Health services epidemiologist in Montreal, Que, Full Professor in the Department of Family Medicine at McGill University in Montreal, and McGill Chair in Family and Community Medicine at St Mary's Hospital in Montreal.
Family physician in the Family Medicine Unit at the Chicoutimi Health and Social Services Center and at the Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean in Quebec, Full Professor in the Department of Family Medicine and Emergency Medicine at the Université de Sherbrooke in Quebec, and Research Chair on Chronic Diseases in Primary Care.
Can Fam Physician. 2018 Sep;64(9):e407-e413.
To describe the demographic characteristics, health, and health care experiences of adult patients in primary care waiting rooms in Quebec, and to determine which pillars of the Patient's Medical Home (PMH) are a priority to align primary care practices with the PMH model.
Baseline survey of a prospective cohort study using self-administered on-site and mailed questionnaires.
Twelve primary care clinics within the geographic boundaries of 4 local health care networks in metropolitan, urban, rural, and remote settings in Quebec.
A total of 1029 adult patients aged between 25 and 75 who were selected during a 1-week period in the 12 primary care clinics; 789 returned questionnaires.
Patients' health profiles, health behaviour patterns, reasons for the visit, and health care experiences.
In this 2010 snapshot, 66.8% of patients waited longer than 2 weeks for their appointment, 71.0% of visits were for routine or follow-up care, and longer wait times and patient multimorbidity correlated with more reasons for the visit. After the visit, most patients reported being able to express their most important needs and that the doctor listened well; however, only 28.1% reported that the doctor had explored whether the recommendations would be realistic for them, and only 18.0% indicated that the doctor had explored the personal or family dimensions that affected their health. Among all patients, 56.9% reported having at least 3 chronic conditions (multimorbidity), and 30.3% reported having high or moderate levels of psychological distress. When describing their financial status, 30.7% of patients indicated it was "poor to squeezed or tight." Slightly more than half of patients did not have complementary private health insurance to cover costs of psychological services.
In this study, the 4 priority pillars for practices to align with the PMH were timely access, team-based care, comprehensive care, and a patient-centred approach. Widespread implementation of advanced access is an urgent priority in light of persisting difficulties in timely access. Team-based and comprehensive care are needed to address the high prevalence of multimorbidity and psychological distress and to support health behaviour change. Finally, the patient-centred approach needs to underpin every care encounter.
描述魁北克省初级保健候诊室成年患者的人口统计学特征、健康状况和医疗保健体验，并确定患者医疗之家（PMH）的哪些支柱是优先事项，以将初级保健实践与 PMH 模式保持一致。
使用现场和邮寄自填问卷对前瞻性队列研究进行基线调查。
魁北克大都市区、城市、农村和偏远地区的 4 个地方卫生保健网络的地理边界内的 12 个初级保健诊所。
在这 12 个初级保健诊所的 1 周内选择的年龄在 25 至 75 岁之间的共 1029 名成年患者；789 名患者返回了问卷。
患者的健康状况、健康行为模式、就诊原因和医疗保健体验。
在 2010 年的这一快照中，66.8%的患者等待预约的时间超过 2 周，71.0%的就诊是为了常规或随访护理，而较长的等待时间和患者多病共存与更多的就诊原因相关。就诊后，大多数患者报告说他们能够表达最重要的需求，并且医生倾听得很好；然而，只有 28.1%的患者报告医生曾探讨过建议对他们来说是否现实，只有 18.0%的患者表示医生曾探讨过影响他们健康的个人或家庭方面。在所有患者中，56.9%报告至少有 3 种慢性疾病（多病共存），30.3%报告有较高或中度心理困扰。在描述他们的财务状况时，30.7%的患者表示“贫困、拮据或紧张”。略多于一半的患者没有补充私人健康保险来支付心理服务费用。
在这项研究中，实践与 PMH 保持一致的 4 个优先支柱是及时获得服务、团队为基础的护理、综合护理和以患者为中心的方法。鉴于及时获得服务方面持续存在困难，广泛实施高级访问是当务之急。需要团队为基础和综合护理来解决多病共存和心理困扰的高患病率，并支持健康行为的改变。最后，以患者为中心的方法需要贯穿每一次医疗保健接触。
