Family Medicine and Emergency, Université de Sherbrooke, Sherbrooke, Quebec, Canada
Nursing Faculty, Université Laval, Quebec, Quebec, Canada.
BMJ Open. 2022 May 11;12(5):e056133. doi: 10.1136/bmjopen-2021-056133.
To better understand the experience of patients attending community-based primary healthcare practices (CBPHCPs) aimed at improving equity and access to primary care for underserved patients, which have been implemented locally in several countries, including Canada. There are currently little data on how, or to what extent, they mitigate patients' experience of social inequalities in care and improve their access to health. This study explored the impacts of the sociospatial characteristics of these practices on patients' care experience.
Qualitative, multisite, focused ethnographic study based on in-situ observations and interviews, incorporating inductive and deductive analysis, and using the concept of sense of place.
Three CBPHCPs located in deprived urban areas in two provinces of Canada.
28 structurally marginalised persons (17 women) attending the clinics, ranging in age from 18 to 79 years, and 16 managers, clinicians and practitioners working in these clinics.
Data underscored the importance of clinic proximity and accessibility in facilitating patients' navigation of the health system. Patients appreciated the clinics' positive sociospatial characteristics. Non-judgmental environments and informal spaces fostered patients' empowerment and social interaction among themselves and with peer navigators and healthcare professionals. The experience of supportive continuity of care had a positive impact on patients' sense of well-being and, for many, a positive ripple effect and long-term impact on their social integration.
These results have important implications for policy given the current context, in which governments are challenged to support primary healthcare that addresses the social determinants of health to achieve greater equity. We conclude that scaling up contextually tailored care and deploying humanistic innovative organisational practices into mainstream care will help narrow the equity gap and reduce current prevalent social inequalities in the health system.
更好地了解旨在为服务不足的患者改善初级保健公平性和可及性而在包括加拿大在内的几个国家实施的以社区为基础的初级保健实践（CBPHCP）中患者的体验。目前，关于这些实践如何或在多大程度上减轻患者在护理方面的社会不平等体验并改善他们获得健康的机会的数据很少。本研究探讨了这些实践的社会空间特征对患者护理体验的影响。
基于现场观察和访谈的定性、多地点、重点民族志研究，结合归纳和演绎分析，并使用场所感的概念。
加拿大两个省的三个位于贫困城市地区的 CBPHCP。
28 名结构上处于边缘地位的人（17 名女性）参加了诊所，年龄从 18 岁到 79 岁不等，以及 16 名在这些诊所工作的经理、临床医生和从业者。
数据强调了诊所的接近度和可及性在促进患者在卫生系统中的导航的重要性。患者赞赏诊所的积极社会空间特征。非评判性环境和非正式空间促进了患者的赋权，以及患者之间、与同伴导航员和医疗保健专业人员之间的社会互动。支持性连续性护理的体验对患者的幸福感产生了积极影响，对许多人来说，对他们的社会融合产生了积极的连锁反应和长期影响。
鉴于当前的情况，这些结果对政策具有重要意义，因为政府面临着支持解决健康决定因素的初级保健以实现更大公平的挑战。我们的结论是，扩大量身定制的护理规模并将以人为本的创新组织实践部署到主流护理中，将有助于缩小公平差距并减少当前普遍存在的卫生系统中的社会不平等。
