Assessing the evolution of primary healthcare organizations and their performance (2005-2010) in two regions of Quebec province: Montréal and Montérégie

A study to understand the evolution of primary healthcare organizational models and their relative performance in the course of the reform process (2005 to 2010), using 3 surveys:

• population-based survey
• organizational survey of PHC organizations
• survey to assess organizational contexts      

Project description

In 2005, we conducted a study in the two most populous regions of Québec (Montréal and Montérégie). The goal was to assess the association between primary healthcare organizational models and the care expérience of the population. We are now carrying out a new study to understand the evolution of primary care organizational mdels and their relative performance in the course of the reform process (2005 to 2010). We also wish to evaluate the factors associated with the transformation of primary care organizational models and their performance. More specifically, our objectives are as follows:

1. To assess the magnitude and direction of organizational change and migration between models of PHC, between 2005 and 2010, at the PHC organization and Local Network levels, as expressed by 1) the prevalence and local configuration of PHC organizational models; 2) the conformity of PHC organizations to a normatively defined ideal-type of organizational characteristics; and 3) the degree of collaboration between PHC organizations within and outside the local network. The survey will be conducted by the firm Jolicoeur & Associés;
2. To determine the association of these PHC organizational changes with factors related to the implementation of Local Networks and policies designed to promote new forms of PHC organization, as well as with factors related to the receptivity of PHC organizations and the influence of professional associations;
3. To examine the association between these organizational changes and various indicators of PHC performance (coverage, process and outcomes of care), on the levels of organization clientele and Local Network population.

This study will consist of three interrelated surveys, hierarchically nested:

• a population-based survey of randomly-selected adults from the populations of Montréal and Montérégie. This survey will assess current affiliations of people with PHC organizations, individuals’ level of utilization of healthcare services, attributes of their experience of care, reception of preventive and curative services, and perception of unmet needs for care. The survey will be conducted by the firm Jolicoeur & Associés;
• an organizational survey of PHC organizations assessing aspects related to their vision, organizational structure, level of resources, and clinical practice characteristics. This information will serve to develop a taxonomy of organizations using a mixed methods approach of factorial analysis and principal component analysis ;
• a survey designed to assess the organizational context in which PHC organizations are evolving.

During the study, an analysis of medical administrative data (medical services, hospitalizations) will also be performed to track the evolution of service utilization among the population under study from 2005 to 2010.

The study is being conducted by a team of researchers of the Direction de santé publique de l’Agence de la santé et des services sociaux de Montréal:

• Jean-Frédéric Levesque, nominated principal investigator
• Raynald Pineault, principal investigator
• Pierre Tousignant, principal investigator
• Audrey Couture, coordinator
• Sylvie Provost, co-investigator
• Roxane Borgès-Da Silva, co- investigator
• Marjolaine Hamel, co- investigator
• Odette Lemoine, research officer
• Brigitte Simard, research technician
• Olivier Juneau , research technician
• Alexandre Prud’homme, research technician

in collaboration with researchers from :

• Direction de santé publique de l’Agence de la santé et des services sociaux de Montréal
• Agence de la santé et des services sociaux de Montréal,
• Agence de la santé et des services sociaux de la Montérégie,
• Institut national de santé publique du Québec,
• Centre de recherche du CHUM
• Charles Lemoyne hospital research centre (Université de Sherbrooke)
• Université de Montréal
• McGill University
• Other partners, including the Collège des médecins du Québec and Ministère de la santé et des services sociaux.

The survey is funded by :

• Canadian Institutes of Health Research,
• Fonds de recherche en santé du Québec in partnership with Ministère de la santé et des services sociaux du Québec,
• Direction de santé publique de l’Agence de la santé et des services sociaux de Montréal,
• Agences de la santé et des services sociaux de Montréal et de la Montérégie
• Institut national de santé publique du Québec.

Timeline of activities 

Publications - 2005

Primary care services organisational models and the population's care experience(Click here)

Report (PDF) In this pamphlet, we describe the different primary care services organisational models, their principal characteristics and certain elements of performance. The organizational and populational data presented here come from a study made in 2005 in primary care offices and clinics in two regions of the province of Quebec: Montréal and Montérégie, totalizing 9,206 persons. Primary care medical clinics were grouped into five organizational models. Four were professional (single provider, contact, coordination and integrated coordination) and one community model. A nominal link was made between the results of the population and the organisational surveys. In general, the respondents of both regions gave favorable assessments of their health care. The professional single-provider model ranks first in almost all aspects of the care experience. Professional contact model ranks last in all dimensions of the care experience.

Accessibility and Continuity of Care: A Study of Primary Healthcare in Québec - Research Report (Click here)

Report : (INSPQ Website) Summary (English) This research report presents the results of a study on care experiences reported by users in the regions of Montréal and Montérégie in 2005. Data originate from a survey of a sample of the two populations (n=9206) where respondents were nominally matched to the medical clinic considered to be their regular source of care. A taxonomy of five organizational models was defined based on data for the organizations (n=473). Users of services provided by professional single-provider model organizations report the most favourable care experience; conversely, users of professional contact model organizations reported the least favourable care experience, including service accessibility. When considering several aspects of performance, especially population coverage, the professional integrated coordination model shows the most potential. This category includes all FMG which make up a third of organizations in this category. Study results suggest that a strategy aiming to increase accessibility to services should also take into account continuity of care. While development of walk-in clinics does not appear to be an effective solution, development of FMG certainly seems more promising.

Primary care services organisation. A portrait of primary care medical services in Montréal and Montérégie (Click here)

Executive summary (PDF) This summary report on primary care services organisation (Hamel, Pineault et al., 2007) is part of a series of publications focusing on the research project results. It presents evidence and unpublished data on primary care medical services organisation. Results are given according to administrative region and Health and Social Services Centre (CSSS) territory.

Unmet health care needs : A reflection of the accessibility of primary care services ? (Click here)

Report (PDF) Summary (PDF) In this thematic pamphlet, we present some results of a study entitled Accessibilité et continuité des services de santé - Une étude sur la première ligne au Québec(1), conducted in 2005 among more than 9000 people in Montréal and Montérégie. Our goal is to provide information concerning unmet health care needs and to analyse the initial implications. Questionnaire Organisational questionnaire - Primary healthcare clinic (PDF)

The population's experience of care portrait of intra-regional variations in Montréal and Montérégie (Click here)

Executive summary (PDF) Population questionnaire (PDF) Primary care services have undergone significant changes in Québec. It is in this context that a study of primary care in Québec was conducted. More specifically, the study looked at accessibility of health services and continuity of care in two health and social services regions in the province, Montréal and Montérégie.

Hospital emergency departments : substitutes for primary care ? Results of a survey among the population of Montréal and Montérégie (Click here)

Report (PDF) Executive summary (PDF) The reported data comes from a survey of people’s primary care experiences answered by 9206 adults living in the community in the regions of Montréal and Montérégie.