Research Collective on the Organization of Primary Care Services in Québec

Key Messages

The research collective provides the messages below for decision makers responsible for the ongoing and future reorganization of primary healthcare services.

  1. Continuity of services provided by physicians seems to be central to achieving the desired effects, since it is closely associated with comprehensiveness and accessibility. It has been noted, however, that a high level of continuity can be detrimental to accessibility, and vice versa. Consequently, policies that emphasize, for example, accessibility or a reduction in use of emergency services risk producing adverse long-term effects if they do not include measures to enhance continuity.
  2. In the context of reorganizing primary care services, the optimum organizational model to simultaneously achieve continuity and accessibility seems to be one that offers services with and without appointments in a balanced manner.
  3. Introducing organizational mechanisms, such as integrated service networks, inter-professional collaboration, and new information and communication technologies, does not appear to reduce the overall cost of services; rather, it contributes to shifting costs from institutional services to the community. Consequently, policies aimed at reorganizing primary care services should target the enhancement of services from the standpoint of continuity, accessibility, and comprehensiveness rather than cost reduction, at least in the short term.
  4. In conjunction with implementing these changes, strategies that seek to affect professional practices rather than structures are more promising. The establishment in Québec of health and social services centres will have a limited effect if it does not rely primarily on the transformation of professional practices in the primary care sector.
  5. Certain system conditions must be met for successful change, and these must be accompanied by reorganization projects initiated by governments. To successfully carry out the clinical projects of the health and social services centres and heighten the accountability of family medicine groups to their registered patients, we must consider different ways of paying physicians and hospitals. Such measures are the government’s responsibility and are essential to creating favourable incentives so that family medicine groups and health and social services centres can assume their responsibilities towards the public.
  6. The reorganization of primary care services must not take a single form and must not be independent of the context in which it takes place. There is no single model to be implemented. Consequently, while a general framework is necessary to ensure some degree of coherence throughout Québec, we must allow regional and local agencies considerable latitude to implement these projects.
  7. Among the conditions that are essential to the success of these implementation projects, two constantly pose a challenge: participation of physicians who are not part of the public institutional network; and development of trusting relationships between the concerned parties. Special attention must be paid to these two conditions and the incentives or other measures that can facilitate their realization.