Health Transition Fund Conferences and Workshops

National Conferences

Conference on National Approaches to Pharmacare

January 18-20, 1998

The Conference on National Approaches to Pharmacare brought together a wide range of stakeholders to explore and discuss the complex issues associated with pharmacare and with exploring national approaches to pharmacare. Participants (approx. 300) attending the conference considered the strengths and weaknesses of current national and international practices relating to pharmaceutical coverage and the management of benefit plans. The conference included presentations on a variety of tools for managing existing programs and discussions around designing a sustainable and effective national pharmacare program. Proceedings from the pharmacare conference are available.

National Conference on Health Info-Structure

February 8-10, 1998

The National Conference on Health Info-Structure was held in Edmonton, Alberta and was the second of three invitational national conferences funded by the Health Transition Fund. This conference was co-sponsored by Health Canada and Alberta Health and represented the establishment of a working partnership on a national initiative.

National Conference on Home Care

March 8-10, 1998

The objective of the National Conference on Home Care was to bring stakeholders together to foster dialogue on the complex issues associated with home care in Canada and with national approaches to home care. A total of approx. 300 participants attended. They considered the strengths and weaknesses of current approaches and identified service gaps, research, system, and planning issues. Participants examined the fundamental question of whether home and community care is the next most urgent challenge in the modernization of Medicare and flagged issues to be considered for the future. Proceedings from the Home Care conference are available.

Workshop on System-wide Primary Care and Primary Health Care Projects

Highlights from the Proceedings

Executive Summary

The Health Transition Fund (HTF) sponsored an invitational Workshop on System-wide Primary Care and Primary Health Care Projects in Edmonton, Alberta, on March 19-20, 1999. The event involved approximately 50 participants, including representatives from six system-wide primary care/primary health care projects receiving funding through the HTF, federal, provincial and territorial government officials, researchers and experts from across Canada.

The HTF was established in the 1997 federal budget, and is providing $150 million to support pilot and evaluation projects in four priority areas: home care, pharmacare, primary care, and integrated service delivery. The HTF mandate is to generate evidence about what works and does not work in health services delivery, for use by policy and program decision makers in ongoing health system reform.

The major objective of the workshop was to bring together people from the six projects to share experiences related to project evaluation activities, and to involve decision makers and experts from across the country in the discussions. It was to provide proponents with the opportunity to learn from each other, foster potential areas of collaboration, and to link the producers of the information (proponents) together with the end users of the information (decision makers), to ensure that results are more comparable and presented in the most useful manner.

The workshop began with an overview of some of the history and issues related to primary health care reform by Miles Kilshaw. The overview was followed by presentations on the Health Transition Fund Evaluation Framework and on each of the six projects and the early plans related to the HTF synthesis and dissemination strategies. Building on what they learned from speaker presentations, the participants discussed the issues in primary care/primary health care reform and evaluation.

Representatives from the six projects indicated that they had found the Evaluation Framework created by the HTF to be flexible and adaptable, and were using it in a variety of ways, such as organizing the information needed, educating project participants about the issues in primary care reform, and ensuring accountability between the project and the HTF.

Participants agreed that evaluating the impact of the projects on health is important, but a challenge within the time frame of the HTF. However, evaluation of processes, structures and activities involved in changing the system can be accomplished within the HTF time frame. Participants believed strongly that evaluating longer-term health outcomes was critical for informed decision making, and that funding for follow-up beyond the current HTF timelines should be sought. Similarly, while some projects thought they might be able to capture costs, they believed they would have difficulty assessing cost-effectiveness in the short run.

Although projects differ widely in terms of structure, process and context, participants agreed that it is possible to draw comparisons and transfer results. The transferability of pilots will be facilitated by evaluators if they describe the characteristics of activities and environments that led to project success or that presented barriers to success. It will also be useful for evaluators to provide explanations about why things worked or not, in addition to indicating the standard indicators used.

A key and reoccurring topic mentioned by participants was public receptivity as it relates to implementing the projects and reform initiatives. The key to acceptance was seen to be gaining public trust. Participants suggested that trust can be fostered by involving the public in projects and implementing accountability measures that will help clearly identify the benefits of the reform in a way that matters to the public.

HTF proponents expressed interest in collaborating with one another, both during and after the HTF time frame. During the life of the Fund, the HTF website, with links to other websites, could be used to share tools, background papers, frameworks and resources. The issue of funding for long-term impact evaluation, and collaboration and ways to share information after the HTF were also discussed.

The Health Transition Fund Secretariat's strategy to synthesize the results of the 150 projects receiving HTF funding, and then to disseminate this information effectively-over and above the dissemination plans of individual projects-was a focus of discussion. For bridging research outcomes and the policy decision-making process, participants indicated that results should be made easily accessible through some sort of indexing database, and should be presented in a user-friendly language which provides the context under which the results were achieved.

Participants agreed that the audience for the national synthesis and dissemination of the HTF project results should include the public as well as the formal program and policy decision makers, and suggested a number of ways to present results to the public effectively.

Discussant Address

Dr. Paul Lamarche, of Laval University, was asked to provide some closing comments and observations to wrap up the workshop. The following is the text of his remarks.

... In the few minutes allotted to me, I will not pretend nor do I intend to summarize the discussions and presentations that took place over the past day and a half, for the simple and very good reason that it would be impossible, in such a short space of time, for me to convey to you the richness of those discussions and presentations.

I will limit myself, simply and humbly, to making some personal observations regarding the discussions and presentations over the past day and a half. I would like to comment on the five following points in particular: first, the projects themselves; second, the evaluation guide; third, the temporal framework in which the Health Transition Fund operates and in which the projects as well must operate; fourth, the follow-up needed on our work; and fifth, this workshop, about which I would like to comment a little.

My first observation concerns the projects which were presented to us and which will be evaluated, and with regard to which we have a certain obligation - that is, the obligation to do as much as possible with the information flowing from those projects. The main thing I noticed was that these projects vary enormously. They vary with respect to their level of development, their nature and scope, their implementation structures and processes, and their evaluation structures and processes.

It seems to me that this variability generated two types of relatively different reactions in the discussions, especially regarding the possibilities for doing a real evaluation and emphasizing the knowledge gained for development of primary health care throughout Canada.

The first reaction is a degree of perplexity. There is something of a conviction that it will not be possible to get much out of these projects because their level of comparability is terribly low and they are highly variable.

This reaction can lead to reflexively saying that certain projects will be chosen or that an effort will be made to render them homogeneous, that, if there is not an actual choosing of certain projects, at least their implementation structures and processes will be made homogeneous, in order that they may resemble each other as much as possible and be as comparable as possible.

However, the second reaction that this variability can prompt - and that it did prompt in me - is one of relief to some extent, of determination to make maximum use of this variability and its great potential, and of realizing the intellectual challenge ahead, which I would say is enormous.

There is a feeling of relief because - and I say this from my perspective as a scholar - we finally have a government initiative that leaves room for variability. There is a perception of richness because - I believe - this variability may, especially with regard to the nature of the projects, make it possible to reflect the aspects of primary health care that are of the greatest concern to Canada's various territories and provinces, the elements on which, in my opinion, we will have to work in order to consolidate the development of primary health care in Canada.

Another reason there is a perception of richness is that the variability in the implementation structures and processes will lead to, or may lead to, in my opinion, new concepts and the testing of different strategies, and implementation of strategies and changes from which we are capable of learning a great deal.

Finally, there is a perception of richness because the variability of the evaluation structures and processes may lead to a better understanding of the role of evaluators and evaluation in relation to the effectiveness of the strategies for change. In my opinion, the variety in the projects means that the intellectual challenge is huge, because the variability must now be structured in such a way as to bring out the converging elements or aspects that may determine or identify the basic elements on which everyone in Canada must work, with a view to the development of primary health care. However, it may also bring out the diverging elements, which could reflect the special provincial and regional characteristics that will have to be respected or that may have to be respected if there is to be the possibility of success throughout Canada.

My second observation concerns the evaluation framework proposed by the Health Transition Fund. You know as well as I do that no perfect evaluation framework exists. I will try to define "perfect." By "perfect," I mean a complete framework that would cover all the dimensions that theoretically could be covered, a framework that would be precise - that is, each of the terms of which would be precisely defined, such that everyone everywhere would understand them to mean exactly the same thing- and a framework that could be adapted to all contexts and all projects. I do not think that such a framework is possible.

However, from the reactions that I saw yesterday, I would say that the proposed framework is a very good one. It is a framework that covers the most fundamental aspects to be covered; it seems to me that it is a framework that has been useful to those who have used it for the preparation of their own evaluation projects; and it is a framework that, in my opinion, is flexible and can thus be adapted to the various projects. Nevertheless, I have two comments and one proposal to make regarding the evaluation framework. My first comment is that the Health Transition Fund must be encouraged to continue resisting the temptation to define the questions more and to propose a complete list of indicators or tracers for people to use. Instead, the Health Transition Fund must be encouraged to make maximum use of the understanding of the actual questions and the indicators and tracers used on a concrete level in the projects.

My second comment is that, given the variability of the projects, it may not be appropriate or feasible for each of the projects to cover each of the issues. But I feel it may prove essential, as far as the Health Transition Fund is concerned, for all the projects to relate to or cover all of the issues.

I therefore propose to the HTF that it ascertain, possibly through the preliminary report, the questions with regard to which each of the projects may suggest some answers, as well as the indicators and tracers that will be used.

I also propose to the HTF that it proceed (as soon as possible, I would think) with an analysis of these answers, in order to identify the questions to which a good many of the projects will be able to suggest some answers, as well as identify the questions being examined by very few projects and make the necessary corrections. I believe that it is essential that this work be undertaken as soon as possible, because it could in fact be the first step in the synthesis that was spoken about this morning.

My third observation concerns the temporal framework in which the HTF operates. The least I can say is that it is very restrictive, that the time allowed is very short, especially when you consider the state of advancement of a number of projects and especially if there is a desire to obtain some indications as to the projects' impact on the health of the populations involved. That impact will be - and, in my opinion, must be - the ultimate criterion for the projects' success, although I do think, and I believe I mentioned this over the past day and a half, that it is possible to obtain much highly useful knowledge from the projects.

The first knowledge is that we need to be able to identify and characterize the nature of those projects, what the projects are attempting to act on in order to improve primary health care in Canada. In addition, very useful information is generated on the implementation processes - a subject that was discussed this morning - especially the facilitating or limiting factors and the ways in which attempts have been made to increase the influence of the facilitating factors, as well as possibly to decrease the influence of the limiting factors.

I think that it is also possible to obtain much information on certain intermediate results, such as mobilization of the players and their satisfaction with the projects, the ability to reach the most vulnerable clienteles, and modification of the mix of services offered, as well as the services used by the population.

I believe that two things came out of yesterday's discussions - namely, the need to continue the work following the HTF period, especially to direct efforts toward evaluation of the projects' impact on health. In addition, the suggestion has been made that the HTF could possibly extend the time period - although maybe not the money - to enable some projects that have not yet started up or that are in their start-up phase to obtain at least some evidence with respect to the processes and the problems connected with the processes, if not with respect to the intermediate results.

My fourth observation has to do with the follow-up that is needed. The organization of the follow-up seems to me to be divided into two periods: the period while the HTF is in existence, and the period following the end of the HTF. During the HTF period, it is my perception that ...many people have expressed a desire ... the need to continue the exchange of information that began at this workshop. Moreover, I think that desire was expressed again this morning. An exchange as much on the persons ... or even the e-mail addresses of the persons involved here ... but perhaps also a more substantial exchange concerning the content and processes of the projects via the Web, via the Internet or by some other means ... and eventually the need to make the results of the individual projects available to everyone.

I personally consider it essential that the analysis of the projects of which I spoke earlier begin immediately, as much with respect to knowledge of the nature of the projects and of their implementation structures and processes and their evaluation structures and processes. In my opinion, preparation or the answer to those questions is fundamental for beginning now to work on synthesizing the results.

For the post-HTF period, there has been discussion regarding, among other things, creating a forum on primary health care, joining with the Canadian Health Services Research Foundation to eventually create a primary health care or health services research institute. In my opinion, one responsibility of the HTF is in fact to ensure continuation of the activities and work it has itself generated after the HTF has ceased operating.

I believe that post-HTF continuation should be an item for discussion at our next meeting, if there is one. I think that, judging by what was discussed this morning, there may well be one. If not, the responsibility should, in my opinion, fall to the Canadian Health Services Research Foundation, owing to the fairly close relationship that seems to exist between the two. My last observations concern the workshop. Mainly, I want to extend warm thanks to those who came up with the idea of this workshop and those who took the initiative of organizing it. Personally, I have learned a lot during this day and a half, especially about the variability of the projects and about convergence with respect to problems and divergence in approaches for the networks. I learned a lot about the people whom I had an opportunity to meet for the first time. It is unfortunate that I do not have many opportunities to meet with them more often. Personally, I greatly appreciated the professionalism, warmth and intellectual vitality of our facilitator throughout our discussions. I believe that she is to be admired for having so brilliantly got the maximum out of this event within such a short amount of time, especially considering us the participants. Thank you.

The opinions expressed in this document are those of the participants at the Workshop on System-wide Primary Care and Primary Health Care Projects, and do not necessarily reflect the views of Federal, Provincial and Territorial governments.

See Also:

• National Conference on Home Care