Misfeldt Renée, Suter Esther, Mallinson Sara, Boakye Omenaa, Wong Sabrina, Nasmith Louise
Senior Research and Evaluation Consultant, Health Systems Evaluation and Evidence, Alberta Health Services, Red Deer, AB.
Adjunct Professor, Department of Social Work, University of Calgary, Calgary, AB.
Healthc Policy. 2017 Aug;13(1):74-93. doi: 10.12927/hcpol.2017.25190.
This paper discusses findings from a high-level scan of the contextual factors and actors that influenced policies on team-based primary healthcare in three Canadian provinces: British Columbia, Alberta and Saskatchewan. The team searched diverse sources (e.g., news reports, press releases, discussion papers) for contextual information relevant to primary healthcare teams. We also conducted qualitative interviews with key health system informants from the three provinces. Data from documents and interviews were analyzed qualitatively using thematic analysis. We then wrote narrative summaries highlighting pivotal policy and local system events and the influence of actors and context. Our overall findings highlight the value of reviewing the context, relationships and power dynamics, which come together and create "policy windows" at different points in time. We observed physician-centric policy processes with some recent moves to rebalance power and be inclusive of other actors and perspectives. The context review also highlighted the significant influence of changes in political leadership and prioritization in driving policies on team-based care. While this existed in different degrees in the three provinces, the push and pull of political and professional power dynamics shaped Canadian provincial policies governing team-based care. If we are to move team-based primary healthcare forward in Canada, the provinces need to review the external factors and the complex set of relationships and trade-offs that underscore the policy process.
本文讨论了对影响加拿大三个省份（不列颠哥伦比亚省、艾伯塔省和萨斯喀彻温省）基于团队的初级医疗保健政策的背景因素和行为主体进行的高层次审视结果。研究团队从各种不同来源（如新闻报道、新闻稿、讨论文件）中搜索与初级医疗保健团队相关的背景信息。我们还对来自这三个省份的关键卫生系统信息提供者进行了定性访谈。使用主题分析法对来自文件和访谈的数据进行了定性分析。然后，我们撰写了叙述性总结，突出了关键政策和地方系统事件以及行为主体和背景的影响。我们的总体研究结果强调了审视背景、关系和权力动态的价值，这些因素在不同时间点相互作用，形成了“政策窗口”。我们观察到以医生为中心的政策过程，以及最近一些旨在重新平衡权力并纳入其他行为主体和观点的举措。背景审视还突出了政治领导层的变化和优先事项设定在推动基于团队的医疗保健政策方面的重大影响。虽然这在三个省份的程度有所不同，但政治和专业权力动态的推拉塑造了加拿大各省基于团队的医疗保健政策。如果我们要在加拿大推进基于团队的初级医疗保健，各省需要审视那些构成政策过程基础的外部因素以及复杂的关系和权衡。
