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Table 3 Factors that affect government agenda setting in Patients First primary care reform, with a focus on midwifery as a service delivery option

From: Understanding the conditions that influence the roles of midwives in Ontario, Canada’s health system: an embedded single-case study

Factors that affect government agenda setting

Description of how these factors influenced agendas in Patients First primary care reform, with a focus on midwifery as a service delivery option

Sources of evidence

Problems

Feedback from existing primary care programs

• While most Ontarians have a primary care physician, many encounter challenges to seeing their provider in a timely manner, which leads to increased number of emergency department visits

• The health system is focused acute care and reorienting the system to primary care is important to maternal health

• Primary care services are at times uncoordinated, which leads to fragmentation in the system

• Many experience long wait times for specialist care, which will likely increase if changes are not made to the health system due to the growth in the older adult population and those with chronic conditions

KIs [22, 30, 45, 50, 65, 66];

Policies

Supportive evidence

• There has been incremental primary care reform since 2002 and feedback from existing programs, including Family Health Teams, has shown the value of team-based care

• Midwives are a natural fit in primary care reform as they are primary care providers

• Expanding home and community care by moving services out of hospitals and into community-based settings

KIs [67,68,69];

Politics

Changes within the government in terms of where midwifery is situated

• The midwifery program is now part of the primary healthcare branch at the Ministry of Health and Long-Term Care

KIs

Participants

Visible

• Current Minister of Health and Long-Term Care, Eric Hoskins is a midwifery consumer

Hidden

• Analysts at the Ministry of Health and Long-Term Care working towards reducing healthcare costs through reforming primary care

• While not explicitly mentioned, the 2016 mandate letter suggests an opportunity for midwives to increase participation in primary care

KIs [70];

KIs [71];