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Table 4 Evidence of effects in Quebec

From: Improving access to primary health care: a cross-case comparison based on an a priori program theory

Box Impact Evidence Source
10 Consumer perceives need All patients appreciated the telephone outreach, and several patients indicated that they did not realize until after receiving the call that they needed the information that was provided. Qualitative interviews
11 Consumer ability to seek Significant increase in score on ‘Ability to seek’ scale (1 = Not easy at all to 4 = Very easy) from 2.8 to 3.3, p = 0.000. Patient survey
12 Consumer gets to social/ community service relative to need Reported use of community health services not significantly increased from 6% (3/51) at baseline to 17% (n = 8/48) at follow-up (p = 0.13).
Helpfulness of services received not significantly increased from an average of 1.6 (n = 14) to 3.3 (n = 44) (p = 0.020) where 1 = “no, not at all” and 4 = “yes, absolutely”.
Patient Survey
13 Consumer gets to GP/FP Among patients who tried to contact their provider by telephone: At baseline, 37% reported it was ‘very easy’ compared to 73% post-intervention. Patient Survey
31 Appropriate referrals Referral to community health and social services by the usual physician increased significantly from 5% at baseline (1/19 with a usual place of care) to 14% (6/42 reporting on new physician) at follow-up (p = 0.06). (NB – providers were different). Patient survey
32 Appropriate PMC is provided Patients reported the extent to which their doctor or nurse provided everything needed to manage their health on a 4-point scale from 1 = not at all to 4 = yes, definitely. Mean scores increased from 3.4 at baseline (n = 24, referring to usual source of care) to 3.8 at follow-up (n = 54, referring to new FP), p = 0.08. Patient survey
33 Consumer engages with care Patients’ abilities to explain their problems to health professionals increased from 3.4 at base line (mostly easy) to 3.8 at follow-up (mostly very easy), p = 0.002.
At follow-up interviews, patients reported that the visit preparation tools had helped them have more effective visits and to better understand their own needs.
Patient survey
Qualitative interview
41 Consumer needs addressed at right location The rate of forgone care because of access difficulties dropped from 41% at baseline to 12% at follow-up. The rate of emergency-room use fell from 20% (12/60) at baseline to 11% at follow-up (6/54, 4 were repeat users). Patient survey
42 Enduring relationship with GP/FP Reported attachment to a specific responsible professional increased from 15% (6/60) at baseline to 89% (48/54) at follow-up, p < 0.000. Patient survey
43 Healthcare is perceived /experienced positively Reports of patient-centered care increased between baseline and follow up:
• 26 to 48% reported their provider explored patient concerns about health
• 48 to 68% gave importance to patient’s ideas about health
• 48 to 85% put patients at ease to discuss issues.
Patient survey