Côté Nancy, Chouinard Rébecca, Freeman Andrew, Gagnon Marie-Pierre, Breton Mylaine, Duhoux Arnaud, Ghandour El Kebir, Laberge Maude, Martin Elisabeth, Fortin Jean-Paul, Bourgeault Ivy
Sociology, Faculty of Social Sciences, Université Laval, Québec City, Québec, Canada
Sociology, Faculty of Social Sciences, Université Laval, Québec City, Québec, Canada.
BMJ Open. 2022 Apr 19;12(4):e059792. doi: 10.1136/bmjopen-2021-059792.
In Canada, as in most Organisation for Economic Co-operation and Development countries, healthcare systems face significant challenges in ensuring better access to primary care. A regional healthcare organisation in Quebec (Canada) serving a population of approximately 755 459 citizens has implemented a standardised access approach to primary care services for this population. The objective of this new clinical and organisational practice is to ensure that users benefit from the same referral process, regardless of the entry point, in order to be directed to the right services. This new practice integrates a shared decision-making process between the user and the professional, and a collaborative process between different health professionals within and between services. The objective of our research is to identify and characterise the conditions of implementation of this practice.
This effectiveness-implementation hybrid investigation will use an embedded single-case study, defined in this case as the process of implementing a clinical and organisational practice within a healthcare organisation. Further to an evaluation conducted during a preliminary phase of the project, this study consists of evaluating the implementation of this new practice in four medical clinics (family medicine groups). A qualitative analysis of the data and a quantitative preimplementation and postimplementation analysis based on performance indicators will be conducted. This study is ultimately situated within a participatory organisational approach that involves various stakeholders and users at each step of the implementation and evaluation process.
This study was approved by the Ethics Committee of the Sectoral Research in Population Health and Primary Care of the Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (#2020-1800). The results of the investigation will be presented to the stakeholders involved in the advisory committees and at several scientific conferences. Manuscripts will be submitted to peer-reviewed journals.
与大多数经济合作与发展组织国家一样，加拿大的医疗保健系统在确保更好地获得初级医疗服务方面面临重大挑战。加拿大魁北克省一个为大约755459名公民提供服务的区域医疗组织，已为该人群实施了标准化的初级医疗服务获取方法。这种新的临床和组织实践的目标是确保用户无论从哪个入口点开始，都能受益于相同的转诊流程，从而被引导至合适的服务。这种新实践整合了用户与专业人员之间的共同决策过程，以及不同医疗专业人员在服务内部和服务之间的协作过程。我们研究的目的是识别并描述这种实践的实施条件。
这项有效性 - 实施混合调查将采用嵌入式单案例研究，在本案例中定义为在医疗组织内实施临床和组织实践的过程。在项目的初步阶段进行评估之后，本研究包括评估这一新实践在四个医疗诊所（家庭医学组）中的实施情况。将对数据进行定性分析，并基于绩效指标进行实施前和实施后的定量分析。本研究最终采用参与式组织方法进行，在实施和评估过程的每个步骤都涉及各种利益相关者和用户。
本研究已获得国家首都综合大学健康与社会服务中心人口健康与初级保健部门研究伦理委员会的批准（#2020 - 1800）。调查结果将提交给咨询委员会的相关利益者以及多个科学会议。研究论文将提交给同行评审期刊。
