Effects of primary care reform in Quebec on access to health care services

Overview

Abstract (English)

Primary health care PHC is the backbone of the health care system, the point of entry for the majority of patients, and the largest source of regular care delivery. Primary health care can be distinguished from other forms of care through four main attributes: accessibility, longitudinality, comprehensiveness and coordination. Primary health care reform in Quebec Quebec’s groupes de médecine de famille (GMF) reflect a team-based model of primary health care characterized by groups of physicians collaborating with nurses and other health professionals to provide patient care. The policy was introduced in late 2002 and participation by physicians and patients in GMFs is entirely voluntary. The GMF program goals included: Improving access to primary health care, including outside of usual clinic hours Improving coordination and comprehensiveness of care, notably the appropriate use of preventive services Access to health care I first examine the potential access to primary health care – that is, the ability to access needed care in a timely fashion. I use three measures to investigate and quantify different facets of potential access. Second, I examine realized access by measuring services actually used. I examine the reported receipt of certain preventive services in accordance with Canadian guidelines. Objectives Evaluate the causal effect of the GMF policy reform on potential access to primary health care in Quebec. Determine if GMFs have improved potential access to primary health care outside of usual office hours. Assess the impact of the GMF policy reform on the utilization of recommended preventive health services in line with Canadian guidelines. Investigate reported barriers to access to identify possible avenues of further health policy intervention to improve access to primary health care. Methods Data Canadian Community Health Survey The CCHS is a nationally representative, cross-sectional survey with a target population of persons 12 years and over living in all ten provinces and three territories of Canada. I use cycles 2001, 2003, 2005, 2007, 2008, 2009, and 2010 for measures of access and covariates. The Health Services Access Survey subsample of CCHS respondents, available only in 2001, 2003, 2005, 2007 and 2009, was analyzed separately. Administrative GMF data Administrative data on the number of GMFs, total GPs, number of GPs practicing in GMFs and patients enrolled inside and outside of GMFs were collected by the Ministère de la santé et les services sociaux by health region and year between 2002 and 2012. Geographic category data Eight geographic categories of health care availability based on residents’ census sub-division (CSD) and travel times to primary, secondary, and tertiary forms of health care. final datasets CCHS and GMF data were merged using region and year; geographic category data was merged to CCHS data using year and CSD. CCHS and GMF years were matched so that GMF participation exposure was recorded before the CCHS access measures. The final sample was restricted to Quebec residents, 18 years and over, and not living in the health regions of Nunavik, Terres-Cries-de-la-Baie-James, and Nord-du-Québec. The main CCHS sample consisted of 113 816 subjects.

Abstract (French)

Primary health care PHC is the backbone of the health care system, the point of entry for the majority of patients, and the largest source of regular care delivery. Primary health care can be distinguished from other forms of care through four main attributes: accessibility, longitudinality, comprehensiveness and coordination. Primary health care reform in Quebec Quebec’s groupes de médecine de famille (GMF) reflect a team-based model of primary health care characterized by groups of physicians collaborating with nurses and other health professionals to provide patient care. The policy was introduced in late 2002 and participation by physicians and patients in GMFs is entirely voluntary. The GMF program goals included: Improving access to primary health care, including outside of usual clinic hours Improving coordination and comprehensiveness of care, notably the appropriate use of preventive services Access to health care I first examine the potential access to primary health care – that is, the ability to access needed care in a timely fashion. I use three measures to investigate and quantify different facets of potential access. Second, I examine realized access by measuring services actually used. I examine the reported receipt of certain preventive services in accordance with Canadian guidelines. Objectives Evaluate the causal effect of the GMF policy reform on potential access to primary health care in Quebec. Determine if GMFs have improved potential access to primary health care outside of usual office hours. Assess the impact of the GMF policy reform on the utilization of recommended preventive health services in line with Canadian guidelines. Investigate reported barriers to access to identify possible avenues of further health policy intervention to improve access to primary health care. Methods Data Canadian Community Health Survey The CCHS is a nationally representative, cross-sectional survey with a target population of persons 12 years and over living in all ten provinces and three territories of Canada. I use cycles 2001, 2003, 2005, 2007, 2008, 2009, and 2010 for measures of access and covariates. The Health Services Access Survey subsample of CCHS respondents, available only in 2001, 2003, 2005, 2007 and 2009, was analyzed separately. Administrative GMF data Administrative data on the number of GMFs, total GPs, number of GPs practicing in GMFs and patients enrolled inside and outside of GMFs were collected by the Ministère de la santé et les services sociaux by health region and year between 2002 and 2012. Geographic category data Eight geographic categories of health care availability based on residents’ census sub-division (CSD) and travel times to primary, secondary, and tertiary forms of health care. final datasets CCHS and GMF data were merged using region and year; geographic category data was merged to CCHS data using year and CSD. CCHS and GMF years were matched so that GMF participation exposure was recorded before the CCHS access measures. The final sample was restricted to Quebec residents, 18 years and over, and not living in the health regions of Nunavik, Terres-Cries-de-la-Baie-James, and Nord-du-Québec. The main CCHS sample consisted of 113 816 subjects.