Evaluation of the implementation of centralized waiting lists for patients without a family physician and their effects across the province of Quebec

Implementation Science

Danièle Roberge⁴  Djamal Berbiche¹  Kareen Nour²  Carl-Ardy Dubois³  Nassera Touati⁵  Christine Loignon¹  Antoine Boivin¹  Astrid Brousselle¹  Mylaine Breton¹ 

[1] Faculty of Medicine and Health Sciences, Université de Sherbrooke-Campus Longueuil, Longueuil J4K 0A8, QC, Canada;Montérégie Regional Department of Public Health, Longueil J4K 2M3, QC, Canada;Faculty of Nursing, University of Montreal, Montreal H3C 3J7, QC, Canada;Charles-LeMoyne Hospital Research Centre, Greenfield Park J4K 0A8, QC, Canada;École Nationale d¿Administration Publique, Montreal G1K 9E5, QC, Canada

关键词: Implementation study;    Continuity;    Access;    Primary healthcare;   

Others  :  1146604
DOI  :  10.1186/s13012-014-0117-9

 received in 2014-07-04, accepted in 2014-08-25,  发布年份 2014

【 摘 要 】

Background

Most national and provincial commissions on healthcare services in Canada over the past decade have recommended that primary care services be strengthened in order to guarantee each citizen access to a family physician. Despite these recommendations, finding a family physician continues to be problematic. The issue of enrolment with a family physician is worrying in Canada, where nearly 21% of the country¿s population reported not having a family physician in the last Commonwealth Fund survey.

To respond to this important need, centralized waiting lists have been implemented in four Canadian provinces to help `orphan,¿ or unaffiliated, patients find a family physician. These organizational mechanisms are intended to better coordinate the demand for and supply of family physicians. The objectives of this study are: to assess the effects of centralized waiting lists for orphan patients (GACOs) implemented in the province of Quebec and to explain the variation among their effects by analyzing factors influencing implementation process.

Methods

This study is based on two complementary and sequential research strategies. The first (objective 1) is a quantitative longitudinal design to assess the effects of all the GACOs (n?=?93) in Quebec using clinical-administrative data. The second (objective 2) involves using four case studies to explain variations in effects through in-depth analysis of the various factors contributing to the observed effects. The primary source of data will be key actors involved in the GACOs. We expect to conduct around 40 semi-structured interviews.

Discussion

This will be the first study in Canada to evaluate the implementation of this innovation. It will provide an exhaustive picture of the effects of GACO implementation in Quebec and to assess their potential for generalization elsewhere in Canada. At the theoretical level, this study will produce new knowledge on the factors having the greatest influence on the implementation of primary care innovations in professional environments.

【 授权许可】

   
2014 Breton et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Romanow RJ: Building on Values: The Future of Health Care in Canada. Final Report. Government of Canada, Ottawa; 2002.
• [2]Clair M: Les solutions émergentes: Rapport et recommandations. Commission d'étude sur les services de santé et les services sociaux, Québec; 2000.
• [3]Mazankowski D: A Framework for Reform: Report of the Premier's Advisory Council on Health. Government of Alberta, Edmonton; 2011.
• [4]Looking Back, Looking Forward: The Ontario Health Services Restructuring Commission (1996¿2000). Government of Ontario, Toronto; 2000.
• [5]Caring for Medicare: Sustaining a Quality System. Saskatchewan Health, Regina; 2001.
• [6]Kirby J, LeBreton M: The Health of Canadians: The Federal Role. Volume 6: Recommendations for Reform. Standing Senate Committee on Social Affairs, Science and Technology, Ottawa; 2002.
• [7]Xu KT: Usual source of care in preventive service use: a regular doctor versus a regular site. Health Serv Res 2002, 37(6):1509-1529.
• [8]Burge F, Haggerty J, Pineault R, Beaulieu MD, Lévesque JF, Beaulieu C, Santor DA: Relational continuity from the patient perspective: comparison of primary healthcare evaluation instruments. Healthc Policy 2011, 7:124-138.
• [9]Blewett LA, Ziegenfuss J, Davern ME: Local access to care programs (LACPs): new developments in the access to care for the uninsured. Milbank Q 2008, 86(3):459-479.
• [10]Loignon C, Allison P, Landry A, Richard L, Brodeur J, Bedos C: Providing humanistic care: dentists' experience in deprived areas. J Dent Res 2010, 89(9):991-995.
• [11]Loignon C, Haggerty JL, Fortin M, Bedos CP, Allen D, Barbeau D: Physicians' social competence in the provision of care to persons living in poverty: research protocol. BMC Health Serv Res 2010, 10:79. BioMed Central Full Text
• [12]Bindman AB, Grumbach K, Osmond D, Komaromy M, Vranizan K, Lurie N, Billings J, Stewart A: Preventable hospitalizations and access to health care. JAMA 1995, 274(4):305-311.
• [13]Jatrana S, Crampton P, Richardson K: Continuity of care with general practioners in New Zealand: results from So-FIE-Primary Care. N Z Med J 2011, 124(1329):286-296.
• [14]Jatrana S, Crampton P: Affiliation with a primary care provider in New Zealand: who is, who isn¿t. Health Policy 2009, 91(3):286-296.
• [15]Frenck JA: The concept and measure of accessibilty. In Health Services Research: An Anthology. Edited by White KL, Frenck JA, Ordóñez C, Paganini JM, Starfield B. Pan American Health Organization, Washington; 1992:842-855.
• [16]Haggerty J, Lévesque JF, Santor DA, Burge F, Beaulieu C, Bouharaoui F, Beaulieu MD, Pineault R: Accessibility from the patient perspective: comparison of primary healthcare evaluation instruments. Health Policy 2011, 7:94-107.
• [17]Lévesque JF, Haggerty JL, Burge F, Beaulieu MD, Gass D, Pineault R, Santor DA: Canadian experts' views on the importance of attributes within professional and community-oriented primary healthcare models. Health Policy 2011, 7:21-30.
• [18]Haggerty J, Pineault R, Beaulieu MD, Brunelle Y, Goulet F, Rodrigue J, Gauthier J: Accessibility and Continuity of Primary Care in Quebec. Canadian Health Services Research Foundation, Ottawa; 2004.
• [19]Kapetanakis C, Ouellet D, Pineault R: Besoins et difficultés d'accès aux services de premier contact. Institut national de santé publique, Agence de la santé et des services sociaux de Montréal, Direction de la santé publique Montréal, Montreal; 2003.
• [20]Crooks VA, Agarwal G, Harrison A: Chronically ill Canadians' experiences of being unattached to a family doctor: a qualitative study of marginalized patients in British Columbia. BMC Fam Pract 2012, 13:69. BioMed Central Full Text
• [21]Brown AD, Goldacre MJ, Hicks N, Rourke JT, McMurty RY, Brown JD, Anderson GM: Hospitalization for ambulatory care-sensitive conditions: a method for comparative access and quality studies using routinely collected statistics. Can J Public Health 2001, 92(2):155-159.
• [22]Weingarten SR, Henning JM, Badamgarav E, Knight K, Hasselblad V, Gano A Jr, Ofman JJ: Interventions used in disease management programmes for patients with chronic illness¿which ones work? Meta-analysis of published reports. BMJ 2002, 325(7370):925.
• [23]McCusker J, Roberge D, Lévesque JF, Ciampi A, Vadeboncoeur A, Larouche D, Sanche S: Emergency department visits and primary care among adults with chronic conditions. Med Care 2010, 48(11):972-980.
• [24]Glazier RH, Moineddin R, Agha MM, Zagorski B, Hall R, Manuel DG, Sibley LM, Koop A: The Impact of Not Having a Primary Care Physician Among People with Chronic Conditions. ICES Investigative Report. Institute for Clinical Investigative Sciences, Toronto; 2008.
• [25]Levesque JF, Harris MF, Russell G: Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health 2013, 12:18-26. BioMed Central Full Text
• [26]Salisbury C, Sampson F, Ridd M, Montgomery AA: How should continuity of care in primary health care be assessed? Br J Gen Pract 2009, 59(561):e134-e141.
• [27]Ionescu-Ittu R, McCusker J, Ciampi A, Vadeboncoeur AM, Roberge D, Larouche D, Verdon J, Pineault R: Continuity of primary care and emergency department utilization among elderly people. CMAJ 2007, 177(11):1362-1368.
• [28]Freeman GK, Olesen F, Hjortdahl P: Continuity of care: an essential element of modern general practice? Fam Pract 2003, 20:623-627.
• [29]Haggerty JL, Reid RJ, Freeman GK, Starfield BH, Adair CE, McKendry R: Continuity of care: a multidisciplinary review. BMJ 2003, 22(327):1219-1221.
• [30]Reid R, Haggerty J, McKendry R: Defusing the Confusion: Concepts and Measures of Continuity of Healthcare. Canadian Health Services Research Foundation, Ottawa; 2002.
• [31]Schoen C, Osborn R, Huynh PT, Doty M, Davis K, Zapert K, Peugh J: Primary care and health system performance: adults' experiences in five countries. Health Aff (Millwood) 2004, 23:487-503.
• [32]Hay C, Pacey M, Bains N: Understanding the unattached population in Ontario: evidence from the Primary Care Access Survey (PCAS). Healthc Policy 2010, 6(2):33-47.
• [33]Nutting PA, Goodwin MA, Flocke SA, Zyzanski SJ, Stange KC: Continuity of primary care: to whom does it matter and when? Ann Fam Med 2003, 1(3):149-155.
• [34]Little P, Everitt H, Williamson I, Warner G, Moore M, Gould C, Ferrier K, Payne S: Preferences of patients for patient centred approach to consultation in primary care: observational study. BMJ 2001, 322:468.
• [35]Turner D, Tarrant C, Windridge K, Bryan S, Boulton M, Freeman G, Baker R: Do patients value continuity of care in general practice? An investigation using stated preference discrete choice experiments. J Health Serv Res Policy 2007, 12(3):132-137.
• [36]Cheraghi-Sohi S, Hole AR, Mead N, McDonald R, Whalley D, Bower P, Roland M: What patients want from primary care consultations: a discrete choice experiment to identify patients' priorities. Ann Fam Med 2008, 6(2):107-115.
• [37]Sualtz JW: Defining and measuring interpersonal continuity of care. Ann Fam Med 2003, 1(3):134-143.
• [38]Gulliford M, Naithani S, Morgan M: What is continuity of care? J Health Serv Res Policy 2006, 11(4):248-250.
• [39]Crossing the Quality Chasm: a New Health System for the 21st Century. Institute of Medicine, Washington, DC; 2001.
• [40]L'expérience de soins de la population: Le Québec comparé. Résultats de l'enquête internationale du Commonwealth Fund de 2010 auprès de la population de 18 ans et plus Commissaire à la santé et au bien-être du Québec, Québec; 2010.
• [41]L'expérience de soins des personnes présentant les plus grands besoins de santé : Le Québec comparé. Résultats de l'enquête internationale sur les politiques de santé du Commonwealth Fund de 2011. Commissaire à la santé et au bien-être du Québec, Québec; 2011.
• [42]Mercer SW, Watt G: The inverse care law: clinical primary care encounters in deprived and affluent areas of Scotland. Ann Fam Med 2007, 5:503-510.
• [43]Chafe R, Laupacis A, Levinson W: Accepting new patients: what does the public think about Ontario's policy? Can Fam Physician 2011, 57(2):e68-e73.
• [44]Schoen C, Osborn R, Doty MM, Squires D, Peugh J, Applebaum S: A survey of primary care physicians in eleven countries, 2009: perspectives on care, costs, and experiences. Health Aff (Millwood) 2009, 28(6):w1171-w1183.
• [45]Breton M, Ricard J, Walter N: Connecting orphan patients with family physicians: differences among Quebec's access registries. Can Fam Physician 2012, 58(9):921-922.
• [46]Champagne F, Brousselle A, Hartz Z, Contandriopoulos A, Denis J: L'analyse de l'implantation. In L'évaluation: concepts et méthodes. Edited by Brousselle A, Champagne F, Contandriopoulos A, Hartz Z. Les Presses de l'Université de Montréal, Montreal; 2011:237-273.
• [47]Chaudoir SR, Dugan AG, Barr CHI: Measuring factors affecting implementation of health innovations: a systematic review of structural, organizational, provider, patient, and innovation level measures. Implement Sci 2013, 8:22. BioMed Central Full Text
• [48]Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O: Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q 2004, 82(4):581-629.
• [49]Damschroder L, Aron D, Keith R, Kirsh S, Alexander JA, Lowery JC: Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci 2009, 4:50-64. BioMed Central Full Text
• [50]Pomey MP, Forest PG, Sanmartin C, Decoster C, Clavel N, Warren E, Drew M, Noseworthy T: Toward systematic reviews to understand the determinants of wait time management success to help decision-makers and managers better manage wait times. Implement Sci 2013, 8:61. BioMed Central Full Text
• [51]Pomey MP, Forest PG, Sanmartin C, De Coster C, Drew M: Wait time management strategies for scheduled care: what makes them succeed? Healthc Policy 2010, 5(3):66-81.
• [52]Hogg W, Rowan M, Russell G, Geneau R, Muldoon L: Framework for primary care organizations: the importance of a structural domain. Int J Qual Health Care 2008, 20(5):308-313.
• [53]Miles MB, Huberman AM: Qualitative Data Analysis: An Expanded Sourcebook. Sage Publications, Thousand Oaks; 1994.
• [54]Maddison P, Jones J, Breslin A, Barton C, Fleur J, Lewis R, McSweeney L, Norgain C, Smith S, Thomas C, Tillson C: Improved access and targeting of musculoskeletal services in northwest Wales: targeted early access to musculoskeletal services (TEAMS) programme. BMJ 2004, 329(7478):1325-1327.
• [55]Hroscikoski MC, Solberg LI, Sperl-Hillen J, Harper PG, McGrail MP, Crabtree BF: Challenges of change: a qualitative study of chronic care model implementation. Ann Fam Med 2006, 4(4):317-326.
• [56]Russell G, Thille P, Hogg W, Lemelin J: Beyond fighting fires and chasing tails? Chronic illness care plans in Ontario. Canada Ann Fam Med 2008, 6(2):146-153.
• [57]Lamarche PA, Beaulieu MD, Pineault R, Contandriopoulos AP, Denis JL, Haggerty J: Choices for Change: The Path for Restructuring Primary Healthcare Services in Canada. Canadian Health Services Research Foundation, Ottawa; 2003.
• [58]Haggerty JL, Roberge D, Pineault R, Larouche D, Touati N: Features of primary healthcare clinics associated with patients' utilization of emergency rooms: urban¿rural differences. Healthc Policy 2007, 3(2):72-85.
• [59]Fernández LA, Martin JM, Del Castillo JD, Gaspar OS, Millán JI, Lozano MJ, Keenoy ED: Sources of influence on medical practice. J Epidemiol Community Health 2000, 54(8):623-630.
• [60]Mendel P, Meredith LS, Schoenbaum M, Sherbourne CD, Wells KB: Interventions in organizational and community context: a framework for building evidence on dissemination and implementation in health services research. Adm Policy Ment Health 2008, 35:21-37.
• [61]Creswell JW, Plano Clark VL: Designing and Conducting Mixed Methods Research. Sage Publications, Los Angeles, CA; 2011.
• [62]Provost S, Pineault R, Couture A, Borges Da Silva R, Lemoine O, Tousignant P: Affiliation à un médecin de famille: Une mesure à partir des banques de données médico-administratives. Institut national de santé publique, Montreal; 2013.
• [63]Breslau N, Reeb KG: Continuity of care in a university-based practice. J Med Educ 1975, 50(10):965-969.
• [64]Sarver JH, Cydulka RK, Baker DW: Usual source of care and nonurgent emergency department use. Acad Emerg Med 2002, 9(9):916-923.
• [65]Belzile E, Sanche S, McCusker J, Vadeboncoueur A, Ciampi A, Lévesque JF: Création d'une mesure de visite au département d'urgence à partir des données administratives du Québec. Rapport technique. St. Mary¿s Hospital Research Centre, Montreal; 2011.
• [66]Da Silva RB, Pineault R: Impact of physician distribution policies on primary care practices in rural Quebec. Can J Rural Med 2012, 17(3):92-98.
• [67]Attride-Stirling J: Thematic networks: an analytic tool for qualitative research. Qual Res 2001, 1(3):385-405.
• [68]Yin RK: Case Study Research: Design and Methods. Sage Publications, Thousand Oaks, CA; 2009.
• [69]Savoir préparer une recherche: la définir, la structurer, la financer. Les Presses de l'Université de Montréal, Montréal; 1990.