Document Detail

Room for improvement: patients' experiences of primary care in Quebec before major reforms.
MedLine Citation:
PMID:  17872786     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To investigate variations in accessibility, continuity of care, and coordination of services as experienced by patients in Quebec on the eve of major reforms, and to provide baseline information against which reforms could be measured. DESIGN: Multilevel cross-sectional survey of practice. SETTING: One hundred primary health care settings were randomly selected in urban, suburban, rural, and remote locations in 5 health regions in Quebec. PARTICIPANTS: In each clinic, we chose up to 4 physicians and 20 consecutive patients consulting each physician. MAIN OUTCOME MEASURES: Patients' responses to a self-administered questionnaire, the Primary Care Assessment Tool, that assessed patient-provider affiliation, accessibility, relational continuity, coordination of primary and specialty care, and whether patients received health promotion and preventive services. RESULTS: A total of 3441 patients participated (87% acceptance rate) in 100 clinics (64% response rate). Timely access was difficult; only 10% expressed confidence they could be seen by their regular doctors within a day if they became suddenly ill. Average waiting time for a doctor's appointment was 24 days. Coordination of care with specialists was at minimally acceptable levels. Patients with family physicians recalled them addressing only 56% of the health promotion and preventive issues appropriate for their age and sex, and patients without family physicians recalled physicians addressing substantially fewer (38%). Most patients reported they were highly confident that their physicians knew them well and would manage their care beyond clinical encounters (relational continuity). The exception was the 16% of patients overall who did not have family physicians (34% of patients at walk-in clinics). CONCLUSION: This survey highlights serious problems with accessibility. Improvement is needed urgently to avoid deterioration of patients' confidence in the health system even though patients rate their relationships with their physician highly. Health promotion, preventive services, and coordination with specialists also needed to be improved, and careful thought must be given to the plight of those without family physicians.
Jeannie L Haggerty; Raynald Pineault; Marie-Dominique Beaulieu; Yvon Brunelle; Josée Gauthier; François Goulet; Jean Rodrigue
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Canadian family physician Médecin de famille canadien     Volume:  53     ISSN:  1715-5258     ISO Abbreviation:  Can Fam Physician     Publication Date:  2007 Jun 
Date Detail:
Created Date:  2007-09-17     Completed Date:  2007-11-07     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  0120300     Medline TA:  Can Fam Physician     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  1057, 2001:e.1-6, 1056     Citation Subset:  IM    
Département des Sciences de la santé communautaire, Université Sherbooke, Complexe St-Charles, Bureau 354, tour Est, 1111, rue St-Charles Ouest, Longueuil, QC J4K 5G4.
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MeSH Terms
Continuity of Patient Care / statistics & numerical data
Cross-Sectional Studies
Health Care Reform / statistics & numerical data*
Health Care Surveys
Health Knowledge, Attitudes, Practice*
Health Services Accessibility / statistics & numerical data
Medicine / statistics & numerical data
Middle Aged
Patient Satisfaction / statistics & numerical data
Primary Health Care / statistics & numerical data*
Rural Population / statistics & numerical data
Urban Population / statistics & numerical data
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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