Department of Community Health Sciences, Université de Sherbrooke, Campus de Longueuil, Longueuil, QC, Canada.
Upstream Lab, Unity Health Toronto, University of Toronto, Toronto, ON, Canada.
BMC Prim Care. 2024 Oct 12;25(1):363. doi: 10.1186/s12875-024-02614-y.
Being attached to a primary care (PC) provider is at the core of a strong primary health care system. Centralized waiting lists (CWL) for unattached patients have been implemented in eight provinces of Canada to support the attachment process. In Quebec, the Ministry of Health mandated the implementation of Primary Care Access Points (GAP) across the province to help unattached patients navigate the health system while awaiting attachment through the CWL. Several local health territories developed complementary innovations to the GAP to respond to local population needs. This paper aims to describe five organizational innovations implemented locally.
This multi-case qualitative study was conducted in four local health territories in the province of Quebec. Fifty-two semi-structured interviews with healthcare managers, nurses, physicians, other health professionals and administrative staff were conducted between April 2023 and April 2024. An interview guide was developed based on existing frameworks on the implementation of innovations and the evaluation of the GAP. Thematic analysis was conducted using NVivo software. Inductive and deductive approaches were used to develop relevant codes and themes. Logic models were built to describe the organizational innovations.
Five organizational innovations are described. First, a multidisciplinary clinic aimed at responding to patients with mental health issues was implemented. Second, a nurse clinic was implemented to provide temporary care for patients with unstable chronic illnesses. The third innovation is a mobile proximity clinic where unattached GAP patients are first evaluated by a paramedic before receiving care from a nurse. Fourth, a pharmacist trajectory was implemented to increase engagement of community pharmacists to respond to GAP patients. The last innovation is a decentralized GAP offering in-person nursing care to unattached GAP patients.
Descriptions of these five innovations are key to inform other territories and provinces on ways to improve access for unattached patients while they are waiting to be attached. The introduction of the GAP and the organizational innovations, suggests a transition where access to PC services does not rely solely on attachment status.
依附于初级保健（PC）提供者是强大的初级卫生保健系统的核心。加拿大八个省份实施了集中等待名单（CWL），以支持未依附患者的依附过程。在魁北克省，卫生部授权在全省范围内实施初级保健准入点（GAP），以帮助未依附患者在等待 CWL 依附的过程中通过卫生系统。几个地方卫生区开发了与 GAP 互补的创新措施，以满足当地人口的需求。本文旨在描述当地实施的五项组织创新。
这项多案例定性研究在魁北克省的四个地方卫生区进行。2023 年 4 月至 2024 年 4 月期间，对医疗保健经理、护士、医生、其他卫生专业人员和行政人员进行了 52 次半结构化访谈。根据现有关于创新实施和 GAP 评估的框架，制定了访谈指南。使用 NVivo 软件进行主题分析。采用归纳和演绎方法开发相关代码和主题。构建逻辑模型以描述组织创新。
描述了五项组织创新。首先，实施了一个多学科诊所，旨在应对有心理健康问题的患者。其次，实施了一个护士诊所，为不稳定的慢性病患者提供临时护理。第三个创新是一个移动邻近诊所，在那里，未依附的 GAP 患者首先由护理人员进行评估，然后由护士提供护理。第四，实施了药剂师轨迹，以增加社区药剂师的参与度，以回应 GAP 患者。最后一个创新是提供现场护理的分散式 GAP，为未依附的 GAP 患者提供护理。
这些五项创新的描述是为了向其他地区和省份提供信息，以便在未依附患者等待依附期间改善他们的就诊机会。GAP 的引入和组织创新表明，获得 PC 服务的途径不再仅仅依赖于依附状态。
