Département de santé communautaire, Université de Sherbrooke, Sherbrooke, QC
Can J Public Health. 2010 Jul-Aug;101(4):314-7. doi: 10.1007/BF03405293.
In 2004, the Quebec government undertook a major reorganization of its health care system by integrating public health more formally into local governance structures. In all, 95 new organizations - Health and Social Services Centres (CSSS)--were created and given a population-based responsibility. This mandate required that CSSSs broaden their range of services by adopting a population-based plan and integrating public health into their activities. To accomplish this, they needed to link public health and health care issues more formally within a single governance structure. The aim of this article is to identify and analyze various activities undertaken by CSSS managers to fulfill their population-based responsibility.
We conducted a longitudinal case study of two CSSSs (2005-2008). Our analyses are based on real-time observations of 144 meetings of decision-makers/managers and professionals at the regional and local levels, 46 interviews with managers, as well as secondary data.
CSSSs focused on five areas of population-based responsibility: primary health care, specialized services, vulnerable groups, health promotion and social services. Over time, the activities developed by CSSSs in relation to these five areas reflected an increasingly population-based perspective on the delivery of health care services.
Service planning in the two cases under study is now based on a broader view of the health care continuum, and managers invest more time and resources in preventive interventions. Our study provides key information on the process of integrating a population-based perspective and preventive approaches in the planning and delivery of primary care services.
2004 年，魁北克省政府对其医疗保健系统进行了重大重组，通过将公共卫生更正式地纳入地方治理结构。总共创建了 95 个新组织——健康与社会服务中心（CSSS）——并赋予其基于人口的责任。这一任务要求 CSSS 通过采用基于人口的计划和将公共卫生纳入其活动来扩大其服务范围。为此，他们需要在单一治理结构内更正式地将公共卫生和医疗保健问题联系起来。本文的目的是确定和分析 CSSS 经理为履行其基于人口的责任而开展的各种活动。
我们对两个 CSSS（2005-2008 年）进行了纵向案例研究。我们的分析基于对决策者/经理和专业人员在区域和地方层面的 144 次会议的实时观察、46 次与经理的访谈以及次要数据。
CSSS 专注于五项基于人口的责任领域：初级保健、专业服务、弱势群体、健康促进和社会服务。随着时间的推移，CSSS 针对这五个领域开展的活动反映了对医疗保健服务提供的越来越基于人口的观点。
在所研究的两个案例中，服务规划现在基于更广泛的医疗保健连续体观点，并且管理人员投入更多的时间和资源用于预防干预措施。我们的研究提供了关于将基于人口的观点和预防方法纳入初级保健服务规划和提供的过程的关键信息。
