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156. Les facteurs individuels influençant l’affiliation des patients sans médecin de famille par l’entremise des listes d’attente centralisées.

Author

Vasiliadis, Helen-Maria, Cacheiro-Millette, Raquel, Breton, Mylaine, Vasiliadis, Helen-Maria, Cacheiro-Millette, Raquel, and Breton, Mylaine

Abstract

Le Canada présente l’un des plus faibles taux d’affiliation à un médecin de famille au sein des pays de l’OCDE. De cette problématique émerge une innovation canadienne : des listes d’attente centralisées pour faciliter l’affiliation des patients à un professionnel de première ligne. Ce mécanisme fut mis en place par 7 provinces canadiennes dans le but de diminuer la proportion de patients sans affiliation à un professionnel en première ligne. Pourtant, peu d’études ont été menées avant l’implantation de ces listes d’attente centralisées. Notre étude vise à explorer quels facteurs prédisposants, facilitants et de besoins influencent les délais d’attente d’affiliation aux médecins de famille pour les patients inscrits aux listes d’attente centralisées du Québec. Nous avons analysé les données de 129 547 patients de la base de données clinico-administrative (SIGACO) de 5 listes d’attente centralisées parmi les 93 implantées à l’échelle du Québec entre 2008 et 2015. Afin de savoir quels facteurs influencent l’affiliation au médecin de famille, des analyses de Cox ont été réalisées. Selon le modèle multivarié, les facteurs de besoins semblent avoir une grande influence sur le taux d’affiliation à un médecin de famille. En effet, les résultats obtenus démontrent notamment que les personnes atteintes de problématiques de santé mentale ont 5% plus de risque d’affiliation que les personnes en santé, c'est à dire ne présentant pas de maladies physiques et psychiatriques (HR 1,05 (IC 1,02-1,09). En comparaison, les gens souffrant de problèmes de santé physique auraient 17% plus de risque d’être affiliés que les personnes en santé (HR 1,17 (IC 1,13-1,20). En contrepartie, une personne présentant un portrait de comorbidité de maladies physique et psychiatrique a 17% moins de risque d’être affilié qu’une personne en santé (HR 0,85 (IC 0,81-0,89). L’étude conduite révèle donc des iniquités dans l’affiliation à un médecin de famille malgré le processus de liste d’attente centralisé

Published
2019

157. Attentes et expériences des patients à l’égard d’une intervention visant à améliorer l’expérience de navigation dans le système de santé

Author

Loignon, Christine, Ngo Bikoko Piemeu, Carine Sandrine, Breton, Mylaine, Loignon, Christine, Ngo Bikoko Piemeu, Carine Sandrine, and Breton, Mylaine

Abstract

Introduction : Les patients défavorisés sont plus nombreux à ne pas avoir de médecin de famille et à vivre des expériences de soins négatives. En plus, ils ont souvent plus des problèmes de santé et ne savent pas où aller pour obtenir des soins de santé. Pour pallier à ce problème, une intervention de soutien à la navigation dénommée « Service Accueil Patient » a été mise en place dans le but d’améliorer l’affiliation des patients défavorisés à un médecin de famille. Cette intervention visait des patients défavorisés socialement et/ou matériellement et consistait à offrir de l’information sur la santé, une préparation à la première consultation avec leur médecin de famille et un soutien dans leur suivi. Objectif et méthodologie : Cette étude visait à décrire et à comprendre les attentes et les experiences des patients défavorisés à l’égard d’une intervention de soutien à la navigation tant auprès de ceux en ayant bénéficié qu’auprès de ceux n’ayant pas bénéficié d’une telle intervention. Une étude qualitative de type descriptive a été menée, car cette approche s’avère judicieuse lorsque l’on dispose de peu de données et que nous souhaitons explorer en profondeur la perspective de patients difficiles à rejoindre ou à impliquer par les devis traditionnels. Ces patients ont été recrutés dans des cliniques médicales situées en Montérégie. Seize entrevues semi-dirigées individuelles en personne et au téléphone ont été réalisées. L’analyse thématique semi-ouverte des données a été réalisée selon le modèle de Miles et collaborateurs (2014) et comprenait la réduction et l’organisation des données, la présentation et l’interprétation des résultats. Résultats et conclusions : Cette étude identifie trois attentes non documentées dans la littérature : le soutien communicationnel, la continuité informationnelle des soins et le soutien lors des déplacements pour les rendez-vous. Les autres attentes identifiées viennent corroborer celles énoncées par des études précédentes et donc

Published
2019

158. Learning from health system reform trajectories in seven Canadian provinces.

Author

Usher, Susan, Denis, Jean-Louis, Préval, Johanne, Baker, Ross, Chreim, Samia, Kreindler, Sara, Breton, Mylaine, and Côté-Boileau, Élizabeth

Abstract

In publicly funded health systems, reform efforts have proliferated to adapt to increasingly complex demands. In Canada, prior research (Lazar et al., 2013, Paradigm Freeze: Why is it so Hard to Reform Health Care in Canada?, McGill-Queen's Press) found that reforms at the end of the 20th century failed to change the fundamentals of the Canadian system based on physician independence and assured universal coverage only for medical and hospital services. This paper focuses on reforms since the turn of the millennium to explore the transformative capacities developed in seven provinces within this system architecture. Longitudinal case studies, based on scientific and grey literature, and interviews with key informants, trace the patterns of reform in each province and reveal five objectives that, to varying degrees, preoccupied reformers: (1) address chronic disease, (2) align health system actors with provincial objectives, (3) shift from hospital to community-based care, (4) integrate physicians, and (5) develop improvement capacities. The range of strategies adopted to achieve these objectives in different provinces is compared to identify emerging pathways of reform and extract lessons for future reformers. We find significant cross-learning between provinces, but also note an emergent dimension to reforms, where multiple strategies aggregate through time to create unique patterns, presenting their own set of possibilities and limitations for the future. [ABSTRACT FROM AUTHOR]

Published
2021
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166. Assessing the evolution of primary healthcare organizations and their performance (2005-2010) in two regions of Québec province: Montréal and Montérégie

Author

Provost Sylvie, Pineault Raynald, Levesque Jean-Frédéric, Tousignant Pierre, Couture Audrey, Da Silva Roxane, and Breton Mylaine

Subjects
Medicine (General), R5-920
Abstract

Abstract Background The Canadian healthcare system is currently experiencing important organizational transformations through the reform of primary healthcare (PHC). These reforms vary in scope but share a common feature of proposing the transformation of PHC organizations by implementing new models of PHC organization. These models vary in their performance with respect to client affiliation, utilization of services, experience of care and perceived outcomes of care. Objectives In early 2005 we conducted a study in the two most populous regions of Quebec province (Montreal and Montérégie) which assessed the association between prevailing models of primary healthcare (PHC) and population-level experience of care. The goal of the present research project is to track the evolution of PHC organizational models and their relative performance through the reform process (from 2005 until 2010) and to assess factors at the organizational and contextual levels that are associated with the transformation of PHC organizations and their performance. Methods/Design This study will consist of three interrelated surveys, hierarchically nested. The first survey is a population-based survey of randomly-selected adults from two populous regions in the province of Quebec. This survey will assess the current affiliation of people with PHC organizations, their level of utilization of healthcare services, attributes of their experience of care, reception of preventive and curative services and perception of unmet needs for care. The second survey is an organizational survey of PHC organizations assessing aspects related to their vision, organizational structure, level of resources, and clinical practice characteristics. This information will serve to develop a taxonomy of organizations using a mixed methods approach of factorial analysis and principal component analysis. The third survey is an assessment of the organizational context in which PHC organizations are evolving. The five year prospective period will serve as a natural experiment to assess contextual and organizational factors (in 2005) associated with migration of PHC organizational models into new forms or models (in 2010) and assess the impact of this evolution on the performance of PHC. Discussion The results of this study will shed light on changes brought about in the organization of PHC and on factors associated with these changes.

Published
2010
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167. Evaluating case studies of community-oriented integrated care

Author

Thomas, Paul, Sachar, Amrit, Papanikitas, Andrew, While, Alison, Brophy, Chris, Manning, Chris, Mills, Cliff, Ruprah-Shah, Baljeet, Millington-Sanders, Catherine, Morris, David, Kelley Patterson, Deirdre, Hill, Diana, McKenzie-Edwards, Emma, Wright, Fiona, Carelli, Francesco, Shaw, Freddy, Vedel, Isabelle, Spicer, John, Wewiora, Liz, Gul, Malik, Kirkbride BA, Michelle, Sadlowski, Mike, Breton, Mylaine, Banarsee, Ricky, Gupta, Sunjai, Burch, Tony, Kempe, Tulloch, Tzortziou Brown, Victoria, Sanfey, John, Thomas, Paul, Sachar, Amrit, Papanikitas, Andrew, While, Alison, Brophy, Chris, Manning, Chris, Mills, Cliff, Ruprah-Shah, Baljeet, Millington-Sanders, Catherine, Morris, David, Kelley Patterson, Deirdre, Hill, Diana, McKenzie-Edwards, Emma, Wright, Fiona, Carelli, Francesco, Shaw, Freddy, Vedel, Isabelle, Spicer, John, Wewiora, Liz, Gul, Malik, Kirkbride BA, Michelle, Sadlowski, Mike, Breton, Mylaine, Banarsee, Ricky, Gupta, Sunjai, Burch, Tony, Kempe, Tulloch, Tzortziou Brown, Victoria, and Sanfey, John

Abstract

This paper summarises a ten-year conversation within London Journal of Primary Care about the nature of community-oriented integrated care (COIC) and how to develop and evaluate it. COIC means integration of efforts for combined disease-treatment and health-enhancement at local, community level. COIC is similar to the World Health Organisation concept of a Community-Based Coordinating Hub – both require a local geographic area where different organisations align their activities for whole system integration and develop local communities for health. COIC is a necessary part of an integrated system for health and care because it enables multiple insights into ‘wicked problems’, and multiple services to integrate their activities for people with complex conditions, at the same time helping everyone to collaborate for the health of the local population. The conversation concludes seven aspects of COIC that warrant further attention.

Published
2018

168. Development of a Patient-Reported Experience Measure Tool for Ambulatory Patients With Acute Unexpected Needs: The APEX Questionnaire

Author

Nadeau, Myriam, Chabot, Dominique, Breton, Mylaine, Guertin, Jason R., Harvey Labbé, Laurie, Roberge, Danièle, Lefebvre, Gabrielle, Mallet, Myriam, Beaulieu, Sandrine, Kavanagh, Éric, Cloutier, Nathalie, Garant, Philippe, Bélanger, Lynda, Vaillancourt, Samuel, Boumenna, Tarek, Bareil, Kathryn, Savard, Joanie, Simonyan, David, Ulrich Singbo, Mahukpe Narcisse, and Berthelot, Simon

Abstract

Background:The aim of this study was to develop a patient-reported experience measure (PREM) for comparing the experience of care received by ambulatory patients with acute unexpected needs presenting in emergency departments (EDs), walk-in clinics, and primary care practices. Methods:The Ambulatory Patient EXperience (APEX) questionnaire was developed using a 5-phase mixed-methods approach. The questionnaire was pretested by asking potential users to rate its clarity, usefulness, redundancy, content and face validities, and discrimination on a 9-point scale (1 = strongly disagree to 9 = strongly agree). The pre-final version was then tested in a pilot study. Results:The final questionnaire is composed of 61 questions divided into 7 sections. In the pretest (n = 25), median responses were 8 and above for all dimensions assessed. In the pilot study, 63 participants were enrolled. Adjusted results show that access, cleanliness, and feeling treated with respect and dignity by nurses and physicians were significantly better in the clinics than in the ED. Conclusion:We developed a questionnaire to assess and compare experience of ambulatory care in different clinical settings.

Published
2024
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169. Key factors for national spread and scale-up of an eConsult innovation.

Author

Moroz, Isabella, Archibald, Douglas, Breton, Mylaine, Cote-Boileau, Elizabeth, Crowe, Lois, Horsley, Tanya, Hyseni, Lirjie, Johar, Gina, Keely, Erin, Burns, Katharina Kovacs, Kuziemsky, Craig, Laplante, Jim, Mihan, Ariana, Oppenheimer, Luis, Sturge, Don, Tuot, Delphine S., and Liddy, Clare

Subjects
MEDICAL personnel, THEMATIC analysis, PROVINCIAL governments, STAKEHOLDER analysis, TECHNOLOGICAL innovations
Abstract

Background: Expanding healthcare innovations from the local to national level is a complex pursuit requiring careful assessment of all relevant factors. In this study (a component of a larger eConsult programme of research), we aimed to identify the key factors involved in the spread and scale-up of a successful regional eConsult model across Canada.Methods: We conducted a constant comparative thematic analysis of stakeholder discussions captured during a full-day National eConsult Forum meeting held in Ottawa, Canada, on 11 December 2017. Sixty-four participants attended, representing provincial and territorial governments, national organisations, healthcare providers, researchers and patients. Proceedings were recorded, transcribed and underwent qualitative analysis using the Framework for Applied Policy Research.Results: This study identified four main themes that were critical to support the intentional efforts to spread and scale-up eConsult across Canada, namely (1) identifying population care needs and access problems, (2) engaging stakeholders who were willing to roll up their sleeves and take action, (3) building on current strategies and policies, and (4) measuring and communicating outcomes.Conclusions: Efforts to promote innovation in healthcare are more likely to succeed if they are based on an understanding of the forces that drive the spread and scale-up of innovation. Further research is needed to develop and strengthen the conceptual and applied foundations of the spread and scale-up of healthcare innovations, especially in the context of emergent learning health systems across Canada and beyond. [ABSTRACT FROM AUTHOR]

Published
2020
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173. Healthcare reforms, inertia polarization and group influence

Author

Contandriopoulos, Damien, primary, Brousselle, Astrid, additional, Larouche, Catherine, additional, Breton, Mylaine, additional, Rivard, Michèle, additional, Beaulieu, Marie-Dominique, additional, Haggerty, Jeannie, additional, Champagne, Geneviève, additional, and Perroux, Mélanie, additional

Published
2018
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176. Evaluating case studies of community-oriented integrated care

Author

Thomas, Paul, primary, Sachar, Amrit, additional, Papanikitas, Andrew, additional, While, Alison, additional, Brophy, Chris, additional, Manning, Chris, additional, Mills, Cliff, additional, Ruprah-Shah, Baljeet, additional, Millington-Sanders, Catherine, additional, Morris, David, additional, Kelley Patterson, Deirdre, additional, Hill, Diana, additional, McKenzie-Edwards, Emma, additional, Wright, Fiona, additional, Carelli, Francesco, additional, Shaw, Freddy, additional, Vedel, Isabelle, additional, Spicer, John, additional, Wewiora, Liz, additional, Gul, Malik, additional, Kirkbride BA, Michelle, additional, Sadlowski, Mike, additional, Breton, Mylaine, additional, Banarsee, Ricky, additional, Gupta, Sunjai, additional, Burch, Tony, additional, Kempe, Tulloch, additional, Tzortziou Brown, Victoria, additional, and Sanfey, John, additional

Published
2018
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177. Centralized Waiting Lists for Unattached Patients in Primary Care: Learning from an Intervention Implemented in Seven Canadian Provinces

Author

Breton, Mylaine, primary, Wong, Sabrina, additional, Smithman, Mélanie, additional, Kreindler, Sara, additional, Jbilou, Jalila, additional, Marshall, Emily, additional, Sutherland, Jason, additional, Brousselle, Astrid, additional, Shaw, Jay, additional, Crooks, Valorie, additional, Contandriopoulos, Damien, additional, Sasseville, Martin, additional, and Green, Michael, additional

Published
2018
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185. Perspectives des professionnels sur la mise en œuvre des modèles de services intégrés aux personnes âgées au Québec

Author

Couturier, Yves, Wankah Nji, Paul, Breton, Mylaine, Couturier, Yves, Wankah Nji, Paul, and Breton, Mylaine

Abstract

Introduction: Developed countries are integrating care for populations living with complex socio-sanitary needs to improve the quality of care. In 2004 the Québec government re-organised its health system, promoting the province-wide implementation of local health networks. Understanding how integrated care models are implemented in different settings may give insights on which factors determine the effective implementation of the model. Providers, as those who deliver services, are at the heart of these reforms. Their perspectives are therefore fundamental in identifying the best strategies for improving the implementation of integrated care models. This dissertation aimed at 1) describing and comparing the implementation of an integrated care model in different contexts as perceived by providers, 2) identifying factors providers perceived as influencing the implementation of an integrated care model. Theory and methods: Descriptive-comparison of the integrated care model along the lines of a framework proposing 6 dimensions (clinical, professional, organisational, systemic, functional, and normative) of integration. Thematic analysis along the lines of a framework positing that structural, organisational, provider, innovation, and patient factors would influence the implementation of an integrated care model. A qualitative multiple case study was done in three cases in Québec based on document analysis and semi-structured interviews of 28 providers. Results: The three cases revealed a great overlap in the implementation of the six dimensions of the integrated care model, reflecting the influence of the systemic dimension, which was mostly prioritised by government since 2004. None the less, there was some variability in the implementation of some clinical components like case management, reflecting the influence of the local context. Structural and organisational factors facilitated and/or hindered the implementation of different components of the integr, Introduction : Les pays développés cherchent à intégrer les services afin d'améliorer la qualité des soins aux populations vivant avec des besoins socio-sanitaires complexes. Dans cette perspective, le gouvernement du Québec a réorganisé en 2004 son système de santé, en promouvant la mise en oeuvre de réseaux locaux de services à l’échelle locale. Une meilleure compréhension de la façon dont les modèles de services intégrés sont implantés dans différents contextes permet d’identifier les facteurs qui déterminent l’efficience de cette implantation. Les professionnels, en tant que ceux qui incarnent les services, sont au coeur de ces transformations, et leurs perspectives sont donc fondamentales pour identifier les meilleures stratégies qui permettent d’améliorer l’intégration des services. Ainsi, sur la base de leurs perspectives, ce mémoire vise à 1) décrire et comparer la mise en oeuvre d’un modèle de services intégrés dans différents contextes, et 2) identifier les facteurs influençant la mise en oeuvre de ce modèle de services intégrés. Théorie et méthodes : Un cadre conceptuel suggérant six dimensions (clinique, professionnelle, organisationnelle, systémiques, fonctionnelle et normative) de l’intégration a été utilisé pour décrire et comparer les modèles de services intégrés. Puis, un cadre conceptuel suggérant que les facteurs structurels, organisationnels, professionnels, de l’innovation, ainsi que les caractéristiques des patients influencent la mise en oeuvre des modèles de services intégré. Une étude de cas multiples a été menée dans trois territoires au Québec, sur la base d'une analyse documentaire et d'entrevues semi-structurées réalisées auprès de 28 professionnels. Résultats : Les trois cas ont révélé une grande convergence dans la mise en oeuvre des six dimensions des services intégrés, reflétant l’importance de l'influence de la dimension systémique, qui fut de facto la priorité du gouvernement depuis 2004. Néanmoins, l’analyse montre une certaine va

Published
2017

188. Managerial strategies for integrated care: Health care provider engagement in the iCOACH project

Author

Shaw, James, primary, Baker, G. Ross, additional, Gutberg, Jennifer, additional, Barnsley, Jan, additional, Steele Gray, Carolyn, additional, Breton, Mylaine, additional, Belzile, Louise, additional, Guillette, Maxime, additional, Embuldeniya, Gayathri, additional, McKillop, Ann, additional, Wodchis, Walter, additional, Sheridan, Nicolette, additional, Parsons, John, additional, and Kenealy, Tim, additional

Published
2017
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195. Implementing Community Based Primary Healthcare for Older Adults with Complex Needs in Quebec, Ontario and New-Zealand: Describing Nine Cases

Author

Breton, Mylaine, primary, Gray, Carolyn Steele, additional, Sheridan, Nicolette, additional, Shaw, Jay, additional, Parsons, John, additional, Wankah, Paul, additional, Kenealy, Timothy, additional, Baker, Ross, additional, Belzile, Louise, additional, Couturier, Yves, additional, Denis, Jean-Louis, additional, and Wodchis, Walter P., additional

Published
2017
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197. How do Policy and Institutional Settings Shape Opportunities for Community-Based Primary Health Care? A Comparison of Ontario, Québec and New Zealand

Author

Tenbensel, Tim, primary, Miller, Fiona, additional, Breton, Mylaine, additional, Couturier, Yves, additional, Morton-Chang, Frances, additional, Ashton, Toni, additional, Sheridan, Nicolette, additional, Peckham, Alexandra, additional, Williams, A Paul, additional, Kenealy, Tim, additional, and Wodchis, Walter, additional

Published
2017
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199. A comparative analysis of centralized waiting lists for patients without a primary care provider implemented in six Canadian provinces: study protocol

Author

Breton, Mylaine, primary, Green, Michael, additional, Kreindler, Sara, additional, Sutherland, Jason, additional, Jbilou, Jalila, additional, Wong, Sabrina T., additional, Shaw, Jay, additional, Crooks, Valorie A., additional, Contandriopoulos, Damien, additional, Smithman, Mélanie Ann, additional, and Brousselle, Astrid, additional

Published
2017
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