Emerging organisational models of primary healthcare and unmet needs for care: insights from a population-based survey in Quebec province
BACKGROUND: Reform of primary healthcare (PHC) organisations is underway in Canada. The capacity of various types of PHC organizations to respond to populations' needs remains to be assessed. The main objective of this study was to evaluate the association of PHC affiliation with unmet needs for care. METHODS: Population-based survey of 9205 randomly selected adults in two regions of Quebec, Canada. Outcomes Self-reported unmet needs for care and identification of the usual source of PHC. RESULTS: Among eligible adults, 18% reported unmet needs for care in the last six months. Reasons reported for unmet needs were: waiting times (59% of cases); unavailability of usual doctor (42%); impossibility to obtain an appointment (36%); doctors not accepting new patients (31%). Regression models showed that unmet needs were decreasing with age and was lower among males, the least educated, and unemployed or retired. Controlling for other factors, unmet needs were higher among the poor and those with worse health status. Having a family doctor was associated with fewer unmet needs. People reporting a usual source of care in the last two-years were more likely to report unmet need for care. There were no differences in unmet needs for care across types of PHC organisations when controlling for affiliation with a family physician. CONCLUSION: Reform models of primary healthcare consistent with the medical home concept did not differ from other types of organisations in our study. Further research looking at primary healthcare reform models at other levels of implementation should be done.