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

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY Accounts of Chemical Research Pub Date : 2024-07-28 DOI:10.1002/hpm.3831

Mylaine Breton, Isabelle Gaboury, Catherine Lamoureux-Lamarche, Véronique Deslauriers, Christine Beaulieu, Élisabeth Martin, Djamal Berbiche

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Abstract

Background

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.

Methods

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.

Findings

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 12 months as observed in the overall sample.

Conclusions

This study indicates that enhancing organizational processes can improve patients' access experiences.

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与患者在多学科初级卫生保健诊所就诊体验相关的因素：多层次分析。

背景：了解患者获得初级卫生保健（PHC）的经历对于改善服务组织是非常必要的。本研究旨在探讨与患者就诊于所就诊的多学科初级卫生保健诊所的经历相关的个人、组织和环境因素：本横断面研究以魁北克省（加拿大）14 个地区的多学科初级保健诊所收集的调查数据为基础。在 2022 年 9 月至 2023 年 6 月期间，通过电子邮件向患者发送了一份在线调查问卷，并将其发送给了一名家庭医生。评估了患者报告的两项体验指标：（1）与固定的家庭医生或执业护士预约就诊的困难；（2）认为未得到满足的医疗保健需求。此外，还向初级保健中心的专业人员和行政人员发送了一份基于先进就医模式的自我报告在线问卷，以评估他们在实践中使用先进就医策略的情况。多层次逻辑回归模型得到了拟合。根据接受咨询的人数进行了分层分析：共有 122,397 名患者、847 名家庭医生、97 名执业护士和 347 名行政人员回答了调查，他们被归入 104 家诊所。在所有样本中，患有慢性疾病是唯一与患者就医体验相关的个人因素。组织因素（包括对供需的估计、转诊算法的使用以及优化咨询的策略）与更好的就医体验有关。与小型诊所相比，中型诊所的患者在两种结果上都有更好的就医体验。分层分析表明，过去12个月中在诊所就诊1-5次的患者的结果与总体样本中观察到的结果相似：本研究表明，加强组织流程可以改善患者的就医体验。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.

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