At the interface of community and healthcare systems: a longitudinal cohort study on evolving health and the impact of primary healthcare from the patient's perspectiv

Abstract

BackgroundMassive efforts in Canada have been made to renew primary healthcare. However, although early evaluations of initiatives and research on certain aspects of the reform are promising, none have examined the link between patient assessments of care and health outcomes or the impacts at a population level. The goal of this project is to examine the effect of patient-centred and effective primary healthcare on the evolution of chronic illness burden and health functioning in a population, and in particularly vulnerable groups: the multi-morbid and the poor.Methods/DesignA randomly selected cohort of 2000 adults aged 25 to 75 years will be recruited within the geographic boundaries of four local healthcare networks in Quebec. At recruitment, cohort members will report on socio-demographic information, functional health and healthcare use. Two weeks, 12 months and 24 months after recruitment, cohort participants will complete a self-administered questionnaire on current health and health behaviours in order to evaluate primary healthcare received in the previous year.The dependent variables are calculated as change over time of functional health status, chronic illness burden, and health behaviours. Dimensions of patient-centred care and clinical processes are measured using sub-scales of validated instruments. We will use Poisson regression modelling to estimate the incidence rate of chronic illness burden scores and structural equation modelling to explore relationships between variables and to examine the impact of dimensions of patient-centred care and effective primary healthcare.DiscussionResults will provide valuable information for primary healthcare clinicians on the course of chronic illness over time and the impact on health outcomes of accessible, patient-centred and effective care. A demonstration of impact will contribute to the promotion of continuous quality improvement activities at a clinical level. While considerable advances have been made in the management of specific chronic illnesses, this will make a unique contribution to effective care for persons with multiple morbidities. Furthermore, the cohort and data architecture will serve as a research platform for future projects.

Multimorbidity in primary care: a systematic review of prospective cohort studies

“…Three protocol papers [14][15][16] were excluded, leaving six papers, which related to five separate cohort studies (Figure 1). [17][18][19][20][21][22] Nature and scope of studies Study aims.…”

Avaliação da qualidade do cuidado a idosos nos serviços da rede pública de atenção primária à saúde de Porto Alegre, Brasil

“…O envelhecimento populacional é uma resposta à mudança de fenômenos demográficos e de saúde, especialmente a queda da fecundidade e da mortalidade, e o aumento da expectativa de vida [1][2][3][4] . Com o aumento da longevidade nas últimas décadas, também ocorreu um aumento do número de doenças crônicas, que, nos idosos, tendem a ser múltiplas 5 . Os sistemas de serviços de saúde, que antes lidavam com problemas agudos, hoje precisam atender às necessidades dos idosos, com uma variedade de fatores de risco, condições crônicas e incapacidades, tendo havido acréscimo na demanda pelos serviços 6 .…”

Integration of chronic disease prevention and management services into primary care: a pragmatic randomized controlled trial (PR1MaC)

“…The control cohort (group C) was from the Program of Research on the Evolution of a Cohort Investigating Health System Effects (PRE-CISE) research program. 28 The PRECISE program recruited a cohort of adults aged 25-75 years who were followed for 4 years with no intervention. The target population was community-dwelling adults undifferentiated by disease, who did not have any major cognitive impairment and were able to respond to written and oral questions in English or French.…”