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Visiting restrictions had to be imposed to prevent the spread of the COVID-19 virus and ensure the safety of long-term care home (LTCH) residents. This mixed method study aimed to explore residents’ and family caregivers’ acceptability of electronic tablets used to preserve and promote contact. Semi-structured individual interviews with 13 LTCH residents and 13 family caregivers were done to study their experiences, as well as the challenges and resources encountered in the implementation and use of videoconferencing. They had to rate, on a scale from 0 to 10, each of the 6 Theoretical Framework of Acceptability’ constructs of the acceptability of the intervention. The results confirm acceptability of videoconferencing, giving residents and caregivers the opportunity to talk to and see each other during the pandemic. Videoconferencing had some benefits, such as being less expensive, and taking less time and effort for family caregivers.

Ce document a été préparé afin de répondre à l’appel fait en juin 2020 du Ministre des Finances du Québec aux groupes de recherche qu’il appuie financièrement afin que ceux-ci proposent, par l’entremise de résultats de recherche appliquée ou de documents de réflexion, des actions à privilégier pour accélérer la reprise, assurer une croissance économique durable, dynamiser les régions du Québec et résorber le déficit budgétaire à venir tout en maintenant un financement adéquat pour la santé et l’éducation., Ministre des Finances du Québec

Le colloque « Financement des établissements de soins axé sur le patient: quelles considérations pour le Québec? » s'est tenu le 21 novembre 2018 à l'Université Laval. Il avait pour objectif de présenter aux décideurs, aux chercheurs, aux étudiants et aux gestionnaires d'établissements de services de santé les connaissances issues d'expériences étrangères concernant l'introduction du financement axé sur le patient (FAP) dans les établissements de soins. La présentation des expériences françaises, australiennes, ontariennes et québécoises a ainsi permis de mettre en lumière des enjeux récurrents concernant l'implantation de modèles de FAP. L'information recueillie soutiendra l'orientation des prochaines étapes de la réforme du financement des services de santé au Québec. À la suite des présentations des conférenciers invités, le ministère de la Santé et des Services sociaux (MSSS) a présenté trois enjeux prioritaires concernant la transformation du modèle de financement sur lesquels il souhaitait obtenir l'avis des acteurs du réseau de la santé. Les discussions qui ont suivi ont permis d'identifier les points importants pour les participants à propos des modalités de financement des patients, de la prise en considération de la performance et du financement de paniers de services.

Jusqu'à la pandémie de la COVID-19, les services de téléconsultation offerts par des médecins omnipraticiens au Québec étaient fortement limités essentiellement parce qu'ils n'étaient pas rémunérés puisque non reconnus comme des actes médicaux assurables. Le décret du 16 mars 2020 , adopté dans le contexte d'urgence sanitaire, permet maintenant cette rémunération au même titre que la rémunération associée à la visite du patient en clinique. De nombreux avantages sont reconnus et associés à la téléconsultation en première ligne si cette téléconsultation est bien encadrée. Le présent projet vise à examiner les bonnes pratiques d'encadrement de la téléconsultation et à proposer des recommandations avant que ne soit négocié la prochaine entente de rémunération avec les médecins omnipraticiens. Nous recommandons notamment une formation obligatoire, une clarification législative quant au droit des assureurs privés de rembourser la téléconsultation et des modalités de rémunération variées en fonction du type de téléconsultation. Il nous appert enfin impératif de rapidement commander une étude détaillée sur les bénéfices et les coûts de la téléconsultation au Québec.

This Pan-Canadian report describes patient and physician perspectives regarding current performance of primary care in each province based on data collected as part of the Quality and Costs of Primary Care (QUALICOPC) study. The QUALICOPC study is an international study of quality and costs of primary care in 34 countries. This report describes results from the data collected in Canada. It includes only data collected from patients and physicians in primary care practices that provide comprehensive primary care. Two patient surveys were conducted as part of the study; one that asked patients about the importance of various aspects of primary care and the other about patients’ experiences with primary care. This report focuses on aspects of primary care that respondents to patient surveys (distributed during visits to primary care physicians) identified as very important aspects of their primary care experience. Primary care physicians from all Canadian provinces were asked to participate in the QUALICOPC study by a research team in each province. In general, one physician from each primary care practice was invited to participate (23 practices, primarily in Quebec, had more than one physician respondent). Physicians who agreed to participate were sent a package containing four different surveys regarding: the practice setting ; the services provided in the practice ; patient values and patient experience. In each practice, the physician was asked to complete the survey about the services provided and any staff member could complete the practice setting survey. One patient was expected to respond to the patient values survey and nine other patients were expected to respond to the patient experience survey. Physicians returned completed surveys to the research team in each province. A total of 8,332 patients of 810 primary care physicians in 785 practices across Canada responded to the surveys. A total of 1,160 completed the patient values survey and a different sampl

The study analyzes the relationship between the risk of a hospitalization for an ambulatory care sensitive condition (ACSC), and the primary care payment and the organizational model used by the patient (fee-for-service, enhanced fee-for-service, blended capitation, blended capitation with interdisciplinary teams).The study used linked patient-level health administrative databases and census data housed at the Institute for Clinical Evaluative Sciences in Ontario. Since the province provides universal health care, the data capture all patients in Ontario, Canada's most populous province, with about 13 million inhabitants. All Ontario patients diagnosed with an ACSC prior to April 1, 2012, who had at least one visit with a physician between April 1, 2012, and March 31. 2013, were included in the study (n=1,710,310). Each patient was assigned to the primary care model of his/her physician. The different models were categorized as Fee-forService (FFS), enhanced-FFS, blended capitation, and interdisciplinary team. A logistic regression was used to model the risk of having an ACSC hospitalization during the one-year observation period. Adjustments were made for patient characteristics (age, sex, health status, and socio-economic status) and for the geographic location of the practice. Using patients belonging to FFS models as the reference group, the risk of an ACSC hospitalization was higher for patients belonging to the blended-capitation model using interdisciplinary teams (Adjusted Odds Ratio [AOR] = 1.06, 95% confidence interval [CI] = 1.00-1.12) and lower for enhancedFFS (AOR = 0.78, CI= 0.74-0.82) and blended capitation patients (AOR = 0.91, CI= 0.86-0.96). Using patients with hypertension as the reference group, the odds of an ACSC hospitalization were much higher for patients with any other ACSC and increased with patients' morbidity. The risk was lower for patients of higher socio-economic status (AOR=0.63, CI=0.60-0.67) in the highest neighborhood income quint

Background The purpose of this study is to analyze the relationship between newly introduced primary care models in Ontario, Canada, and patients’ primary care and total health care costs. A specific focus is on the payment mechanisms for primary care physicians, i.e. fee-for-service (FFS), enhanced-FFS, and blended capitation, and whether providers practiced as part of a multidisciplinary team. Methods Utilization data for a one year period was measured using administrative databases for a 10% sample selected at random from the Ontario adult population. Primary care and total health care costs were calculated at the individual level and included costs from physician services, hospital visits and admissions, long term care, drugs, home care, lab tests, and visits to non-medical health care providers. Generalized linear model regressions were conducted to assess the differences in costs between primary care models. Results Patients not enrolled with a primary care physicians were younger, more likely to be males and of lower socio-economic status. Patients in blended capitation models were healthier and wealthier than FFS and enhanced-FFS patients. Primary care and total health care costs were significantly different across Ontario primary care models. Using the traditional FFS as the reference, we found that patients in the enhanced-FFS models had the lowest total health care costs, and also the lowest primary care costs. Patients in the blended capitation models had higher primary care costs but lower total health care costs. Patients that were in multidisciplinary teams (FHT), where physicians are also paid on a blended capitation basis, had higher total health care costs than non-FHT patients but still lower than the FFS reference group. Primary care and total health care costs increased with patients’ age, morbidity, and lower income quintile across all primary care payment types. Conclusions The new primary care models were associated with lower total health ca

Medical genetic services are facing an unprecedented demand for counseling and testing for hereditary breast and ovarian cancer (HBOC) in a context of limited resources. To help resolve this issue, a collaborative oncogenetic model was recently developed and implemented at the CHU de Québec-Université Laval; Quebec; Canada. Here, we present the protocol of the C-MOnGene (Collaborative Model in OncoGenetics) study, funded to examine the context in which the model was implemented and document the lessons that can be learned to optimize the delivery of oncogenetic services. Within three years of implementation, the model allowed researchers to double the annual number of patients seen in genetic counseling. The average number of days between genetic counseling and disclosure of test results significantly decreased. Group counseling sessions improved participants' understanding of breast cancer risk and increased knowledge of breast cancer and genetics and a large majority of them reported to be overwhelmingly satisfied with the process. These quality and performance indicators suggest this oncogenetic model offers a flexible, patient-centered and efficient genetic counseling and testing for HBOC. By identifying the critical facilitating factors and barriers, our study will provide an evidence base for organizations interested in transitioning to an oncogenetic model integrated into oncology care; including teams that are not specialized but are trained in genetics.

Background: In Canada, 30%-60% of patients presenting to emergency departments are ambulatory. This category has been labeled as a source of emergency department overuse. Acting on the presumption that primary care practices and walk-in clinics offer equivalent care at a lower cost, governments have invested massively in improving access to these alternative settings in the hope that patients would present there instead when possible, thereby reducing the load on emergency departments. Data in support of this approach remain scarce and equivocal. Objective: The aim of this study is to compare the value of care received in emergency departments, walk-in clinics, and primary care practices by ambulatory patients with upper respiratory tract infection, sinusitis, otitis media, tonsillitis, pharyngitis, bronchitis, influenza-like illness, pneumonia, acute asthma, or acute exacerbation of chronic obstructive pulmonary disease. Methods: A multicenter prospective cohort study will be performed in Ontario and Québec. In phase 1, a time-driven activity-based costing method will be applied at each of the 15 study sites. This method uses time as a cost driver to allocate direct costs (eg, medication), consumable expenditures (eg, needles), overhead costs (eg, building maintenance), and physician charges to patient care. Thus, the cost of a care episode will be proportional to the time spent receiving the care. At the end of this phase, a list of care process costs will be generated and used to calculate the cost of each consultation during phase 2, in which a prospective cohort of patients will be monitored to compare the care received in each setting. Patients aged 18 years and older, ambulatory throughout the care episode, and discharged to home with one of the aforementioned targeted diagnoses will be considered. The estimated sample size is 1485 patients. The 3 types of care settings will be compared on the basis of primary outcomes in terms of the proportion of return vis

Having a child who lives with a Type 1 Diabetes (T1D) can represent a high burden for parents. The objective of our study is to identify and analyze the main challenges expressed by parents so that health care services better meet the needs of parents of T1D children. Semi-structured interviews were conducted with parents of 19 T1D children regarding detection and diagnosis, initial management at the hospital, post-discharge adaptation including daycare or school reintegration, and long-term T1D monitoring. Data analysis was performed following an inductive approach. The results showed a lack of knowledge regarding T1D in the society, especially for parents and educators. Furthermore, most parents felt overwhelmed at the hospital, and not ready for the intense self-management education (SME). They suggested it could be split over an extended period and discussed from a more practical perspective. Parents' burden is highest in the post-discharge adaptation stage especially for school reintegration, management of blood glucose levels and calculation of carbohydrates. Finally, returning to a social life was difficult, but contacts with diabetic families was a relief. In conclusion, the SME ought to be flexible and adapted to parents' needs. Spreading it over a longer period would ease families' experience. Efforts should also be made to alleviate the parents' burden on the post-discharge adaptation perceived as the most difficult stage, especially for school reintegration where training and resources on T1D should be given to key staff. Public education campaigns would raise awareness and ensure better knowledge of T1D by general population.

Background Variable, and typically inadequate, delivery of skills training following manual wheelchair (MWC) provision has a detrimental impact on user mobility and participation. Traditional in-person delivery of training by rehabilitation therapists has diminished due to cost, travel time, and most recently social distancing restrictions due to COVID-19. Effective alternative training approaches include eHealth home training applications and interactive peer-led training using experienced and proficient MWC users. An innovative TEAM Wheels program integrates app-based self-training and teleconference peer-led training using a computer tablet platform. Objective This protocol outlines implementation and evaluation of the TEAM Wheels training program in a randomized control trial using a wait-list control group. Setting The study will be implemented in a community setting in three Canadian cities. Participants Individuals ≥ 18 years of age within one year of transitioning to use of a MWC. Intervention Using a computer tablet, participants engage in three peer-led teleconference training sessions and 75–150 minutes of weekly practice using a video-based training application over 4 weeks. Peer trainers individualize the participants’ training plans and monitor their tablet-based training activity online. Control group participants also receive the intervention following a 1-month wait-list period and data collection. Measurements Outcomes assessing participation; skill capacity and performance; self-efficacy; mobility; and quality of life will be measured at baseline and post-treatment, and at 6-month follow-up for the treatment group. Impact statement We anticipate that TEAM Wheels will be successfully carried out at all sites and participants will demonstrate statistically significant improvement in the outcome measures compared with the control group

Primary care can potentially make an important contribution to improving health system performance. However, Canada does not fare as well as other developed countries in terms of timely access to primary health care services. In November 2015, Bill 20 was introduced in the province of Québec. The goal of Bill 20 was to optimize the utilisation of medical and financial resources to improve access to primary care. Bill 20 states the obligations of general practitioners to register a minimum number of patients, ensure the continuity of care of that population, and practice a minimum number of hours in hospitals. Many actors agreed that access to primary care had to be improved in Québec, but disagreed with Bill 20. In particular, family physicians strongly opposed the financial penalties that were introduced for physicians failing to meet the specified targets. In January 2018, 3 years after Bill 20, indicators for patient registration and continuity of care have considerably improved. However, the attractiveness of general practice seems to have decreased among medical graduates, which creates uncertainty regarding the sustainability of the achievements brought on by Bill 20

Background: Fibromyalgia, defined as chronic, wide-spread musculoskeletal pain, affects 4 to 10 million Americans and up to 6% of the world population. Medication nonadherence results in $100 to $300 billion in US health expenditures annually. Previous studies have examined medication adherence in commercial health plans or public health plans, but relatively few have compared both populations. The purpose of this study was to estimate the effect of type of insurance on adherence to medication for older adults with fibromyalgia. Methods: The retrospective cohort study analyzed medical claims of fibromyalgia patients collected between January 1, 2005 to June 30, 2011 from the Blue Cross Blue Shield South Carolina State Health Plan (BCBS) and Medicaid data. Older adults age 60 and older were included if they were prescribed duloxetine, milnacipran, or pregabalin (N=3,187). The primary outcome, medication adherence, was defined as having a medication possession ratio (MPR) of ≥ 80%. Independent variables included health insurance, FMS medication, selected comorbidities (FMS-related, musculoskeletal pain, or neuropathic pain), gender, age, and the interaction between health insurance type and treatment. Results: Logistic regression showed older adults with fibromyalgia on Medicaid were over 3 times more likely to be adherent when compared to BCBS in both unadjusted (OR: 3.21, p<0.0001) and adjusted models (OR: 3.74, p<0.0001). Conclusion: Most states do not require a Medicaid prescription co-pay; whereas, private insurers, like Blue Cross Blue Shield, require more out-of-pocket costs. Our study suggests that the co-pays for medications in private plans may present a barrier to patient adherence.

Xanthogranulomatous pyelonephritis (XGP) is a rare and severe form of pyelonephritis, generally treated with nephrectomy. We report a case of XGP complicated by a pyeloduodenal fistula in which conservative medical treatment was successful.