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Comparative Study
. 2007 Jun;53(6):1057, 2001:e.1-6, 1056.

Room for improvement: patients' experiences of primary care in Quebec before major reforms

Jeannie L Haggerty  1 , Raynald Pineault, Marie-Dominique Beaulieu, Yvon Brunelle, Josée Gauthier, François Goulet, Jean Rodrigue
Affiliations
Comparative Study

Room for improvement: patients' experiences of primary care in Quebec before major reforms

Jeannie L Haggerty et al. Can Fam Physician. 2007 Jun.

Abstract
in English, French

Objective: To investigate variations in accessibility, continuity of care, and coordination of services as experienced by patients in Quebec on the eve of major reforms, and to provide baseline information against which reforms could be measured.

Design: Multilevel cross-sectional survey of practice.

Setting: One hundred primary health care settings were randomly selected in urban, suburban, rural, and remote locations in 5 health regions in Quebec.

Participants: In each clinic, we chose up to 4 physicians and 20 consecutive patients consulting each physician.

Main outcome measures: Patients' responses to a self-administered questionnaire, the Primary Care Assessment Tool, that assessed patient-provider affiliation, accessibility, relational continuity, coordination of primary and specialty care, and whether patients received health promotion and preventive services.

Results: A total of 3441 patients participated (87% acceptance rate) in 100 clinics (64% response rate). Timely access was difficult; only 10% expressed confidence they could be seen by their regular doctors within a day if they became suddenly ill. Average waiting time for a doctor's appointment was 24 days. Coordination of care with specialists was at minimally acceptable levels. Patients with family physicians recalled them addressing only 56% of the health promotion and preventive issues appropriate for their age and sex, and patients without family physicians recalled physicians addressing substantially fewer (38%). Most patients reported they were highly confident that their physicians knew them well and would manage their care beyond clinical encounters (relational continuity). The exception was the 16% of patients overall who did not have family physicians (34% of patients at walk-in clinics).

Conclusion: This survey highlights serious problems with accessibility. Improvement is needed urgently to avoid deterioration of patients' confidence in the health system even though patients rate their relationships with their physician highly. Health promotion, preventive services, and coordination with specialists also needed to be improved, and careful thought must be given to the plight of those without family physicians.

OBJECTIF: Déterminer les différences d’accessibilité, de continuité des soins et de coordination des services selon l’expérience des patients du Québec à la veillede réformes majeures, et fournir les données de base qui permettront d’évaluer les effets des réformes.

TYPE D’ÉTUDE: Enquête transversale à plusieurs niveaux portant sur la pratique.

CONTEXTE: On a choisi au hasard 100 établissements de soins primaires de divers milieux: ville, banlieue, campagne et régions éloignées dans 5 régions sanitaires du Québec.

PARTICIPANTS: Dans chaque clinique, on a choisi 4 médecins et 20 patients consécutifs de chaque médecin.

PRINCIPAUX PARAMÈTRES ÉTUDIÉS: Réponses des patients à l’Outil d’évaluation des soins primaires, un questionnaire auto-administré qui évalue l’affiliation patient-soignant, l’accessibilité, la continuité relationnelle, la coordination entre soins primaires et spécialisés, et le fait que les patients sont ou non l’objet de promotion de la santé et de services préventifs.

RÉSULTATS: Au total, 3441 patients ont participé (taux d’acceptation de 87%) dans 100 cliniques (taux de réponse de 64%). L’accès au médecin habituel en temps opportun était difficile, seulement 10% se disant confiants de pouvoir être reçus en moins de 24 heures en cas de maladie soudaine. Le temps d’attente moyen pour rencontrer un médecin était de 24 jours. La coordination des soins avec les spécialistes était tout au plus acceptable. Les patients avec médecins de famille rapportaient que ceux-ci avaient abordé seulement 56% des questions de promotion et de prévention de la santé appropriées pour leur âge et leur sexe et ceux sans médecins de famille rapportaient que les médecins avaient abordé encore beaucoup moins de ces questions (38%). La plupart des patients se disaient très confiants que leur médecin les connaissaient bien et qu’il s’occuperait du suivi au-delà des rencontres cliniques (continuité relationnelle). Faisaient exception ceux qui n’avaient pas de médecin de famille (16% du total et 34% des patients des cliniques sans rendezvous).

CONCLUSION: Cette enquête révèle de sérieux problèmes d’accessibilité. Il est urgent d’apporter des correctifs pour éviter que la confiance des patients dans le système de santé ne subisse une baisse, même si les patients disent avoir une excellente relation avec leur médecin. Il y a également place à l’amélioration pour la promotion de la santé, les services préventifs et la coordination avec les spécialistes; on doit aussi accorder une attention particulière à la situation des patients sans médecin de famille.

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Figures

Figure 1
Figure 1
Selection of study clinics
Figure 2
Figure 2
Mean level of patients’ experience: Comparison of urban and rural patients’ ratings relative to minimum expected and maximum scores (all differences were statistically significant).
See this image and copyright information in PMC

References

    1. Clair M, editor. Commission d’étude sur les services de santé et les services soci-aux: les solutions émergentes. Rapport et recommandations. Quebec city, Que: Government of Quebec; 2000.
    1. Sinclair DG, editor. Looking back, looking forward: the Ontario Health Services Restructuring Commission (1996–2000). A legacy report. Toronto, Ont: Government of Ontario; 2000.
    1. Fyke KJ, editor. Caring for Medicare: sustaining a quality system. Regina, Sask: Policy and Planning Branch, Saskatchewan Health; 2001.
    1. Premier’s Advisory Council on Health. A framework for reform. Report of the Premier’s Advisory Council on Health. Edmonton, Alta: Government of Alberta; 2001. [Accessed 2007 March 30]. Available from: www.health.gov.ab.ca/resources/publications/PACH_report_final.pdf.
    1. Romanow RJ. Building on values—the future of health care in Canada. Final report. Ottawa, Ont: Commission on the Future of Health Care in Canada; 2002.

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