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Room for improvement

Patients’ experiences of primary care in Quebec before major reforms

Raynald Pineault, MD PhD
Emeritus Professor in the Department of Social and Preventive Medicine at the University of Montreal in Quebec

Marie-Dominique Beaulieu, MD MSc
Professor in the Department of Family Medicine at the University of Montreal

Yvon Brunelle, MA
Staff at the Ministry of Health and Social Services in Quebec city, Que

Josée Gauthier, MSc
Staff at the Institut national de santé publique du Québec in Rimouski, Que

François Goulet, MD
Assistant Director of the Practice Enhancement Division at the Collège des médecins du Québec in Montreal

Jean Rodrigue, MD
Staff at the Fédération des médecins omnip-raticiens du Québec in Montreal

Correspondence to: Dr Jeannie Haggerty, Associate Professor and Canada Research Chair, Département des Sciences de la santé communautaire, Université Sherbooke, Complexe St-Charles, Bureau 354, tour Est, 1111, rue St-Charles Ouest, Longueuil, QC J4K 5G4; telephone 450 466-5000, extension 3682; fax 450 651-6589; e-mail Jeannie.Haggerty{at}usherbrooke.ca

OBJECTIVE To investigate variations in accessibility, continuity of care, and coordination of services as experienced by patients in Quebec on the eve of major reforms, and to provide baseline information against which reforms could be measured.

DESIGN Multilevel cross-sectional survey of practice.

SETTING One hundred primary health care settings were randomly selected in urban, suburban, rural, and remote locations in 5 health regions in Quebec.

PARTICIPANTS In each clinic, we chose up to 4 physicians and 20 consecutive patients consulting each physician.

MAIN OUTCOME MEASURES Patients’ responses to a self-administered questionnaire, the Primary Care Assessment Tool, that assessed patient-provider affiliation, accessibility, relational continuity, coordination of primary and specialty care, and whether patients received health promotion and preventive services.

RESULTS A total of 3441 patients participated (87% acceptance rate) in 100 clinics (64% response rate). Timely access was difficult; only 10% expressed confidence they could be seen by their regular doctors within a day if they became suddenly ill. Average waiting time for a doctor’s appointment was 24 days. Coordination of care with specialists was at minimally acceptable levels. Patients with family physicians recalled them addressing only 56% of the health promotion and preventive issues appropriate for their age and sex, and patients without family physicians recalled physicians addressing substantially fewer (38%). Most patients reported they were highly confident that their physicians knew them well and would manage their care beyond clinical encounters (relational continuity). The exception was the 16% of patients overall who did not have family physicians (34% of patients at walk-in clinics).

CONCLUSION This survey highlights serious problems with accessibility. Improvement is needed urgently to avoid deterioration of patients’ confidence in the healthsystem even though patients rate their relationships with their physician highly. Health promotion, preventive services, and coordination with specialists also needed to be improved, and careful thought must be given to the plight of those without family physicians.