Abstract
BackgroundIn 2016, Quebec, a Canadian province, implemented a program to improve access to specialized health services (Accès priorisé aux services spécialisés (APSS)), which includes single regional access points for processing requests to such services via primary care (Centre de répartition des demandes de services (CRDS)). Family physicians fill out and submit requests for initial consultations with specialists using a standardized form with predefined prioritization levels according to listed reasons for consultations, which is then sent to the centralized referral system (the CRDS) where consultations with specialists are assigned. We 1) described the APSS-CRDS program in three Quebec regions using logic models; 2) compared similarities and differences in the components and processes of the APSS-CRDS models; and 3) explored contextual factors influencing the models’ similarities and differences.MethodsWe relied on a qualitative study to develop logic models of the implemented APSS-CRDS program in three regions. Semi-structured interviews with health administrators (n = 9) were conducted. The interviews were analysed using a framework analysis approach according to the APSS-CRDS’s components included in the initially designed program, Mitchell and Lewis (2003)’s logic model framework, and Chaudoir and colleagues (2013)’s framework on contextual factors’ influence on an innovation’s implementation.ResultsFindings show the APSS-CRDS program’s regional variability in the implementation of its components, including its structure (centralized/decentralized), human resources involved in implementation and operation, processes to obtain specialists’ availability and assess/relay requests, as well as monitoring methods. Variability may be explained by contextual factors’ influence, like ministerial and medical associations’ involvement, collaborations, the context’s implementation readiness, physician practice characteristics, and the program’s adaptability.InterpretationFindings are useful to inform decision-makers on the design of programs like the APSS-CRDS, which aim to improve access to specialists, the essential components for the design of these types of interventions, and how contextual factors may influence program implementation. Variability in program design is important to consider as it may influence anticipated effects, a next step for the research team. Results may also inform stakeholders should they wish to implement similar programs to increase access to specialized health services via primary care.
Highlights
Accessing specialized health services is a challenge in Canada; mean wait times increased from 3.7 weeks in 1993 to 8.9 weeks in 2018 [1]
-Population: 525,684 inhabitants -Density: 12 inhabitants/square km -1 CIUSSSa regrouping 6 hospital centres -2,07 physicians/1000 inhabitants a Centres intégrés universitaires de santé et de services sociaux (English: University Health and Social Services Centres) regroup hospital centres, clinics, group homes, child protection centres, and rehabilitation centres. It is in a health region where a university offers a full undergraduate medical program and/or operates a center designated as a university institute in the health and/or social fields b Centres intégrés de santé et de services sociaux (English: Integrated Health and Social Services Centres) regroup hospital centers, clinics, group homes, child protection centres, and rehabilitation centres was chosen as a methodological tool to help us collect, analyze, and organize data that describes the mechanisms of the APSSCRDS’s operation
Included in our sample were: a health planner responsible for the regional hospital central booking service (n = 1), an administrative technician working to ensure conformity of requests sent to this central booking service (n = 1), Centre de répartition de services (CRDS) project managers (n = 2), chief of services at the CRDS (n = 3), a head clinical nurse (n = 1), and a regional service access planner (n = 1)
Summary
Accessing specialized health services is a challenge in Canada; mean wait times increased from 3.7 weeks in 1993 to 8.9 weeks in 2018 [1]. In Quebec, a Canadian province, wait times to access specialized health services have increased. Like in other Canadian provinces and several countries worldwide [5], majorly relies on family physicians (FPs) to refer patients to specialized health services [6]. In 2016, Quebec, a Canadian province, implemented a program to improve access to specialized health services (Accès priorisé aux services spécialisés (APSS)), which includes single regional access points for process‐ ing requests to such services via primary care (Centre de répartition des demandes de services (CRDS)). We 1) described the APSS-CRDS program in three Quebec regions using logic models; 2) compared similarities and differences in the components and processes of the APSSCRDS models; and 3) explored contextual factors influencing the models’ similarities and differences
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