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A Thousand Papercuts: Understanding and addressing changing administrative workload in primary care
Funded by:
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There are more primary care providers per person than ever before in Canada. At the same time, Canadians struggle to access needed care and primary care providers report record levels of stress and overwork. There is an urgent need to understand factors contributing to the gap between growing per-capita supply of primary care providers and declining patient primary care visits. Administrative activities, including work related to caring for individual patients and clinic administration, may play a substantial role in understanding changing primary care workload, however this has not been carefully studied.


This project will address three objectives and nested research questions, toward the overarching goal of reducing administrative workload, while ensuring efficient coordination of care in Nova Scotia and New Brunswick:​

1. Determine how the volume of services requiring primary care coordination has changed over time

  • How has service volume shifted from inpatient services to outpatient and community-basedservices requiring coordination through primary care?

  • How has the volume of outpatient services requiring primary care coordination andoversight (i.e. prescriptions, testing, imaging, and specialist consultations) changed overtime?​

2. Use interviews with family physicians, nurse practitioners, and administrative team members to understand how administrative workload has changed.

  • What are current experiences of administrative workload, including work related to patientcare and clinic administration?​

  • How has administrative workload changed over time? What factors have shaped changes?

  • What are areas of particular concern and how might these be addressed?


3. Drawing on the findings of Objectives 1 and 2, with primary care providers and service planners,co-identify priority issues and co-develop practical response strategies to make administrativework more efficient.

  • Which areas of concern are addressable in the short, medium and long term?

  • What actions would be needed, who is in a position to act, and what resources would beinvolved?


Understanding and supporting coordination of care is central to people-centred, flexible, quality healthcare. A robust system of primary care is fundamental to addressing health inequalities in access to care, as limited primary care capacity and inadequate systems of coordination impact patients with more complex health and social needs most severely. Identifying practical strategies to make coordination more efficient can support innovative healthcare models, more seamless integration of virtual care into patients’ journeys, and strengthen primary care capacity more broadly.

Team Members

Nominated Principal Investigator:  Dr. Ruth Lavergne

Co-Investigators & Collaborators:  Dr. Ruth Martin-Misener, Richard Boute, Fiona Bergin, Julie Easley, Roetka Gradstein, Agnes Grudniewicz, Lindsay Hedden, Myles Leslie, Emily Marshall, Maddi MacKay, Melanie Mooney, Catherine Moravac, Erin Palmer, Joshua Tracey.


Papers & Preprints


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