title: Impacts of Québec Primary Healthcare Reforms on Patients' Experience of Care, Unmet Needs, and Use of Services.
abstract: Introduction. Healthcare reforms launched in the early 2000s in Québec, Canada, involved the implementation of new forms of primary healthcare (PHC) organizations: Family Medicine Groups (FMGs) and Network Clinics (NCs). The objective of this paper is to assess how the organizational changes associated with these reforms have impact on patients' experience of care, use of services, and unmet needs. Methods. We conducted population and organization surveys in 2005 and 2010 in two regions of the province of Québec. The design was a before-and-after natural experiment. Changes over time between new models and other practices were assessed using difference-in-differences statistical procedures. Results. Accessibility decreased between 2003 and 2010, but less so in the treatment than in the comparison group. Continuity of care generally improved, but the increase was less for patients in the treatment group. Responsiveness also increased during the period and more so in the treatment group. There was no other significant difference between the two groups. Conclusion. PHC reform in Québec has brought about major organizational changes that have translated into slight improvements in accessibility of care and responsiveness. However, the reform does not seem to have had an impact on continuity, comprehensiveness, perceived care outcomes, use of services, and unmet needs.
authors.affiliation: Direction de Santé Publique du Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Est-de-l'Île-de-Montréal, 1301 rue Sherbrooke Est, Montréal, QC, Canada H2L 1M3; Institut National de Santé Publique du Québec, 190 boulevard Crémazie Est, Montréal, QC, Canada H2P 1E2; Centre de Recherche du Centre hospitalier de l'Université de Montréal, 900 rue St-Denis, Montréal, QC, Canada H2X 0A9; Institut de Recherche en Santé Publique de l'Université de Montréal, 7101 avenue du Parc, Montréal, QC, Canada H3N 1X9.
authors.forename: Raynald
authors.initials: R
authors.lastname: Pineault
authors.affiliation: Direction de Santé Publique du Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Est-de-l'Île-de-Montréal, 1301 rue Sherbrooke Est, Montréal, QC, Canada H2L 1M3; Centre de Recherche du Centre hospitalier de l'Université de Montréal, 900 rue St-Denis, Montréal, QC, Canada H2X 0A9; Institut de Recherche en Santé Publique de l'Université de Montréal, 7101 avenue du Parc, Montréal, QC, Canada H3N 1X9; Faculté des Sciences Infirmières de l'Université de Montréal, 2375 chemin de la Côte-Ste-Catherine, Montréal, QC, Canada H3T 1A8.
authors.forename: Roxane
authors.initials: R
authors.lastname: Borgès Da Silva
authors.affiliation: Direction de Santé Publique du Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Est-de-l'Île-de-Montréal, 1301 rue Sherbrooke Est, Montréal, QC, Canada H2L 1M3; Institut National de Santé Publique du Québec, 190 boulevard Crémazie Est, Montréal, QC, Canada H2P 1E2; Institut de Recherche en Santé Publique de l'Université de Montréal, 7101 avenue du Parc, Montréal, QC, Canada H3N 1X9.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Provost
authors.affiliation: Centre de Recherche de l'Hôpital Charles-Lemoyne, 150 place Charles-Lemoyne, Bureau 200, Longueuil, QC, Canada J5C 2B6; Département des Sciences de la Santé Communautaire de l'Université de Sherbrooke, 3001 12 avenue Nord, Sherbrooke, QC, Canada J1H 5H3.
authors.forename: Mylaine
authors.initials: M
authors.lastname: Breton
authors.affiliation: Direction de Santé Publique du Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Est-de-l'Île-de-Montréal, 1301 rue Sherbrooke Est, Montréal, QC, Canada H2L 1M3; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 avenue des Pins Ouest, Montréal, QC, Canada H3A 1A2.
authors.forename: Pierre
authors.initials: P
authors.lastname: Tousignant
authors.affiliation: Direction de Santé Publique du Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Est-de-l'Île-de-Montréal, 1301 rue Sherbrooke Est, Montréal, QC, Canada H2L 1M3.
authors.forename: Michel
authors.initials: M
authors.lastname: Fournier
authors.affiliation: Direction de Santé Publique du Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Est-de-l'Île-de-Montréal, 1301 rue Sherbrooke Est, Montréal, QC, Canada H2L 1M3.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Prud'homme
authors.affiliation: Centre for Primary Health Care and Equity, University of New South Wales, Kensington, NSW 2033, Australia; Bureau of Health Information, 67 Albert Avenue, Chatswood, NSW 2067, Australia.
authors.forename: Jean-Frédéric
authors.initials: JF
authors.lastname: Levesque