Table 1.

Comparison of Brazil and Canada’s relative adoption of the Starfield principles

PRINCIPLEBRAZILCANADA
First contact: “Primary care is personalized, and the patient has a specific person to go to first that connects them with the health care system”12Family health teams are a patient’s first contact with the health care system. Patients struggle to access their teams owing to mismatch of human resources and population size, as well as challenges in after-hours and same-day accessFamily physicians act as gatekeepers to all health care services. This is enforced by the design of the Canadian health care system. Canadians experience challenges in same-day and after-hours access to their primary care providers, particularly in rural areas
Comprehensive: “Primary care is all-encompassing and meets the needs of the entire population”12Comprehensive generalist care is provided by family physicians and interprofessional primary care teams. When the competencies of professionals are compared with their actual activities, there are considerable gaps. When these gaps are found, targeted training is provided to primary care providers in order for them to improve competencyComprehensive generalist care is provided by family physicians and interprofessional primary care teams. However, particularly in urban areas with larger densities of specialists, the comprehensive generalist nature of primary care has eroded. Opportunities to practise generalist medicine exist in rural areas, but there are challenges recruiting and training physicians in those areas. Numerous fellowships and programs to further subspecialize within family medicine have emerged, creating a trend of “focused practice” within family medicine
Coordination: “Primary care is delivered such that the system moves around the patient”12The Brazilian health care system has a deficiency in structure and internal organization, particularly with EMRs. Adoption is poor and even within primary care teams different EMRs are used without the ability to share data. Coordination is often left to individual providersCoordination is often strong within primary care teams, but there are important challenges as patients transition to and from other parts of the health care system (eg, long-term care, hospitalization, home care)
Longitudinality: “Primary care is person-centred rather than disease-centred”12Longitudinality is still an ongoing priority in the Brazilian health care system. It did not come first, as in the Canadian case. It is unclear whether there is a longitudinal familiar provider within the Brazilian primary care systemLongitudinality still commonly exists between a patient and his or her family doctor. This was the foundation upon which health systems were built in Canada. Canadians have a high degree of trust in their personal primary care physicians
  • EMR—electronic medical record.