In Canada, we are still struggling to achieve the critical goal of enabling performant health care systems that moves research results to real-world impact. This is particularly true within the context of primary care, arguably the cornerstone of any well performing system and demonstrably where the majority of health prevention, promotion and management occurs.
The funding and establishment of 11 provincial and territorial primary care focused research networks under the pan-Canadian umbrella of PIHCIN has catalyzed the development of a new research paradigm. With a unique tri-partite leadership model that consists of a researcher, a policy maker and a health care provider supported by strong patient partnership, the research paradigm developed by the PIHCIN networks builds on the biomedical approach along with other key research traditions. This has evolved into an approach that is appropriate for the complexity of primary care and possibly the key to effectively addressing many of the current intractable challenges in health care delivery.
The key characteristics of this paradigm are: (1) a holistic approach that is firmly grounded in developing, nurturing and sustaining strong relationships among key stakeholders; (2) incorporation of the priorities and need of patients and communities; (3) inclusion at all stages of the expertise embodied in researchers, policy makers, health care providers, patients, community members and trainees; and (4) the use of expert mediators (managers and directors) to match ideas, skills and resources for relevant evidence creation.
The networks have taken a bottom-up approach to build the necessary infrastructure to support the combination of all of these critical elements into evidence creation that can be readily implemented for improved health experiences. This has also built the groundwork for creation and integration of evidence into rapid learning and practice systems.
The development of the necessary trusted relationships builds on pre-existing strong collaborative approaches that are the hallmark of excellent primary care research. The CIHR support for the development of these networks that are unified under PIHCIN, represents a significant investment into state-of-the-art research methodological developments and approaches that have begun to see the impact in terms of new knowledge creation, implementation and policy changes. The progress and potential of PICHIN is considered to be an international role model of cutting-edge research in primary care that can be expected to make a real difference.
The PIHCI Network is a key CIHR initiative under the Strategy for Patient-Oriented Research. The defining characteristic of the PIHCI Network was the establishment of a network in each jurisdiction that is governed through tripartite leadership, i.e. a shared governance approach that includes researchers, policy makers and health care providers and that also ensures a meaningful voice for patients.
The networks are overseen by a Network Leadership Council and supported by a Network Coordinating Office. The oversight efforts have included the creation and development of a Patient Advisory Council, a Network Managers Committee, and several working committees with pan-Canadian representation that deal with governance, communications, performance reporting and sustainability.
Through the Network Leadership Council and Pan-Canadian Patient Advisory Council, the individual networks share processes, best practices and impact for this new research approach. The is supported by several working groups coordinated by the Network Coordinating Office.
Network Coordinating Office Members:
NCO Co-Lead: Onil Bhattacharyya, University of Toronto
NCO Co-Lead: Sabrina Wong, University of British Columbia
NCO Executive Director: Gillian Bartlett, McGill University
NCO Administrative Coordinator: Jamie DeMore, McGill University
The unique infrastructure of SPOR PIHCIN promoted capacity building within the networks seeking external research funding for at many cross-jurisdictional projects resulting in an estimate of over $5 M of additional funding being obtained.
Matching funders include CIHR, universities, foundations, provincial governments, health authorities, disease special interest associations, and other public agencies.
Importantly, SPOR PIHCIN has supported and leveraged the Transdisciplinary Understanding and Training on Research – Primary Health Care program (TUTOR-PHC). TUTOR-PHC is a one-year, pan-Canadian, interdisciplinary research capacity building program that has been training primary and integrated health care researchers and decision-makers from many disciplines.
The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) is also a critical data resource for both clinical quality improvement and for research. It is one of the only sources of Canada-wide primary care electronic medical record data and many of the networks currently work in close partnership with CPCSSN. The expectation going forward is that CPCSSN and PIHCIN will play a key role in ensuring primary care clinical data capture for the CIHR funded-Canadian Data Platform.
Unlike other specialties, primary and integrated care has developed in response to a broadly perceived lack of adequate primary health care, before an active research base was established. To address this lag and enhance the generation and integration of relevant research for the betterment of the Canadian population, an infrastructure that is uniquely suited to the challenges faced in primary care is needed. The PIHCI Network directly addresses this gap with its unique reach into the Canadian population and partnerships with patients, health care providers and policy makers. Not only can PIHCIN help achieve the strategic vision of the ‘network of networks’ to improve health, health equity, and health system outcomes for individuals across the life course, but can provide innovation research, research methodologies, training in these methodologies and stakeholder engagement to contribute to the academic discipline of patient-oriented primary and integrated health care.
The next phase for PIHCIN will be to build on the solid achievements from the initial investments made by CIHR, and to maintain key infrastructures and partnerships particularly with health care providers, patients and policy makers. We propose the expansion of our networks into Practice-Based Learning Networks that will support a pan-Canadian learning platform. The future focus will be in line with CIHR’s investment in a SPOR National Training Entity with PIHCIN concentrating on the training and development of highly qualified personnel who are able to work in the patient-oriented primary and integrated health care context.
PIHCIN is ideally situated to support the growing pan-Canadian quality improvement movement and to tie this strongly to primary care research, practice improvement and policy changes. The SPOR-PIHCIN infrastructure is also key to the success of ongoing programmatic grants. With continued support for the ‘network of networks’ and extant partnerships, ongoing coordination and expansion into the two remaining Canadian territories, PIHCIN will facilitate efficiencies in knowledge translation, expand patient and community partnerships, and offer a training environment that could create a truly Canadian learning health system.