title: Evaluation of the implementation of centralized waiting lists for patients without a family physician and their effects across the province of Quebec.
abstract: BACKGROUND
  Most national and provincial commissions on healthcare services in Canada over the past decade have recommended that primary care services be strengthened in order to guarantee each citizen access to a family physician. Despite these recommendations, finding a family physician continues to be problematic. The issue of enrollment with a family physician is worrying in Canada, where nearly 21% of the country's population reported not having a family physician in the last Commonwealth Fund survey.To respond to this important need, centralized waiting lists have been implemented in four Canadian provinces to help 'orphan,' or unaffiliated, patients find a family physician. These organizational mechanisms are intended to better coordinate the demand for and supply of family physicians. The objectives of this study are: to assess the effects of centralized waiting lists for orphan patients (GACOs) implemented in the province of Quebec and to explain the variation among their effects by analyzing factors influencing implementation process.
  
  
  METHODS
  This study is based on two complementary and sequential research strategies. The first (objective 1) is a quantitative longitudinal design to assess the effects of all the GACOs (n = 93) in Quebec using clinical-administrative data. The second (objective 2) involves using four case studies to explain variations in effects through in-depth analysis of the various factors contributing to the observed effects. The primary source of data will be key actors involved in the GACOs. We expect to conduct around 40 semi-structured interviews.
  
  
  CONCLUSIONS
  This will be the first study in Canada to evaluate the implementation of this innovation. It will provide an exhaustive picture of the effects of GACO implementation in Quebec and to assess their potential for generalization elsewhere in Canada. At the theoretical level, this study will produce new knowledge on the factors having the greatest influence on the implementation of primary care innovations in professional environments.
authors.affiliation: Charles-LeMoyne Hospital Research Centre, Greenfield Park J4K 0A8, QC, Canada. mylaine.breton@usherbrooke.ca.
authors.forename: Mylaine
authors.initials: M
authors.lastname: Breton
authors.forename: Astrid
authors.initials: A
authors.lastname: Brousselle
authors.forename: Antoine
authors.initials: A
authors.lastname: Boivin
authors.forename: Christine
authors.initials: C
authors.lastname: Loignon
authors.forename: Nassera
authors.initials: N
authors.lastname: Touati
authors.forename: Carl-Ardy
authors.initials: CA
authors.lastname: Dubois
authors.forename: Kareen
authors.initials: K
authors.lastname: Nour
authors.forename: Djamal
authors.initials: D
authors.lastname: Berbiche
authors.forename: Danièle
authors.initials: D
authors.lastname: Roberge
mesh_terms: D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D010821:Physicians, Family / Q000458:organization & administration* / Q000706:statistics & numerical data / Q000600:supply & distribution; D016730:Program Development; D015397:Program Evaluation; D011792:Quebec / Q000453:epidemiology; D014850:Waiting Lists