Strengthening Primary Care Systems: Building Relational Equity into Practice

Background: The complexity of patient care demands transformation that fully integrates the patient/family preferences, needs, and values while at the same time recognizing each person not merely as a recipient of care but as an expert in their lived experience. Relational equity is defined as understanding and knowing about someone through repeated interactions. It is co-created and carefully cultivated so that it is preserved by those who desire to influence others. This is crucial for the strengthening of primary care systems over time; and the establishment of trust that is sustainable over time. In Saskatchewan, Canada, we facilitated this approach in two unique ways: . through our involvement in initiatives like the Organisation for Economic Co-operation and Development (OECD) Patient Reported Indicator Survey (PaRIS) Project; and, 2. the Strategic Patient-Oriented Research (SPOR) Refresh. The PaRIS Project focused on optimizing patient and primary care provider (PCP) participation through relationship-driven recruitment strategies. The SPOR Refresh, facilitated by the Patient Council of the Canadian Primary Care Research Network (CPCRN), aimed to identify new and innovative approaches to engaging in SPOR by building on strengths and reflecting on evolving priorities for strengthening primary care systems. Approach: Our approach to facilitating these processes was informed by an integrated framework of community-based participatory research (CBPR) and transformative action research; grounded in the culture of the communities that were engaged; which involves acknowledging and valuing each person's voice and experiences equally in the collaborative processes. The partnerships of the PaRIS Project spanned many health agencies in Saskatchewan, including the Ministry of Health, Health Authority, Health Quality Council, Centre for Patient Oriented Research, Saskatchewan Medical Association, Cooperative Community Clinics, and the University of Saskatchewan. Academic Family Medicine Residency Training Sites. Engaging a broad spectrum of healthcare professionals (which included, family physicians, nurse practitioners, nurses, pharmacists, and medical office administrators) and people with lived experience (PWLE) in several primary care clinics, we invited and engaged with our partners throughout every aspect of the project. In the SPOR Refresh Project, members of the Patient Council of the CPCRN, were engaged. We invited them to contribute their ideas to the questions put forward by the Canadian Institutes of Health Research (CIHR) and subsequently undertook a participatory analysis of the findings. Relational equity was integrated into all aspects of the Program Evaluation with the aim of co-creating a comprehensive report that highlighted the successes and opportunities for change identified by the members of the Patient Council of the CPCRN. Results: The PaRIS project resulted in ,324 returned surveys [50 PCPs (response rate =54%); ,274 from patients (response rate =39%)] within a four-month timeframe in 2023. Recruitment successes were attributed to the integration of patients and providers as Co-Investigators /partners in all aspects of the research process undertaken. The SPOR Refresh Project engaged all members (7/7) of the Patient Council and subsequently identified several strengths including: the active engagement of dedicated PWLE; the development of infrastructure that enhanced collaboration and knowledge exchange both nationally and internationally; and, the nurturing of strong relationships. Identified areas for improvement included: re-defining the term "patient" to better reflect their role in all aspects of research, education and practice; enhancing access to technology; ensuring timely compensation; and, further integrating relational equity, accountability, and servant leadership into all aspects of practice. ImplicationsEmphasizing relational equity in primary care fosters inclusive, responsive, and effective healthcare systems. The PaRIS Project and the SPOR Refresh Project in Saskatchewan exemplified how integrating relational equity, accountability, and leadership into healthcare research, education and practice has the potential to transform primary care structures which in turn will better serve the unique practices and communities.

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