Attributes of FMG reform to improve accessibility to care and care continuity
| ASPECT OF CARE | BEFORE FMGs | AFTER FMGs |
|---|---|---|
| Constitution of practices | PCPs operate within medical practices (in general 3–4 physicians) that share mainly administrative services | Regrouping of 8–10 physicians who share clinical activities (discussing patients’ cases, sharing after-hours care) and nursing and administrative services to improve access to primary care |
| Chronic disease, health promotion, and preventive care | PCPs provide care for patients with chronic diseases and are in charge of health promotion and preventive care | 1–2 nurses with increased responsibilities take charge of the follow-up of patients with chronic diseases, health promotion, and preventive care so PCPs are released to achieve other tasks within their competencies (improves accessibility) |
| Coordination of care | Medical activities are not coordinated with those of other primary care services | FMG services are coordinated with those offered in local health agencies so psychosocial resources are made available to patients in the FMG |
| Continuity of care | Patients change physicians often and sometimes seek advice from multiple physicians for the same problem | Patients are registered, which improves continuity by linking patients to PCPs and to the professional teams of their FMGs |
| Accessibility of care | Patients have problems accessing the medical system; often this means visits to emergency departments or walk-in clinics | Health coverage 24 h/d, 7 d/wk, by the FMG using health hot-lines and emergency on-call services |
| Relational and informational continuity | Patients are in charge of coordinating their own care | Electronic patient records within the FMG (although these were not yet available at the time of the study); care pathways for the interdisciplinary follow-up of patients with chronic diseases, to promote patient empowerment, treatment adherence, and prevention; service agreement with local health agencies to improve patient access to technical and specialized expertise |
FMG—family medicine group, PCP—primary care physician.