Primary health care organizational characteristics associated with better accessibility: data from the QUALICO-PC survey in Quebec

Andrée-Anne Paré-Plante,Antoine Boivin,Maryse Guay,Djamal Berbiche,Mylaine Breton

doi:10.1186/s12875-018-0871-x

Abstract

BackgroundFirst-contact accessibility remains an important problem in Canada, with this indicator staying the worst of all Organization for Economic Co-operation and Development countries. In the province of Quebec, a number of primary healthcare (PHC) organizations have adopted measures to improve access (e.g. advance access scheduling, expanded nursing role, electronic medical record, financial incentives). The impact of those changes is unknown. The goal of this study is to assess which PHC organizations’ characteristics are associated with improved first-contact accessibility.MethodsWe conducted a secondary data analysis of the Quebec survey, conducted as part of the QUALICO-PC study on primary care performance. QUALICO-PC is a cross-sectional study to assess quality, costs and equity in PHC across 35 countries and jurisdictions. Organizational characteristics were measured from the family practitioners’ questionnaire. First-contact accessibility was measured from the patient questionnaire filled by patients who received care in the participating PHC organizations. Multi-level logistic regression was used to assess the association of organizational characteristics as predictors of patient-reported accessibility.ResultsA total of 218 family practitioners participated in the study with 1798 of their patients. PHC organizations characteristics associated with increased first-contact accessibility included the possibility to have a same-day appointment or to walk in the clinic without an appointment, higher number of physicians per clinic and higher number of hours worked by the family physician. Electronic medical record and expanded nursing role were not associated with increased accessibility.ConclusionsSame-day access and higher family physician working hours are associated with improved patient-reported accessibility. Other PHC organizations characteristics targeted by recent reforms were not associated with improved accessibility.

Highlights

First-contact accessibility remains an important problem in Canada, with this indicator staying the worst of all Organization for Economic Co-operation and Development countries
The scope of services offered by family practitioners in the clinics varied between 3 and 80 h worked per week as a family practitioner and between 8 and 53 contacts with patients on a typical day
The main finding of this study was that first-contact accessibility increased almost threefold when there was a possibility for patients to get a same-day appointment or walk-in clinic appointment in their own primary care practice

Summary

Introduction

First-contact accessibility remains an important problem in Canada, with this indicator staying the worst of all Organization for Economic Co-operation and Development countries. In the province of Quebec, a number of primary healthcare (PHC) organizations have adopted measures to improve access (e.g. advance access scheduling, expanded nursing role, electronic medical record, financial incentives). The impact of those changes is unknown. The goal of this study is to assess which PHC organizations’ characteristics are associated with improved first-contact accessibility. The practice level is where specific characteristics of clinics influence their performance on care delivery. This study will look at organizational characteristics of PHC organizations, resources and types and scope of services, and their effect on first-contact accessibility

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Discussion

Conclusion