Multidisciplinary Health Care Research Articles

Update on Practical Management of Early-Stage Non-Small Cell Lung Cancer (NSCLC): A Report from the Ontario Forum

Therapeutic strategies for early-stage non-small cell lung cancer (NSCLC) are advancing, with immune checkpoint inhibitors (ICIs) and targeted therapies making their way into neoadjuvant and adjuvant settings. With recent advances, there was a need for multidisciplinary lung cancer healthcare providers from across Ontario to convene and review recent data from practical and implementation standpoints. The focus was on the following questions: (1) To what extent do patient (e.g., history of smoking) and disease (e.g., histology, tumor burden, nodal involvement) characteristics influence treatment approaches? (2) What are the surgical considerations in early-stage NSCLC? (3) What is the role of radiation therapy in the context of recent evidence? (4) What is the impact of biomarker testing on treatment planning? Ongoing challenges, treatment gaps, outstanding questions, and controversies with the data were assessed through a pre-meeting survey, interactive cases, and polling questions. By reviewing practice patterns across Ontario cancer centers in the context of evolving clinical data, Health Canada indications, and provincial (Cancer Care Ontario [CCO]) funding approvals, physicians treating lung cancer voiced their opinions on how new approaches should be integrated into provincial treatment algorithms. This report summarizes the forum outcomes, including pre-meeting survey and polling question results, as well as agreements on treatment approaches based on specific patient scenarios.

18 Past and current care practices for neonates with complex medical needs: A scoping review to support clinical program evaluation

Abstract Background Neonates with complex medical needs (NCMN) are a rapidly growing patient population internationally. Although NCMN are a relatively small proportion of all Neonatal Intensive Care Unit (NICU) admissions, they are high healthcare utilizers. Since 2018, a dedicated Neonatal Complex Care Team (NCCT) has cared for NCMN at a large quaternary care center. The NCCT cares for NCMN in a dedicated, single-family room, patient area within the NICU. This model of care has yet to be evaluated for its potential impact on healthcare outcomes. Objectives The objective of the scoping review is to determine the breadth of available literature on the care practices for the management of NCMN and to collate the available evidence to define outcome measures to be used in a formal program evaluation. Design/Methods The review followed the PRISMA extension for scoping reviews and utilized resources from the Joanna Briggs Institute. The two databases that were utilized include Medline via OVID and CINAHL. The dates for included publications are January 1st 1993, until July 15th 2023. Only studies published in English and primary research were included. Two independent reviewers performed the initial title and abstract screening, and the full text review. The data extraction was completed by one independent reviewer. Results 102 articles were included in the title and abstract screen, and 12 were considered for full text review. Four articles were included. Interventions discussed in the included articles ranged from discharge conferences with patient’s caregivers, to the implementation of an entirely new model of care. Multidisciplinary health care teams appear to be integral to the in-hospital care and smooth discharge of NCMN. We identified that caregiver involvement and satisfaction are important to the discharge process as they are primarily responsible for their infant’s care after discharge, and so it is important that the specifics of care are communicated and taught effectively. The outcomes of interest identified as most useful for clinical program evaluation were length of stay and readmission rate. Additionally there was limited data reported on long-term health outcomes of this patient population. Conclusion This scoping review identified few articles that reported new models of care, a lack of consistent outcomes used in evaluating existing care models and overall a gap in research in this rapidly growing patient population. There is more work to be done to improve care of NCMN and our findings will be used in designing future studies that evaluate care models.

Telehealth-delivered physical activity interventions provided by maternal healthcare services influence postpartum women’s engagement in physical activity: a systematic review

The benefits of physical activity in the postpartum population are well documented, and regarded as being vitally important to the recovery process. Psychological health, musculoskeletal conditions, cardiorespiratory fitness and weight retention are among the postpartum health issues that physical activity can positively influence. Although international guidelines for physical activity postpartum have been published, there is a lack of current research into the effectiveness of, and patient compliance with, physical activity programmes in this population. Physiotherapists are well placed to deliver physical activity interventions for these women because of the multidisciplinary maternal healthcare services that are provided for them. The focus of this paper is to examine the available evidence regarding how the delivery and accessibility of physical activity programmes have changed with the exponential growth of telehealth. A detailed systematic literature search limited to randomized controlled trials published in English was performed for the period from 2014 to 2022. Four relevant publications were identified that utilized an element of telehealth physical activity in the postpartum population, although the timescale and definition of postpartum was not standardized across the papers. The findings of this literature review indicate that there is tentative support for the use of remote intervention as a means of improving physical activity in postpartum patients. The literature does not provide a consensus on the most appropriate length, type or duration of telehealth-delivered postpartum physical activity intervention for this population. There is a need for future high-quality research to investigate the effect of remote physical activity delivery on cost-effectiveness and patient satisfaction.

Identifying the need for a nurse-driven palliative care intervention for American Indian and rural family caregivers.

The purpose of this qualitative study was to understand the needs of family caregivers (FCGs) from the perspectives of health care professionals delivering cancer care to American Indian and rural populations. A descriptive content analysis of 18 interviews with multidisciplinary health care professionals delivering cancer care at a rural cancer institute in the Great Plains region was conducted. We identified three themes: access, support, and awareness with six subthemes. Consideration of these core needs, coupled with the individual cultural circumstance, is critical in addressing disparities faced by American Indian/Alaska Native and rural FCGs. The availability of specialized health care services, like palliative care, can positively impact the experience of FCGs providing care. However, access is limited. The needs and challenges faced by American Indian/Alaska Native and rural FCGs described in this study can inform the development of a culturally responsive palliative care intervention. Nurses are well positioned to develop and lead this intervention, which will be the first of its kind. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Nurse-Led Medication Management for Older People in Home Care: A Systematic Review of Evolving Nurse Responsibilities in Technology-assisted Care

Technology-assisted care is transforming the home care landscape for older people requiring medication management. With evolving roles and responsibilities, nurse-led interventions are shaping the future of nursing practice in home care. This review aimed to identify and describe nurse-led roles in medication management in home care for older people within the context of technology-assisted care. A systematic review employing an integrative approach was conducted on the PubMed (covering MEDLINE), Scopus, CINAHL, ProQuest, and Embase, targeting studies published in English over the past decade, from 2014 to 2024. The initial database search identified 1629 studies, which were subsequently narrowed down to 20 studies selected for data analysis and narrative research synthesis. The review findings were classified into 3 categories: “fundamental principles,” “nurses and their role identities,” and “enhanced care quality and medication safety.” Given the effectiveness of nurses as leaders in technology-assisted home care for enhancing medication management safety, it is essential to implement policies that support and improve their involvement in multidisciplinary healthcare teams. Additionally, continuous education and training focused on technology-assisted care competencies are necessary to ensure nurses are well-prepared to enhance patient safety in home care.

Mobile Health-Based Health Literacy Weight Management Intervention Using Smart Devices for Adolescents: A Convergent Mixed-Methods Pilot Study.

This study aimed to develop and evaluate the feasibility of a mobile health-based health literacy weight management intervention program for adolescents during the COVID-19 pandemic. Therefore, a convergent mixed-method design was used. The "GO! GO! Smart Healthy" intervention development engaged multidisciplinary healthcare professionals, utilizing mobile health applications and smartwatches. Participants provided data on weight management, dietary habits, and health literacy via an mHealth app, while smartwatches collected objective information on physical activity and sleep. The 12-week pilot study was conducted from March to September 2021. It evaluated the program's feasibility, employing both quantitative and thematic analyses of focus group discussions for a comprehensive assessment. Of the 27 participants, 44.4% were overweight or obese, with insufficient physical activity reported. Thematic analysis identified three main themes: empowerment, self-awareness and self-regulation, and self-comparison and reflection. Adolescents engaged with smartwatches, demonstrated increased awareness, altruistic behavior, and satisfaction. After integrating mixed-method data, revisions ensured the program's alignment with participants' preferences. Despite pandemic disruptions, mHealth apps ensured uninterrupted research, showcasing technology's evolving role in healthcare and education. Iterative feedback with participants ensured program suitability, fostering effectiveness. Trial Registration: ClinicalTrials.gov: NCT04759716.

Cross-cultural adaptation of the Quebecois Patient-Centered Coordination by a Care Team Questionnaire for use in France

BackgroundThe prevalence of chronic disease and multimorbidity is increasing and the associated disease and treatment burden is particularly heavy. Coordinated multidisciplinary, patient-centered care is particularly important for people living with chronic disease or multimorbidity. There was no valid tool to measure the quality of coordinated patient-centered care from the patient’s perspective until the Patient-Centered Coordination by a Care Team (PCCCT) questionnaire was recently developed in Canada (Quebec/Ontario). The Quebecois version has been validated but is not directly transferable to France due to linguistic, cultural and health system differences between the two countries. To perform a cross-cultural adaptation of the Quebecois PCCCT questionnaire is therefore necessary to obtain a questionnaire’s new version adapted for use in France, ensuring item and semantic equivalence.MethodsThe adaptation process consisted of two stages, both of which were supervised by a scientific committee made up of five healthcare professionals. The first stage was a Delphi consensus involving a multidisciplinary healthcare professional panel to evaluate and harmonize the clarity and appropriateness of the questionnaire for patients in the French health system. During the second stage, adult patients with one or more chronic diseases, from various age, sex, socio-occupational categories, assessed the comprehensibility and conformity of the adapted version of the questionnaire resulting from stage 1 and improved it if necessary. This was achieved using cognitive interviews.ResultsDuring Stage 1, two rounds were undertaken with 10 professional experts resulting in consensual reformulation of 10 out of the 14 items. These newly formulated items and the 4 remaining items were submitted to patients in Stage 2. Cognitive interviews were undertaken with 14 patients, testing 3 successively adapted versions of the questionnaire, until three consecutive patients did not find any ambiguity or misunderstanding. The final version resulting from the cross-cultural adaptation process aimed at being used in France, has item and semantic equivalence to the original Quebecois version.ConclusionsMeasurement equivalence will be addressed in a future study. This French version is intended to be a useful resource for the health system reforms aimed at promoting more integrated and patient-centered care pathways.

The potential use of game theory in decision-making in CHD.

Background: Congenital cardiac care involves multiple stakeholders including patients and their families, surgeons, cardiologists, anaesthetists, the wider multidisciplinary team, healthcare providers, and manufacturers, all of whom are involved in the decision-making process to some degree. Game theory utilises human behaviour to address the dynamics involved in a decision and what the best payoff is depending on the decision of other players. Aim: By presenting these interactions as a strategic game, this paper aims to provide a descriptive analysis on the utility and effectiveness of game theory in optimising decision-making in congenital cardiac care. Methodology: The comprehensive literature was searched to identify papers on game theory, and its application within surgery.Results: The analysis demonstrated that by utilising game theories, decision-making can be more aligned with patient-centric approaches, potentially improving clinical outcomes. Conclusion: Game theory is a useful tool for improving decision-making and may pave the way for more efficient and improved patient-centric approaches.

Association between body mass index and physical activity among prostate cancer survivors.

We assessed the associations between (1) body mass index (BMI) and participating in any physical activities (PAs) in past 30days and (2) cancer and behavioral-related variables and participating in any PAs in past 30days among prostate cancer (PCa) survivors. We conducted a cross-sectional analysis of data from the 2018-2022 Behavioral Risk Factor Surveillance System. Multivariable weighted logistic regression was used to examine the associations. Of the 4944 PCa respondents, 22.9% were classified as obese class I and 10.6% as obese class II or III. Obese class I and obese class II or III respondents were significantly less likely to participate in any PAs in past 30days (odds ratio (OR) = 0.48; 95% confidence interval (CI): 0.28-0.84 and OR = 0.37; 95% CI: 0.20-0.67, respectively). Men who received a summary of their cancer treatment were significantly more likely to participate in any PAs in past 30days (OR = 1.53; 95% CI: 1.03-2.28). Men who received instructions from a doctor for routine check-ups after completing treatment for cancer were not significantly more likely to participate in any PAs in past 30days (OR = 1.36; 95% CI: 0.87-2.12). Current smokers were less likely to participate in any PAs in past 30 days (OR = 0.50; 95% CI: 0.26-0.96). Obese men and current smokers were less likely to participate in any PAs in past 30days. Men who received a summary of their cancer treatment were more likely to participate in any PAs in past 30days. Health care providers should talk to their patients about the benefits of participating in PA and refer PCa patients to available exercise programs. PA was lowest among obese class II or III PCa survivors. These men could benefit from a coordinated multidisciplinary health care team effort to improve PCa prognosis and QoL.

PROCare4Life integrated care model validation

This article focuses on reporting the methodology and results of the EU funded project PROCare4Life, whose main goal has been to develop an integrated, personalised, IT system, to empower and improve the Quality of Life of elderly people living with Parkinsons’, Alzheimer’s or other dementia. Research has been implemented to evaluate the results against the PROCare4Life integrated care strategy. Multimethod, quantitative, and qualitative research has been performed, benefiting from the Pilot 3 results gathered by consortium members. The article has been organised according to the research questions, which were based on the expected results by PROCare4Life that might support the future integration of care when the system is further developed and integrated into healthcare provision organisations. The PROCare4Life system is a digital tool that includes features that might support the advance of the integration of care, such as data sharing among multidisciplinary healthcare professionals and with patients and caregivers, the enhancement of direct communication among them or the constant sharing of the data monitored by the PROCare4Life system. Technology readiness levels (TRLs) 7 was achieved by the final prototype of the PROCare4Life system. Pilot representatives consider the PROCare4Life idea and underlying model of care very innovative and promising, and believe it can certainly improve care practice through more enhanced integrated care. It is usable for people of different ages, conditions, and socioeconomic levels. It has been assessed to be more effective for elderly people living with Parkinson’s than with dementia. Patients and caregivers indicated that the system helped them reduce their anxiety and increase their quality of life. Although overall assessment of the system by healthcare professionals was positive, divided opinions were shared on its capability to save time. Requirements for future scalability have been included in the last section.

Promoting sleep and rest in hospitalized children: a best practice implementation project.

The objective of this project was to implement scientific evidence to promote sleep and rest in pediatric patients during hospitalization. Hospitals are not conducive to quality sleep, as external factors such as light, noise, and interruptions from health care staff can disturb patients. Being hospitalized has a detrimental impact on children's sleep because it reduces how much sleep they get and the quality of that sleep. It has been reported that up to 20% to 30% of hospitalized children experience sleep problems. This project was conducted at the Marqués de Valdecilla University Hospital in Cantabria, northern Spain. The project used the JBI Evidence Implementation Framework, which is grounded in an audit, feedback, and re-audit process, together with a structured approach to identifying and managing barriers to change. The study subjects were 100 children aged 2 to 16 years, who were admitted to the hospital's pediatric unit from November to December 2021, and 27 multi-disciplinary health care staff. Implementing the evidence-based strategies improved our care practices, with the follow-up audit results showing a marked improvement in compliance. Thus, training health care staff on pediatric sleep increased from 4% to 80%; using a multi-faceted approach to sleep promotion increased from 21% to 87%; and promoting relaxation techniques to promote sleep increased from 0% to 80%. The project met its objectives. Areas for improving children's sleep and rest during hospitalization were identified. To avoid resistance to change, it was necessary to involve the entire team and maintain training. We recommend follow-up audits once a year, to ensure the sustainability of the project. http://links.lww.com/IJEBH/A252.

Strategies for adapting under pressure: an interview study in intensive care units

BackgroundHealthcare systems are operating under substantial pressures. Clinicians and managers are constantly having to make adaptations, which are typically improvised, highly variable and not coordinated across teams. This study aimed...

Updating a conceptual model of effective symptom management in palliative care to include patient and carer perspective: a qualitative study

BackgroundA conceptual model of effective symptom management was previously developed from interviews with multidisciplinary healthcare professionals (HCP) working in English hospices. Here we aimed to answer the question; does a HCP data-derived model represent the experience of patients and carers of people with advanced cancer?MethodsSemi-structured interviews were undertaken with six patients with advanced cancer and six carers to gain an in-depth understanding of their experience of symptom management. Analysis was based on the framework method; transcription, familiarisation, coding, applying analytical framework (conceptual model), charting, interpretation. Inductive framework analysis was used to align data with themes in the existing model. A deductive approach was also used to identify new themes.ResultsThe experience of patients and carers aligned with key steps of engagement, decision making, partnership and delivery in the HCP-based model. The data aligned with 18 of 23 themes. These were; Role definition and boundaries, Multidisciplinary team decision making, Availability of services/staff, Clinician-Patient relationship/rapport, Patient preferences, Patient characteristics, Quality of life versus treatment need, Staff time/burden, Psychological support -informal, Appropriate understanding, expectations, acceptance and goals- patients, Appropriate understanding, expectations, acceptance and goals-HCPs, Appropriate understanding, expectations, acceptance and goals- family friends, carers, Professional, service and referral factors, Continuity of care, Multidisciplinary team working, Palliative care philosophy and culture, Physical environment and facilities, Referral process and delays. Four additional patient and carer-derived themes were identified: Carer Burden, Communication, Medicines management and COVID-19. Constructs that did not align were Experience (of staff), Training (of staff), Guidelines and evidence, Psychological support (for staff) and Formal psychological support (for patients).ConclusionsA healthcare professional-based conceptual model of effective symptom management aligned well with the experience of patients with advanced cancer and their carers. Additional domains were identified. We make four recommendations for change arising from this research. Routine appraisal and acknowledgement of carer burden, medicine management tasks and previous experience in healthcare roles; improved access to communication skills training for staff and review of patient communication needs. Further research should explore the symptom management experience of those living alone and how these people can be better supported.

Synoptic operative reports for pediatric surgical oncology.

Synoptic operative notes for pediatric surgical oncology provide standardized and structured documentation of surgical procedures performed on pediatric patients with cancer. These reports capture essential details such as preoperative diagnosis, intraoperative findings, surgical technique, and tumor characteristics in a concise and uniform format. By promoting consistency, accuracy, and completeness in reporting, synoptic operative notes facilitate effective communication among multidisciplinary healthcare teams, enhance quality assurance efforts, and streamline data extraction for research purposes. The integration of synoptic reporting within electronic medical record systems further enhances accessibility and usability, ensuring efficient documentation practices and improved patient care outcomes in pediatric surgical oncology.

Multidisciplinary Perspectives on Medical Decision-Making for Ostomy Surgery in Pediatric IBD: Themes from Focus Groups.

Pediatric Inflammatory Bowel Disease (IBD) is a chronic illness where patients may undergo ostomy surgery. Medical decision-making (MDM) for ostomy surgery is complex for patients/families and multidisciplinary healthcare professionals (HCPs) alike, with current uncertainty about how multidisciplinary HCPs think about ostomy care to inform future interventions to facilitate equitable multidisciplinary care for patients. This study sought to understand pediatric IBD multidisciplinary HCPs' perceptions regarding ostomy-related MDM and education. Multidisciplinary HCPs (e.g., gastroenterology medical providers, social workers, surgeons, and ostomy nurses) participated in semi-structured focus groups. Focus group data underwent qualitative analysis to identify themes. Three multidisciplinary focus groups were conducted, with n = 12 participants across all groups. Qualitative analysis identified three main themes, including (1) HCP perceptions of ostomies, (2) Patient/family-related factors, and (3) Professional roles and collaboration challenges. Ostomy surgery in pediatric IBD requires complex multidisciplinary MDM and education. Perspectives of multidisciplinary HCPs identified patient, HCP, and systems factors that may impact MDM for ostomy surgery. This work highlights nuances in MDM and education in IBD, and the critical role of ongoing research and improved standardized processes to coordinate multidisciplinary ostomy-related MDM and education in this population.

Development of a Smart Home Modification Program: A Delphi Survey of Multidisciplinary Health Care Experts.

There is a critical gap between the potential of smart home technologies to enhance the lives of people with physical disabilities (PwPD) and their limited use because of complex interfaces, high costs, technical issues, and insufficient institutional support. To bridge this gap and ensure that PwPD can fully benefit from smart home advancements to improve their daily living and quality of life by developing a smart home modification program. A Delphi survey involving three rounds was conducted with experts in disability and smart home technologies. Online survey. Thirty multidisciplinary health care experts. Experts rated the level of relevance in smart home modification with each survey. Consensus was set at ≥75%, content validity (CVR) was ≥.33, and convergence was ≤.5. The first Delphi result selected 26 items, and the second included 59 items after adjusting for values that fell below a CVR of .33. In the third Delphi survey, 59 items were selected. The final Delphi study had an average CVR of .96 and a coefficient of variation of .10. The last survey's consensus point was .92, indicating a high level of agreement among participants. On the basis of expert consensus, the study provides a validated framework for smart home modifications to aid PwPD. Plain-Language Summary: This research highlights the role of smart home adaptations to promote responsible, independent living for people with physical disabilities. There is a critical gap between the potential of smart home technologies to improve the lives of people with physical disabilities and their limited use because of complex interfaces, high costs, technical issues, and insufficient institutional support. The study authors developed a smart home modification program with the goal of closing this gap and to ensure that people with physical disabilities can fully benefit from smart home advancements to improve their daily living and quality of life. Based on expert ratings, the study findings provide a validated framework that occupational therapists can use to recommend smart home modifications to help people with physical disabilities. The framework can also be used by occupational therapists to identify people who may need more extensive environmental modifications and interventions.

The experience of adolescence process among French teenager pregnancies: a mixed-methods study

ABSTRACT Purpose Teenage pregnancy remains a significant global public health concern worldwide. However, it presents a complex phenomenon in developed countries, carrying potential short- and long-term consequences for both mothers and children. Methods This mixed method study used data from the French cross-sectional study “Portraits of adolescents”, which included 6000 girls aged between 13 and 17 years. The quantitative approach involved comparisons between a subgroup with an history of pregnancy and their peers, examining their lived-experience and mental health. The qualitative approach investigated the question “What does being a teenager mean for you?” specifically for the girls who reported an history of pregnancy. Results Teenage pregnancies presented elevated rates of mental health disorders, including dark thoughts, depression, self-harm, participating in dangerous games, attempting suicide and increased use of psychoactive substances. With limited support, in comparison to their peers. The qualitative approach revealed three major themes: “being in action”, “a way of feeling”, and “quality of relationship”. Conclusion This vulnerable subgroup of adolescents suggests the need for a coordinated multidisciplinary healthcare approach, given their limited parental and friend support, with a high risk of experiencing poor mental health. Additionally, these findings portray a “silent sufferer” population characterized by difficulties recognizing or managing emotions due to difficulties in expressing their emotional distress.

Decision Support and Behavioral Health for Reducing High-Dose Opioids in Comorbid Chronic Pain, Depression and Anxiety: Stepped-Wedge Cluster Randomized Trial.

High prevalence of depression or anxiety with opioid use for chronic pain complicates co-management and may influence prescribing behaviors. Compare clinical effectiveness of electronic medical record clinical decision support (EMR-CDS) versus additional behavioral health (BH) care management for reducing rates of high-dose opioid prescriptions. Type 2 effectiveness-implementation hybrid stepped-wedge cluster randomized trial in 35 primary care clinics within a health system in LA, USA. Patients aged 18+ receiving chronic opioid therapy for non-cancer pain with depression or anxiety and matched controls. EMR-CDS included opioid risk mitigation procedures. BH care included cognitive behavioral therapy; depression or anxiety medication adjustments; and case management. Outcomes of interest included difference-in-difference (DID) estimate of changes in probability for prescribing high-dose morphine equivalent daily dose (MEDD ≥50 mg/day and MEDD ≥90), average MEDD, and rates of hospitalization, emergency department use, and opioid risk mitigation. Most participants were female with 3+ pain syndromes. Data analysis included 632 patients. Absolute risk differences for MEDD≥50 and ≥90 decreased post-index compared to pre-index (DID of absolute risk difference [95%CI]: -0.036 [-0.089, 0.016] and -0.029 [-0.060, 0.002], respectively). However, these differences were not statistically significant. The average MEDD decreased at a higher rate for the BH group compared to EMR-CDS only (DID rate ratio [95%CI]: 0.85 [0.77, 0.93]). There were no changes in hospitalization and emergency department utilization. The BH group had higher probabilities of new specialty referrals and prescriptions for naloxone and antidepressants. Incorporation of a multidisciplinary behavioral health care team into primary care did not decrease high-dose prescribing; however, it improved adherence to clinical guideline recommendations for managing chronic opioid therapy for non-cancer pain. ClinicalTrials.gov ID NCT03889418.

The Impact of Workflow Interruptions on Team Communication in Multidisciplinary Healthcare Settings

The Impact of Workflow Interruptions on Team Communication in Multidisciplinary Healthcare Settings

Factors associated with patients' experience of access to their multidisciplinary primary health care clinic: A multilevel analysis.

Understanding patients' experiences accessing primary health care (PHC) is necessary to improve service organisation. This study aims to examine individual, organisational, and contextual factors associated with patients' experience of accessing the multidisciplinary PHC clinic to which they are attached. This cross-sectional study builds on survey data collected in multidisciplinary PHC clinics located in 14 regions in the province of Quebec (Canada). Between September 2022 and June 2023, an online questionnaire was sent to patients with an email contact and attached to a family physician. Two patient-reported experience measures were assessed: (1) difficulty obtaining an appointment with their regular family physician or nurse practitioner and (2) perceived unmet healthcare needs. A self-reported online questionnaire based on the advanced access model was also sent to PHC professionals and administrative staff to assess the use of advanced access strategies in their practice. Multilevel logistic regression models were fit. Stratified analyses were conducted according to the number of consultations received. In total, 122,397 patients and 847 family physicians, 97 nurse practitioners and 347 administrative staff nested into 104 clinics answered the survey. In the overall sample, having a chronic disorder was the only individual factor associated with the patient experience of access. Organizational factors including estimation of demand and supply, use of a referral algorithm, and strategies to optimise consultations were associated with a better access experience. Patients from medium size clinics compared to small clinics had better experiences of care for both outcomes. Stratified analysis indicated similar results for patients who consulted at the clinic 1-5 times in the last 12months as observed in the overall sample. This study indicates that enhancing organizational processes can improve patients' access experiences.