COVID-19 – an opportunity to improve access to primary care through organizational innovations? A qualitative multiple case study in Quebec and Nova Scotia (Canada)

BMC Health Services Research

卷:22

Rhonda Kirkwood¹  Emily Gard Marshall²  Jennifer E. Isenor²  Katherine Stringer²  Lauren R. Moritz²  Richard Buote²  Madeleine McKay³  Claire Godard-Sebillotte⁴  Adrian MacKenzie⁵  Erin K. Christian⁵  Beth McDougall⁵  Michael E. Green⁶  Bobbi Morrison⁷  Rachelle Ashcroft⁸  Line Guénette⁹  Maude Laberge⁹  Arnaud Duhoux¹⁰  Nadia Sourial¹⁰  Mylaine Breton¹¹  Mélanie Ann Smithman¹¹  Catherine Hudon¹¹  Benoit Cossette¹¹  Véronique Deslauriers¹¹  Maria Mathews¹² 

[1]College of Physicians and Surgeons of Nova Scotia

[2]|Dalhousie University

[3]|Doctors Nova Scotia

[4]|McGill University

[5]|Nova Scotia Health Authority

[6]|Queen’s University

[7]|St. Francis Xavier University

[8]|University of Toronto

[9]|Université Laval

[10]|Université de Montréal

[11]|Université de Sherbrooke

[12]|Western University

关键词: COVID-19;    Primary care;    Access;    Organizational innovation;    Qualitative case study;    Logic models;   

DOI  :  10.1186/s12913-022-08140-w

来源: DOAJ

【 摘 要 】

Abstract Background COVID-19 catalyzed a rapid and substantial reorganization of primary care, accelerating the spread of existing strategies and fostering a proliferation of innovations. Access to primary care is an essential component of a healthcare system, particularly during a pandemic. We describe organizational innovations aiming to improve access to primary care and related contextual changes during the first 18 months of the COVID-19 pandemic in two Canadian provinces, Quebec and Nova Scotia. Methods We conducted a multiple case study based on 63 semi-structured interviews (n = 33 in Quebec, n = 30 in Nova Scotia) conducted between October 2020 and May 2021 and 71 documents from both jurisdictions. We recruited a diverse range of provincial and regional stakeholders (e.g., policy-makers, decision-makers, family physicians, nurses) involved in reorganizing primary care during the COVID-19 pandemic using purposeful sampling (e.g., based on role, region). Interviews were transcribed verbatim and thematic analysis was conducted in NVivo12. Emerging results were discussed by team members to identify salient themes and organized into logic models. Results We identified and analyzed six organizational innovations. Four of these – centralized public online booking systems, centralized access centers for unattached patients, interim primary care clinics for unattached patients, and a community connector to health and social services for older adults – pre-dated COVID-19 but were accelerated by the pandemic context. The remaining two innovations were created to specifically address pandemic-related needs: COVID-19 hotlines and COVID-dedicated primary healthcare clinics. Innovation spread and proliferation was influenced by several factors, such as a strengthened sense of community amongst providers, decreased patient demand at the beginning of the first wave, renewed policy and provider interest in population-wide access (versus attachment of patients only), suspended performance targets (e.g., continuity ≥80%) in Quebec, modality of care delivery, modified fee codes, and greater regional flexibility to implement tailored innovations. Conclusion COVID-19 accelerated the uptake and creation of organizational innovations to potentially improve access to primary healthcare, removing, at least temporarily, certain longstanding barriers. Many stakeholders believed this reorganization would have positive impacts on access to primary care after the pandemic. Further studies should analyze the effectiveness and sustainability of innovations adapted, developed, and implemented during the COVID-19 pandemic.

【 授权许可】

Unknown