Lavergne M Ruth, Easley Julie, Grudniewicz Agnes, Hedden Lindsay, McDonald Ted, Rudoler David, Sauré Antoine, Correia Rebecca H, Dufour Émilie, Gallant François, Hakim Jennifer, Johnson Claire, Jose Caroline, Katz Alan, MacKenzie Adrian, Martin-Misener Ruth, McCracken Rita, Nethery Elizabeth, Piccinini-Vallis Helena, Peterson Sandra, Scott Ian, Shiplett Hugh, Simkin Sarah, Spencer Sarah, Thelen Rachel, Welton Stephanie, Wilson Erin
Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
BMJ Open. 2025 Mar 21;15(3):e099302. doi: 10.1136/bmjopen-2025-099302.
Despite having more family physicians (FPs) and nurse practitioners (NPs) per capita than ever before in Canada, there is a clear gap between population primary care needs and system capacity. Primary care needs may be shaped by population ageing, increasing clinical and social complexity and growing service intensity. System capacity may be shaped by falling practice volumes, increasing administrative workload, changing clinician demographics and new health system roles (eg, hospitalist and focused practices). These changing factors could contribute to reduced patient access to primary care, worsened health inequities and stress and overwork among primary care clinicians. Workforce planning tools used in most countries do not adequately consider these factors. Our study will identify and explore factors shaping population service use and system capacity over time and develop planning tools to estimate future primary care needs and capacity.
We will interview FPs and NPs about factors shaping workload, including patient characteristics, practice expectations and system context. This will inform analysis of administrative data to describe factors shaping primary care need (patient demographics, clinical and social complexity, service intensity) and capacity (provider supply, demographics, service volume, roles) over a 20-year period from 2004/2005 to 2023/2024. Qualitative and quantitative findings will inform analytical models that project and compare need and capacity under stakeholder-informed scenarios. The study includes the Canadian provinces of British Columbia, Manitoba, New Brunswick and Nova Scotia, provinces with varied policy and population contexts and complementary administrative health data.
Research ethics board (REB) approval for the qualitative study has been provided by Research Ethics BC, with subsequent approvals from Horizon Health Network, Nova Scotia Health, University of Manitoba and University of Ottawa. REB approval for analysis of linked administrative data was obtained from the Nova Scotia Health REB, Research Ethics BC, University of Manitoba and University of New Brunswick. Our findings will support primary care capacity planning to equitably meet the needs of a growing and ageing population.
尽管加拿大人均家庭医生（FP）和执业护士（NP）的数量比以往任何时候都多，但人口初级保健需求与系统能力之间仍存在明显差距。初级保健需求可能受到人口老龄化、临床和社会复杂性增加以及服务强度不断提高的影响。系统能力可能受到业务量下降、行政工作量增加、临床医生人口结构变化以及新的卫生系统角色（如住院医师和专科诊所）的影响。这些不断变化的因素可能导致患者获得初级保健的机会减少、健康不平等加剧以及初级保健临床医生的压力和过度劳累。大多数国家使用的劳动力规划工具并未充分考虑这些因素。我们的研究将识别和探讨随时间推移影响人口服务利用和系统能力的因素，并开发规划工具以估计未来的初级保健需求和能力。
我们将采访家庭医生和执业护士，了解影响工作量的因素，包括患者特征、业务期望和系统背景。这将为行政数据分析提供信息，以描述2004/2005年至2023/2024年这20年期间影响初级保健需求（患者人口统计学、临床和社会复杂性、服务强度）和能力（提供者供应、人口统计学、服务量、角色）的因素。定性和定量研究结果将为分析模型提供信息，这些模型将在利益相关者提供信息的情景下预测和比较需求与能力。该研究涵盖加拿大的不列颠哥伦比亚省、曼尼托巴省、新不伦瑞克省和新斯科舍省，这些省份具有不同的政策和人口背景以及互补的行政卫生数据。
不列颠哥伦比亚省研究伦理委员会已为定性研究提供了研究伦理委员会（REB）批准，随后地平线健康网络、新斯科舍省卫生厅、曼尼托巴大学和渥太华大学也给予了批准。对关联行政数据进行分析的REB批准已获得新斯科舍省卫生厅REB、不列颠哥伦比亚省研究伦理委员会、曼尼托巴大学和新不伦瑞克大学的批准。我们的研究结果将支持初级保健能力规划，以公平地满足不断增长和老龄化人口的需求。
