Assessing the evolution of primary healthcare organizations and their performance (2005-2010) in two regions of Québec province: Montréal and Montérégie

<p>Abstract</p> <p>Background</p> <p>The Canadian healthcare system is currently experiencing important organizational transformations through the reform of primary healthcare (PHC). These reforms vary in scope but share a common feature of proposing the transformation of PHC organizations by implementing new models of PHC organization. These models vary in their performance with respect to client affiliation, utilization of services, experience of care and perceived outcomes of care.</p> <p>Objectives</p> <p>In early 2005 we conducted a study in the two most populous regions of Quebec province (Montreal and Montérégie) which assessed the association between prevailing models of primary healthcare (PHC) and population-level experience of care. The <b>goal </b>of the present research project is to track the <it>evolution </it>of PHC organizational models and their relative performance through the reform process (from 2005 until 2010) and to assess factors at the organizational and contextual levels that are associated with the transformation of PHC organizations and their performance.</p> <p>Methods/Design</p> <p>This study will consist of three interrelated surveys, hierarchically nested. The first survey is a population-based survey of randomly-selected adults from two populous regions in the province of Quebec. This survey will assess the current affiliation of people with PHC organizations, their level of utilization of healthcare services, attributes of their experience of care, reception of preventive and curative services and perception of unmet needs for care. The second survey is an organizational survey of PHC organizations assessing aspects related to their vision, organizational structure, level of resources, and clinical practice characteristics. This information will serve to develop a taxonomy of organizations using a mixed methods approach of factorial analysis and principal component analysis. The third survey is an assessment of the organizational context in which PHC organizations are evolving. The five year prospective period will serve as a natural experiment to assess contextual and organizational factors (in 2005) associated with migration of PHC organizational models into new forms or models (in 2010) and assess the impact of this evolution on the performance of PHC.</p> <p>Discussion</p> <p>The results of this study will shed light on changes brought about in the organization of PHC and on factors associated with these changes.</p

Meeting the home-care needs of disabled older persons living in the community: does integrated services delivery make a difference?

<p>Abstract</p> <p>Background</p> <p>The PRISMA Model is an innovative coordination-type integrated-service-delivery (ISD) network designed to manage and better match resources to the complex and evolving needs of elders. The goal of this study was to examine the impact of this ISD network on unmet needs among disabled older persons living in the community.</p> <p>Methods</p> <p>Using data from the PRISMA study, we compared unmet needs of elders living in the community in areas with or without an ISD network. Disabilities and unmet needs were assessed with the Functional Autonomy Measurement System (SMAF). We used growth-curve analysis to examine changes in unmet needs over time and the variables associated with initial status and change. Sociodemographic characteristics, level of disability, self-perceived health status, cognitive functioning, level of empowerment, and the hours of care received were investigated as covariates. Lastly, we report the prevalence of needs and unmet needs for 29 activities in both areas at the end of the study.</p> <p>Results</p> <p>On average, participants were 83 years old; 62% were women. They had a moderate level of disability and mild cognitive problems. On average, they received 2.07 hours/day (SD = 1.08) of disability-related care, mostly provided by family. The findings from growth-curve analysis suggest that elders living in the area where ISD was implemented and those with higher levels of disability experience better fulfillment of their needs over time. Besides the area, being a woman, living alone, having a higher level of disability, more cognitive impairments, and a lower level of empowerment were linked to initial unmet needs (r²= 0.25; p < 0.001). At the end of the study, 35% (95% CI: 31% to 40%) of elders with needs living in the ISD area had at least one unmet need, compared to 67% (95% CI: 62% to 71%) in the other area. In general, unmet needs were highest for bathing, grooming, urinary incontinence, walking outside, seeing, hearing, preparing meals, and taking medications.</p> <p>Conclusions</p> <p>In spite of more than 30 years of home-care services in the province of Quebec, disabled older adults living in the community still have unmet needs. ISD networks such as the PRISMA Model, however, appear to offer an effective response to the long-term-care needs of the elderly.</p

Greenhouse gas emissions after application of landfilled paper mill sludge for land reclamation of a nonacidic mine tailings site

Large areas of mine tailings are reclaimed by applying organic amendments such as paper mill sludge (PMS). Although mining industries can use PMS freshly generated by paper mills, operational constraints on paper industries make temporary landfilling of this material an unavoidable alternative for the paper industries, creating the most prominent PMS source for mining industries. This study aimed to quantify soil greenhouse gas (GHG) emissions (N2O, CO2, and CH4) after application of landfilled PMS (LPMS; i.e., excavated from a landfill site at a paper mill) and LPMS combined with a seeding treatment of white clover (Trifolium repens L.) on nonacidic mine tailings site prior to reforestation. Soil N2O, CO2, and CH4 fluxes were measured after applications of 50 and 100 Mg dry LPMS ha−1 during two consecutive snowfree seasons on two adjacent sites; LPMS was applied once in the first season. The LPMS application increased N2O emissions (7.6 to 34.7 kg N2O-N ha−1, comprising 1.04 to 2.43% of applied N) compared with the unamended control during the first season; these emissions were negligible during the second season. The LPMS application increased CO2 emissions (~5800 to 11,400 kg CO2–C ha−1, comprising 7 to 27% of applied C) compared with the unamended control on both sites and in both seasons. Fluxes of CH4 were negligible. White clover combined with LPMS treatments did not affect soil GHG emissions. These new GHG emission factors should be integrated into life-cycle analyses to evaluate the C footprint of potential symbioses between the mining and paper industries. Future research should focus on the effect of PMS applications on soil GHG emissions from a variety of mine tailings under various management practices and climatic conditions to plan responsible and sustainable land reclamation

L'enseignement collégial une formule gagnante et perfectible : mémoire /

Titre de l'écran-titre (visionné le 25 mai 2005