Evidence of Value

Care coordination in primary care: new HQO report and AFHTO case study

“Coordinating patient care is a fundamental role of primary care, which is the foundation of Ontario’s complex health system… However, patients do not always move through the system as smoothly as they could.”

Health Quality Ontario’s (HQO) new report Connecting the Dots for Patients: Family Doctors’ Views on Coordinating Patient Care in Ontario’s Health System, released today, shows that family doctors are experiencing systemic barriers when coordinating care for their patients. The report highlights some of the experiences of family doctors including Dr. Thuy-Nga Pham, South East Toronto FHT (on pg. 13); Dr. Harry O’Halloran, Georgian Bay FHT (on pg. 28); and the CMHA Durham NPLC (p.15) in strengthening care coordination within their communities.

This report adds to the growing body of evidence to support AFHTO and the Ontario Primary Care Council’s (OPCC) position statement on the role of primary care providers to lead care coordination. Care coordination in primary care has the potential to significantly:

  • Reduce the duplication and role conflict that currently exists in our health system;
  • Improve patient outcomes through much greater continuity and coordination of person-centred care.

Click to read AFHTO’s position statement: Transitioning care coordination resources to primary care.

Primary care providers work to ensure access to interprofessional care for patients and identify a single point of contact to help patients and families navigate and access programs and services. The Ministry’s Patients First proposal speaks to deploying care coordinators in primary care. A number of teams have already done this and their experience can help other primary care teams as well.

NEW Case StudyEffectively Embedding Care Coordinators within Primary Care”* for AFHTO Members explores teams that currently have CCAC care coordinators embedded within their teams and the success factors and principles for establishing effective working relations. The case study explores lessons learned along the way and their advice to other teams.

*Please note: The case study on Guelph FHT, which was completed in 2016, no longer reflects the current state of care coordination in the Waterloo Wellington LHIN region. The LHIN has opted for a different approach and is not embedding care coordination in primary care.