title: Reforming healthcare systems on a locally integrated basis: is there a potential for increasing collaborations in primary healthcare?
abstract: BACKGROUND
  Over the past decade, in the province of Quebec, Canada, the government has initiated two consecutive reforms. These have created a new type of primary healthcare - family medicine groups (FMGs) - and have established 95 geographically defined local health networks (LHNs) across the province. A key goal of these reforms was to improve collaboration among healthcare organizations. The objective of the paper is to analyze the impact of these reforms on the development of collaborations among primary healthcare practices and between these organisations and hospitals both within and outside administrative boundaries of the local health networks.
  
  
  METHODS
  We surveyed 297 primary healthcare practices in 23 LHNs in Quebec's two most populated regions (Montreal & Monteregie) in 2005 and 2010. We characterized collaborations by measuring primary healthcare practices' formal or informal arrangements among themselves or with hospitals for different activities. These collaborations were measured based on the percentage of clinics that identified at least one collaborative activity with another organization within or outside of their local health network. We created measures of collaboration for different types of primary healthcare practices: first- and second-generation FMGs, network clinics, local community services centres (CLSCs) and private medical clinics. We compared their situations in 2005 and in 2010 to observe their evolution.
  
  
  RESULTS
  Our results showed different patterns of evolution in inter-organizational collaboration among different types of primary healthcare practices. The local health network reform appears to have had an impact on territorializing collaborations firstly by significantly reducing collaborations outside LHNs areas for all types of primary healthcare practices, including new type of primary healthcare and CLSCs, and secondly by improving collaborations among healthcare organizations within LHNs areas for all organizations. This is with the exception of private medical clinics, where collaborations decreased both outside and within LHNs.
  
  
  CONCLUSIONS
  Health system reforms aimed at creating geographically based networks influenced primary healthcare practices' both among themselves (horizontal collaborations) and with hospitals (vertical collaborations). There is evidence of increased collaborations within defined geographic areas, particularly among new type of primary healthcare.
authors.affiliation: Centre de recherche - Hôpital Charles Lemoyne, Longueuil, QC, Canada. mylaine.breton@usherbrooke.ca
authors.forename: Mylaine
authors.initials: M
authors.lastname: Breton
authors.forename: Raynald
authors.initials: R
authors.lastname: Pineault
authors.forename: Jean-Frédéric
authors.initials: JF
authors.lastname: Levesque
authors.forename: Danièle
authors.initials: D
authors.lastname: Roberge
authors.forename: Roxane Borgès
authors.initials: RB
authors.lastname: Da Silva
authors.forename: Alexandre
authors.initials: A
authors.lastname: Prud'homme
mesh_terms: D003153:Community Health Services; D016001:Confidence Intervals; D003299:Cooperative Behavior; D003695:Delivery of Health Care; D018166:Health Care Reform; D019538:Health Care Surveys; D006801:Humans; D009313:National Health Programs; D011320:Primary Health Care; D011792:Quebec; D011795:Surveys and Questionnaires