Background In 2004, the Québec government implemented an important reform of the healthcare system. The reform was based on the creation of new organisations called Health Services and Social Centres (HSSC), which were formed by merging several healthcare organisations. Upon their creation, each HSSC received the legal mandate to establish and lead a Local Health Network (LHN) with different partners within their territory. This mandate promotes a 'population-based approach' based to the responsibility for the population of a local territory.
peer-reviewed ; Background: In Botswana, one fifth of the adult population is infected with HIV, with young women most at risk. Structural factors such as poverty, poor education, strong gender inequalities and gender violence render many young women unable to act on choices to protect themselves from HIV. A national trial is testing an intervention to assist young women to access government programs for returning to education, and improving livelihoods. Accessing marginalised young women (aged 16–29 and not in education, employment or training) through door-to-door recruitment has proved inefficient. We investigated social networks of young women to see if an approach based on an understanding of these networks could help with recruitment. Methods: This mixed methods study used social network analysis to identify key young women in four communities (using in-degree centrality), and to describe the types of people that marginalised young women (n = 307) turn to for support (using descriptive statistics and then generalized linear mixed models to examine the support networks of sub-groups of participants). In discussion groups (n = 46 participants), the same young women helped explain results from the network analysis. We also tracked the recruitment method for each participant (door to door, peers, or key community informants). Results: Although we were not able to identify characteristics of the most central young women in networks, we found that marginalised young women went most often to other women, usually in the same community, and with children, especially if they had children themselves. Rural women were better connected with each other than women in urban areas, though there were isolated young women in all communities. Peer recruitment contributed most in rural areas; door-to-door recruitment contributed most in urban areas. Conclusions: Since marginalised young women seek support from others like themselves, outreach programs could use networks of women to identify and engage those who most need help ...
CONTEXT: Significant reforms are needed to improve healthcare system performance in Quebec. Even though the characteristics of high-performing healthcare systems are well-known, Quebec's reforms have not succeeded in implementing many critical elements. Converging evidence from political science models suggests stakeholders' preferences are central in determining policy content, adoption, and implementation. OBJECTIVE: To analyze whether doctors', nurses', pharmacists' and health administrators' preferences could explain the observed inability to implement known characteristics of high-performing healthcare systems. DESIGN: A questionnaire on various propositions identified in the scientific literature was sent to 2,491 potential respondents. RESULTS: Overall response rate was 37%. There was considerable consensus on identified solutions to improve the healthcare system. Resistance was observed in two major areas: information systems and changes directly affecting doctors' practice. The groups' positions cannot explain the inability to implement important characteristics of high-performing systems. The findings raise new questions on the actual sources of resistance.
This article presents and discusses five challenges encountered in conducting a knowledge synthesis on primary healthcare, commissioned by the Canadian Health Services Research Foundation. These challenges are (1) conceptualizing, defining and operationalizing complex interventions; (2) integrating quantitative and qualitative studies and assessing strength of evidence; (3) incorporating expert opinions and decision-makers' viewpoints; (4) producing timely results; and (5) presenting the results in a concise yet understandable form. We also propose methods and operational tools to deal with these issues, particularly regarding integration of qualitative and quantitative evidence and incorporation of expert opinions into syntheses. The major challenge of the synthesis was to provide pertinent and useful information for decision- and policy-makers, while maintaining an acceptable level of scientific rigour. This approach seems promising for knowledge syntheses, which sustain a deliberative process that leads to more enlightened decision and policy-making.
Demander aux personnes atteintes de maladies chroniques d'évaluer l'impact de leurs soins sur leur santé et leur expérience de soins primaires est l'étape la plus importante pour en rehausser la qualité. Le système de santé québécois collecte massivement des données médico-administratives qui peuvent fournir de l'information pertinente à l'orientation des politiques et à la mise en place de soins primaires pour répondre à leurs besoins. Cependant, peu d'information est disponible en ce qui a trait à la perception de ce public quant à leurs expériences de soins et leur santé. De plus, aucune collecte systématisée de données au niveau provincial ou canadien en santé primaire n'a été réalisée. La perspective du patient ou de la patiente est souvent absente des indicateurs collectés pour moduler les soins primaires et les politiques ministérielles. Pourtant, ces données sont essentielles à considérer pour : 1) la mise en place de plans d'intervention centrés sur leurs besoins réels; 2) l'établissement de politiques en santé en soins primaires, permettant une meilleure prise en charge de cette clientèle atteinte de maladies chroniques et; 3) pour l'amélioration (continue) des soins et services de santé. Notre équipe a été mandatée pour réaliser la portion québécoise de l'enquête internationale PaRIS (Patientreported Indicator Surveys) de l'Organisation de coopération et de développement économiques (OCDE), qui vise à dresser un portrait comparatif de l'expérience de soins et des résultats de santé de la patientèle atteinte de maladies chroniques bénéficiant de soins primaires. Afin de développer une méthodologie efficace et optimale, nous avons réalisé un colloque dans le cadre du 88e congrès de l'ACFAS, ayant eu lieu le 7 mai 2021. Celuici avait pour titre : Enjeux, priorités et leçons apprises pour les enquêtes sur la qualité des soins primaires selon la perspective des patients et des patientes. Nous avons réuni un groupe de personnes provenant de différents secteurs clés (patients et patientes partenaires, personnel de recherche et clinique, entreprises privées, experte en éthique, etc.) afin d'identifier les barrières et facilitants de l'implantation d'études de grande envergure et de s'inspirer des leçons apprises de celles-ci. Ce livre blanc vise à regrouper les constats tirés de cette journée ainsi que des recommandations formulées par l'équipe de co-responsables de la portion québécoise du PaRIS-OCDE.
