La mobilité des patients et les modèles de création de demande : le cas du Québec

Dans ce texte nous analysons les conséquences de l’inégalité dans la distribution des ressources médicales sur l’utilisation des interventions chirurgicales électives en tenant compte de la mobilité des patients. Après avoir présenté un modèle théorique qui permet d’analyser l’influence de la mobilité des patients dans un marché privé d’interventions chirurgicales, nous adaptons ce modèle à un contexte d’assurance-maladie généralisée. Dans la partie empirique de notre travail nous discutons brièvement des principaux résultats que l’on retrouve dans la littérature et nous présentons quelques résultats empiriques préliminaires en utilisant des données du Québec.In this paper, we analyse the effects of the inequality in the distribution ofmedical resources on the use of elective surgeries taking into account the mobilityof the patients between geographical areas. In the first part of the paper, wepresent a theoretical model which analyses the effects of patients' mobility on aprivate market of chirurgical services and, then, we adapt this model to a regime ofpublic health insurance. In the empirical part of the paper, we discuss shortly themain results in the literature and we present some preliminary results using datafrom the province of Quebec

La mobilité des patients et les modèles de création de demande : le cas du Québec

In this paper, we analyse the effects of the inequality in the distribution of medical resources on the use of elective surgeries taking into account the mobility of the patients between geographical areas. In the first part of the paper, we present a theoretical model which analyses the effects of patients' mobility on a private market of chirurgical services and, then, we adapt this model to a regime of public health insurance. In the empirical part of the paper, we discuss shortly the main results in the literature and we present some preliminary results using data from the province of Quebec. Dans ce texte nous analysons les conséquences de l’inégalité dans la distribution des ressources médicales sur l’utilisation des interventions chirurgicales électives en tenant compte de la mobilité des patients. Après avoir présenté un modèle théorique qui permet d’analyser l’influence de la mobilité des patients dans un marché privé d’interventions chirurgicales, nous adaptons ce modèle à un contexte d’assurance-maladie généralisée. Dans la partie empirique de notre travail nous discutons brièvement des principaux résultats que l’on retrouve dans la littérature et nous présentons quelques résultats empiriques préliminaires en utilisant des données du Québec.

Prévention en médecine générale : approche néo-institutionnelle des systèmes de santé français et québécois

The aim of this paper is to highlight the potential of the French and the Quebec health systems for prevention in general practice. We use a neo-institutional approach of health system, an approach that emphasizes the importance of institutions and health organizations to understand the provision of preventive medicine. The institutional weakness of the prevention in France, strengthened by organizational rules unsuited, lead the French system to be inappropriate to the development of preventive activities in general practice. The Quebec system seems more favourable since prevention is highly institutionalized. However, the potential of Quebec organizations varies.institutions;organisations;primary care;prevention;public health

Avaliação de serviços em saúde mental no Brasil: revisão sistemática da literatura

ResumoA avaliação em saúde mental é um mecanismo capaz de produzir informações que contribuam positivamente para a tomada de decisão na área. Logo, é preciso apropriar-se das discussões existentes, refletindo sobre desafios e possibilidades na produção de conhecimento neste campo. Realizou-se uma revisão sistemática da produção científica brasileira sobre avaliação de serviços em saúde mental, identificando e discutindo métodos, perspectivas avaliativas e resultados. A busca de artigos ocorreu nas bases de dados IBECS, Lilacs e Scielo, com recorte temporal da publicação da lei 10.216. Foram encontrados 35 artigos por meio dos descritores e critérios de inclusão e exclusão utilizados. A produção da área concentrou-se nas regiões Sul e Sudeste, com diversos âmbitos e participantes, visando contribuir para o aprimoramento de serviços e decisões na área. Destacam-se os avanços no cuidado, com tratamento humanizado, participativo e comunitário, mas carecendo de maiores investimentos, qualificação profissional e melhorias organizacionais. Postula-se maior integração entre pesquisas, com as avaliações ultrapassando aspectos estruturais e a comparação com modelos hospitalocêntricos

Institutional context: What elements shape how community occupational therapists think about their clients’ care?

Abstract : Clinical reasoning (CR) is the cognitive process that therapists use to plan, direct, perform and reflect on client care. Linked to intervention efficiency and quality, CR is a core competency that occurs within an institutional context (legal, regulatory, administrative and organisational elements). Because this context can shape how community therapists think about their clients’ care, its involvement in their CR could have a major impact on the interventions delivered. However, little is known about this involvement. Our study thus aimed to describe the elements of the institutional context involved in community therapists’ CR. From March 2012 to June 2014, we conducted an institutional ethnography (IE) inquiry in three Health and Social Services Centres in Québec (Canada). We observed participants and conducted semi-structured interviews with 10 occupational therapists. We also interviewed 12 secondary key informants (colleagues and managers) and collected administrative documents (n = 50). We analysed data using the IE process. Of the 13 elements of the institutional context identified, we found that four are almost constantly involved in participants’ CR. These four elements, that is, institutional procedures, organisation's basket of services, occupational therapists’ mandate and wait times for their services, restrictively shape CR. Specifically, occupational therapists restrict their representation of the client's situation and exploration of potential solutions to what is possible within the bounds of these four elements. In light of such restrictions on the way they think about their clients’ care, therapists should pay close attention to the elements of their own institutional context and how they are involved in their CR. Because of its potentially important impact on the future of professions (e.g. further restrictions on professionals’ role, reduced contribution to population health and well-being), this involvement of the institutional context in CR concerns all professionals, be they clinicians, educators, researchers or regulatory college officers

A systematic review of frameworks for the interrelationships of mental health evidence and policy in low- and middle-income countries

Background: The interrelationships between research evidence and policy-making are complex. Different theoretical frameworks exist to explain general evidence–policy interactions. One largely unexplored element of these interrelationships is how evidence interrelates with, and influences, policy/political agenda-setting. This review aims to identify the elements and processes of theories, frameworks and models on interrelationships of research evidence and health policy-making, with a focus on actionability and agenda-setting in the context of mental health in low- and middle-income countries (LMICs). Methods: A systematic review of theories was conducted based on the BeHeMOTh search method, using a tested and refined search strategy. Nine electronic databases and other relevant sources were searched for peer-reviewed and grey literature. Two reviewers screened the abstracts, reviewed full-text articles, extracted data and performed quality assessments. Analysis was based on a thematic analysis. The included papers had to present an actionable theoretical framework/model on evidence and policy interrelationships, such as knowledge translation or evidence-based policy, specifically target the agenda-setting process, focus on mental health, be from LMICs and published in English. Results: From 236 publications included in the full text analysis, no studies fully complied with our inclusion criteria. Widening the focus by leaving out ‘agenda-setting’, we included ten studies, four of which had unique conceptual frameworks focusing on mental health and LMICs but not agenda-setting. The four analysed frameworks confirmed research gaps from LMICs and mental health, and a lack of focus on agenda-setting. Frameworks and models from other health and policy areas provide interesting conceptual approaches and lessons with regards to agenda-setting. Conclusion: Our systematic review identified frameworks on evidence and policy interrelations that differ in their elements and processes. No framework fulfilled all inclusion criteria. Four actionable frameworks are applicable to mental health and LMICs, but none specifically target agenda-setting. We have identified agenda-setting as a research theory gap in the context of mental health knowledge translation in LMICs. Frameworks from other health/policy areas could offer lessons on agenda-setting and new approaches for creating policy impact for mental health and to tackle the translational gap in LMICs

A study protocol for applying the co-creating knowledge translation framework to a population health study

BACKGROUND: Population health research can generate significant outcomes for communities, while Knowledge Translation (KT) aims to expressly maximize the outcomes of knowledge producing activity. Yet the two approaches are seldom explicitly combined as part of the research process. A population health study in Port Lincoln, South Australia offered the opportunity to develop and apply the co-KT Framework to the entire research process. This is a new framework to facilitate knowledge formation collaboratively between researchers and communities throughout a research to intervention implementation process. DESIGN: This study employs a five step framework (the co-KT Framework) that is formulated from engaged scholarship and action research principles. By following the steps a knowledge base will be cumulatively co-created with the study population that is useful to the research aims. Step 1 is the initiating of contact between the researcher and the study contexts, and the framing of the research issue, achieved through a systematic data collection tool. Step 2 refines the research issue and the knowledge base by building into it context specific details and conducting knowledge exchange events. Step 3 involves interpreting and analysing the knowledge base, and integrating evidence to inform intervention development. In Step 4 the intervention will be piloted and evaluated. Step 5 is the completion of the research process where outcomes for improvement will be instituted as regular practice with the facilitation of the community. In summary, the model uses an iterative knowledge construction mechanism that is complemented by external evidence to design interventions to address health priorities within the community. DISCUSSION: This is a systematic approach that operationalises the translational cycle using a framework for KT practice. It begins with the local context as its foundation for knowledge creation and ends with the development of contextually applicable interventions. It will be of interest to those involved in KT research, participatory action research, population health research and health care systems studies. The co-KT Framework is a method for embedding the principles of KT into all stages of a community-based research process, in which research questions are framed by emergent data from each previous stage.Kathryn Powell, Alison Kitson, Elizabeth Hoon, Jonathan Newbury, Anne Wilson and Justin Beilb

Development, implementation, and evaluation of the Apollo model of pediatric rehabilitation service delivery

This article presents the experience of a rehabilitation program that un- dertook the challenge to reorganize its services to address accessibility issues and im- prove service quality. The context in which the reorganization process occurred, along with the relevant literature justifying the need for a new service delivery model, and an historical perspective on the planning; implementation; and evaluation phases of the process are described. In the planning phase, the constitution of the working committee, the data collected, and the information found in the literature are presented. Apollo, the new service delivery model, is then described along with each of its components (e.g., community, group, and individual interventions). Actions and lessons learnt during the implementation of each component are presented. We hope by sharing our experiences that we can help others make informed decisions about service reorganization to im- prove the quality of services provided to children with disabilities, their families, and their communities

Why Do Evaluations of eHealth Programs Fail? An Alternative Set of Guiding Principles

Trisha Greenhalgh and Jill Russell discuss the relative merits of “scientific” and “social practice” approaches to evaluation and argue that eHealth evaluation is in need of a paradigm shift