Dalla Lana School of Public Health

Putting Primary Care at the Centre of Ontario’s Health System: DLSPH Researchers to Advise Primary Care Groups

November 30/2022

By Heidi Singer

With Canadian health care systems in crisis, a University of Toronto researcher is working to inform stakeholders on building high-performing integrated primary care systems – work that she hopes will support them to make real change in the sector.

Prof. Monica Aggarwal is leading a research collaboration between the Dalla Lana School of Public Health (DLSPH) and the Association of Family Health Teams of Ontario (AFHTO), the Ontario College of Family Physicians (OCFP) and the Section on General and Family Practice of the Ontario Medical Association (OMA). As a leading expert in primary care systems across Canada,  Aggarwal has consulted at the federal and provincial levels on multiple occasions. She recently completed a 13 cross-comparative study of primary care transformation in Canada, which identified over 100 primary care innovations in the country.

“I feel honoured and privileged to have the opportunity to work with inspiring and passionate  primary care leaders who truly want to make a difference for the primary care sector in Ontario,” says Aggarwal, a professor in DLSPH’s Division of Clinical and Public Health. “The leaders of these organizations have a deep understanding of the issues in health care and recognize the critical role that evidence-based research can have to advance improvements in the primary care sector. ”

The partners decided together to focus first on showing how Ontario could implement compensation models that encourage and reward team-based care.

“There’s a real desire to build and spread interprofessional teams,” says Aggarwal. “However, we are not seeing the results expected from mainstream models in Canada. I think this is not because teams don’t work but because they are not being implemented in a manner that would allow them to be successful. Provider compensation is a key piece of the puzzle.”

She is working with DLSPH Prof. Ross Upshur, head of the Division of Clinical Public Health. Together, they are developing collaborations with researchers and primary care leaders in Ontario, Canada, and abroad to meet the research needs of knowledge users.

“This is a timely and important collaboration in light of the current crisis in primary care,” says Upshur. “Rigorous research is needed to inform solutions to the current situation.”

Aggarwal’s research will inform policy recommendations by groups representing primary care providers to help strengthen primary care in Ontario.

“Across the world, cost-effective and high-performing health systems share a common characteristic – they are based on a foundation of comprehensive primary care, which is supported through a team,” says AFHTO CEO Kavita Mehta. “Jurisdictions that invest robustly in primary care are farther ahead in achieving health system goals, ensuring a lens on equitable and accessible care close to home. The research is clear. Now we need to develop an evidence-based roadmap on the best way to invest in interprofessional primary care teams in Ontario to create a strong and sustainable health system.”

 Building a strong primary care foundation would also help to address the current workforce shortage crisis, says family physician Dr. David Barber, Vice-Chair of the OMA’s Section on General and Family Practice Executive.

 “We are seeing an ongoing decline in medical students wanting to practice family medicine because of the expanding demands in the current practice model,” says Barber. “And we will continue to see doctors leaving comprehensive family medicine. We need to change how primary care systems work in Ontario, so that family medicine becomes a more viable and attractive practice.”

“Primary care is where most care happens in our health system, and evidence from around the world shows that high-performing health systems have strong primary care foundations, anchored by family doctors,” says OCFP CEO Kimberly Moran. “This important research effort will inform much-needed policy action and spark meaningful change for Ontario’s patients and families.”

The three-year grant totals almost $450,000.