Innovations driving improvements in primary care

In Canada, we have more family doctors per capita now than ever before, with Nova Scotia and New Brunswick consistently maintaining a slightly higher-than-average ratio.

But if that’s the case, why is it that 110,000 people in the province are without one?

That's a question Dr. Ruth Lavergne, Tier II Canada Research Chair in Primary Care, posed to a group of 130 at the Faculty of Medicine’s first Breakthrough Breakfast of 2025, Improving Family Medicine through Research, on January 28. 

The event was hosted by Dr. David Anderson, dean of the Faculty of Medicine, and in addition to Dr. Lavergne, featured presentations from Dalhousie researchers Drs. Emily Gard Marshall, Mathew Grandy, and Kevin Pottie.

Dr. Marshall, who is a professor in the Dalhousie Department of Family Medicine Primary Care Research Unit, credits population growth, provider retirements, an aging population, and federal funding that doesn't account for the region’s demographics, for the high numbers of unattached patients. 

“The consequences of being without a primary care provider are significant,” said Dr. Marshall. “Our Unattached Patient (UP) study revealed that patients experience increased stress, gaps in care, and a lack of continuity in their medical treatment.”

With primary care facing significant challenges, and increasing pressure on the healthcare system, governments are investing in recruiting and training more primary care professionals, including family physicians and nurses. Nova Scotia has introduced short-term access clinics, virtual care, and financial incentives to encourage family doctors to take on more patients. 

Collaborations among governments, health authorities, universities, physicians, and community organizations are driving improvements—but for many, availability of care remains a growing challenge.

"Access to primary care appears to be declining, and the gaps in access are widening based on factors like income, homeownership, immigration status, and racial identity,” said Dr. Lavergne.

And while we see increased commitments to hire and train family doctors, many of those physicians are taking on roles outside of primary care, such as in emergency departments or in hospital coordination. 

Administrative tasks in primary care have also increased significantly, overwhelming physicians and nurse practitioners. While essential for proper information flow, the workload contributes to burnout and inefficiencies.

"Patients themselves face administrative challenges when navigating a system not designed to support them adequately,” said Dr. Lavergne. “For marginalized populations, including Indigenous communities and individuals with disabilities, these barriers constitute what is known as administrative violence.”

To address these challenges, she says we need well-equipped teams, including administrative staff to streamline workflows, proactive workforce planning to anticipate needs, and fit-for-purpose infrastructure, from clinic spaces to strong information systems and administrative support.

Dr. Marshall’s research revealed similar findings, and she notes the best strategy is to ensure existing healthcare professionals work to their full scope of practice. 

“This means expanding roles such as physician assistants and increasing collaborative care models, where family physicians, nurse practitioners, dietitians, and pharmacists work together. Evidence from my studies supports the benefits of these models.” 

Data-driven solutions 

Primary care is fragmented across government departments and health stakeholders, creating significant coordination challenges. To address this, Dr. Lavergne and her team are exploring solutions to reduce administrative burdens, implement new care models, develop innovative payment structures, and use data-driven workforce planning to improve efficiency and accessibility.

She is not alone in tackling these challenges. Dr. Grandy, a family physician and director of the Maritime Family Practice Research Network (MaRNet-FP), is leveraging data to enhance prescribing practices, manage chronic diseases, and explore AI’s role in primary care.

With electronic medical records (EMRs) now central to patient care, vast amounts of data are generated daily. Dr. Grandy is using this information to improve medication management and identify patients at risk of polypharmacy—a condition linked to higher rates of medication interactions, hospital visits, and increased healthcare costs.

“One of our key initiatives leverages EMR data to identify patients at risk due to polypharmacy and implement targeted interventions,” said Dr. Grandy. “By leveraging real-world data, our project trains providers on deprescribing strategies and supports clinics with quality improvement coaching.”

Equity-based approaches in primary care

Technology and data analytics offer significant potential to enhance patient capacity and improve care in family medicine, but they require collaboration between clinicians, researchers, and policymakers. This in turn will help to address health disparities, much like Dr. Lavergne alluded to in her discussion.

Dr. Pottie, distinguished professor and Research Chair in Family Medicine at Dalhousie, focuses much of his work on this very thing, with research covering health equity and digital transformation. 

Using the example of semaglutide medication, or more widely known as Ozempic, Dr. Pottie spoke about disparities in care. Despite the drug’s promise for weight loss and reducing risks of stroke, heart disease, and even neurological conditions, its success depends on access to comprehensive lifestyle support—something he says many underserved communities lack. 

“Indigenous populations, African Nova Scotians, newcomers, and low-income or rural residents face barriers to care. Many of these individuals lack access to reliable health information, the medication itself, or culturally appropriate diet and exercise programs.”  

He says health equity is not about giving everyone the same resources—it’s about giving people what they need to succeed. Some populations require more targeted support to achieve the same health outcomes as others.

Innovation and collaboration

The challenges facing primary care in Nova Scotia, including increasing patient demand, administrative burdens, and disparities in access, require innovative, collaborative solutions. Researchers at Dalhousie, including Drs. Lavergne, Marshall, Grandy, and Pottie, are at the forefront of addressing these issues, from improving workforce planning and care models to harnessing data and technology to enhance patient care. Their work is helping to create more efficient, equitable, and sustainable primary care systems, that can ultimately improve health outcomes and access for all populations.

As Dr. Pottie emphasized when he made his closing remarks, "As we move forward, I hope we can work together to create sustainable, inclusive solutions that will improve the health and well-being of all Nova Scotians."