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Lemelin L, Gallagher F, Haggerty J. Supporting parents of preschool children in adopting a healthy lifestyle. BMC Nurs 2012; 11:12. [PMID: 22852762 PMCID: PMC3489519 DOI: 10.1186/1472-6955-11-12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 07/05/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Childhood obesity is a public health epidemic. In Canada 21.5% of children aged 2-5 are overweight, with psychological and physical consequences for the child and economic consequences for society. Parents often do not view their children as overweight. One way to prevent overweight is to adopt a healthy lifestyle (HL). Nurses with direct access to young families could assess overweight and support parents in adopting HL. But what is the best way to support them if they do not view their child as overweight? A better understanding of parents' representation of children's overweight might guide the development of solutions tailored to their needs. METHODS/DESIGN This study uses an action research design, a participatory approach mobilizing all stakeholders around a problem to be solved. The general objective is to identify, with nurses working with families, ways to promote HL among parents of preschoolers. Specific objectives are to: 1) describe the prevalence of overweight in preschoolers at vaccination time; 2) describe the representation of overweight and HL, as reported by preschoolers' parents; 3) explore the views of nurses working with young families regarding possible solutions that could become a clinical tool to promote HL; and 4) try to identify a direction concerning the proposed strategies that could be used by nurses working with this population. First, an epidemiological study will be conducted in vaccination clinics: 288 4-5-year-olds will be weighed and measured. Next, semi-structured interviews will be conducted with 20 parents to describe their representation of HL and their child's weight. Based on the results from these two steps, by means of a focus group nurses will identify possible strategies to the problem. Finally, focus groups of parents, then nurses and finally experts will give their opinions of these strategies in order to find a direction for these strategies. Descriptive and correlational statistical analyses will be done on the quantitative survey data using SPSS. Qualitative data will be analyzed using Huberman and Miles' (2003) approach. NVivo will be used for the analysis and data management. DISCUSSION The anticipated benefits of this rigorous approach will be to identify and develop potential intervention strategies in partnership with preschoolers' parents and produce a clinical tool reflecting the views of parents and nurses working with preschoolers' parents.
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Hudon C, Fortin M, Haggerty J, Loignon C, Lambert M, Poitras ME. Patient-centered care in chronic disease management: a thematic analysis of the literature in family medicine. PATIENT EDUCATION AND COUNSELING 2012; 88:170-6. [PMID: 22360841 DOI: 10.1016/j.pec.2012.01.009] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 12/21/2011] [Accepted: 01/14/2012] [Indexed: 05/16/2023]
Abstract
OBJECTIVE The objective was to provide a synthesis of the results of the research and discourse lines on main dimensions of patient-centered care in the context of chronic disease management in family medicine, building on Stewart et al.'s model. METHODS We developed search strategies for the Medline, Embase, and Cochrane databases, from 1980 to April 2009. All articles addressing patient-centered care in the context of chronic disease management in family medicine were included. A thematic analysis was performed using mixed codification, based on Stewart's model of patient-centered care. RESULTS Thirty-two articles were included. Six major themes emerged: (1) starting from the patient's situation; (2) legitimizing the illness experience; (3) acknowledging the patient's expertise; (4) offering realistic hope; (5) developing an ongoing partnership; (6) providing advocacy for the patient in the health care system. CONCLUSION The context of chronic disease management brings forward new dimensions of patient-centered care such as legitimizing the illness experience, acknowledging patient expertise, offering hope and providing advocacy. PRACTICE IMPLICATIONS Chronic disease management calls for the adaptation of the family physician's role to patients' fluctuating needs. Literature also suggests the involvement of the family physician in care transitions as a component of patient-centered care.
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Lévesque JF, Haggerty J, Beninguissé G, Burge F, Gass D, Beaulieu MD, Pineault R, Santor D, Beaulieu C. Mapping the coverage of attributes in validated instruments that evaluate primary healthcare from the patient perspective. BMC FAMILY PRACTICE 2012; 13:20. [PMID: 22423617 PMCID: PMC3353250 DOI: 10.1186/1471-2296-13-20] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 03/16/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Primary healthcare in developed countries is undergoing important reforms, and these require evaluation strategies to assess how well the population's expectations are being met. Although numerous instruments are available to evaluate primary healthcare (PHC) from the patient perspective, they do not all measure the same range of constructs. To analyze the extent to which important PHC attributes are covered in validated instruments measuring quality of care from the patient perspective. METHOD We systematically identified validated instruments from the literature and by consulting experts. Using a Delphi consensus-building process, Canadian PHC experts identified and operationally defined 24 important PHC attributes. One team member mapped instrument subscales to these operational definitions; this mapping was then independently validated by members of the research team and conflicts were resolved by the PHC experts. RESULTS Of the 24 operational definitions, 13 were evaluated as being best measured by patients, 10 by providers, three by administrative databases and one by chart audits (some being best measured by more than one source). Our search retained 17 measurement tools containing 118 subscales. After eliminating redundancies, we mapped 13 unique measurement tools to the PHC attributes. Accessibility, relational continuity, interpersonal communication, management continuity, respectfulness and technical quality of clinical care were the attributes widely covered by available instruments. Advocacy, management of clinical information, comprehensiveness of services, cultural sensitivity, family-centred care, whole-person care and equity were poorly covered. CONCLUSIONS Validated instruments to evaluate PHC quality from the patient perspective leave many important attributes of PHC uncovered. A complete assessment of PHC quality will require adjusting existing tools and/or developing new instruments.
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Poitras ME, Fortin M, Hudon C, Haggerty J, Almirall J. Validation of the disease burden morbidity assessment by self-report in a French-speaking population. BMC Health Serv Res 2012; 12:35. [PMID: 22333434 PMCID: PMC3305524 DOI: 10.1186/1472-6963-12-35] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 02/14/2012] [Indexed: 12/21/2022] Open
Abstract
Background The Disease Burden Morbidity Assessment (DBMA) is a self-report questionnaire used to estimate the disease burden experienced by patients. The aim of this study was to test and to measure the properties of the French translation of the DBMA (DBMA-Fv). Methods The original version of the DBMA was translated into French (Canadian) and first assessed during cognitive interviews. In the validation study, patients recruited during consecutive consultation periods completed the DBMA-Fv questionnaire while they were in the waiting room of a primary care setting (T1). Participants completed the same questionnaire mailed to their home two weeks later (T2). Concomitant validity of the DBMA-Fv was assessed using the Cumulative Illness Rating Scale (CIRS). Patient medical records were reviewed to verify chronic diseases and past medical history. Results Ninety-seven patients were recruited and 85 (88%) returned the mailed questionnaires; 5 (5.9%) were incomplete. DBMA-Fv scores of the 80 participants with a complete questionnaire at T2 ranged from 0 to 30 (median 5.5, mean 7.7, SD = 7.0). Test-retest reliability of the DBMA-Fv was high (ICC: 0.86, 95% CI: 0.79-0.92). The DBMA-Fv and the CIRS correlated moderately at T1 (r = 0.46, 95% CI: 0.26 - 0.62, p < 0.01) and T2 (r = 0.56, 95% CI: 0.38 - 0.70, p < 0.01). The mean (SD) sensitivity of patient reports of a condition in relation to chart review at T2 was 73.9 (8.4) (range 62.5% to 90%). The overall mean (SD) specificity was 92.2 (6.7) (range 77.6% to 98.6%). Conclusions The DBMA-Fv's properties are similar to its English counterpart as to its median sensitivity and specificity compared to chart reviews. It correlated moderately with an established index of multimorbidity. A high percentage of patients were able to complete the test correctly as a mail questionnaire and it showed high test-retest reliability.
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Haggerty J, Beaulieu MD, Pineault R, Burge F, Lévesque JF, Santor D, Bouharaoui F, Lévesque C. Comprehensiveness of Care from the Patient Perspective: Comparison of Primary Healthcare Evaluation Instruments. Healthc Policy 2011. [DOI: 10.12927/hcpol.2011.22708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Santor D, Haggerty J, Lévesque JF, Burge F, Beaulieu MD, Gass D, Pineault R. An Overview of Confirmatory Factor Analysis and Item Response Analysis Applied to Instruments to Evaluate Primary Healthcare. ACTA ACUST UNITED AC 2011. [DOI: 10.12927/hcpol.2011.22694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Haggerty J, Bouharaoui F, Santor D. Differential Item Functioning in Primary Healthcare Evaluation Instruments by French/English Version, Educational Level and Urban/Rural Location. Healthc Policy 2011. [DOI: 10.12927/hcpol.2011.22692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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83
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Lévesque JF, Haggerty J, Burge F, Beaulieu MD, Gass D, Pineault R, Santor D. Canadian Experts' Views on the Importance of Attributes within Professional and Community-Oriented Primary Healthcare Models. Healthc Policy 2011. [DOI: 10.12927/hcpol.2011.22690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Haggerty J, Burge F, Beaulieu MD, Pineault R, Beaulieu C, Lévesque JF, Santor D, Gass D, Lawson B. Validation of Instruments to Evaluate Primary Healthcare from the Patient Perspective: Overview of the Method. Healthc Policy 2011. [DOI: 10.12927/hcpol.2011.22691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Burge F, Haggerty J, Pineault R, Beaulieu MD, Lévesque JF, Beaulieu C, Santor D. Relational Continuity from the Patient Perspective: Comparison of Primary Healthcare Evaluation Instruments. Healthc Policy 2011. [DOI: 10.12927/hcpol.2011.22637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Beaulieu MD, Haggerty J, Beaulieu C, Bouharaoui F, Lévesque JF, Pineault R, Burge F, Santor D. Interpersonal Communication from the Patient Perspective: Comparison of Primary Healthcare Evaluation Instruments. Healthc Policy 2011. [DOI: 10.12927/hcpol.2011.22636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Haggerty J, Lévesque JF, Santor D, Burge F, Beaulieu C, Bouharaoui F, Beaulieu MD, Pineault R. Accessibility from the Patient Perspective: Comparison of Primary Healthcare Evaluation Instruments. Healthc Policy 2011. [DOI: 10.12927/hcpol.2011.22635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Haggerty J, Beaulieu C, Lawson B, Santor D, Fournier M, Burge F. What Patients Tell Us about Primary Healthcare Evaluation Instruments: Response Formats, Bad Questions and Missing Pieces. Healthc Policy 2011. [DOI: 10.12927/hcpol.2013.22693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Haggerty J, Burge F, Pineault R, Beaulieu MD, Bouharaoui F, Beaulieu C, Santor D, Lévesque JF. Management Continuity from the Patient Perspective: Comparison of Primary Healthcare Evaluation Instruments. Healthc Policy 2011. [DOI: 10.12927/hcpol.2011.22709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Haggerty J. Measurement of Primary Healthcare Attributes from the Patient Perspective. Healthc Policy 2011. [DOI: 10.12927/hcpol.2011.22689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Lévesque JF, Pineault R, Haggerty J, Burge F, Beaulieu MD, Gass D, Santor D, Beaulieu C. Respectfulness from the Patient Perspective: Comparison of Primary Healthcare Evaluation Instruments. Healthc Policy 2011. [DOI: 10.12927/hcpol.2011.22707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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McIver Z, Mielke S, Shenoy A, Fellows V, Stroncek D, Leitman S, Childs R, Batiwalla M, Koklanaris E, Haggerty J, Savani B, Rezvani K, Barrett A. Selectively T Cell Depleted Allografts From HLA-Matched Sibling Donors Followed by Low-Dose Post Transplant Immunosuppression to Limit Disease Relapse in Patients With Hematological Malignancies. Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lamarche PA, Pineault R, Gauthier J, Hamel M, Haggerty J. Availability of healthcare resources, positive ratings of the care experience and extent of service use: an unexpected relationship. Healthc Policy 2011; 6:46-56. [PMID: 22294991 PMCID: PMC3082387 DOI: 10.12927/hcpol.2011.22178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Two main avenues are advocated to improve the capability of healthcare systems to satisfy the public's needs and expectations: more resources and better organization. This paper sheds some light on this debate. It assesses the extent to which patients' positive rating of their healthcare experience and the extent to which they use services are related to the availability of healthcare resources. Findings indicate that patients' evaluations of their care experience and use of services were higher when the availability of resources was either limited or average. In no case were positive ratings of services and greater use of them associated with greater resource availability. Thus, simply adding resources runs the risk of diminishing, rather than improving, users' healthcare experience.
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Haggerty J, Fortin M, Beaulieu MD, Hudon C, Loignon C, Préville M, Roberge D. At the interface of community and healthcare systems: a longitudinal cohort study on evolving health and the impact of primary healthcare from the patient's perspective. BMC Health Serv Res 2010; 10:258. [PMID: 20815880 PMCID: PMC2940881 DOI: 10.1186/1472-6963-10-258] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 09/03/2010] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Massive efforts in Canada have been made to renew primary healthcare. However, although early evaluations of initiatives and research on certain aspects of the reform are promising, none have examined the link between patient assessments of care and health outcomes or the impacts at a population level. The goal of this project is to examine the effect of patient-centred and effective primary healthcare on the evolution of chronic illness burden and health functioning in a population, and in particularly vulnerable groups: the multi-morbid and the poor. METHODS/DESIGN A randomly selected cohort of 2000 adults aged 25 to 75 years will be recruited within the geographic boundaries of four local healthcare networks in Quebec. At recruitment, cohort members will report on socio-demographic information, functional health and healthcare use. Two weeks, 12 months and 24 months after recruitment, cohort participants will complete a self-administered questionnaire on current health and health behaviours in order to evaluate primary healthcare received in the previous year.The dependent variables are calculated as change over time of functional health status, chronic illness burden, and health behaviours. Dimensions of patient-centred care and clinical processes are measured using sub-scales of validated instruments. We will use Poisson regression modelling to estimate the incidence rate of chronic illness burden scores and structural equation modelling to explore relationships between variables and to examine the impact of dimensions of patient-centred care and effective primary healthcare. DISCUSSION Results will provide valuable information for primary healthcare clinicians on the course of chronic illness over time and the impact on health outcomes of accessible, patient-centred and effective care. A demonstration of impact will contribute to the promotion of continuous quality improvement activities at a clinical level. While considerable advances have been made in the management of specific chronic illnesses, this will make a unique contribution to effective care for persons with multiple morbidities. Furthermore, the cohort and data architecture will serve as a research platform for future projects.
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Tourigny A, Aubin M, Haggerty J, Bonin L, Morin D, Reinharz D, Leduc Y, St-Pierre M, Houle N, Giguère A, Benounissa Z, Carmichael PH. Patients' perceptions of the quality of care after primary care reform: Family medicine groups in Quebec. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2010; 56:e273-e282. [PMID: 20631263 PMCID: PMC2922830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To evaluate how a primary care reform, which aimed to promote interprofessional and interorganizational collaborative practices, affected patients' experiences of the core dimensions of primary care. DESIGN Before-and-after comparison of patients' perceptions of care at the beginning of family medicine group (FMG) implementation (15 to 20 months after accreditation) and 18 months later. SETTING Five FMGs in the province of Quebec from various settings and types of practice. PARTICIPANTS A random sample of patients was selected in each FMG; a total of 1046 participants completed both the baseline and follow-up questionnaires. MAIN OUTCOME MEASURES Patients' perceptions of relational and informational continuity, organizational and first-contact accessibility, attitude and efficiency of the clinic's personnel and waiting times (service responsiveness), physician-nurse and primary care physician-specialist coordination, and intra-FMG collaboration were assessed over the telephone, mostly using a modified version of the Primary Care Assessment Tool. Additional items covered patients' opinions about consulting nurses, patients' use of emergency services, and patients' recall of health promotion and preventive care received. RESULTS A total of 1275 patients were interviewed at the study baseline, and 82% also completed the follow-up interviews after 18 months (n = 1046). Overall, perceptions of relational and informational continuity increased significantly (P < .05), whereas organizational and first-contact accessibility and service responsiveness did not change significantly. Perception of physician-nurse coordination remained unchanged, but perception of primary care physician-specialist coordination decreased significantly (P < .05). The proportion of participants reporting visits with nurses and reporting use of FMGs' emergency services increased significantly from baseline to follow-up (P < .05). CONCLUSION This reorganization of primary care services resulted in considerable changes in care practices, which led to improvements in patients' experiences of the continuity of care but not to improvements in their experiences of the accessibility of care.
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Fortin M, Hudon C, Haggerty J, Akker MVD, Almirall J. Prevalence estimates of multimorbidity: a comparative study of two sources. BMC Health Serv Res 2010; 10:111. [PMID: 20459621 PMCID: PMC2907759 DOI: 10.1186/1472-6963-10-111] [Citation(s) in RCA: 196] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Accepted: 05/06/2010] [Indexed: 12/01/2022] Open
Abstract
Background Published prevalence studies on multimorbidity present diverse data collection methods, sources of data, targeted age groups, diagnoses considered and study populations, making the comparability of prevalence estimates questionable. The objective of this study was to compare prevalence estimates of multimorbidity derived from two sources and to examine the impact of the number of diagnoses considered in the measurement of multimorbidity. Methods Prevalence of multimorbidity was estimated in adults over 25 years of age from two separate Canadian studies: a 2005 survey of 26,000 respondents randomly selected from the general population and a 2003 study of 980 patients from 21 family practices. We estimated the prevalence of multimorbidity based on the co-occurrence of ≥ 2 and ≥ 3 diseases of the seven diseases listed in the general population survey. For primary care patients, we also estimated multimorbidity prevalence using an open list of chronic diseases. Results Prevalence estimates were considerably higher for each age group in the primary care sample than in the general population. For primary care patients, the number of chronic diseases considered for estimates resulted in large differences, especially in younger age groups. The prevalence of multimorbidity increased with age in both study populations. Conclusions The prevalence of multimorbidity was substantially lower when estimated in a general population than in a family practice-based sample and was higher when the number of conditions considered increased.
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Ehrmann Feldman D, Xiao Y, Bernatsky S, Haggerty J, Leffondré K, Tousignant P, Roy Y, Abrahamowicz M. Consultation with cardiologists for persons with new-onset chronic heart failure: a population-based study. Can J Cardiol 2010; 25:690-4. [PMID: 19960128 DOI: 10.1016/s0828-282x(09)70528-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND It is recommended that persons recently diagnosed with heart failure consult with a specialist in heart failure. OBJECTIVES To determine whether patients who were diagnosed with new-onset chronic heart failure (CHF) by a noncardiologist consulted with a cardiologist, and identify the factors associated with delayed consultation. METHODS Physician reimbursement administrative data were obtained for all adults with suspected new-onset CHF in the year 2000 in Quebec, defined operationally as a physician visit for CHF (based on the International Classification of Diseases, 9th Revision diagnostic codes), with no previous physician visit code for CHF in the preceding three years. Among those first diagnosed by a noncardiologist, Cox regression modelling was used to identify patient and physician characteristics associated with time to cardiology consultation. RESULTS Of the 13,523 persons coded as having incident CHF, 54.9% consulted a cardiologist within the next 2.5 to 3.5 years, and 67.4% were seen by an internist or cardiologist. Older patients, women, and those with lower comorbidity and socioeconomic status had significantly longer times to cardiology consultation. CONCLUSION The data suggest that many patients with suspected new-onset CHF do not receive prompt cardiology care, as stipulated by current recommendations. Equity of access for women and those with lower socioeconomic status appears to be problematic.
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Yavich N, Báscolo EP, Haggerty J. Construyendo un marco de evaluación de la atención primaria de la salud para Latinoamérica. SALUD PUBLICA DE MEXICO 2010; 52:39-45. [PMID: 20464252 DOI: 10.1590/s0036-36342010000100007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Accepted: 09/21/2009] [Indexed: 11/21/2022] Open
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Rodríguez C, Lamothe L, Barten F, Haggerty J. Gobernanza y salud: significado y aplicaciones en América Latina. Rev Salud Publica (Bogota) 2010. [DOI: 10.1590/s0124-00642010000700011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Lamarche PA, Pineault R, Haggerty J, Hamel M, Levesque JF, Gauthier J. The experience of primary health care users: a rural-urban paradox. CANADIAN JOURNAL OF RURAL MEDICINE 2010; 15:61-66. [PMID: 20350447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION We sought to assess the care experience of primary health care users, to determine whether users' assessments of their experience vary according to the geographical context in which services are obtained, and to determine whether the observed variations are consistent across all components of the care experience. METHODS We examined the experience of 3389 users of primary care in 5 administrative regions in Quebec, focusing on accessibility, continuity, responsiveness and reported use of health services. RESULTS We found significant variations in users' assessments of the specific components of the care experience. Access to primary health care received positive evaluations least frequently, and continuity of information received the approval of the highest percentage of users. We also found significant variations among geographical contexts. Positive assessments of the care experience were more frequently made by users in remote rural settings; they became progressively less frequent in near-urban rural and near-urban settings, and were found least often in urban settings. We observed these differences in almost all of the components of the care experience. CONCLUSION Given the relatively greater supply of services in urban areas, this analysis has revealed a rural-urban paradox in the care experience of primary health care users.
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