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COVID-19 – an opportunity to improve access to primary care through organizational innovations? A qualitative multiple case study in Quebec and Nova Scotia (Canada)

BACKGROUND: COVID-19 catalyzed a rapid and substantial reorganization of primary care, accelerating the spread of existing strategies and fostering a proliferation of innovations. Access to primary care is an essential component of a healthcare system, particularly during a pandemic. We describe org...

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Autores principales: Breton, Mylaine, Marshall, Emily Gard, Deslauriers, Véronique, Smithman, Mélanie Ann, Moritz, Lauren R., Buote, Richard, Morrison, Bobbi, Christian, Erin K., McKay, Madeleine, Stringer, Katherine, Godard-Sebillotte, Claire, Sourial, Nadia, Laberge, Maude, MacKenzie, Adrian, Isenor, Jennifer E., Duhoux, Arnaud, Ashcroft, Rachelle, Mathews, Maria, Cossette, Benoit, Hudon, Catherine, McDougall, Beth, Guénette, Line, Kirkwood, Rhonda, Green, Michael E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9177136/
https://www.ncbi.nlm.nih.gov/pubmed/35676668
http://dx.doi.org/10.1186/s12913-022-08140-w
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author Breton, Mylaine
Marshall, Emily Gard
Deslauriers, Véronique
Smithman, Mélanie Ann
Moritz, Lauren R.
Buote, Richard
Morrison, Bobbi
Christian, Erin K.
McKay, Madeleine
Stringer, Katherine
Godard-Sebillotte, Claire
Sourial, Nadia
Laberge, Maude
MacKenzie, Adrian
Isenor, Jennifer E.
Duhoux, Arnaud
Ashcroft, Rachelle
Mathews, Maria
Cossette, Benoit
Hudon, Catherine
McDougall, Beth
Guénette, Line
Kirkwood, Rhonda
Green, Michael E.
author_facet Breton, Mylaine
Marshall, Emily Gard
Deslauriers, Véronique
Smithman, Mélanie Ann
Moritz, Lauren R.
Buote, Richard
Morrison, Bobbi
Christian, Erin K.
McKay, Madeleine
Stringer, Katherine
Godard-Sebillotte, Claire
Sourial, Nadia
Laberge, Maude
MacKenzie, Adrian
Isenor, Jennifer E.
Duhoux, Arnaud
Ashcroft, Rachelle
Mathews, Maria
Cossette, Benoit
Hudon, Catherine
McDougall, Beth
Guénette, Line
Kirkwood, Rhonda
Green, Michael E.
author_sort Breton, Mylaine
collection PubMed
description BACKGROUND: COVID-19 catalyzed a rapid and substantial reorganization of primary care, accelerating the spread of existing strategies and fostering a proliferation of innovations. Access to primary care is an essential component of a healthcare system, particularly during a pandemic. We describe organizational innovations aiming to improve access to primary care and related contextual changes during the first 18 months of the COVID-19 pandemic in two Canadian provinces, Quebec and Nova Scotia. METHODS: We conducted a multiple case study based on 63 semi-structured interviews (n = 33 in Quebec, n = 30 in Nova Scotia) conducted between October 2020 and May 2021 and 71 documents from both jurisdictions. We recruited a diverse range of provincial and regional stakeholders (e.g., policy-makers, decision-makers, family physicians, nurses) involved in reorganizing primary care during the COVID-19 pandemic using purposeful sampling (e.g., based on role, region). Interviews were transcribed verbatim and thematic analysis was conducted in NVivo12. Emerging results were discussed by team members to identify salient themes and organized into logic models. RESULTS: We identified and analyzed six organizational innovations. Four of these – centralized public online booking systems, centralized access centers for unattached patients, interim primary care clinics for unattached patients, and a community connector to health and social services for older adults – pre-dated COVID-19 but were accelerated by the pandemic context. The remaining two innovations were created to specifically address pandemic-related needs: COVID-19 hotlines and COVID-dedicated primary healthcare clinics. Innovation spread and proliferation was influenced by several factors, such as a strengthened sense of community amongst providers, decreased patient demand at the beginning of the first wave, renewed policy and provider interest in population-wide access (versus attachment of patients only), suspended performance targets (e.g., continuity ≥80%) in Quebec, modality of care delivery, modified fee codes, and greater regional flexibility to implement tailored innovations. CONCLUSION: COVID-19 accelerated the uptake and creation of organizational innovations to potentially improve access to primary healthcare, removing, at least temporarily, certain longstanding barriers. Many stakeholders believed this reorganization would have positive impacts on access to primary care after the pandemic. Further studies should analyze the effectiveness and sustainability of innovations adapted, developed, and implemented during the COVID-19 pandemic. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-022-08140-w.
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spelling pubmed-91771362022-06-09 COVID-19 – an opportunity to improve access to primary care through organizational innovations? A qualitative multiple case study in Quebec and Nova Scotia (Canada) Breton, Mylaine Marshall, Emily Gard Deslauriers, Véronique Smithman, Mélanie Ann Moritz, Lauren R. Buote, Richard Morrison, Bobbi Christian, Erin K. McKay, Madeleine Stringer, Katherine Godard-Sebillotte, Claire Sourial, Nadia Laberge, Maude MacKenzie, Adrian Isenor, Jennifer E. Duhoux, Arnaud Ashcroft, Rachelle Mathews, Maria Cossette, Benoit Hudon, Catherine McDougall, Beth Guénette, Line Kirkwood, Rhonda Green, Michael E. BMC Health Serv Res Research BACKGROUND: COVID-19 catalyzed a rapid and substantial reorganization of primary care, accelerating the spread of existing strategies and fostering a proliferation of innovations. Access to primary care is an essential component of a healthcare system, particularly during a pandemic. We describe organizational innovations aiming to improve access to primary care and related contextual changes during the first 18 months of the COVID-19 pandemic in two Canadian provinces, Quebec and Nova Scotia. METHODS: We conducted a multiple case study based on 63 semi-structured interviews (n = 33 in Quebec, n = 30 in Nova Scotia) conducted between October 2020 and May 2021 and 71 documents from both jurisdictions. We recruited a diverse range of provincial and regional stakeholders (e.g., policy-makers, decision-makers, family physicians, nurses) involved in reorganizing primary care during the COVID-19 pandemic using purposeful sampling (e.g., based on role, region). Interviews were transcribed verbatim and thematic analysis was conducted in NVivo12. Emerging results were discussed by team members to identify salient themes and organized into logic models. RESULTS: We identified and analyzed six organizational innovations. Four of these – centralized public online booking systems, centralized access centers for unattached patients, interim primary care clinics for unattached patients, and a community connector to health and social services for older adults – pre-dated COVID-19 but were accelerated by the pandemic context. The remaining two innovations were created to specifically address pandemic-related needs: COVID-19 hotlines and COVID-dedicated primary healthcare clinics. Innovation spread and proliferation was influenced by several factors, such as a strengthened sense of community amongst providers, decreased patient demand at the beginning of the first wave, renewed policy and provider interest in population-wide access (versus attachment of patients only), suspended performance targets (e.g., continuity ≥80%) in Quebec, modality of care delivery, modified fee codes, and greater regional flexibility to implement tailored innovations. CONCLUSION: COVID-19 accelerated the uptake and creation of organizational innovations to potentially improve access to primary healthcare, removing, at least temporarily, certain longstanding barriers. Many stakeholders believed this reorganization would have positive impacts on access to primary care after the pandemic. Further studies should analyze the effectiveness and sustainability of innovations adapted, developed, and implemented during the COVID-19 pandemic. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-022-08140-w. BioMed Central 2022-06-08 /pmc/articles/PMC9177136/ /pubmed/35676668 http://dx.doi.org/10.1186/s12913-022-08140-w Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Breton, Mylaine
Marshall, Emily Gard
Deslauriers, Véronique
Smithman, Mélanie Ann
Moritz, Lauren R.
Buote, Richard
Morrison, Bobbi
Christian, Erin K.
McKay, Madeleine
Stringer, Katherine
Godard-Sebillotte, Claire
Sourial, Nadia
Laberge, Maude
MacKenzie, Adrian
Isenor, Jennifer E.
Duhoux, Arnaud
Ashcroft, Rachelle
Mathews, Maria
Cossette, Benoit
Hudon, Catherine
McDougall, Beth
Guénette, Line
Kirkwood, Rhonda
Green, Michael E.
COVID-19 – an opportunity to improve access to primary care through organizational innovations? A qualitative multiple case study in Quebec and Nova Scotia (Canada)
title COVID-19 – an opportunity to improve access to primary care through organizational innovations? A qualitative multiple case study in Quebec and Nova Scotia (Canada)
title_full COVID-19 – an opportunity to improve access to primary care through organizational innovations? A qualitative multiple case study in Quebec and Nova Scotia (Canada)
title_fullStr COVID-19 – an opportunity to improve access to primary care through organizational innovations? A qualitative multiple case study in Quebec and Nova Scotia (Canada)
title_full_unstemmed COVID-19 – an opportunity to improve access to primary care through organizational innovations? A qualitative multiple case study in Quebec and Nova Scotia (Canada)
title_short COVID-19 – an opportunity to improve access to primary care through organizational innovations? A qualitative multiple case study in Quebec and Nova Scotia (Canada)
title_sort covid-19 – an opportunity to improve access to primary care through organizational innovations? a qualitative multiple case study in quebec and nova scotia (canada)
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9177136/
https://www.ncbi.nlm.nih.gov/pubmed/35676668
http://dx.doi.org/10.1186/s12913-022-08140-w
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