Breton Mylaine, Maillet Lara, Haggerty Jeannie, Vedel Isabelle
Professeure adjointe, Faculté de Médecine et des sciences de la santé, Centre de recherche - Hôpital Charles-Le Moyne, Longueuil (Québec), Canada.
École d'administration publique de l'Université de Montréal (ESPUM), Université de Montréal, Montréal (Québec), Canada.
London J Prim Care (Abingdon). 2014;6(4):71-8. doi: 10.1080/17571472.2014.11493420.
Background In 2004, the Québec government implemented an important reform of the healthcare system. The reform was based on the creation of new organisations called Health Services and Social Centres (HSSC), which were formed by merging several healthcare organisations. Upon their creation, each HSSC received the legal mandate to establish and lead a Local Health Network (LHN) with different partners within their territory. This mandate promotes a 'population-based approach' based to the responsibility for the population of a local territory. Objective The aim of this paper is to illustrate and discuss how primary healthcare organisations (PHC) are involved in mandated LHNs in Québec. For illustration, we describe four examples that facilitate a better understanding of these integrated relationships. Results The development of the LHNs and the different collaboration relationships are described through four examples: (1) improving PHC services within the LHN - an example of new PHC models; (2) improving access to specialists and diagnostic tests for family physicians working in the community - an example of centralised access to specialists services; (3) improving chronic-disease-related services for the population of the LHN - an example of a Diabetes Centre; and (4) improving access to family physicians for the population of the LHN - an example of the centralised waiting list for unattached patients. Conclusion From these examples, we can see that the implementation of large-scale reform involves incorporating actors at all levels in the system, and facilitates collaboration between healthcare organisations, family physicians and the community. These examples suggest that the reform provided room for multiple innovations. The planning and organisation of health services became more focused on the population of a local territory. The LHN allows a territorial vision of these planning and organisational processes to develop. LHN also seems a valuable lever when all the stakeholders are involved and when the different organisations serve the community by providing acute care and chronic care, while taking into account the social, medical and nursing fields.
背景 2004年，魁北克省政府实施了一项重要的医疗保健系统改革。该改革基于创建名为健康服务与社会中心（HSSC）的新组织，这些组织由合并多个医疗保健组织而成。每个HSSC成立后，都获得了在其辖区内与不同合作伙伴建立和领导地方健康网络（LHN）的法定任务。这项任务促进了基于对当地人口负责的“以人口为基础的方法”。目的 本文旨在说明和讨论初级医疗保健组织（PHC）如何参与魁北克的法定地方健康网络。为便于说明，我们描述了四个例子，以更好地理解这些整合关系。结果 通过四个例子描述了地方健康网络的发展和不同的合作关系：（1）改善地方健康网络内的初级医疗保健服务——新初级医疗保健模式的一个例子；（2）改善社区家庭医生获得专科医生和诊断测试的机会——专科医生服务集中接入的一个例子；（3）改善地方健康网络人群的慢性病相关服务——糖尿病中心的一个例子；（4）改善地方健康网络人群获得家庭医生的机会——无固定医生患者集中等候名单的一个例子。结论 从这些例子中，我们可以看到大规模改革的实施涉及将系统各级的行为者纳入其中，并促进了医疗保健组织、家庭医生和社区之间的合作。这些例子表明，改革为多种创新提供了空间。卫生服务的规划和组织更加关注当地人口。地方健康网络使这些规划和组织过程能够形成地域视野。当所有利益相关者都参与其中，且不同组织通过提供急性护理和慢性护理来服务社区，同时兼顾社会、医疗和护理领域时，地方健康网络似乎也是一个有价值的杠杆。
