Health and social services organisation

This summary includes highlights of the population survey results on services utilization by people living in Montérégie, unmet service needs and the assessments of care experiences of respondents who have a regular source of primary care. Moreover, the values obtained in 2010 are compared with those for 2005.

Primary Health Care (PHC) reform is currently underway in various Canadian provinces. Emerging models and policies are at various levels of implementation across differing jurisdictions. While there have been some evaluations of the impact of these reforms, there have been few cross provincial analyses. The aim of this project is to better understand the impact of emerging models and to identify the factors that have been facilitating or hindering their implementation.

A review of grey and published literature on primary care organisational models in Canada was achieved to describe the reform process in five Canadian provinces and understand the various contexts of reforms. Experts were asked to review these case studies and generate hypotheses with regard to potential barriers and facilitators of these reforms. A one-day deliberative forum was held on November 3^rd 2010, bringing together researchers (n=40) and decision-makers (n=20) from each province i…

In 2005, the Population Health and Health Services team, a joint team from Direction de santé publique de l'Agence de la santé et des services sociaux de Montréal and Institut national de santé publique du Québec, conducted a study in the two most populated regions of Québec (Montréal and Montérégie) to evaluate the association between primary care organizational models existing at that time and the population's care experiences. A second study was undertaken in 2010 to understand the evolution of primary care organizational models and how they have performed during the healthcare reform process, and to evaluate the organizational and contextual factors associated with these changes.

The study consists of three interrelated and hierarchically nested surveys:

• A population survey of adults randomly selected among the population of both regions to assess patient affiliation with primary care organizations, use of services, various attributes of patient care exper…

Some Canadian regional health authorities have fully committed to partnerships with not-for-profit (NFP) organizations for the purpose of promoting healthy public policy. Some are seeking to go further in this direction and others have not yet embarked on this course. This document is part of a series of texts documenting existing partnership practices and analyzing their contributions in terms of public health. The aim is to allow authorities to weigh the benefits of such partnerships for the health of the populations under their responsibility and to determine the conditions for implementing such action.

Specifically, this document describes how the establishment of partnerships between the Vancouver regional health authority and an NFP organization delivering “low-threshold services” made it possible to reach people living with mental illness or substance abuse problems, while at the same time acting on the social and public policy context that, in part, determined their…

Population targeted by the screening

All women who are sexually active or were in the past.

Sexual activities include all types of genital contact, with or without vaginal penetration, with male or female partners.

At what age should screening begin?

The recommended age to begin screening is 21.

However, screening can be delayed for women who have not yet had sexual activity at this age. Exceptionally and based on the clinical context, screening may begin earlier, for example, among immunodepressed young women.

How often should one have a screening test?

The recommended interval between screening tests is two to three years.

At what age should screening be stopped?

Among women who have had screening tests regularly, screening may cease at the age of 65 if the results of the last two tests conducted in the previous 10 years were neg…

In Canada, everyone has the right to receive health and social services in the language of their choice—English or French (Official Languages Act, 1985). In Québec, health and social services legislation affirms English speakers’ right to receive health and social services in English.

From this perspective, it will be instructive to analyze whether healthcare providers communicate in the minority official language, i.e., English in Québec. Using the 2001 and 2006 censuses, Statistics Canada drew a picture of official-language knowledge among healthcare professionals, and we have examined that data to assess the situation in Québec. The province was divided into five (5) geographic regions that can be linked to Québec’s health and social services regions.

A number of linguistic variables are available from the census, including native language, language spoken at home, knowledge of official languages, and the derived “first official language spoken” (FOLS) variable2.…

By its very nature, screening is characterised by administering a test to presymptomatic or early symptomatic individuals who may benefit from a more effective intervention if it is performed before the usual time of diagnosis.

Far from being a trivial intervention, screening can lead to significant consequences to the people screened. Therefore, before offering screening to workers, its effectiveness and the predominance of benefits over disadvantages must be demonstrated at the population level. Furthermore, screening should have the recommended characteristics in order that the expected benefits can be observed in practice.

Approaches using algorithms or flowcharts are generally meant to be sequential. Our approach had to be flexible and allow for compromises. The proposed approach involves three key decision-making nodes, which must generally be addressed in a sequential manner. Generally speaking, a satisfactory response to one of them is required before moving…

Randomized comparative trials have shown that screening can reduce the mortality from colorectal cancer. However, due to difficulties of implementation, as observed in various countries, the expected benefits might not be achieved. The Committee recommends that the following conditions be met prior to implementing a provincial program:

Accessibility to colonoscopic examinations should be governed by the implementation of clinical, quality and performance standards that will be applied to all clienteles in all services offering this examination in Québec.

Individuals with a high risk of colorectal cancer, primarily those identified by a family history of colorectal cancer, should be so informed, and they should have access to screening that corresponds to their specific risk.

A demonstration project to show the feasibility of a program targeting average-risk individuals should be carried out before implementing a program at the provincial level.

The ef…

In 2007, the Comité sur l'immunisation du Québec (CIQ) recommended the establishment of a human papillomavirus (HPV) immunization program with the main objective of reducing the incidence of cervical cancer. In its recommendation paper, the CIQ pointed out the importance of measuring the impact of such a program and the necessary complementarity that should exist between the immunization program and cancer screening activities. However, it was not within the organization's mandate to issue specific recommendations regarding screening.

The present recommendation paper is an extension of the CIQ's recommendations. Its objectives are to clarify the relevance of cervical cancer screening now that vaccination is on its way, to document the current weaknesses in screening, and most of all, to identify the conditions, strategies and means to maximize the effectiveness and efficiency of cervical cancer screening in Québec.

The analysis of current screening weaknesses was bas…

The survey was conducted during the summer of 2003 using a representative sample of residents aged 12 and older from the nine communities in Iiyiyiu Aschii: Chisasibi, Eastmain, Mistissini, Nemaska, Oujé- Bougoumou, Waskaganish, Waswanipi, Wemindji, and Whapmagoostui.

• 87% of residents received some type of health care in the year prior to the survey. Use of health care was affected by factors such as age, sex, and education. It was also associated with need: people in poor health and those with chronic conditions were more likely to consult all types of health professionals (particularly specialists).
• Residents of inland communities were more likely than coastal residents to consult most types of health professionals, including dentists, and were also more likely to be hospitalized.
• 14% of respondents reported an unmet need for health care in the year prior to the survey. Women, younger adults, and people living in the inland communities were more…