Trust as the foundation: thoughts on the Starfield principles in Canada and Brazil: The Besrour Papers: a series on the state of family medicine in Canada and Brazil
- PMID: 30429175
- PMCID: PMC6234947
Trust as the foundation: thoughts on the Starfield principles in Canada and Brazil: The Besrour Papers: a series on the state of family medicine in Canada and Brazil
Abstract
Objective: To compare primary care in Canada and Brazil and how both countries have embraced the Starfield principles in the design of their health care systems.
Composition of the committee: A subgroup of the Besrour Centre of the College of Family Physicians of Canada developed connections with colleagues in Brazil and collaborated to undertake a between-country comparison, comparing and contrasting various elements of both countries' efforts to strengthen primary care over the past few decades.
Methods: Following a literature review, the authors collectively reflected on their experiences in an attempt to explore the past and current state of family medicine in Canada and Brazil.
Report: The Brazilian and Canadian primary care systems have both adopted and advanced the Starfield principles in various ways, with both countries showing an increasing trend toward adopting interprofessional team-based care. Access to primary care remains a challenge in rural areas in both countries, and longitudinal relationships between providers and patients appear to be more common in Canada. With the advent of technology, increasing patient engagement and expectations, the decline of paternalistic medicine, and the sheer mass of readily available information (and misinformation), to be successful, primary care systems must also be constructed to engender trust at both the local and the system levels. Both countries face challenges to maintaining trust in the context of the increasing prevalence of team-based care, and a lack of trust at the system level can be seen in patients' perceptions about the difficulty of finding a family doctor and in high rates of emergency department and urgent care centre use in both countries. Primary care reform must be implemented with the public's trust in mind.
Conclusion: Trust is a crucial ingredient to the success of primary care and must be protected at both local and system levels. If designed with trust in mind, primary care in Canada and Brazil has the potential to meet the challenges set out by the Starfield principles.
Objectif: Comparer les soins primaires au Canada et au Brésil et la façon dont les deux pays ont adopté les principes de Starfield dans la conception de leurs soins de santé.
Composition du comité: Un sous-groupe du Centre Besrour du Collège des médecins de famille du Canada a tissé des liens avec des collègues au Brésil et a entrepris une étude, en comparant les divers éléments des deux pays qui visaient à renforcer des soins primaires au cours des dernières décennies.
Méthodes: À la suite d’une révision de la documentation, les auteurs ont fait un retour collectif sur leurs expériences dans le but d’explorer l’état passé et actuel de la médecine familiale au Canada et au Brésil.
Rapport: Les systèmes de soins primaires brésilien et canadien ont tous deux adopté et intégré les principes de Starfield, et ce de différentes façons. Les deux ont démontré une tendance vers l’adoption de l’équipe interprofessionnelle pour la prestation des soins. L’accès aux soins primaires demeure un défi dans les milieux ruraux pour les deux pays, et les relations longitudinales entre les professionnels de la santé et les patients semblent plus courants au Canada. Avec l’avènement des nouveautés technologiques, l’augmentation de l’engagement du patient et de ses attentes, le déclin de la médecine paternaliste et l’incroyable masse d’information (et de désinformation) disponible, les systèmes de soins primaires qui souhaitent réussir doivent être bâtis afin d’inspirer la confiance tant à l’échelle locale que du système. Les deux pays font face à des défis pour maintenir la confiance dans le contexte de la prévalence des soins offerts en équipe. Les perceptions des patients concernant la difficulté de trouver un médecin de famille et le taux élevé d’utilisation des services d’urgence sont présentes dans les deux pays. La réforme des soins primaires doit être mise en œuvre en tenant compte de la confiance du public.
Conclusion: La confiance est cruciale au succès des soins primaires et doit être préservée à l’échelle locale et du système. S’ils sont conçus avec la confiance comme l’un des éléments fondamentaux, les soins primaires au Canada et au Brésil ont le potentiel de surmonter les défis fixés par les principes de Starfield.
Copyright© the College of Family Physicians of Canada.
Similar articles
-
Challenges facing efforts to strengthen primary health care: The Besrour Papers: a series on the state of family medicine in Canada and Brazil.Can Fam Physician. 2018 Nov;64(11):795-796. Can Fam Physician. 2018. PMID: 30429172 Free PMC article. No abstract available.
-
Contrasting current challenges from the Brazilian and Canadian national health systems: The Besrour Papers: a series on the state of family medicine in Canada and Brazil.Can Fam Physician. 2019 Dec;65(12):890-896. Can Fam Physician. 2019. PMID: 31831488 Free PMC article. Review.
-
Telemedicine in the driver's seat: new role for primary care access in Brazil and Canada: The Besrour Papers: a series on the state of family medicine in Canada and Brazil.Can Fam Physician. 2020 Feb;66(2):104-111. Can Fam Physician. 2020. PMID: 32060190 Free PMC article. Review.
-
Narratives in family medicine: a global perspective: The Besrour Papers: a series on the state of family medicine in the world.Can Fam Physician. 2017 Feb;63(2):121-127. Can Fam Physician. 2017. PMID: 28209677 Free PMC article. Review.
-
Framework for ethical international academic partnerships in family medicine: The Besrour Papers: a series on the state of family medicine in Canada and Brazil.Can Fam Physician. 2019 Oct;65(10):705-710. Epub 2019 Oct 11. Can Fam Physician. 2019. PMID: 31604737 Free PMC article.
Cited by
-
At home and away.Can Fam Physician. 2018 Nov;64(11):790. Can Fam Physician. 2018. PMID: 30429168 Free PMC article. No abstract available.
-
Les défis à relever pour renforcer les soins primaires: Les articles Besrour : une série sur l’état de la médecine familiale au Canada et au Brésil.Can Fam Physician. 2018 Nov;64(11):e471-e472. Can Fam Physician. 2018. PMID: 30429189 Free PMC article. French. No abstract available.
-
Challenges facing efforts to strengthen primary health care: The Besrour Papers: a series on the state of family medicine in Canada and Brazil.Can Fam Physician. 2018 Nov;64(11):795-796. Can Fam Physician. 2018. PMID: 30429172 Free PMC article. No abstract available.
References
-
- GBD 2015 Healthcare Access and Quality Collaborators. Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: a novel analysis from the Global Burden of Disease Study 2015. Lancet. 2017;390(10091):231–66. - PMC - PubMed
-
- Romanow RJ. Building on values. The future of health care in Canada. Saskatoon, SK: Commission on the Future of Health Care in Canada; 2002.
-
- A 10-year plan to strengthen health care. Ottawa, ON: Government of Canada; 2004.
-
- Naylor D, Fraser N, Girard F, Jenkins T, Mintz J, Power C. Unleashing innovation: excellent healthcare for Canada. Report of the Advisory Panel on Healthcare Innovation. Ottawa, ON: Health Canada; 2015.
-
- Hall Commission. Royal Commission on Health Services: 1964: Volume I. Ottawa, ON: Government of Canada; 1964.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Research Materials
Miscellaneous