Paré-Plante Andrée-Anne, Boivin Antoine, Berbiche Djamal, Breton Mylaine, Guay Maryse
Département de Médecine de Famille et de Médecine d'Urgence de l'Université de Sherbrooke, Campus de Longueuil, 150 place Charles-Le Moyne, 9e étage, Longueuil, J4K 0A8, Canada.
Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, Campus de Longueuil, 150 place Charles-Le Moyne, 9e étage, Longueuil, J4K 0A8, Canada.
BMC Fam Pract. 2018 Dec 3;19(1):188. doi: 10.1186/s12875-018-0871-x.
First-contact accessibility remains an important problem in Canada, with this indicator staying the worst of all Organization for Economic Co-operation and Development countries. In the province of Quebec, a number of primary healthcare (PHC) organizations have adopted measures to improve access (e.g. advance access scheduling, expanded nursing role, electronic medical record, financial incentives). The impact of those changes is unknown. The goal of this study is to assess which PHC organizations' characteristics are associated with improved first-contact accessibility.
We conducted a secondary data analysis of the Quebec survey, conducted as part of the QUALICO-PC study on primary care performance. QUALICO-PC is a cross-sectional study to assess quality, costs and equity in PHC across 35 countries and jurisdictions. Organizational characteristics were measured from the family practitioners' questionnaire. First-contact accessibility was measured from the patient questionnaire filled by patients who received care in the participating PHC organizations. Multi-level logistic regression was used to assess the association of organizational characteristics as predictors of patient-reported accessibility.
A total of 218 family practitioners participated in the study with 1798 of their patients. PHC organizations characteristics associated with increased first-contact accessibility included the possibility to have a same-day appointment or to walk in the clinic without an appointment, higher number of physicians per clinic and higher number of hours worked by the family physician. Electronic medical record and expanded nursing role were not associated with increased accessibility.
Same-day access and higher family physician working hours are associated with improved patient-reported accessibility. Other PHC organizations characteristics targeted by recent reforms were not associated with improved accessibility.
在加拿大，首次就诊的可及性仍然是一个重要问题，在经济合作与发展组织的所有国家中，这一指标一直是最差的。在魁北克省，一些初级卫生保健（PHC）组织已采取措施来改善可及性（例如提前预约安排、扩大护士职责、电子病历、经济激励措施）。这些变化的影响尚不清楚。本研究的目的是评估哪些初级卫生保健组织的特征与改善首次就诊的可及性相关。
我们对魁北克调查进行了二次数据分析，该调查是作为初级保健绩效QUALICO-PC研究的一部分进行的。QUALICO-PC是一项横断面研究，旨在评估35个国家和司法管辖区初级卫生保健的质量、成本和公平性。组织特征通过家庭医生问卷进行测量。首次就诊的可及性通过在参与的初级卫生保健组织接受治疗的患者填写的患者问卷进行测量。多级逻辑回归用于评估组织特征作为患者报告的可及性预测因素的关联。
共有218名家庭医生及其1798名患者参与了该研究。与首次就诊可及性增加相关的初级卫生保健组织特征包括有可能进行当日预约或无需预约即可走进诊所、每个诊所的医生数量较多以及家庭医生的工作时间较长。电子病历和扩大护士职责与可及性增加无关。
当日就诊机会和家庭医生较长的工作时间与患者报告的可及性改善相关。近期改革所针对的其他初级卫生保健组织特征与可及性改善无关。
