Advancing knowledge on building capacity and sustaining the primary health care system in BC: Primary health care research round-up brief

In collaboration with the Ministry of Health (MoH), the BC Primary Health Care Research Network (BC-PHCRN) hosted a virtual Primary Health Care Research Round-up on November 29, 2024, to discuss leading research, priorities and initiatives happening in the primary health care sector of British Columbia (BC). This half-day session, facilitated by co-Director Dr. Rubee Dev (School of Nursing, UBC), was initiated by the BC-PHCRN to address questions raised through meetings with the MoH. The BC-PHCRN brought together researchers from across BC (and Canada) to speak to two themes: (1) building capacity within
primary health care, and (2) sustaining primary health care through the use of artificial intelligence (AI). These topics acknowledged the MoH goals reported in the 2024/25 – 2026/27 Service Plan (Goal #3), and strategies set forward in the Ministry’s refreshed approach to BC Primary Care Networks (reported by Family Practice Services Committee, 2024). This brief provides an overview of the three presentations and panelist discussion.

Ministry of Health: Primary Care Research Priorities

Presented by Jeremy McLay (Executive Director, Primary Care Strategy, Policy, and Quality), the MoH opened the round-up by discussing current government objectives, strategies and research priorities in primary care. This was a timely discussion, as the Government of British Columbia held a general election in the preceding month (October 2024). The MoH intends to increase service capacity (supply of providers, teams, clinic infrastructure) to meet projected patient demand, increase attachment and access to longitudinal primary care, provide episodic service options for urgent and/or unattached patients, and take specific actions to support culturally safe care for Indigenous peoples. Recent MoH efforts have been dedicated to increasing supply of family physicians (through the recent transition to longitudinal family physician payment model), supporting team-based models of care and primary care networks, diversifying clinical models of care (such as community health centers or nurse practitioner-led clinics), as well as investing into a provincial attachment system to better support primary care clinics, providers, and patients to manage patient attachment. The following bullet points reflect some of the Primary Care Division’s current research priorities to inform future initiatives:

• Future primary care infrastructure needs
  • Clinic built environment layout, equipment, digital technology and data sources
• Impact of nurses and allied health in primary care teams
  • Seeking ways to define and monitor the impact of these teams
• Collaborative team-based care models
  • Looking at tools and supports to alleviate administrative burden
• Impact of Indigenous initiatives on health outcomes and cultural safety
  • Working with Indigenous groups on how to collaborate and move forward
    

Topic 1: Building Capacity in Primary Health Care

As outlined in the multi-year B.C.’s Health Human Resources Strategy (2022) and reflected in the MoH opening presentation, action is being taken to build and maintain capacity throughout the province in four key areas: retain, redesign, recruit and train. The intention is to close the gap in healthcare access, prepare for increase in demand, and advance the vision for integrated (and accessible) team-based care. The following two presentations relate to the ‘redesign strategy’; evaluating current and embracing new models of care to improve health outcomes and enhance accessible, people-centered, culturally safe care. See brief summaries below, and presentations slides following this brief.

Increasing Access to Psychologists in Primary Healthcare
Presented by Drs. Lesley Lutes and Erika Penner, University of British Columbia Okanagan

This presentation addressed the growing need for mental and behavioral health services in primary care to improve overall health outcomes and system efficiencies. Through a project called the Primary Care Psychologist (PCPsych) Program, psychologists will be re-integrated into primary care clinics to provide mental health services for patients, reduce workload for providers, and address the quadruple aim.

• Pilot phase (2024) outputs reflected a decrease in patient suicidal ideation as well as symptoms of depression and anxiety. Results also indicated high patient and provider satisfaction. With ongoing collaboration with MoH and other partners, this project is anticipating to launch in 2025

Optimizing Teams for Interprofessional Care in Primary Health Care (OPTIC-PHC)
Presented by Dr. Walter Wodchis, University of Toronto

• Funded by the Canadian Institute of Health Research, the OPTIC-PHC pan-Canadian research team intends to evaluate team-based primary health care (TBPHC) models to understand team development, maturation, patterns and infrastructure needs. This longitudinal, mixed-methods, case study design project seeks to scale out optimized models, with the intention of providing strengthened interprofessional teams for patients experiencing multimorbidity, and better resource allocation to support health care expenditures.

Topic 2: Role of Artificial Intelligence (AI) in Sustaining Primary Health Care

Panel members: Jacqueline Kueper (Western University), Drs. Alex Singer (University of Manitoba), Carolyn Steele-Gray (University of Toronto) and Sabrina Wong (University of British Columbia)

As reflected in Goal 3 of the MoH Service Plan (2024), sustaining the healthcare system through integrated provincial infrastructure and meaningful partnerships is key to continued success. This pan-Canadian panel debated the rise and use of AI in healthcare, and its potential to reduce administrative burden, improve data quality and clinical diagnoses. Key highlights include:

• Panelists’ research in AI: Jacqueline Kueper is focused on developing a tool to predict mental health service capacity needs for patients with diabetes. This work reviews current care to predict and project how others may benefit. Also conducted focus groups and interviews in Ontario to develop an introduction course for family physicians in understanding AI. Dr. Alex Singer has significant background assessing the adoption of electronic medical record (EMR) data, machine learning algorithms (form of AI) and how this can improve and drive forward change in primary care. Dr. Carolyn Steele-Gray is focused on supporting highest-need folks and is seeking how digital technology (not limited to AI) can provide significantly more access and resources for these cases. Dr. Sabrina Wong has worked with EMR data for over a decade, seeking opportunities to utilize the data to inform quality improvement initiatives with BC clinics. Recent work with Dr. Manpreet Thandi uses EMR data to calculate frailty scores to further identify those in greater risk of negative health outcomes.
• Addressing the AI hype: AI is still a fairly new tool that is being integrated into personal and professional life. Panelists recognize it’s value, but also caution against being swept up by obvious efficiencies. Being aware of these concerns, and getting involved in smaller research projects can help ground focus and acknowledge other factors associated with its use (such as implementation barriers, privacy and security concerns). For example, patients not feeling comfortable talking to their doctor with an AI Scribe “listening” to their conversation. Public concerns can often be addressed through information, privacy policies and time (use of new technology typically initiates early adopters, or, moral panic before the tech becomes normalized and trusted).
• Value of AI in primary health care: two key areas – reduction of administrative burden and supporting access to healthcare. One significant use of AI is ambient documentation. Another is to utilize AI for risk-prediction models and to supplement knowledge. For example, we know AI plus radiologist do better in interpreting imaging than either alone. Current BC MoH investments in the health registries (example: Health Connect) could include use AI to request information from patients to link to providers. For example, potential for predictive analytics to analyze care required (avoid ordering unnecessary care) for providers so they may treat someone predicted to end up in the hospital. Panelists and attendees agree future research needs to pursue iterative, adaptive and implementation trials in real time with ambient documentation. Questions were raised about how AI could impact provider-to-patient relationship. Currently, one of the major disrupters to this relationship is the computer. Does implementation of AI allow physicians to see more patients, write better notes and/or go home earlier? Many questions are still in the air and more research assessing this area needs to be pursued to inform all parties involved (decision-makers, researchers, health organization representatives and patients).

If you wish to contact the presenters/panelists from this event, or wish to be pointed toward current primary care research projects or topics, please contact our Network at info@spor-bcphcrn.ca

Recommended Readings

Karunananthan, S., Rahgozar, A., Hakimjavadi, R., Yan, H., Dalsania, KA., Bergman, H., Ghose, B., LaPlante, J., McCutcheon, T., McIsaac, DI., Abbasgholizadeh Rahimi, S., Sourial, N., Thandi, M., Wong, S.T., & Liddy, C. (2023). Use of Artificial Intelligence in the Identification and Management of Frailty: A Scoping Review Protocol. BMJ Open, 13(12). doi: 10.1136/bmjopen-2023-076918

Kueper, J. (2021). Primer for artificial intelligence in primary care. Canadian Family Physician, 67(12). DOI: https://doi.org/10.46747/cfp.6712889

Kueper, J., Emu, M., Banbury, M., Bjerre, L., Choudhury, S., Green, M., Pimlott, N., Slade, S., Tsuei S., & Sisler, J. (2024). Artificial intelligence for family medicine research in Canada: current state and future directions. Canadian Family Physician, 70(3), 161-168; DOI: https://doi.org/10.46747/cfp.7003161

Steele Gray, C., Lewis, L., Zonneveld, N., Meyer, I., Wright, V., & Jimenez, J. P. (2023). The Translational Work of Interoperability: Digital Health and Data Enabling Integrated Care Special Interest Group Workshop. International Journal of Integrated Care, 23(S1). DOI: 10.5334/ijic.ICIC23710

Terry, A.L., Kueper, J.K., Beleno, R. et al. (2022). Is primary health care ready for artificial intelligence? What do primary health care stakeholders say? BMC Medical Informatics and Decision Making, 22(237). https://doi.org/10.1186/s12911-022-01984-6

Thandi, M., Wong, S.T., Price, M., & Baumbusch, J. (2024). Perspectives on the representation of frailty in the electronic frailty index. BMC Primary Care, 22(1). doi: 10.1186/s12875-023-02225-z.