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.

Objectives To examine the extent to which experience of care varies across chronic diseases, and to analyze the relationship of primary health care (PHC) organizational models with the experience of care reported by patients in different chronic disease situations. Methods We linked a population survey and a PHC organizational survey conducted in two regions of Quebec. We identified five groups of chronic diseases and contrasted these with a no–chronic-disease group. Results Accessibility of care is low for all chronic conditions and shows little variation across diseases. The contact and the coordination-integrated models are the most accessible, whereas the single-provider model is the least. Process and outcome indices of care experience are much higher than accessibility for all conditions and vary across diseases, with the highest being for cardiovascular-risk-factors and the lowest for respiratory diseases (for people aged 44 and under). However, as we move from risk factors to more severe chronic conditions, the coordination-integrated and community models are more likely to generate better process of care, highlighting the greater potential of these two models to meet the needs of more severely chronically ill individuals within the Canadian health care system.

No abstract

Objective: To measure the association between primary healthcare (PHC) organizational types and patient coverage for clinical preventive services (CPs). Method: study conducted in quebec (2005), including a population-based survey of patients' experience of care (N=4,417) and a survey of PHC clinics. Outcome measures: Patient-reported CPs delivery rates and CPs coverage scores. multiple logistic regressions used to assess factors associated with higher probability of receiving CPs. Results: CPs delivery rates were higher among patients with a regular source of PHC. Higher CPs score was associated with having a public (OR 1.79; 95% CI 1.35-2.37) or mixed (OR 1.22; 95% CI 1.01-1.48) type of organization as source of PHC compared to a private one, and having had a high number of visits to the regular source of PHC in the past two years (≥6: OR 1.83; 95% CI 1.41-2.38) compared to a single visit. Conclusion: Public and mixed PHC organizations seem to perform better. CPs delivery is strongly associated with having a regular source of care. RésuméObjectif : mesurer la relation entre le type d' organisation de services médicaux de première ligne et la prestation des pratiques cliniques préventives (PCP). Méthodologie : étude menée au québec (2005), comprenant une enquête auprès

Two main avenues are advocated to improve the capability of healthcare systems to satisfy the public' s needs and expectations: more resources and better organization. This paper sheds some light on this debate. It assesses the extent to which patients' positive rating of their healthcare experience and the extent to which they use services are related to the availability of healthcare resources. findings indicate that patients' evaluations of their care experience and use of services were higher when the availability of resources was either limited or average. In no case were positive ratings of services and greater use of them associated with greater resource availability. Thus, simply adding resources runs the risk of diminishing, rather than improving, users' healthcare experience. RésuméDeux principales démarches sont favorisées pour l' amélioration de la capacité des systèmes de santé, afin de satisfaire les besoins et les attentes de la clientèle : des ressources accrues et une meilleure organisation. Cet article fait un peu de lumière sur ce débat. Il évalue à quel point l' appréciation positive des soins exprimée par les patients et leur degré d'utilisation des services sont liés à la disponibilité des ressources de soins de santé. Les résultats indiquent que l' évaluation de l' expérience et l'utilisation des services sont plus élevées quand la disponibilité des ressources est limitée ou de niveau moyen. Dans aucun cas, l' appréciation positive et une plus grande utilisation des services sont associées à une plus grande disponibilité de ressources. Ainsi, le simple fait d'injecter des ressources peut conduire au risque de diminuer l' appréciation de l' expérience de l'utilisateur, au lieu de l' améliorer.