La réforme des soins primaires de santé mentale au Québec et le rôle et les stratégies de coordination des omnipraticiens

Fleury, Marie‐Josée

doi:10.7202/1025905ar

Cited by 13 publications

(4 citation statements)

References 33 publications

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“…MH systems in developed countries (United Kingdom, Australia, Belgium, etc.) have undergone major transformation in recent decades aimed at improving overall performance [7–11], primary care [12, 13], service integration [14, 15], care continuity [16], and in adopting multidisciplinary teams, and recovery best-practices (e.g. care pathways, intensive case management, assertive community treatment) [17–19].…”

Section: Introductionmentioning

confidence: 99%

Assessing quality indicators related to mental health emergency room utilization

et al. 2019

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BackgroundThis descriptive study compared 2014–15 to 2005–06 data on the quality of mental health services (MHS) in relation to emergency room (ER) use to assess the impact of the 2005 Quebec MH reform regarding access, continuity and appropriateness of care for patients with mental illnesses (PMI).MethodsData emanated from the Quebec Integrated Chronic Disease Surveillance System (Quebec/Canada). Participants (865,255 for 2014–15; 817,395 for 2005–06) were age 12 or over, with at least one MI, including substance use disorders (SUD), diagnosed during an ER visit, outpatient treatment or hospitalization. Variables included: access (ER use/frequency, hospitalization rates, outpatient consultations preceding an ER visit), care continuity (outpatient consultations following an ER visit/hospitalization, consecutive returns to the ERs), and care appropriateness (high ER use, recurrence of yearly ER visits, length of hospitalization). Frequency distributions were calculated on sex, age and geographic area for ER visits/hospitalizations in 2014–15, and between 2014 and 15 and 2005–06.ResultsPMI accounted for 12 % of the Quebec population in 2014–15 (n = 865,255), of whom 39% visited an ER for any reason. Amount and frequency of ER use and number/length of hospitalizations were almost twice as high for PMI versus patients without MI; 17% of PMI were also high/very high ER users and were frequently hospitalized. Among PMI, ER users were also frequent users of outpatient services despite a lack of follow-up appointments after ER visits or hospitalizations. Findings revealed some positive changes over time, such as decreased ER and hospitalization rates; yet overall access, continuity and appropriateness of care, as measured in this study, remained low.ConclusionsThis study demonstrated that the Quebec reform did not produce a substantial impact on ER use or substantially improved care, as hypothesized. Better access and continuity of care should be promoted to reduce the high prevalence of ER use among PMI. Quality improvement in MHS may be realized if ERs are supported by substantial and well-integrated community MH networks.

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Section: Introductionmentioning

confidence: 99%

Assessing quality indicators related to mental health emergency room utilization

et al. 2019

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“…This may reflect the lack of access to primary care physicians in rural regions, with ratios of physicians per capita being between 30 to 50% greater in major urban centres compared to other regions [ 40 ], a situation that has barely evolved over the past 20 years [ 49 ]. General practitioners in rural areas may be especially overwhelmed and not able/willing to treat severe mental illnesses [ 50 ], preferring to refer to psychiatric care [ 51 , 52 ]. Community psychosocial services are also lacking outside urban areas [ 53 ], which may result in a greater involvement of medical professionnals.…”

Section: Discussionmentioning

confidence: 99%

Barriers and facilitators of access and utilization of mental health services among forensic service users along the care pathway

Leclair

Charette

Seto

et al. 2022

BMC Health Serv Res

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Background The verdict of Not Criminally Responsible on account of a Mental Disorder (NCRMD) is increasingly used to access specialized mental health services in Canada and elsewhere. This situation highlights the importance of ensuring timely access to services in the community to prevent violence and justice involvement. The objective of the present study is to identify individual and contextual barriers and facilitators of access to mental health services during the period preceding an offense leading to a verdict of NCRMD. Methods The sample includes 753 people found NCRMD in Québec, Canada. All episodes of mental health hospitalizations and service use before the index offense were identified using provincial administrative health data, for an average period of 4.5 years. Access was conceptualized as a function of the possibility of seeking, reaching and receiving appropriate health care services, based on Lévesque and colleagues patient-centred model of access to care. Generalized linear models were computed to identify the individual and contextual predictors of: (1) seeking mental healthcare (at least one contact with any type of services for mental health reasons); (2) reaching psychiatric care (at least one contact with a psychiatrist); (3) receiving psychiatric care, operationalized as (3a) continuity and (3b) intensity. Factors associated with volume of emergency mental health services were examined as exploratory analysis. Results Geographical considerations were highly important in determining who reached, and who received specialized mental health care – above and beyond individual factors related to need. Those who lived outside of major urban centres were 2.6 times as likely to reach psychiatric services as those who lived in major urban centres, and made greater use of emergency mental health services by 2.1 times. Living with family decreased the odds of seeking mental healthcare by half and the intensity of psychiatric care received, even when adjusting for level of need. Conclusions Findings support efforts to engage with the family of service users and highlights the importance of providing resources to make family-centred services sustainable for health practitioners. Health policies should also focus on the implementation of outreach programs, such as Forensic Assertive Community Treatment teams as part of prevention initiatives.

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“…Cette étude est ainsi originale, visant à dresser un portrait de l'utilisation de l'urgence au Québec des patients avec TM, y compris l'hospitalisation, ainsi que des raisons associées aux visites à l'urgence et à l'hospitalisation en 2014-2015, selon le sexe, l'âge, et la zone d'habitation. Certains résultats de 2014-15 seront aussi comparés à ceux des patients sans TM, ainsi qu'à ceux d'une seconde cohorte de patients avec TM, recrutés en 2000-01, année marquant le début des réformes des soins primaires au niveau international et au Québec 30,31 , afin de cerner l'évolution de l'utilisation de l'urgence.…”

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“…Les diagnostics sont codés selon la neuvième révision de la Classification internationale des maladies dans RAMQ, et de la dixième révision pour MED-ÉCHO. Soutenus par de précédents travaux 25,29,30,32 , les TM correspondent aux troubles : anxio-dépressifs i , de la personnalité ii , schizophréniques iii , du déficit de l'attention avec ou sans hyperactivité (TDAH) iv et autres i. (296.0 ; 296.2 ; 296.9 ; 300 ; 311.9 ; F30.0 ; F32.1-F32.5 ; F32.9 ; F33.0-F32.3 ; F32.9 ;…”

Section: Méthodologieunclassified

Utilisation de l’urgence au Québec des patients avec des troubles mentaux incluant les troubles liés aux substances psychoactives

Fleury

Fortin

Rochette

et al. 2019

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La réforme des soins primaires de santé mentale au Québec et le rôle et les stratégies de coordination des omnipraticiens

Cited by 13 publications

References 33 publications

Assessing quality indicators related to mental health emergency room utilization

Assessing quality indicators related to mental health emergency room utilization

Barriers and facilitators of access and utilization of mental health services among forensic service users along the care pathway

Utilisation de l’urgence au Québec des patients avec des troubles mentaux incluant les troubles liés aux substances psychoactives

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