Transforming primary care for the better starts with asking the right questions

Study begins building a picture of current primary care practice to improve healthcare outcomes for Albertans.

Danica Erickson - 28 April 2017

Prior to Dr. Lee Green's arrival at University of Alberta in July of 2012, he knew he was in for a challenge. Part of his role of as the newly-appointed chair of the Department of Family Medicine was to lead the transformation of primary care in Alberta. In order to do this, Green knew he would have one major obstacle to overcome: the lack of access to data about primary care in Alberta. Green was up for the challenge: he had been recruited by his predecessor, Dr. Rick Spooner, in large part because of his solid track record as a health services researcher.

Green's first order of business in Alberta was to find ways to access more information and unveil a clear picture of how primary care is currently practiced in Alberta. This would mean shoring up primary care research and support of research; in 2013, with funding support from Alberta Innovates Health Services, Green took the initial steps toward this goal when he became the first Translational Health Chair in Engaged Scholarship. As translational chair, he established Enhancing Alberta Primary Care Research Networks (EnACt), a research infrastructure with the two-fold mission of supporting research on primary care (how care is delivered, how to improve care and generating useful knowledge) and research in primary care (answering questions primary care teams have and creating practical, useful evidence).

A major goal of EnACt is to provide primary care medical professionals who want to get involved in research with the resources, support and encouragement they require to carry out their project ideas, as well as helping them to build partnerships and collaborations. Tanya Barber, research coordinator with EnACt points out "In order to do research in primary care, but also have improvements and practice transformation, you have to have the right people asking the right questions and have them involved." EnACt believes that engaged scholarship - having all the key players involved in the enquiry process from asking the questions through to finding the answers - will result in a better understanding about primary care in Alberta.

Terrence McDonald, a Family and Sport Medicine Physician with over 10 years of experience and a lot of curiosity about inefficiencies in health care and health care systems, was one of those primary care medical professionals who wanted to get involved in research. He was especially curious about the link between patient volumes and service codes, the codes used to identify the various clinical activities provided by physicians, an interest shared by many of his colleagues. McDonald explains "As gatekeepers and stewards of the system, there is a need to ask difficult questions about how we are involved in the system. How is fee for service payment system impacting health outcomes for Albertans?"

Fortunately, one of these colleagues was aware of EnACt and Green's interest in enhancing primary care research, and made an introduction. McDonald had begun pursuing his Master of Science in Health Economics, Policy and Management at the London School of Economics (LSE). With the support of Green and Barber, he was able to transform his questions into the topic of his master's thesis: "To what extent do physicians demographics, geography and fee for service code types predict high volume General Practitioner (GP) practices in Alberta, Canada?" Uncovering this information about who is practicing family medicine, determining if they are full-time practitioners and their average patient volume in addition to where they are practicing, will establish a foundation to answer more complex questions. Questions that Green and McDonald have already begun to probe as part of a larger province wide study that is examining the link between patient volume seen by GPs and patient health outcomes (the results of this larger study are expected later this year).

The research has involved data analysis of almost 3500 fee-for-service GPs in Alberta, with interesting results. For instance, there are more family physicians working part-time than full-time in Alberta, a pattern similar in other jurisdictions. The number of patients a physician sees in a day is influenced by age, gender and even the geographic location of the GP. EnACt has supported McDonald in fostering positive working relationships with Alberta Health Services, specifically the Applied Research and Evaluation Services (ARES) team.The ARES team has provided ongoing data analysis support of this very large data set from Alberta Health that includes anonymized administrative billing data for every GP working fee-for-service in Alberta from 2011 to 2015. The review of this province wide data will help shed light on the reality of current practices. "I suspect this is a sentinel work for a provincial study this size in the health services literature" says McDonald.

McDonald graduated with his degree from the LSE in December of 2016, but he will continue to work with Green and EnACt to develop a comprehensive picture of the current state of healthcare in the province from a provider's perspective; ultimately informing positive changes in the system and contributing to better health care outcomes for Albertans.

For more Information about EnACt, visit their website.

For more information about Dr. Terrence McDonald's research, contact him at

Terrence.Mcdonald@ualberta.ca