IMPACT - An Australian and Canadian collaboration to improve access to primary health care for vulnerable populations

APHCRI Conversations was a regular program of presentations held at the Department of Health to facilitate exchange between APHCRI Network researchers and Department policymakers. Topics are developed jointly with the Department of Health and involve a range of speakers from APHCRI, including CRE invited experts, CRE Chief Investigators and stream project Chief Investigator

Prevalence estimates of multimorbidity: a comparative study of two sources

<p>Abstract</p> <p>Background</p> <p>Published prevalence studies on multimorbidity present diverse data collection methods, sources of data, targeted age groups, diagnoses considered and study populations, making the comparability of prevalence estimates questionable. The objective of this study was to compare prevalence estimates of multimorbidity derived from two sources and to examine the impact of the number of diagnoses considered in the measurement of multimorbidity.</p> <p>Methods</p> <p>Prevalence of multimorbidity was estimated in adults over 25 years of age from two separate Canadian studies: a 2005 survey of 26,000 respondents randomly selected from the general population and a 2003 study of 980 patients from 21 family practices. We estimated the prevalence of multimorbidity based on the co-occurrence of ≥ 2 and ≥ 3 diseases of the seven diseases listed in the general population survey. For primary care patients, we also estimated multimorbidity prevalence using an open list of chronic diseases.</p> <p>Results</p> <p>Prevalence estimates were considerably higher for each age group in the primary care sample than in the general population. For primary care patients, the number of chronic diseases considered for estimates resulted in large differences, especially in younger age groups. The prevalence of multimorbidity increased with age in both study populations.</p> <p>Conclusions</p> <p>The prevalence of multimorbidity was substantially lower when estimated in a general population than in a family practice-based sample and was higher when the number of conditions considered increased.</p

Financiamiento, organización, costos y desempeño de los servicios de los subsistemas de salud argentinos

Objetivo: Analizar la relación entre modelos de financiamiento y la organización con costos y desempeño de los servicios de los subsistemas de salud de Rosario,Argentina. Material y métodos: Los modelos de financiamiento y organización se caracterizaron utilizando información secundaria. Se calcularon los costos utilizando la metodología SHA/ OMS. Se midió el desempeño con una encuesta poblacional (n=822). Resultados: Subsistema público: financiamiento integrado verticalmente y servicios organizados desde la estrategia de atención primaria contribuyeron a bajos costos y alto desempeño en continuidad y orientación de la atención con debilidades en accesibilidad e integralidad. Subsistema privado: integración contractual y débiles mecanismos de regulación y coordinación condujeron a resultados opuestos a los del subsistema público. Seguridad social: integración contractual y fuertes mecanismos de regulación y coordinación contribuyeron a costos intermedios y un alto desempeño general. Conclusiones: El modelo de financiamiento y organización tiene una fuerte influencia sobre los costos y el desempeño de los servicios.Objective: To analyze the relationship between health system financing and services organization models with costs and health services performance in each of Rosario's health sub-systems. Materials and methods: The financing and organization models were characterized using secondary data. Costs were calculated using the WHO/SHA methodology. Healthcare quality was measured by a household survey (n=822). Results: Public subsystem:Vertically integrated funding and primary healthcare as a leading strategy to provide services produced low costs and individual-oriented healthcare but with weak accessibility conditions and comprehensiveness. Private subsystem: Contractual integration and weak regulatory and coordination mechanisms produced effects opposed to those of the public sub-system. Social security: Contractual integration and strong regulatory and coordination mechanisms contributed to intermediate costs and overall high performance. Conclusion: Each subsystem financing and services organization model had a strong and heterogeneous influence on costs and health services performance.Fil: Yavich, Natalia. Universidad Nacional de Rosario. Centro de Estudios Interdisciplinarios; ArgentinaFil: Báscolo, Ernesto Pablo. Universidad Nacional de Rosario. Centro de Estudios Interdisciplinarios; Argentin

Gobernanza y salud: significado y aplicaciones en américa latina

El término gobernanza es cada vez mas utilizado en la formulación, implementación y evaluación de políticas públicas. El propósito de este artículo es de clarificar su significado y de estudiar su utilidad en el estudio de las recientes políticas de salud de la América Latina. Después de discutir de las diferencias existentes entre gobernanza y los conceptos conexos de gestión, gobernabilidad y gobierno, proponemos la noción de la dualidad de la estructura social de Giddens para una mejor comprensión de los procesos de gobernanza. Utilizamos después este marco teórico para discutir de las implicaciones conceptuales y empíricas del grupo de trabajos sobre la gobernanza en salud en América Latina incluidos en el presente número de la Revista de Salud Pública. Reconociendo que el debate sobre gobernanza aun no está cerrado, terminamos nuestro texto subrayando las contribuciones más importantes de los trabajos revisados, a saber la importancia de la equidad en el proceso de toma de decisiones, el reconocimiento de la naturaleza política de la gobernanza, y las ventajas y limitaciones del modelo de clan en la regulación de las interacciones entre los actores implicados en la toma de decisiones políticas en salud

At the interface of community and healthcare systems: a longitudinal cohort study on evolving health and the impact of primary healthcare from the patient's perspectiv

<p>Abstract</p> <p>Background</p> <p>Massive efforts in Canada have been made to renew primary healthcare. However, although early evaluations of initiatives and research on certain aspects of the reform are promising, none have examined the link between patient assessments of care and health outcomes or the impacts at a population level. The goal of this project is to examine the effect of patient-centred and effective primary healthcare on the evolution of chronic illness burden and health functioning in a population, and in particularly vulnerable groups: the multi-morbid and the poor.</p> <p>Methods/Design</p> <p>A randomly selected cohort of 2000 adults aged 25 to 75 years will be recruited within the geographic boundaries of four local healthcare networks in Quebec. At recruitment, cohort members will report on socio-demographic information, functional health and healthcare use. Two weeks, 12 months and 24 months after recruitment, cohort participants will complete a self-administered questionnaire on current health and health behaviours in order to evaluate primary healthcare received in the previous year.</p> <p>The dependent variables are calculated as change over time of functional health status, chronic illness burden, and health behaviours. Dimensions of patient-centred care and clinical processes are measured using sub-scales of validated instruments. We will use Poisson regression modelling to estimate the incidence rate of chronic illness burden scores and structural equation modelling to explore relationships between variables and to examine the impact of dimensions of patient-centred care and effective primary healthcare.</p> <p>Discussion</p> <p>Results will provide valuable information for primary healthcare clinicians on the course of chronic illness over time and the impact on health outcomes of accessible, patient-centred and effective care. A demonstration of impact will contribute to the promotion of continuous quality improvement activities at a clinical level. While considerable advances have been made in the management of specific chronic illnesses, this will make a unique contribution to effective care for persons with multiple morbidities. Furthermore, the cohort and data architecture will serve as a research platform for future projects.</p

Lifestyle factors and multimorbidity: a cross sectional study

Background: Lifestyle factors have been associated mostly with individual chronic diseases. We investigated the relationship between lifestyle factors (individual and combined) and the co-occurrence of multiple chronic diseases. Methods: Cross-sectional analysis of results from the Program of Research on the Evolution of a Cohort Investigating Health System Effects (PRECISE) in Quebec, Canada. Subjects aged 45 years and older. A randomly-selected cohort in the general population recruited by telephone. Multimorbidity (3 or more chronic diseases) was measured by a simple count of self-reported chronic diseases from a list of 14. Five lifestyle factors (LFs) were evaluated: 1) smoking habit, 2) alcohol consumption, 3) fruit and vegetable consumption, 4) physical activity, and 5) body mass index (BMI). Each LF was given a score of 1 (unhealthy) if recommended behavioural targets were not achieved and 0 otherwise. The combined effect of unhealthy LFs (ULFs) was evaluated using the total sum of scores. Results: A total of 1,196 subjects were analyzed. Mean number of ULFs was 2.6 ± 1.1 SD. When ULFs were considered separately, there was an increased likelihood of multimorbidity with low or high BMI [Odd ratio (95% Confidence Interval): men, 1.96 (1.11-3.46); women, 2.57 (1.65-4.00)], and present or past smoker [men, 3.16 (1.74-5.73)]. When combined, in men, 4-5 ULFs increased the likelihood of multimorbidity [5.23 (1.70-16.1)]; in women, starting from a threshold of 2 ULFs [1.95 (1.05-3.62)], accumulating more ULFs progressively increased the likelihood of multimorbidity. Conclusions: The present study provides support to the association of lifestyle factors and multimorbidity

What makes primary care effective for people in poverty living with multiple chronic conditions?: study protocol

Abstract Background: The inverse care law persists: people living in poverty have the greatest needs and face considerable challenges in getting the care they need. Evidence reveals that GPs encounter difficulties in delivering care to poor patients, while many of those patients feel stigmatized by healthcare professionals. Patients living in poverty report negative healthcare experiences and unmet healthcare needs. Indeed, there is a growing recognition in primary care research of the importance of addressing the capabilities and social conditions of the poor when delivering care. Few studies have looked at the factors contributing to effective and &quot;socially responsive&quot; care for people living in poverty. Methods/Design: Our study adopts a qualitative ethnographic approach in four healthcare organizations in deprived areas of metropolitan Montreal (Québec, Canada), using patient shadowing techniques and interviews. Data will be collected through fieldwork observations and informal interviews with patients before and after consultations. We will observe medical consultations, care organization activities, and waiting areas and reception of patients. We will conduct a total of 36 individual interviews with 12 GPs and 24 patients. The interviews will be audio-recorded and transcribed for purposes of analysis. The analysis consists of debriefing sessions, coding and interpretive analysis. Discussion: This study aims to investigate how positive healthcare interactions between physicians and patients can improve the management of chronic conditions. We hypothesize that factors related to care organization, to healthcare professionals&apos; experience and to patients may enhance the quality of healthcare interactions, which may have positive impacts for preventing and managing chronic conditions. Our study will provide a unique set of data grounded in the perspectives of healthcare professionals and of patients living in poverty

Les indicateurs de santé et d’expérience rapportés par les patients et les patientes. Conduire le changement pour l’amélioration des soins.

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.