Organizational Innovations Related to Primary Care Access Points (GAP) for Unattached Patients in Quebec: a Multi-case Qualitative Study

Overview

Journal BMC Prim Care

Specialties Health Services
Public Health

Date 2024 Oct 12

PMID 39395972

Authors

Mylaine Breton

Veronique Deslauriers

Catherine Lamoureux-Lamarche

Melanie Ann Smithman

Carine Sauve

Marie Beausejour

Maude Laberge

Aude Motulsky

Marie-Pascale Pomey

Affiliations

Soon will be listed here.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

References

Shi L . The impact of primary care: a focused review. Scientifica (Cairo). 2013; 2012:432892. PMC: 3820521. DOI: 10.6064/2012/432892. View

Macinko J, Starfield B, Shi L . The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970-1998. Health Serv Res. 2003; 38(3):831-65. PMC: 1360919. DOI: 10.1111/1475-6773.00149. View

Breton M, Marshall E, Deslauriers V, Smithman M, Moritz L, Buote R . COVID-19 - an opportunity to improve access to primary care through organizational innovations? A qualitative multiple case study in Quebec and Nova Scotia (Canada). BMC Health Serv Res. 2022; 22(1):759. PMC: 9177136. DOI: 10.1186/s12913-022-08140-w. View

McIsaac W, Fuller-Thomson E, Talbot Y . Does having regular care by a family physician improve preventive care?. Can Fam Physician. 2001; 47:70-6. PMC: 2014713. View

Nundy S, Cooper L, Mate K . The Quintuple Aim for Health Care Improvement: A New Imperative to Advance Health Equity. JAMA. 2022; 327(6):521-522. DOI: 10.1001/jama.2021.25181. View

Grunfeld E, Levine M, Julian J, Coyle D, Szechtman B, Mirsky D . Randomized trial of long-term follow-up for early-stage breast cancer: a comparison of family physician versus specialist care. J Clin Oncol. 2006; 24(6):848-55. DOI: 10.1200/JCO.2005.03.2235. View

Lavergne M, Bodner A, Allin S, Christian E, Hajizadeh M, Hedden L . Disparities in access to primary care are growing wider in Canada. Healthc Manage Forum. 2023; 36(5):272-279. PMC: 10447912. DOI: 10.1177/08404704231183599. View

Griffin S, Kinmonth A, Veltman M, Gillard S, Grant J, Stewart M . Effect on health-related outcomes of interventions to alter the interaction between patients and practitioners: a systematic review of trials. Ann Fam Med. 2004; 2(6):595-608. PMC: 1466743. DOI: 10.1370/afm.142. View

Damschroder L, Reardon C, Widerquist M, Lowery J . The updated Consolidated Framework for Implementation Research based on user feedback. Implement Sci. 2022; 17(1):75. PMC: 9617234. DOI: 10.1186/s13012-022-01245-0. View

10.

Vaismoradi M, Turunen H, Bondas T . Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nurs Health Sci. 2013; 15(3):398-405. DOI: 10.1111/nhs.12048. View

11.

Breton M, Brousselle A, Boivin A, Roberge D, Pineault R, Berbiche D . Who gets a family physician through centralized waiting lists?. BMC Fam Pract. 2015; 16:10. PMC: 4328670. DOI: 10.1186/s12875-014-0220-7. View

12.

Contandriopoulos D, Brousselle A . Reliable in their failure: an analysis of healthcare reform policies in public systems. Health Policy. 2009; 95(2-3):144-52. DOI: 10.1016/j.healthpol.2009.11.018. View

13.

Strumpf E, Levesque J, Coyle N, Hutchison B, Barnes M, Wedel R . Innovative and diverse strategies toward primary health care reform: lessons learned from the Canadian experience. J Am Board Fam Med. 2012; 25 Suppl 1:S27-33. DOI: 10.3122/jabfm.2012.02.110215. View

14.

Begin M, Eggertson L, MacDonald N . A country of perpetual pilot projects. CMAJ. 2009; 180(12):1185, E88-9. PMC: 2691427. DOI: 10.1503/cmaj.090808. View

15.

Duong D, Vogel L . National survey highlights worsening primary care access. CMAJ. 2023; 195(16):E592-E593. PMC: 10125184. DOI: 10.1503/cmaj.1096049. View

16.

Breton M, Smithman M, Kreindler S, Jbilou J, Wong S, Marshall E . Designing centralized waiting lists for attachment to a primary care provider: Considerations from a logic analysis. Eval Program Plann. 2021; 89:101962. DOI: 10.1016/j.evalprogplan.2021.101962. View

17.

Hanson K, Brikci N, Erlangga D, Alebachew A, De Allegri M, Balabanova D . The Lancet Global Health Commission on financing primary health care: putting people at the centre. Lancet Glob Health. 2022; 10(5):e715-e772. PMC: 9005653. DOI: 10.1016/S2214-109X(22)00005-5. View

18.

Isenor J, Renaud L, Mathews M, Morrison B, Murphy A, Bishop A . Patient perspectives on the vital primary care role of community pharmacists in Nova Scotia, Canada: qualitative findings from the PUPPY Study. Int J Pharm Pract. 2024; 32(3):216-222. PMC: 11074504. DOI: 10.1093/ijpp/riae008. View

19.

Damschroder L, Aron D, Keith R, Kirsh S, Alexander J, Lowery J . Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009; 4:50. PMC: 2736161. DOI: 10.1186/1748-5908-4-50. View

20.

Shi L, Macinko J, Starfield B, Wulu J, Regan J, Politzer R . The relationship between primary care, income inequality, and mortality in US States, 1980-1995. J Am Board Fam Pract. 2003; 16(5):412-22. DOI: 10.3122/jabfm.16.5.412. View