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© 2023 Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Introduction

Many Canadians struggle to access the primary care they need while at the same time primary care providers report record levels of stress and overwork. There is an urgent need to understand factors contributing to the gap between a growing per-capita supply of primary care providers and declines in the availability of primary care services. The assumption of responsibility by primary care teams for services previously delivered on an in-patient basis, along with a rise in administrative responsibilities may be factors influencing reduced access to care.

Methods and analysis

In this mixed-methods study, our first objective is to determine how the volume of services requiring primary care coordination has changed over time in the Canadian provinces of Nova Scotia and New Brunswick. We will collect quantitative administrative data to investigate how services have shifted in ways that may impact administrative workload in primary care. Our second objective is to use qualitative interviews with family physicians, nurse practitioners and administrative team members providing primary care to understand how administrative workload has changed over time. We will then identify priority issues and practical response strategies using two deliberative dialogue events convened with primary care providers, clinical and system leaders, and policy-makers.

We will analyse changes in service use data between 2001/2002 and 2021/2022 using annual total counts, rates per capita, rates per primary care provider and per primary care service. We will conduct reflexive thematic analysis to develop themes and to compare and contrast participant responses reflecting differences across disciplines, payment and practice models, and practice settings. Areas of concern and potential solutions raised during interviews will inform deliberative dialogue events.

Ethics and dissemination

We received research ethics approval from Nova Scotia Health (#1028815). Knowledge translation will occur through dialogue events, academic papers and presentations at national and international conferences.

Details

Title
Understanding and addressing changing administrative workload in primary care in Canada: protocol for a mixed-method study
Author
Lavergne, M Ruth 1   VIAFID ORCID Logo  ; Moravac, Catherine 2 ; Bergin, Fiona 3 ; Buote, Richard 4 ; Easley, Julie 5 ; Grudniewicz, Agnes 6 ; Hedden, Lindsay 7 ; Myles, Leslie 8 ; McKay, Madeleine 9 ; Emily Gard Marshall 2   VIAFID ORCID Logo  ; Martin-Misener, Ruth 10   VIAFID ORCID Logo  ; Mooney, Melanie 11 ; Palmer, Erin 12 ; Tracey, Joshua 12 

 Department of Family Medicine, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada; Simon Fraser University, Burnaby, British Columbia, Canada 
 Department of Family Medicine, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada 
 Practice Ready Assessment Program, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada 
 College of Family Physicians of Canada, Mississauga, Ontario, Canada 
 Family Medicine, Horizon Health Network, Fredericton, New Brunswick, Canada 
 Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada 
 Simon Fraser University, Burnaby, British Columbia, Canada 
 University of Calgary, Calgary, Alberta, Canada 
 Doctors Nova Scotia, Dartmouth, Nova Scotia, Canada 
10  School of Nursing, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada 
11  Primary Health Care and Chronic Disease Management, Nova Scotia Health Authority, Yarmoth, Nova Scotia, Canada 
12  Dalhousie University Faculty of Medicine, Saint John, New Brunswick, Canada 
First page
e076917
Section
General practice / Family practice
Publication year
2023
Publication date
2023
Publisher
BMJ Publishing Group LTD
e-ISSN
20446055
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
3060768615
Copyright
© 2023 Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.