing administrative burden that is linked, in particular, to electronic medical records, are well documented. Limited digital interoperability (flow of information) between siloed systems and a reliance on fax technology has exacerbated stresses on family physicians, adding time to their days.

Pockets of clinical innovation in primary care exist across the country, often as small-scale, clinician-created solutions to real-world problems. Sometimes, they leverage emerging digital technologies. Can a national program amplify these innovative solutions, particularly those underpinned by digitally interoperable technologies that enhance efficient health information exchange, and thus reduce the digital administrative burden on family physicians? The big idea proposed is a clinical accelerator grant to support clinical innovations powered by interoperable digital solutions.

Historically, meaningful change regarding the adoption of digital health technologies in primary care in Canada occurred slowly, in absence of change catalysts involving multiple partners such as government and clinical groups. This was certainly the case with electronic medical record adoption in Canada. Change catalysts can take multiple forms, including change management and thought leadership supports for clinicians, as well as financial incentives. Our hypothesis is that a clinical accelerator grant can act as a change catalyst by identifying and supporting unique, interoperability-aligned initiatives that have the potential for scalability.

Additionally, some ideas could align to national standards and gain support from provincial, territorial, and federal ministries of health. The impact of this intervention will be measured using an evaluation framework and surveying techniques adapted from past digital health initiatives. Such a program could invigorate clinicians making changes with limited resources and enhance the sustainability of their innovations.