Effects on patients of variations in the implementation of a cardiometabolic risk intervention program in Montréal.

Introduction: In 2011, the Agence de la santé et des services sociaux de Montréal (ASSSM), in partnership with the region's Centres de santé et de services sociaux (CSSS), coordinated the implementation of a program on cardiometabolic risk based on the Chronic Care Model. The program, intended for patients suffering from diabetes or hypertension, involved a series of individual follow-up appointments, group classes and exercise sessions. Our study assesses the impact on patient health outcomes of variations in the implementation of some aspects of the program among the six CSSSs taking part in the study.

Nursing Practice in Primary Care and Patients' Experience of Care.

Purpose: Nurses are identified as a key provider in the management of patients in primary care. The objective of this study was to evaluate patients' experience of care in primary care as it pertained to the nursing role. The aim was to test the hypothesis that, in primary health care organizations (PHCOs) where patients are systematically followed by a nurse, and where nursing competencies are therefore optimally used, patients' experience of care is better.

What can organizations do to improve family physicians' interprofessional collaboration? Results of a survey of primary care in Quebec.

Objective: To assess the degree of collaboration in primary health care organizations between FPs and other health care professionals; and to identify organizational factors associated with such collaboration.

Design: Cross-sectional survey.

Setting: Primary health care organizations in the Montreal and Monteregie regions of Quebec.

Explaining time elapsed prior to cancer diagnosis: patients' perspectives.

Background: Cancer is the leading cause of death in Canada. Early cancer diagnosis could improve patients' prognosis and quality of life. This study aimed to analyze the factors influencing elapsed time between the first help-seeking trigger and cancer diagnosis with respect to the three most common and deadliest cancer types: lung, breast, and colorectal.

Do Gender-Predominant Primary Health Care Organizations Have an Impact on Patient Experience of Care, Use of Services, and Unmet Needs?

Physicians' gender can have an impact on many aspects of patient experience of care. Organization processes through which the influence of gender is exerted have not been fully explored. The aim of this article is to compare primary health care (PHC) organizations in which female or male doctors are predominant regarding organization and patient characteristics, and to assess their influence on experience of care, preventive care delivery, use of services, and unmet needs.

Implementation of an integrated primary care cardiometabolic risk prevention and management network in Montréal: does greater coordination of care with primary care physicians have an impact on health outcomes?

Introduction: Chronic disease management requires substantial services integration. A cardiometabolic risk management program inspired by the Chronic Care Model was implemented in Montréal for patients with diabetes or hypertension. One of this study's objectives was to assess the impact of care coordination between the interdisciplinary teams and physicians on patient participation in the program, lifestyle improvements and disease control.

International changes in end-of-life practices over time: a systematic review.

Background: End-of-life policies are hotly debated in many countries, with international evidence frequently used to support or oppose legal reforms. Existing reviews are limited by their focus on specific practices or selected jurisdictions. The objective is to review international time trends in end-of-life practices.

Evolution of Experience of Care of Patients with and without Chronic Diseases following a Québec Primary Healthcare Reform.

Objectives. To assess the extent to which new primary healthcare (PHC) models implemented in two regions of Quebec have improved patient experience of care, unmet needs, and use of services for individuals with and without chronic diseases, compared with other forms of PHC practices. Methods.

Impacts of Québec Primary Healthcare Reforms on Patients' Experience of Care, Unmet Needs, and Use of Services.

Introduction. Healthcare reforms launched in the early 2000s in Québec, Canada, involved the implementation of new forms of primary healthcare (PHC) organizations: Family Medicine Groups (FMGs) and Network Clinics (NCs). The objective of this paper is to assess how the organizational changes associated with these reforms have impact on patients' experience of care, use of services, and unmet needs.

Why Is Bigger Not Always Better in Primary Health Care Practices? The Role of Mediating Organizational Factors.

Size of primary health care (PHC) practices is often used as a proxy for various organizational characteristics related to provision of care. The objective of this article is to identify some of these organizational characteristics and to determine the extent to which they mediate the relationship between size of PHC practice and patients' experience of care, preventive services, and unmet needs. In 2010, we conducted population and organization surveys in 2 regions of the province of Quebec.

Barriers and Facilitators for Primary Care Reform in Canada: Results from a Deliberative Synthesis across Five Provinces.

Introduction: Since 2000, primary care (PC) reforms have been implemented in various Canadian provinces. Emerging organizational models and policies are at various levels of implementation across jurisdictions. Few cross-provincial analyses of these reforms have been realized.

The impact of primary healthcare reform on equity of utilization of services in the province of Quebec: a 2003-2010 follow-up.

Introduction: In 2003, the Quebec government made important changes in its primary healthcare (PHC) system. This reform included the creation of new models of PHC, Family Medicine Groups (e.g.

Pathways of healthcare utilisation in patients with suspected adolescent idiopathic scoliosis: a cross-sectional study.

Background: School screening programs for adolescent idiopathic scoliosis (AIS) have been discontinued in Canada and elsewhere because they were not considered cost-effective. In communities lacking such programs, we expect a significant variety of healthcare pathways and timeframes for patient referrals to orthopaedics. The objectives of this study were: 1) to characterise the healthcare pathways of young children with suspected AIS in a population without school screening; and 2) to investigate the relationships between these healthcare pathways and the appropriateness of referrals to specialised orthopaedic clinics.

Does the Primary Care Experience Influence the Cancer Diagnostic Process?

Objective. To analyze the impact of patients' experience of care at their usual source of primary care on their choice of point of entry into cancer investigation process, time to diagnosis, and presence of metastatic cancer at time of diagnosis. Method.

An Algorithm Using Administrative Data to Identify Patient Attachment to a Family Physician.

Background. Commonly self-reported questions in population health surveys, such as "do you have a family physician?", represent one of the best-known sources of information about patients' attachment to family physicians. Is it possible to find a proxy for this information in administrative data? Objective.

[Are new forms of primary health care organization (PHLU) associated with a better health care experience for patients with chronic diseases in Quebec?].

Aim: To assess the extent to which new forms of PHC organization - Family medicine groups (FMG) and Network clinics (NC) - established in Quebec since 2003, are associated with a better experience of care than other forms of PHC organization, for patients with chronic diseases.

Methods: Two surveys were conducted in 2010 in two regions of Quebec: the first among 9,180 residents and the second among 606 PHC organizations. Indices of experience of care were constructed concerning accessibility, continuity, comprehensiveness and perceived outcomes.

[Impact of standing order prescriptions on the joint follow-up of diabetics in primary care: a case study].

The burden of chronic disease requires a new organization of medical care and services. Enhancing collaboration among front-line care givers facilitates access to care and optimizes follow-up. As a result, a new organizational structure has been gradually deployed in Quebec since 2003.

Who gets a family physician through centralized waiting lists?

Background: North American patients are experiencing difficulties in securing affiliations with family physicians. Centralized waiting lists are increasingly being used in Organisation for Economic Co-operation and Development countries to improve access. In 2011, the Canadian province of Quebec introduced new financial incentives for family physicians' enrolment of orphan patients through centralized waiting lists, the Guichet d'accès aux clientèles orphelines, with higher payments for vulnerable patients.

Comparing end-of-life practices in different policy contexts: a scoping review.

Objectives: End-of-life policy reforms are being debated in many countries. Research evidence is used to support different assumptions about the effects of public policies on end-of-life practices. It is however unclear whether reliable international practice comparisons can be conducted between different policy contexts.

Effects of practice setting on GPs' provision of care.

Objective: To define a physician classification system based on practice settings and to analyze the service provision associated with those classifications.

Design: A cross-sectional, retrospective study.

Setting: Province of Quebec.

Impact of Québec's healthcare reforms on the organization of primary healthcare (PHC): a 2003-2010 follow-up.

Background: Healthcare reforms initiated in the early 2000s in Québec involved the implementation of new modes of primary healthcare (PHC) delivery and the creation of Health and Social Services Centers (HSSCs) to support it. The objective of this article is to assess and explain the degree of PHC organizational change achieved following these reforms.

Methods: We conducted two surveys of PHC organizations, in 2005 and 2010, in two regions of the province of Québec, Canada.

Primary healthcare solo practices: homogeneous or heterogeneous?

Introduction. Solo practices have generally been viewed as forming a homogeneous group. However, they may differ on many characteristics.