BackgroundWith 4.6 million patients who do not have a regular family physician, Canada performs poorly compared to other OECD countries in terms of attachment to a family physician. To address this issue, several provinces have implemented centralized waiting lists to coordinate supply and demand for attachment to a family physician. Although significant resources are invested in these centralized waiting lists, no studies have measured their performance. In this article, we present a performance assessment of centralized waiting lists for unattached patients implemented in Quebec, Canada.MethodsWe based our approach on the Balanced Scorecard method. A committee of decision-makers, managers, healthcare professionals, and researchers selected five indicators for the performance assessment of centralized waiting lists, including both process and outcome indicators. We analyzed and compared clinical-administrative data from 86 centralized waiting lists (GACOs) located in 14 regions in Quebec, from April 1, 2013, to March 31, 2014.ResultsDuring the study period, although over 150,000 patients were attached to a family physician, new requests resulted in a 30% median increase in patients on waiting lists. An inverse correlation of average strength was found between the rates of patients attached to a family physician and the proportion of vulnerable patients attached to a family physician meaning that as more patients became attached to an FP through GACOs, the proportion of vulnerable patients became smaller (r = −0.31, p < 0.005). The results showed very large performance variations both among GACOs of different regions and among those of a same region for all performance indicators.ConclusionsCentralized waiting lists for unattached patients in Quebec seem to be achieving their twofold objective of attaching patients to a family physician and giving priority to vulnerable patients. However, the demand for attachment seems to exceed the supply and there appears to be a tension between giving priority to vulnerable patients and attaching of a large number of patients. Results also showed heterogeneity in the performance of centralized waiting lists across Quebec. Finally, our findings suggest it is critical that similar mechanisms should use available data to identify the best strategies for reducing variations and improving performance.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0573-1) contains supplementary material, which is available to authorized users.

This study examines the impact of a self-management intervention for housebound adults with arthritis and presence of moderating variables. A total of 113 adults with a mean age of 77.7 years and diagnosed with osteoarthritis (62%) or rheumatoid arthritis (38%) were randomized to intervention (n = 65) and control groups (n = 48). Information on health, self-efficacy, outcome expectations, and health behaviors was collected (a) at baseline, (b) 2 months later, and (c) following the intervention. Multilevel analysis reveals that experimental group participants reported significantly fewer functional limitations and less helplessness than control participants postintervention. A trend for improved coping effectiveness was observed (p = .06). Greater improvements in outcome expectations and physical behaviors were associated with greater decreases in helplessness. Larger improvements in outcome expectations were associated with greater decreases in functional limitations. A structured self-management intervention can have a positive impact on the health status of housebound adults with arthritis.

BackgroundAccess to primary healthcare is an important social determinant of health and having a regular general practitioner (GP) has been shown to improve access. In Canada, socio-economically disadvantaged patients are more likely to be unattached (i.e. not have a regular GP). In the province of Quebec, where over 30% of the population is unattached, centralized waiting lists were implemented to help patients find a GP. Our objectives were to examine the association between social and material deprivation and 1) likelihood of attachment, and 2) wait time for attachment to a GP through centralized waiting lists.MethodsA cross-sectional study was conducted in five local health networks in Quebec, Canada, using clinical administrative data of patients attached to a GP between June 2013 and May 2015 (n = 24, 958 patients) and patients remaining on the waiting list as of May 2015 (n = 49, 901), using clinical administrative data. Social and material area deprivation indexes were used as proxies for patients’ socio-economic status. Multiple regressions were carried out to assess the association between deprivation indexes and 1) likelihood of attachment to a GP and 2) wait time for attachment. Analyses controlled for sex, age, local health network and variables related to health needs.ResultsPatients from materially medium, disadvantaged and very disadvantaged areas were underrepresented on the centralized waiting lists, while patients from socially disadvantaged and very disadvantaged areas were overrepresented. Patients from very materially advantaged and advantaged areas were less likely to be attached to a GP than patients from very disadvantaged areas. With the exception of patients from socially disadvantaged areas, all other categories of social deprivation were more likely to be attached to a GP compared to patients from very disadvantaged areas. We found a pro-rich gradient in wait time for attachment to a GP, with patients from more materially advantaged areas waiting less than those from disadvantaged areas.ConclusionOur findings suggest that there are socio-economic inequities in attachment to a GP through centralized waiting lists. Policy makers should take these findings into consideration to adjust centralized waiting list processes to avoid further exacerbation of health inequities.

Several arthritis self-management programs have been developed for community dwelling people. However, many of those are not suited for frail older seniors who have more comorbidity, are more likely to be isolated or present depression symptoms, and have fewer resources. To meet their needs and for the health professionals who provide services to them, this article discusses the development and follow-up of I'm Taking Charge of My Arthritis! a program for frail older adults who are housebound because of their arthritis. This program targeted management of symptoms like pain, as well as the impact of the disease on activities. The purpose of this paper is: (a) to discuss the development of the self-management program and (b) to report on the program's process analysis. This paper provides practitioners who want to develop a similar program with a rigorous program development approach.