Accessibility and continuity of health services : A study on primary healthcare in Quebec : Research report : Summary
- Overall, individuals’ assessment of their health care experiences with their regular source of primary care is favourable. These observations are similar to the results of international studies on health care user satisfaction. However, the population is clearly less appreciative of geographical and organisational accessibility.
- Appreciation of care experience varies greatly among territories of the health and social service centres (HSSC) in the two regions under study. The population’s perception of the primary care experience is generally better in Montérégie than in Montréal.
- The contrasts characterizing the population’s care experience is brought to light when CSSS territories are grouped by context. Urban territories described as affluent commerçant and characterised by the density of their populations and the wide diversity and quantity of health care resources obtain the lowest scores for both aggregate index of care experience and for most specific indices. It is also the context where the number of people who have regular family physicians is lowest. Rural territories, grouped in the category équilibre coordonné, are very different; they obtain the best scores for almost all care experience indices. Among this population, the rate of having a regular family physician is very high, with an average of 80%.
- Urban territories described as affluent commerçant have by far the greatest number of primary care resources. Even when taking into account the fact that resources in urban areas serve a sizeable number of people who live in other territories, this finding suggests that it is primary care service organisation rather than quantity of resources that shapes a positive care experience.
- Primary care organisations have been classified into five distinct models: four professional and one community model.
- The professional single provider model—characterised by a focus on the client, poor integration into the network, low number of resources, restricted range of services and mostly walk-in consultations—stands out favourably in terms of certain performance aspects, particularly the population’s care experience and response to vulnerable individuals. However, this model shows little potential for coverage of the population and poor conformance with the primary care organisational ideal type. Although it is difficult for this model to represent an option for reform, its performance in terms of response to the needs and expectations of individuals highlights the need to preserve a positive patientphysician relationship in the other, more complex organisational models.
- The professional contact model—characterised by a responsibility that focuses on individual clients, moderate integration into components of the health system, modest number of resources, restricted range of services and mostly walk-in consultations— is the least well-performing model; it is noticeably unfavourable when compared with other models of primary care organisation. What is more, contrary to the set objectives, service accessibility in this model is inferior to that in other models.
- The professional coordination model—characterised by a responsibility that focuses on individual clients, moderate integration into components of the health system, average number of resources, a moderate rage of services and services provided mostly on an appointment basis—stands out favourably in terms of productivity, care experiences and population coverage. However, this model’s organisational characteristics conform less with an ideal-type organisational structure.
- The professional integrated coordination model— characterised by population-based responsibility, strong integration into the health network’s activities, a significant number of resources, a broad range of services delivered, and a mixture of services available through walk-in clinics or with appointments—stands out favourably from the other models in all aspects of performance. This model includes, for the large part, “Family Medicine Groups” (FMG) implemented in the two regions at the time of the study. Results aggregate to demonstrate that organisations associated with FMG post the best performance.
- The community model–characterised by a populationbased approach, public governance, many resources, a broad scope of services offered, and a mixture of walk-in or with appointment clinics—stands out in terms of how it conforms to ideal-type primary care organisations and individuals’ care experiences. However, low productivity and limited population coverage reduce its overall performance evaluation. These organisations are integrated into public institutions that extend beyond the context of general medical services delivery. An analysis of their potential for reform should take into account their complementary mission.
- The configuration profile of primary care service delivery differs greatly from one context to another. In rural areas, it is characterised by the predominance of professional integrated coordination organisations and the absence of the lack of a professional contact model. The community model is poorly represented here. In urban contexts, the single-provider model is still preferred, although each model is represented.