Chief Family Medicine Resident at Credit Valley Hospital in Mississauga, Ont, and a member of the College of Family Physicians of Canada's Section of Residents Council and the Resident Doctors of Canada Board of Directors.
Dr Martin is a family physician and Vice President for Medical Affairs and Health System Solutions at Women's College Hospital in Toronto, Ont, and Associate Professor in the Department of Family and Community Medicine and the Institute of Health Policy, Management and Evaluation at the University of Toronto.
Can Fam Physician. 2018 Nov;64(11):811-815.
To compare primary care in Canada and Brazil and how both countries have embraced the Starfield principles in the design of their health care systems.
A subgroup of the Besrour Centre of the College of Family Physicians of Canada developed connections with colleagues in Brazil and collaborated to undertake a between-country comparison, comparing and contrasting various elements of both countries' efforts to strengthen primary care over the past few decades.
Following a literature review, the authors collectively reflected on their experiences in an attempt to explore the past and current state of family medicine in Canada and Brazil.
The Brazilian and Canadian primary care systems have both adopted and advanced the Starfield principles in various ways, with both countries showing an increasing trend toward adopting interprofessional team-based care. Access to primary care remains a challenge in rural areas in both countries, and longitudinal relationships between providers and patients appear to be more common in Canada. With the advent of technology, increasing patient engagement and expectations, the decline of paternalistic medicine, and the sheer mass of readily available information (and misinformation), to be successful, primary care systems must also be constructed to engender trust at both the local and the system levels. Both countries face challenges to maintaining trust in the context of the increasing prevalence of team-based care, and a lack of trust at the system level can be seen in patients' perceptions about the difficulty of finding a family doctor and in high rates of emergency department and urgent care centre use in both countries. Primary care reform must be implemented with the public's trust in mind.
Trust is a crucial ingredient to the success of primary care and must be protected at both local and system levels. If designed with trust in mind, primary care in Canada and Brazil has the potential to meet the challenges set out by the Starfield principles.
比较加拿大和巴西的初级保健，并展示两国如何在医疗保健系统设计中采用 Starfield 原则。
加拿大家庭医生学院 Besrour 中心的一个小组与巴西的同事建立了联系，并合作进行了国家间比较，比较和对比了过去几十年两国在加强初级保健方面的各种努力。
在文献综述之后，作者共同反思了他们的经验，试图探讨加拿大和巴西家庭医学的过去和现状。
巴西和加拿大的初级保健系统都以各种方式采用和推进了 Starfield 原则，两国都表现出越来越倾向于采用跨专业团队为基础的护理。在两国的农村地区，获得初级保健仍然是一个挑战，提供者和患者之间的纵向关系在加拿大似乎更为常见。随着技术的出现，患者参与度和期望的增加，家长式医学的衰落，以及大量现成信息（和错误信息）的出现，为了取得成功，初级保健系统还必须在本地和系统层面建立信任。两国都面临着在基于团队的护理日益普及的情况下维护信任的挑战，并且在患者对寻找家庭医生的困难程度以及两国急诊部和紧急护理中心使用率高的看法中，可以看出系统层面缺乏信任。初级保健改革必须考虑到公众的信任。
信任是初级保健成功的关键因素，必须在本地和系统层面得到保护。如果以信任为设计理念，加拿大和巴西的初级保健有可能应对 Starfield 原则提出的挑战。
