title: Patients' perceptions of the quality of care after primary care reform: Family medicine groups in Quebec.
abstract: OBJECTIVE
  To evaluate how a primary care reform, which aimed to promote interprofessional and interorganizational collaborative practices, affected patients' experiences of the core dimensions of primary care.
  
  
  METHODS
  Before-and-after comparison of patients' perceptions of care at the beginning of family medicine group (FMG) implementation (15 to 20 months after accreditation) and 18 months later.
  
  
  METHODS
  Five FMGs in the province of Quebec from various settings and types of practice.
  
  
  METHODS
  A random sample of patients was selected in each FMG; a total of 1046 participants completed both the baseline and follow-up questionnaires.
  
  
  METHODS
  Patients' perceptions of relational and informational continuity, organizational and first-contact accessibility, attitude and efficiency of the clinic's personnel and waiting times (service responsiveness), physician-nurse and primary care physician-specialist coordination, and intra-FMG collaboration were assessed over the telephone, mostly using a modified version of the Primary Care Assessment Tool. Additional items covered patients' opinions about consulting nurses, patients' use of emergency services, and patients' recall of health promotion and preventive care received.
  
  
  RESULTS
  A total of 1275 patients were interviewed at the study baseline, and 82% also completed the follow-up interviews after 18 months (n = 1046). Overall, perceptions of relational and informational continuity increased significantly (P < .05), whereas organizational and first-contact accessibility and service responsiveness did not change significantly. Perception of physician-nurse coordination remained unchanged, but perception of primary care physician-specialist coordination decreased significantly (P < .05). The proportion of participants reporting visits with nurses and reporting use of FMGs' emergency services increased significantly from baseline to follow-up (P < .05).
  
  
  CONCLUSIONS
  This reorganization of primary care services resulted in considerable changes in care practices, which led to improvements in patients' experiences of the continuity of care but not to improvements in their experiences of the accessibility of care.
authors.affiliation: Research Center of the Centre hospitalier affilié universitaire de Québec, Quebec city, Canada. andre.tourigny.cha@ssss.gouv.qc.ca
authors.forename: André
authors.initials: A
authors.lastname: Tourigny
authors.forename: Michele
authors.initials: M
authors.lastname: Aubin
authors.forename: Jeannie
authors.initials: J
authors.lastname: Haggerty
authors.forename: Lucie
authors.initials: L
authors.lastname: Bonin
authors.forename: Diane
authors.initials: D
authors.lastname: Morin
authors.forename: Daniel
authors.initials: D
authors.lastname: Reinharz
authors.forename: Yvan
authors.initials: Y
authors.lastname: Leduc
authors.forename: Michele
authors.initials: M
authors.lastname: St-Pierre
authors.forename: Nathalie
authors.initials: N
authors.lastname: Houle
authors.forename: Anik
authors.initials: A
authors.lastname: Giguère
authors.forename: Zohra
authors.initials: Z
authors.lastname: Benounissa
authors.forename: Pierre-Hugues
authors.initials: PH
authors.lastname: Carmichael
mesh_terms: D001294:Attitude to Health; D003266:Continuity of Patient Care; D005194:Family Practice / Q000458:organization & administration / Q000592:standards*; D005260:Female; D006123:Group Practice / Q000458:organization & administration / Q000592:standards*; D018166:Health Care Reform; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D019555:Physician-Nurse Relations; D011320:Primary Health Care; D011787:Quality of Health Care; D011792:Quebec; D011795:Surveys and Questionnaires; D014850:Waiting Lists