Pineault R, Provost S, Hamel M, Couture A, Levesque J F
Direction de santé publique de l'Agence de la santé et des services sociaux de Montréal, Montréal, Quebec, Canada.
Chronic Dis Inj Can. 2011 Jun;31(3):109-20.
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.
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.
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.
探讨不同慢性病患者的护理体验差异程度，并分析初级卫生保健（PHC）组织模式与不同慢性病情况下患者报告的护理体验之间的关系。
我们将在魁北克两个地区进行的人口调查和初级卫生保健组织调查相联系。我们确定了五组慢性病，并将其与无慢性病组进行对比。
所有慢性病的护理可及性都较低，且各疾病间差异不大。联系和协调整合模式的可及性最高，而单一提供者模式的可及性最低。护理体验的过程和结果指标在所有情况下都远高于可及性，且因疾病而异，心血管危险因素方面最高，呼吸系统疾病（44岁及以下人群）方面最低。然而，随着我们从危险因素转向更严重的慢性病，协调整合模式和社区模式更有可能产生更好的护理过程，这凸显了这两种模式在加拿大医疗保健系统中满足更严重慢性病患者需求方面的更大潜力。
