title: Evolution of Experience of Care of Patients with and without Chronic Diseases following a Québec Primary Healthcare Reform.
abstract: Objectives. To assess the extent to which new primary healthcare (PHC) models implemented in two regions of Quebec have improved patient experience of care, unmet needs, and use of services for individuals with and without chronic diseases, compared with other forms of PHC practices. Methods. In 2005 and 2010, we carried out population and organization surveys. We divided PHC organizations into new model practices and other practices and followed the evolution over time of patient experience of care. Results. Patients with chronic diseases had better accessibility but worse continuity of care in the new model practices than in the other practices at both time periods. Through the reform, accessibility decreased evenly in both groups, but continuity and perceived outcomes improved more in the other practices. Use of primary care services decreased more in the new model practices. Among patients without chronic disease, accessibility decreased much less in the new models and responsiveness increased more. There was no significant change in ER attendance and hospitalization. Conclusion. The evolution of patient experience of care has been more favorable for patients without chronic diseases. These findings raise concerns about equity since the aim of the PHC reform was targeting in priority individuals with the greatest needs.
authors.affiliation: Direction de Santé Publique de l'Agence de la Santé et des Services Sociaux 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 Saint-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 de l'Agence de la Santé et des Services Sociaux de Montréal, 1301 Rue Sherbrooke Est, Montréal, QC, Canada H2L 1M3; 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-Sainte-Catherine, Montréal, QC, Canada H3T 1A8.
authors.forename: Roxane
authors.initials: R
authors.lastname: Borgès Da Silva
authors.affiliation: Direction de Santé Publique de l'Agence de la Santé et des Services Sociaux de Montréal, 1301 Rue Sherbrooke Est, Montréal, QC, Canada H2L 1M3; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, 900 Rue Saint-Denis, Montréal, QC, Canada H2X 0A9; Faculté des Sciences Infirmières de l'Université de Montréal, 2375 Chemin de la Côte-Sainte-Catherine, Montréal, QC, Canada H3T 1A8.
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, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, QC, Canada J1H 5H3.
authors.forename: Mylaine
authors.initials: M
authors.lastname: Breton
authors.affiliation: Direction de Santé Publique de l'Agence de la Santé et des Services Sociaux 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 de l'Agence de la Santé et des Services Sociaux 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 de l'Agence de la Santé et des Services Sociaux 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, Level 3, AGSM Building, Sydney, NSW 2033, Australia; Bureau of Health Information, 67 Albert Avenue, Chatswood, NSW 2067, Australia.
authors.forename: Jean-Frédéric
authors.initials: JF
authors.lastname: Levesque