Evaluation of the implementation and associated effects of advanced access in university family medicine groups: a study protocol

Bréton, Mylaine; Maillet, Lara; Duhoux, Arnaud; Malham, Sabina Abou; Gaboury, Isabelle; Manceau, Luiza Maria; Hudon, Catherine; Rodrigues, Isabel; Haggerty, Jeannie; Touati, Nassera; Beaulieu, Marie‐Claude; Loignon, Christine; Lussier, Marie-Thérèse; Vedel, Isabelle; Jbilou, Jalila

doi:10.1186/s12875-020-01109-w

Cited by 17 publications

(23 citation statements)

References 26 publications

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“…A cross-sectional study was conducted based on an open e-survey hosted on a web platform and distributed between May and August 2020 to all U-FMGs in Quebec ( n = 50). The U-FMG model involves interdisciplinary teams with a teaching mission for family medicine residents ( Breton et al 2020 ). An FMG is a group of physicians working closely with nurses, social workers, pharmacists and other professionals in the provision of services to enrolled patients on a non-geographic basis ( Breton et al 2011 ).…”

Section: Methodsmentioning

confidence: 99%

Telehealth in Primary Healthcare: A Portrait of its Rapid Implementation during the COVID-19 Pandemic

Bréton¹,

Deville‐Stoetzel²,

Gaboury³

et al. 2021

hcpol

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Objective: This study documents the adoption of telehealth by various types of primary healthcare (PHC) providers working in teaching PHC clinics in Quebec during the COVID-19 pandemic. It also identifies the perceived advantages and disadvantages of telehealth. Method: A cross-sectional study was conducted between May and August 2020. The e-survey was completed by 48/50 teaching primary care clinics representing 603/1,357 (44%) PHC providers. Results: Telephone use increased the most, becoming the principal virtual modality of consultation, during the pandemic. Video consultations increased, with variations by type of PHC

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Section: Methodsmentioning

confidence: 99%

Telehealth in Primary Healthcare: A Portrait of its Rapid Implementation during the COVID-19 Pandemic

Bréton¹,

Deville‐Stoetzel²,

Gaboury³

et al. 2021

hcpol

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“…Canada ranked 10th out of 11 countries in the 2020 Commonwealth Fund survey of the proportion of the population with a regular primary care provider [ 3 ]. Across Canada, timely access to primary care also remains a major challenge [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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

Bréton

Marshall

Deslauriers

et al. 2022

BMC Health Serv Res

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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.

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“…Implementation of the AA model requires reorganizing the practice of all team members [9,10], including various categories of nurses who have to adapt their tasks and practice to ensure that implementation is effective and patient-focused [11,12]. Indeed, optimizing the role of nurses is a key strategy for improving timely Table 1 The key principles of advanced access, adapted from Murray & Berwick (2003) [6], Breton et al (2017) [7] Key principles of Advanced Access Definition…”

Section: Introductionmentioning

confidence: 99%

Changing nursing practice within primary health care innovations: the case of advanced access model

et al. 2020

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Background The advanced access (AA) model has attracted much interest across Canada and worldwide as a means of ensuring timely access to health care. While nurses contribute significantly to improving access in primary healthcare, little is known about the practice changes involved in this innovative model. This study explores the experience of nurse practitioners and registered nurses with implementation of the AA model, and identifies factors that facilitate or impede change. Methods We used a longitudinal qualitative approach, nested within a multiple case study conducted in four university family medicine groups in Quebec that were early adopters of AA. We conducted semi-structured interviews with two types of purposively selected nurses: nurse practitioners (NPs) (n = 6) and registered nurses (RNs) (n = 5). Each nurse was interviewed twice over a 14-month period. One NP was replaced by another during the second interviews. Data were analyzed using thematic analysis based on two principles of AA and the Niezen & Mathijssen Network Model (2014). Results Over time, RNs were not able to review the appointment system according to the AA philosophy. Half of NPs managed to operate according to AA. Regarding collaborative practice, RNs were still struggling to participate in team-based care. NPs were providing independent and collaborative patient care in both consultative and joint practice, and were assuming leadership in managing patients with acute and chronic diseases. Thematic analysis revealed influential factors at the institutional, organizational, professional, individual and patient level, which acted mainly as facilitators for NPs and barriers for RNs. These factors were: 1) policy and legislation; 2) organizational policy support (leadership and strategies to support nurses’ practice change); facility and employment arrangements (supply and availability of human resources); Inter-professional collegiality; 3) professional boundaries; 4) knowledge and capabilities; and 5) patient perceptions. Conclusions Our findings suggest that healthcare decision-makers and organizations need to redefine the boundaries of each category of nursing practice within AA, and create an optimal professional and organizational context that supports practice transformation. They highlight the need to structure teamwork efficiently, and integrate and maximize nurses’ capacities within the team throughout AA implementation in order to reduce waiting times.

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Evaluation of the implementation and associated effects of advanced access in university family medicine groups: a study protocol

Cited by 17 publications

References 26 publications

Telehealth in Primary Healthcare: A Portrait of its Rapid Implementation during the COVID-19 Pandemic

Telehealth in Primary Healthcare: A Portrait of its Rapid Implementation during the COVID-19 Pandemic

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

Changing nursing practice within primary health care innovations: the case of advanced access model

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