Institut national de santé publique du Québec, 190 boulevard Crémazie Est, Montréal, Québec, Canada.
BMC Fam Pract. 2012 Jul 2;13:66. doi: 10.1186/1471-2296-13-66.
Reform of primary healthcare (PHC) organisations is underway in Canada. The capacity of various types of PHC organizations to respond to populations' needs remains to be assessed. The main objective of this study was to evaluate the association of PHC affiliation with unmet needs for care.
Population-based survey of 9205 randomly selected adults in two regions of Quebec, Canada. Outcomes Self-reported unmet needs for care and identification of the usual source of PHC.
Among eligible adults, 18% reported unmet needs for care in the last six months. Reasons reported for unmet needs were: waiting times (59% of cases); unavailability of usual doctor (42%); impossibility to obtain an appointment (36%); doctors not accepting new patients (31%). Regression models showed that unmet needs were decreasing with age and was lower among males, the least educated, and unemployed or retired. Controlling for other factors, unmet needs were higher among the poor and those with worse health status. Having a family doctor was associated with fewer unmet needs. People reporting a usual source of care in the last two-years were more likely to report unmet need for care. There were no differences in unmet needs for care across types of PHC organisations when controlling for affiliation with a family physician.
Reform models of primary healthcare consistent with the medical home concept did not differ from other types of organisations in our study. Further research looking at primary healthcare reform models at other levels of implementation should be done.
加拿大正在进行基层医疗（PHC）组织改革。各种类型的 PHC 组织对满足人群需求的能力仍有待评估。本研究的主要目的是评估 PHC 附属机构与未满足的护理需求之间的关联。
对加拿大魁北克两个地区的 9205 名随机选择的成年人进行基于人群的调查。结果自我报告的护理需求未得到满足以及确定 PHC 的通常来源。
在符合条件的成年人中，18%在过去六个月中报告存在护理需求未得到满足的情况。报告未满足需求的原因包括：等待时间（59%的情况）；通常的医生无法提供服务（42%）；无法预约（36%）；医生不接受新患者（31%）。回归模型显示，未满足的需求随着年龄的增长而减少，男性、受教育程度最低、失业或退休的人较少。在控制其他因素的情况下，贫困人群和健康状况较差的人群的未满足需求更高。有家庭医生的人未满足的需求较低。在过去两年中报告有常规医疗服务来源的人更有可能报告存在护理需求未得到满足的情况。在控制与家庭医生的附属关系后，不同类型的 PHC 组织在护理需求未得到满足方面没有差异。
与医疗之家概念一致的基层医疗改革模式在我们的研究中与其他类型的组织没有区别。应该进一步研究在其他实施层面的基层医疗改革模式。
