Department of Community Health Sciences, Université De Sherbrooke, Longueuil, Quebec, Canada.
Centre De Recherche Charles-Le Moyne, Longueuil, Quebec, Canada.
Int J Health Plann Manage. 2024 Nov;39(6):1712-1728. doi: 10.1002/hpm.3831. Epub 2024 Jul 28.
Understanding patients' experiences accessing primary health care (PHC) is necessary to improve service organisation. This study aims to examine individual, organisational, and contextual factors associated with patients' experience of accessing the multidisciplinary PHC clinic to which they are attached.
This cross-sectional study builds on survey data collected in multidisciplinary PHC clinics located in 14 regions in the province of Quebec (Canada). Between September 2022 and June 2023, an online questionnaire was sent to patients with an email contact and attached to a family physician. Two patient-reported experience measures were assessed: (1) difficulty obtaining an appointment with their regular family physician or nurse practitioner and (2) perceived unmet healthcare needs. A self-reported online questionnaire based on the advanced access model was also sent to PHC professionals and administrative staff to assess the use of advanced access strategies in their practice. Multilevel logistic regression models were fit. Stratified analyses were conducted according to the number of consultations received.
In total, 122,397 patients and 847 family physicians, 97 nurse practitioners and 347 administrative staff nested into 104 clinics answered the survey. In the overall sample, having a chronic disorder was the only individual factor associated with the patient experience of access. Organizational factors including estimation of demand and supply, use of a referral algorithm, and strategies to optimise consultations were associated with a better access experience. Patients from medium size clinics compared to small clinics had better experiences of care for both outcomes. Stratified analysis indicated similar results for patients who consulted at the clinic 1-5 times in the last 12 months as observed in the overall sample.
This study indicates that enhancing organizational processes can improve patients' access experiences.
了解患者在初级卫生保健（PHC）中的就诊体验对于改善服务组织至关重要。本研究旨在探讨与患者在其所属多学科 PHC 诊所就诊体验相关的个体、组织和背景因素。
本横断面研究基于在魁北克省（加拿大） 14 个地区的多学科 PHC 诊所收集的调查数据。在 2022 年 9 月至 2023 年 6 月期间，向与家庭医生有电子邮件联系的患者发送了在线问卷。评估了两项患者报告的体验指标：（1） 与他们的常规家庭医生或执业护士预约的困难程度，（2） 感知未满足的医疗需求。还向 PHC 专业人员和行政人员发送了一份基于高级预约模型的自我报告在线问卷，以评估其在实践中使用高级预约策略的情况。拟合了多水平逻辑回归模型。根据接受的咨询次数进行了分层分析。
共有 122397 名患者和 847 名家庭医生、97 名执业护士和 347 名行政人员嵌套在 104 个诊所中回答了调查。在整个样本中，患有慢性疾病是与患者就诊体验相关的唯一个体因素。组织因素，包括需求和供应的估计、使用转诊算法以及优化咨询的策略，与更好的就诊体验相关。与小型诊所相比，中等规模诊所的患者在这两个结果方面都有更好的就诊体验。分层分析表明，在过去 12 个月内到诊所就诊 1-5 次的患者与在整个样本中观察到的结果相似。
本研究表明，加强组织流程可以改善患者的就诊体验。
