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- Title
Providing high-quality care in primary care settings: how to make trade-offs.
- Authors
Beaulieu, Marie-Dominique; Geneau, Robert; Grande, Claudio Del; Denis, Jean-Louis; Hudon, Eveline; Haggerty, Jeannie L; Bonin, Lucie; Duplain, Réjean; Goudreau, Johanne; Hogg, William; Del Grande, Claudio
- Abstract
<bold>Objective: </bold>To gain a deeper understanding of how primary care (PC) practices belonging to different models manage resources to provide high-quality care.<bold>Design: </bold>Multiple-case study embedded in a cross-sectional study of a random sample of 37 practices.<bold>Setting: </bold>Three regions of Quebec.<bold>Participants: </bold>Health care professionals and staff of 5 PC practices.<bold>Methods: </bold>Five cases showing above-average results on quality-of-care indicators were purposefully selected to contrast on region, practice size, and PC model. Data were collected using an organizational questionnaire; the Team Climate Inventory, which was completed by health care professionals and staff; and 33 individual interviews. Detailed case histories were written and thematic analysis was performed.<bold>Main Findings: </bold>The core common feature of these practices was their ongoing effort to make trade-offs to deliver services that met their vision of high-quality care. These compromises involved the same 3 areas, but to varying degrees depending on clinic characteristics: developing a shared vision of high-quality care; aligning resource use with that vision; and balancing professional aspirations and population needs. The leadership of the physician lead was crucial. The external environment was perceived as a source of pressure and dilemmas rather than as a source of support in these matters.<bold>Conclusion: </bold>Irrespective of their models, PC practices' pursuit of high-quality care is based on a vision in which accessibility is a key component, balanced by appropriate management of available resources and of external environment expectations. Current PC reforms often create tensions rather than support PC practices in their pursuit of high-quality care.
- Publication
Canadian Family Physician / Médecin de Famille Canadien, 2014, Vol 60, Issue 5, pe281
- ISSN
0008-350X
- Publication type
journal article