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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]

Background: Physiological jaundice generally appears between the third and fifth days of life. The danger of hyperbilirubinemia is therefore a major challenge when postpartum hospital stays are short, and part of the responsibility for screening for signs of jaundice is assumed by the mother. The objective of this study was to identify the model of postnatal continuity of care most likely to prepare mothers for discharge, to reduce newborn readmission for jaundice, and to enhance maternal satisfaction. Methods: An epidemiological study was conducted in regions operating under 3 different models of postnatal continuity of care. Eligible mothers were those who had spent less than 60 hours in hospital after an uncomplicated vaginal delivery. Of this group, 70.8 percent participated in telephone interviews conducted 1 month after their deliveries (n = 1,096). Newborns who had presented with signs of jaundice were identified through statements from their mothers. Results: Of the participating newborns, 45.5 percent presented with signs of jaundice, and 3.2 percent were readmitted for jaundice during the first week of life. The follow-up procedures used in regions operating under a community-based model most closely followed the recommendations of health authorities and featured a high level of mothers' satisfaction. In the region operating under a mixed hospital model, mothers reported signs of jaundice significantly more often, and postdischarge services received by mothers were less effective at allaying their fears compared with other models. Phototherapy was offered in the home only in the region operating under a mixed ambulatory model, and no readmissions for jaundice were recorded in this region. Conclusions: An effective coordination between community-based perinatal services and hospital-linked home phototherapy in the form of an integrated network appears to be an essential condition for improved monitoring of newborns' health since it fosters a follow-up that is focused not only on jaundice but also on mothers' and newborns' needs while reducing the costs generated by newborn readmissions. (BIRTH 34:2 June 2007) [ABSTRACT FROM AUTHOR]

BACKGROUND: The debate continues as to what constitutes an adequate postnatal follow-up after an early hospital discharge. The main objective of this study was to determine whether the type and timing of postnatal services were associated with mothers' and newborns' health, breastfeeding duration, and maternal assessment of the delay and usefulness of the services they received after discharge. METHODS: A telephone survey was conducted one month after a vaginal, uncomplicated delivery by 2,583 mothers who had given birth in five health regions of the Province of Québec, between 1999 and 2003. RESULTS: The response rate to the survey was 72.1%. Virtually all the newborns (98.1%) had at least one routine contact with a health professional after discharge. Within 72 hours of discharge, 26.0% of the mothers received only a telephone call, 44.3% were visited by a public health nurse, 11.1% of the babies were examined by a physician and 49.5% were examined by a nurse or a physician. Newborns who had a first contact with a health professional within 72 hours of hospital discharge were less likely to have been readmitted to the hospital (adjusted Odds Ratio 0.45; 95% CI 0.21-0.97), while their mothers were less likely to have signs of moderate to severe depression at one month postpartum (adjusted Odds Ratio 0.60; 95% CI 0.45-0.79). The sooner the telephone call and the home visit were received the more likely the women were to have found that the services were useful. CONCLUSION: Our findings suggest that the timing, more than the type, of postnatal follow-up after an early obstetrical discharge could make a difference. [ABSTRACT FROM AUTHOR]

AIMS: This paper reports an investigation of the nature and strength of parental beliefs about their participation in their children's day-care surgery as well as demonstrated parental behaviours during the immediate post-recovery period. BACKGROUND: Parents want to participate in their children's hospital care but their behaviour does not reflect their intention. Parents' beliefs about their role in the hospital may be a factor influencing the way they help their children at the course of a day-care surgery. RESEARCH METHODS:A descriptive correlative design was used. French and English speaking parents of 3-12-year old children were asked to complete a self-administered questionnaire which comprised 42 items measuring the intensity of attitudes, norms and sense of control and their influence in predicting their intention to participate in hospital care. Parents' behaviours during the first hour following the child's return from the recovery room were video-recorded. RESULTS: A total of 220 parents participated in the study. Parental beliefs about participation in care were quite strong in terms of subjective norms, sense of control and attitude, predicting 64% of their intention to participate. Parents demonstrated mostly attitude type behaviours, while the level of demonstrated helping behaviours was somewhat low. CONCLUSIONS: Parents can be valuable partners in ambulatory care settings. Clinicians and health care managers should aim at establishing a true partnership with parents, in order to improve the quality of care given to children and their family in hospital and at home. [ABSTRACT FROM AUTHOR]

Research has shown that preventive and health promotion (PHP) services offered by community health centres are often vulnerable in times of health reform or budgetary cutbacks. The present study was conducted in Quebec, Canada, approximately 10 years after the start of a major transformation of health care services. The objectives were: (1) to examine the diversity of infant/toddler prevention and health promotion services offered by centres locaux de services communautaires (CLSCs, local community health and social services centres); and (2) to investigate the organisational and environmental correlates of such diversity. All Quebec CLSCs were invited to complete a survey questionnaire regarding their PHP services (response rate = 69%). Data on environmental and organisational factors were extracted from existing Quebec government data sets. Bivariate and multivariate analyses were performed to identify the correlates of the CLSCs' level of diversity of PHP services. The results revealed that CLSCs varied greatly in terms of their diversity of PHP services. The number of full-time equivalents in the Child and Family Services Programme (one of two programmes aimed at reaching the targeted clientele) and the degree of CLSC collaboration with other community-based organisations in the planning and delivery of PHP activities were positively associated with the level of diversity, whereas the unemployment rate in the population served was a negative predictor. This study makes an important contribution in being one of the very few which contribute to building our knowledge about the performance of community health centres. Identifying the correlates of diversity among PHP services offered by CLSCs helps us to begin to understand the processes at work in the production of PHP activities, as well as the potential leveraging forces. [ABSTRACT FROM AUTHOR]