Richard Lucie, Pineault Raynald, D'Amour Danielle, Brodeur Jean-Marc, Séguin Louise, Latour Robert, Labadie Jean-François
Faculty of Nursing, Université de Montréal, Canada.
Health Soc Care Community. 2005 Sep;13(5):399-408. doi: 10.1111/j.1365-2524.2005.00576.x.
Research has shown that preventive and health promotion (PHP) services offered by community health centres are often vulnerable in times of health reform or budgetary cutbacks. The present study was conducted in Québec, Canada, approximately 10 years after the start of a major transformation of health care services. The objectives were: (1) to examine the diversity of infant/toddler prevention and health promotion services offered by centres locaux de services communautaires (CLSCs, local community health and social services centres); and (2) to investigate the organisational and environmental correlates of such diversity. All Québec CLSCs were invited to complete a survey questionnaire regarding their PHP services (response rate = 69%). Data on environmental and organisational factors were extracted from existing Québec government data sets. Bivariate and multivariate analyses were performed to identify the correlates of the CLSCs' level of diversity of PHP services. The results revealed that CLSCs varied greatly in terms of their diversity of PHP services. The number of full-time equivalents in the Child and Family Services Programme (one of two programmes aimed at reaching the targeted clientele) and the degree of CLSC collaboration with other community-based organisations in the planning and delivery of PHP activities were positively associated with the level of diversity, whereas the unemployment rate in the population served was a negative predictor. This study makes an important contribution in being one of the very few which contribute to building our knowledge about the performance of community health centres. Identifying the correlates of diversity among PHP services offered by CLSCs helps us to begin to understand the processes at work in the production of PHP activities, as well as the potential leveraging forces.
研究表明，在医疗改革或预算削减时期，社区卫生中心提供的预防和健康促进（PHP）服务往往较为脆弱。本研究在加拿大魁北克进行，此时距离医疗服务重大转型开始约10年。目标如下：（1）考察社区当地服务中心（CLSCs，地方社区卫生和社会服务中心）提供的婴幼儿预防和健康促进服务的多样性；（2）调查这种多样性的组织和环境相关因素。所有魁北克CLSCs都被邀请填写一份关于其PHP服务的调查问卷（回复率 = 69%）。环境和组织因素的数据从魁北克政府现有的数据集中提取。进行了双变量和多变量分析，以确定CLSCs的PHP服务多样性水平的相关因素。结果显示，CLSCs在PHP服务的多样性方面差异很大。儿童和家庭服务项目（旨在覆盖目标客户群体的两个项目之一）的全职等效人员数量以及CLSCs在PHP活动的规划和提供方面与其他社区组织的合作程度与多样性水平呈正相关，而所服务人群的失业率是一个负向预测因素。本研究是极少数有助于增进我们对社区卫生中心绩效了解的研究之一，做出了重要贡献。确定CLSCs提供的PHP服务多样性的相关因素有助于我们开始理解PHP活动产生过程中起作用的机制以及潜在的推动力量。
