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Introduction: We sought to assess the care experience of primary health care users, to determine whether users' assessments of their experience vary according to the geographical context in which services are obtained, and to determine whether the observed variations are consistent across all components of the care experience. Methods: We examined the experience of 3389 users of primary care in 5 administrative regions in Quebec, focusing on accessibility, continuity, responsiveness and reported use of health services. Results: We found significant variations in users' assessments of the specific components of the care experience. Access to primary health care received positive evaluations least frequently, and continuity of information received the approval of the highest percentage of users. We also found significant variations among geographical contexts. Positive assessments of the care experience were more frequently made by users in remote rural settings; they became progressively less frequent in near-urban rural and near-urban settings, and were found least often in urban settings. We observed these differences in almost all of the components of the care experience. Conclusion: Given the relatively greater supply of services in urban areas, this analysis has revealed a rural-urban paradox in the care experience of primary health care users. [ABSTRACT FROM AUTHOR]

Offers a working definition of intersectoral action and explores the usefulness of coalition theory as a theoretical framework through which to understand intersectoral health-related action theoretically and practically. Review of related literature; Types of health-related intersectoral actions; Provincial coalition of public health agencies.

Abstract Background The work of general practitioners (GPs) is increasingly being looked at from the perspective of the strategies and factors shaping it. This reflects the importance given to primary care services in health care system reform. However, the literature provides little insight into the medical decision-making processes in general practice. Our main objective was to better understand how organizational and environmental factors influence the work of GPs. Methods We interviewed 28 GPs working in contrasting organizational settings and environments. The data analysis involved using structuration theory to enrich the interpretation of empirical material. Results We identified four main factors that influence the practice of GPs: mode of remuneration, peer-to-peer interactions, patients' demands and the availability of other medical resources in the environment. These four conditions of action – what we call primary effects – can directly influence the performance of medical acts and time management, as well as the degree of specialization of GPs. Decisions related to each of those aspects can have a variety of both intentional and non-intentional consequences – what we call secondary effects – that are then likely to become conditions for subsequent action. Conclusion This qualitative study helps shed light on the complex causal loops of interrelated factors that shape the work of GPs.

This article focuses on multilevel governance applied to health organizations in Québec (Canada). The objective is to understand the action levers that facilitate the adaptation of the services toward migrant populations. This type of population establishes itself as an excellent tracer case to analyze the adaptation process, its fractalization and its involvement with the Environment. The dynamics between the actors and their self-organization takes part in the development of a multilevel governance. Interactions with the Environment-both internal and external-highlight the development of networks that emerge from the field and are then implemented at strategic levels in the organizations. The presence of connectivity actors within the organization and the Environment is established. The context, the bonds of trust between the actors and the credibility of the policymakers are reflected as important factors. However, connectivity actors cannot be successful without the support and contribution of the more "hierarchical" actors. Eight action levers are revealed by the analysis. We categorized them in 3 functions: administrative, enabling, and emerging. The levers of the administrative and emerging functions require that the levers of the enabling function be credible and legitimate and be able to support them for the adaptation to spread throughout the healthcare organization, regardless of the scope or policymaking level. The fractal function facilitates this process, by combining connectivity actors with the implementation of connectivity structures., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

This study examines the relationship between the vulnerabilities of individuals and their assessments of their primary care experiences in the setting of a universal care system. It focuses on 2 specific objectives: (1) evaluating the influence of each of the 5 vulnerabilities on the assessment of the care experience; (2) evaluating the influence of the interactions between the different types of vulnerabilities on the assessment of the care experience. The study identifies the primary care experience of 9,206 people. The health-related, biological, material, relational, and cultural vulnerabilities are also evaluated. Generally, individuals' vulnerabilities are associated with a positive assessment of the primary care experience except for the cultural vulnerability. Material vulnerability is most frequently associated with a positive assessment of the primary care experience. The interactions between the multiple vulnerabilities present for one individual often modify the effect of vulnerability on the assessment of the experience of care. The positive effect of a vulnerability on the assessment of the care experience often increases in the presence of a second vulnerability, especially the health-related vulnerability. The simultaneous presence of health-related vulnerability cancels the negative influence of cultural vulnerability on the assessment of the primary care experience.

The article is based on a multidimensional conception of healthcare system performance. Our objectives are to assess the performance of the healthcare systems of 27 Organisation for Economic Co-operation and Development (OECD) countries and to discern the countries' profiles according to the homogeneity of their healthcare systems' levels of performance. The analyses were carried out on data collected from the 27 high-income OECD countries, primarily using the OECD Health Data 2007 database, the World Health Organization 2008 statistics, OECD Health at a Glance and OECD Social Indicators. Each healthcare system's performance was assessed on the basis of the volume of available resources, services produced and health outcomes achieved and efficiency, effectiveness and productivity, thus characterizing the investments made in proportion to the available resources and services produced. Overall performance profiles were constructed taking into account simultaneously the level of all these components. Using multiple clusters analysis, we were able to group the countries into four profiles (satisfactory, promising, weak-polarized and limited) according to the homogeneity of their performance levels. This article offers a broad overview of the performance of these healthcare systems. The results will enable decision-makers to know the strengths and weaknesses of their own health care system and also to compare it with those of other countries., (Copyright © 2012 John Wiley & Sons, Ltd.)

Two main avenues are advocated to improve the capability of healthcare systems to satisfy the public's needs and expectations: more resources and better organization. This paper sheds some light on this debate. It assesses the extent to which patients' positive rating of their healthcare experience and the extent to which they use services are related to the availability of healthcare resources. Findings indicate that patients' evaluations of their care experience and use of services were higher when the availability of resources was either limited or average. In no case were positive ratings of services and greater use of them associated with greater resource availability. Thus, simply adding resources runs the risk of diminishing, rather than improving, users' healthcare experience.

Brian Hutchison views the numerous initiatives on primary healthcare in provinces and territories as indications that transformative changes are finally under way in Canada. Changes are indeed occurring. New primary healthcare models are being introduced. One could question whether they are the most promising models and whether they have the characteristics to become performing ones. These initiatives are being taken precisely at the time when the performance of the Canadian healthcare system is at the bottom. But performance was a lot better long before these changes were being introduced. Something else is at play in shaping the Canadian healthcare system, which involves but goes beyond primary healthcare: a tilting healthcare system. Unless a rebalance in favour of primary healthcare is accomplished, it is unlikely that the introduction of new PHC models alone could make the difference.

Background: Primary care revival in Canada and elsewhere is viewed by many as conditional to the introduction of new organizational models. Endorsement by GPs is a key factor in the success of these models, and increasing GPs' job satisfaction is often one of the desired outcomes of the reforms currently underway., Objectives: The phenomenon of work satisfaction from the GP's perspective is not yet fully understood. The objectives of this study were to elicit its different facets and to understand better how organizational factors affect it., Methods: This is a case study carried out in the province of Quebec (Canada). We conducted semi-structured interviews with 28 GPs working in private clinics and community health centres (Centre local de services communautaires)., Results: The main themes uncovered are related to the relationship between time management and quality of care, variation in work, autonomy in day-to-day practice, team 'orientedness' and social rewards. We also found that some GPs prefer to combine work in different organizations and models in order to increase their job satisfaction and to better cope with an increasingly complex task environment., Conclusion: Our study provides a comprehensive view of the various dimensions that GPs consider important in their professional life. Our findings suggest that, for many GPs, the perfect practice is tailor made and implies a combination of organizational models in order to fulfil their multiple professional goals. This has important implications for decision makers who are promoting new primary care models.

The Forum Dialogue on national health systems which took place as a satellite meeting of the 2nd International Conference on Local and Regional Health Programmes compared four countries (Brazil, France, Switzerland and Canada) sustain "conditions to integrate prevention and promotion in health systems". Despite the diversity of the four systems presented, several similarities regarding difficulties faced and achievements obtained in the integration process have been extracted, which has allowed highlighting three perspectives of action. It is suggested that prevention and promotion can be integrated into health systems by mobilising the population and health professionals towards prevention, but with the condition that the promotion and prevention sector increase its credibility by developing practices of quality, organisation, discourse, and prevention practices adjusted to the health care context. Finally, exchange between the countries on this subject is the way forward to nourish the thinking and support each other to obtain this desired integration.

The objective of this study was to determine the effect of practice settings (CLSC and private office) and family characteristics (mother's age and education, children's rank in families) on children's immunization status and adherence to the immunization schedule. The study population was composed of 209 children born in 1991 and residing in the Regional Municipal County of Montmagny, Quebec. After adjusting for mother's education, those children vaccinated in a private office were at 13.3 times higher risk for incomplete immunization than those vaccinated in a CLSC. A similar but nonsignificant result was obtained regarding adherence to the immunization schedule. The factors likely to account for the results are the first contact and follow-up mechanisms put into place by the CLSC. The effectiveness of such mechanisms seems to be related to their population-based rather than client-oriented responsibility.

The objective was to describe the relationship between preoperative delay, postoperative complications, and risk of death at 6 months. The population is constituted of 200 subjects aged 65 years or older who were living at home and treated for a hip fracture in any of three of Québec's hospitals between April, 1st, 1987 and March, 31, 1989. Chi-square or F-test, and linear and logistic regression were used to test the relationship between the variables. Preoperative delays varied from 2 to 403 h (median, 45 h). Variations between hospitals were particularly important; median delay at hospital 1 was 109 h, at hospital 2, 36 h, at hospital 3, 30.5 h. Only 5% of the variance of the delay was explained by the subjects' characteristics before the fracture. The relationships between delay and postoperative complications are not significant. However, the risk of death at 6 months increased with the length of operative delay; the observed increase tends to be linear (p = 0.03). These results suggest first, that surgery for hip fracture had to be consider as an urgency, second, that it could be done 36 hours or less after the arrival at hospital.

Health care systems are rapidly shifting attention from providing health care to producing health, profoundly altering how and which services are provided. To free up individual and collective resources for investment in activities with a greater impact on health, less care will be given. This paper posits that the current model--increased health resources make for better health care make for better health status--is too simplistic a system. Structural problems inherent in this model are being observed as the boundaries of the paradigm are pushed. Resources are limited, and health outcomes are no longer being improved despite the application of large percentages of Gross National Product. A new health paradigm is emerging, one with increased focus on health prerequisites such as housing, minimum decent income, food, education, and good social and physical environment.

The recent reform of the health care system in Quebec can be viewed as the result of a continuous process that originated with the first reform launched in the early 70s. The reform focuses on three elements: decentralization, citizen participation, and outcome-centered management. The context in which the reform is being launched contains both favorable conditions and obstacles to its successful implementation.