Room for improvement: patients' experiences of primary care in Quebec before major reforms.
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.


METHODS
Multilevel cross-sectional survey of practice.


METHODS
One hundred primary health care settings were randomly selected in urban, suburban, rural, and remote locations in 5 health regions in Quebec.


METHODS
In each clinic, we chose up to 4 physicians and 20 consecutive patients consulting each physician.


METHODS
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).


CONCLUSIONS
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.
Haggerty
Jeannie L
JL
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. Jeannie.Haggerty@usherbrooke.ca
Pineault
Raynald
R
Beaulieu
Marie-Dominique
MD
Brunelle
Yvon
Y
Gauthier
Josée
J
Goulet
François
F
Rodrigue
Jean
J
D003266:Continuity of Patient Care / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D018166:Health Care Reform / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011792:Quebec; D012424:Rural Population / Q000706:statistics & numerical data; D013038:Specialization; D014505:Urban Population / Q000706:statistics & numerical data; D014850:Waiting Lists