At the heart of a national effort to ensure every Canadian has a home base in the health-care system is a University of Alberta research team leading the provincial arm of a massive study designed to turn innovative ideas into permanent realities.
The team, led by Stephanie Montesanti, professor and Canada Research Chair in Health System Integration in the School of Public Health, is leading Alberta’s role in a national initiative called PRIME (Primary Care Reimagined: Impact, Mobilization and Engagement) to improve access to primary care — embedding researchers directly within front-line practices, working alongside care teams to test and scale real-world solutions in real time.
“Primary care is the foundation of our health-care system, but right now too many Canadians can’t access it when and where they need it,” says Montesanti, who is also a governance board director for the Canadian Primary Care Research Consortium (CPCRC) and a member of the Women and Children’s Health Research Institute (WCHRI).
In 2024, 17 per cent of Canadian adults and 11 per cent of children and youth lacked access to a regular health-care provider. This gap increases pressure on emergency departments and contributes to significant inequities in health outcomes across the country.
To help close this gap, the Canadian Institutes of Health Research is investing $3 million to accelerate practical, evidence-based improvements in primary care. The investment is a partnership with Healthcare Excellence Canada (HEC), a pan-Canadian organization dedicated to spreading health-care innovation.
This funding supports the CPCRC, a national network of researchers, clinicians, policy-makers and patients — working alongside primary care practices across Canada that are applying innovative approaches to improve health-care quality and safety.
Care Forward is a national initiative led by Healthcare Excellence Canada that supports primary and integrated care teams through a suite of improvement programs. Two of these programs — Primary Care Access Improvement and Enhancing Integrated Care — are directly integrated into the PRIME study, with participating clinics testing and adapting innovations in real-world settings.
While HEC provides the coaching and seed funding to support clinics in piloting new approaches, Montesanti and her team will embed evaluation and implementation science expertise to determine what works within Alberta’s primary care settings.
One of the most significant shifts being tested is the move away from the traditional physician-led model toward team-based care. In Alberta, where most doctors are still paid on a fee-for-service basis, Montesanti notes that time constraints often limit access to high-quality care.
“Access to care can’t depend on physician availability alone,” she says. “We are looking at team-based models that include nurse practitioners, registered nurses, mental health professionals and navigators. This ensures no patient is left behind and every provider works to their full scope of practice.”
Montesanti is currently overseeing nine practices across Alberta that have agreed to receive research and evaluation support as part of the PRIME study. These practices are experimenting with ways to reduce the “bottleneck” that occurs when patients cannot find a family doctor.
Montesanti and her colleague, Lindsay Crowshoe of the University of Calgary, will also support interested Indigenous primary care practices across the country participating in the Care Forward initiative through their roles with the Indigenous Primary Health Care and Policy Research Network.
Specific innovations include using virtual care to bridge the gap when patients transition from hospital to home, and expanding the capacity of licensed practical nurses and medical office assistants. Beyond patient care, the project creates a collaborative learning environment that supports the training of more than 200 medical students and residents each year.
The $3-million investment allows researchers to apply what Montesanti calls a “learning health system lens.” Traditionally, a clinic might launch a new program, but because staff are stretched thin, they lack the resources to evaluate whether the change is improving health or saving money.
“We are providing that embedded research and evaluation support so these innovative practices can be sustained and grow over time,” says Montesanti. “We’re not just studying the problem; we are actively improving access and quality of care across the country.”
As the study progresses, findings from the Alberta clinics will be shared across the national network, allowing successful models to be scaled up in other provinces.
In Alberta, ongoing primary care reforms and a shift toward regional structures create both urgency and opportunity to test and scale new models of care.
“What success looks like at the end of this is Canadians having more access to integrated, team-based primary care and better continuity of care,” Montesanti says. “It means building a system that can continuously learn and adapt over time.”
