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Reforming healthcare systems on a locally integrated basis: is there a potential for increasing collaborations in primary healthcare?

Breton M, Pineault R, Levesque JF, Roberge D, Da Silva RB, Prud'homme A - BMC Health Serv Res (2013)

Bottom Line: Our results showed different patterns of evolution in inter-organizational collaboration among different types of primary healthcare practices.The local health network reform appears to have had an impact on territorializing collaborations firstly by significantly reducing collaborations outside LHNs areas for all types of primary healthcare practices, including new type of primary healthcare and CLSCs, and secondly by improving collaborations among healthcare organizations within LHNs areas for all organizations.This is with the exception of private medical clinics, where collaborations decreased both outside and within LHNs.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centre de recherche - Hôpital Charles Lemoyne, Longueuil, QC, Canada. mylaine.breton@usherbrooke.ca

ABSTRACT

Background: Over the past decade, in the province of Quebec, Canada, the government has initiated two consecutive reforms. These have created a new type of primary healthcare - family medicine groups (FMGs) - and have established 95 geographically defined local health networks (LHNs) across the province. A key goal of these reforms was to improve collaboration among healthcare organizations. The objective of the paper is to analyze the impact of these reforms on the development of collaborations among primary healthcare practices and between these organisations and hospitals both within and outside administrative boundaries of the local health networks.

Methods: We surveyed 297 primary healthcare practices in 23 LHNs in Quebec's two most populated regions (Montreal & Monteregie) in 2005 and 2010. We characterized collaborations by measuring primary healthcare practices' formal or informal arrangements among themselves or with hospitals for different activities. These collaborations were measured based on the percentage of clinics that identified at least one collaborative activity with another organization within or outside of their local health network. We created measures of collaboration for different types of primary healthcare practices: first- and second-generation FMGs, network clinics, local community services centres (CLSCs) and private medical clinics. We compared their situations in 2005 and in 2010 to observe their evolution.

Results: Our results showed different patterns of evolution in inter-organizational collaboration among different types of primary healthcare practices. The local health network reform appears to have had an impact on territorializing collaborations firstly by significantly reducing collaborations outside LHNs areas for all types of primary healthcare practices, including new type of primary healthcare and CLSCs, and secondly by improving collaborations among healthcare organizations within LHNs areas for all organizations. This is with the exception of private medical clinics, where collaborations decreased both outside and within LHNs.

Conclusion: Health system reforms aimed at creating geographically based networks influenced primary healthcare practices' both among themselves (horizontal collaborations) and with hospitals (vertical collaborations). There is evidence of increased collaborations within defined geographic areas, particularly among new type of primary healthcare.

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The local health network.
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Figure 1: The local health network.

Mentions: In addition to these primary healthcare practice reforms, in 2004 the Quebec government initiated a large-scale redesign of its health system structure with the objective of improving accessibility, continuity, integration and quality of services for the population of a given area, by setting up integrated local health networks (LHNs) across the province. At the heart of the local health networks, 95 new organizations, called Health and Social Services Centres, were created by merging territorially-based CLSCs with long-term care institutions and, in 85% of cases, an acute care hospital [13]. The merger of all these organizations to form Health and Social Services Centres is illustrated in the box at the centre of Figure 1. Each Health and Social Services Centre was formally mandated to lead the creation of a local health network (LHN) by encouraging the establishment of formal or informal arrangements among various providers within its territory presently offering services [14]. These LHNs were largely created through virtual integration in the form of alliances and partnerships among autonomous organizations at different levels of care.


Reforming healthcare systems on a locally integrated basis: is there a potential for increasing collaborations in primary healthcare?

Breton M, Pineault R, Levesque JF, Roberge D, Da Silva RB, Prud'homme A - BMC Health Serv Res (2013)

The local health network.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750424&req=5

Figure 1: The local health network.
Mentions: In addition to these primary healthcare practice reforms, in 2004 the Quebec government initiated a large-scale redesign of its health system structure with the objective of improving accessibility, continuity, integration and quality of services for the population of a given area, by setting up integrated local health networks (LHNs) across the province. At the heart of the local health networks, 95 new organizations, called Health and Social Services Centres, were created by merging territorially-based CLSCs with long-term care institutions and, in 85% of cases, an acute care hospital [13]. The merger of all these organizations to form Health and Social Services Centres is illustrated in the box at the centre of Figure 1. Each Health and Social Services Centre was formally mandated to lead the creation of a local health network (LHN) by encouraging the establishment of formal or informal arrangements among various providers within its territory presently offering services [14]. These LHNs were largely created through virtual integration in the form of alliances and partnerships among autonomous organizations at different levels of care.

Bottom Line: Our results showed different patterns of evolution in inter-organizational collaboration among different types of primary healthcare practices.The local health network reform appears to have had an impact on territorializing collaborations firstly by significantly reducing collaborations outside LHNs areas for all types of primary healthcare practices, including new type of primary healthcare and CLSCs, and secondly by improving collaborations among healthcare organizations within LHNs areas for all organizations.This is with the exception of private medical clinics, where collaborations decreased both outside and within LHNs.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centre de recherche - Hôpital Charles Lemoyne, Longueuil, QC, Canada. mylaine.breton@usherbrooke.ca

ABSTRACT

Background: Over the past decade, in the province of Quebec, Canada, the government has initiated two consecutive reforms. These have created a new type of primary healthcare - family medicine groups (FMGs) - and have established 95 geographically defined local health networks (LHNs) across the province. A key goal of these reforms was to improve collaboration among healthcare organizations. The objective of the paper is to analyze the impact of these reforms on the development of collaborations among primary healthcare practices and between these organisations and hospitals both within and outside administrative boundaries of the local health networks.

Methods: We surveyed 297 primary healthcare practices in 23 LHNs in Quebec's two most populated regions (Montreal & Monteregie) in 2005 and 2010. We characterized collaborations by measuring primary healthcare practices' formal or informal arrangements among themselves or with hospitals for different activities. These collaborations were measured based on the percentage of clinics that identified at least one collaborative activity with another organization within or outside of their local health network. We created measures of collaboration for different types of primary healthcare practices: first- and second-generation FMGs, network clinics, local community services centres (CLSCs) and private medical clinics. We compared their situations in 2005 and in 2010 to observe their evolution.

Results: Our results showed different patterns of evolution in inter-organizational collaboration among different types of primary healthcare practices. The local health network reform appears to have had an impact on territorializing collaborations firstly by significantly reducing collaborations outside LHNs areas for all types of primary healthcare practices, including new type of primary healthcare and CLSCs, and secondly by improving collaborations among healthcare organizations within LHNs areas for all organizations. This is with the exception of private medical clinics, where collaborations decreased both outside and within LHNs.

Conclusion: Health system reforms aimed at creating geographically based networks influenced primary healthcare practices' both among themselves (horizontal collaborations) and with hospitals (vertical collaborations). There is evidence of increased collaborations within defined geographic areas, particularly among new type of primary healthcare.

Show MeSH