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Introduction: Integrated Primary Care Teams (IPCTs) have four common key characteristics (intensive interdisciplinary practice; advanced nursing practice with an expanded role; group practice; increased proximity and availability) aimed at strengthening primary care in Quebec, Canada. However, their mission varies depending on the target population. Patient Reported Experience Measures (PREM) provide patient-centered measures that allow for the capture of quality dimensions that are important to patients but that are not captured by other data sources usually used in health services research such as administrative data.Aims, Objectives, Theory or Methods: The aim of this study is to examine the association between the care experience of patients and the mission of the IPCT they have as their primary source of care. We used a quasi-experimental longitudinal design based on a pre and-post administered survey at a 2-year interval. Patients who used an IPCT as their primary source of care were recruited during a consultation received in one a the participating IPCT. They completed a self-administered questionnaire at inception and two years later. We measured 5 PREM: patient-reported accessibility, continuity, comprehensiveness, responsiveness and outcomes of care. Results: A total of 1473 patients completed both the pre- and post-surveys. Results showed that patients receiving care from IPCTs had a significant increase in reported care experience compared to previous experience. The six participating IPCTs differ in terms of their target populations and mission. Three of them are intended to provide general care to an overall population and therefore have a structure similar to that of the common primary care practice model, the Family Practice Groups (FMGs). The three other IPCTs involve vulnerable populations, including immigrant and homeless populations. The increase in care experience was higher for patients receiving care from IPCTs designed for vulnerable population even when controlling for patients’ characteristics with linear regression models.Conclusions: Our results suggest that the IPCT model is tailored to the needs of its target populations, resulting in improved PREM. Implications for applicability/transferability, sustainability, and limitations: These results imply that broader implementation of innovative and flexible community-based care models should be considered by policymakers.

Since 2016, abortion care has undergone several important changes, particularly related to the provision of medical abortion using mifepristone. We aimed to document characteristics of the abortion care workforce in Canada after the update of clinical practice guidelines of mifepristone use for medical abortion.We conducted a national, web-based, anonymized, bilingual (English/French) survey. We collected demographics and clinical care characteristics of physicians and nurse practitioners who provided abortion care in 2019. Between July and December 2020, we distributed the survey through professional organizations, including The College of Family Physicians of Canada and The Society of Obstetricians and Gynaecologists of Canada. We present descriptive statistics.Overall, 465 respondents representing all 10 provinces and 3 territories in Canada completed the survey. Of these, 388 (83.4%), including 30 nurse practitioners, provided first-trimester medical abortion, of which 350 (99.4%) used mifepristone. Two hundred and nineteen (47.1%) respondents provided first-trimester surgical abortion, 109 (23.4%) provided second-trimester surgical abortion and 115 (24.7%) provided second- or third-trimester medical abortion. Half of respondents reported fewer than 5 years of experience with any abortion care. Respondents reported providing a total of 48 509 abortions in 2019, including 32 345 (66.7%) first-trimester surgical abortions and 13 429 (27.7%) first-trimester medical abortions. In Quebec, only 1918 (12.5%) of reported abortions were first-trimester medical abortions. Primary care providers provided 34 540 (71.2%) of the total abortions. First-trimester medical abortions represented 44.4% (in/i= 2334) of all abortions in rural areas, as opposed to 25.6% (in/i= 11 067) in urban areas.The increased availability of medical abortion facilitates abortion access, especially in primary care and rural settings, and where surgical abortion is not available. Rejuvenation of the workforce is a critical contributor to equitable access to abortion services.

Context Many health systems have centralized waiting lists (CWLs), but there is limited evidence on CWL effectiveness and how to design and implement them. Aim To understand how CWLs’ design and implementation influence their use and effect on access to healthcare. Methods We conducted a realist review (n = 21 articles), extracting context-intervention-mechanism-outcome configurations to identify demi-regularities (i.e., recurring patterns of how CWLs work). Results In implementing non-mandatory CWLs, acceptability to providers influences their uptake of the CWL. CWL eligibility criteria that are unclear or conflict with providers’ role or judgement may result in inequities in patient registration. In CWLs that prioritize patients, providers must perceive the criteria as clear and appropriate to assess patients’ level of need; otherwise, prioritization may be inconsistent. During patients’ assignment to service providers, providers may select less-complex patients to obtain CWLs rewards or avoid penalties; or may select patients for other policies with stronger incentives, disregarding the established patient order and leading to inequities and limited effectiveness. Conclusion These findings highlight the need to consider provider behaviours in the four sequential CWL design components: CWL implementation, patient registration, patient prioritization and patient assignment to providers. Otherwise, CWLs may result in limited effects on access or lead to inequities in access to services.

Background The use of chemical restraints (CRs) in health care facilities is a complex intervention that raises questions about its effectiveness and whether it is safe and patient oriented. Purpose This review aims to gather nursing quality standards for the use of CR through an innovative method of knowledge synthesis, the realist review, to support the development of a quality evaluation tool. Methods A realist review method was chosen. Results An operational definition of chemical restraint is proposed, a concept seen as synonymous with the management of behavioral symptoms by pharmacological agents with sedative proprieties. Twenty-eight quality standards were identified and presented in a theoretical model. Conclusions These quality standards will allow the evaluation of practices from a nursing perspective for the use of CR in health care settings.

Background Access to both valid and reliable nursing-sensitive indicators is currently limited in primary care. Purpose The objectives were to (1) measure primary care nursing indicators using a wound care tracer condition and (2) study the associations between process and outcome indicators. Methods We conducted a longitudinal study in an ambulatory care clinic in Quebec, Canada. The sample included 482 episodes of care. We studied 5 indicators related to processes and 3 to outcomes. Results Performance levels were moderately high for indicators of initial assessment and duration and low for those of continuity and education. Associations between nursing follow-up and continuity indicators and 3 outcome indicators were highly significant. Conclusion Continuity and nursing follow-up are associated with improved outcomes. Increasing these indicators' performance level can improve both nursing processes and patient outcomes.

Introduction : Cette etude presente les resultats d’une revue systematique mixte qui visait a elaborer une cartographie ainsi qu’a comprendre les elements essentiels au succes des innovations visant a ameliorer l’acces aux soins des personnes en situation de vulnerabilite sociale.Methode : Une revue systematique mixte de la litterature a ete conduite. La recherche documentaire qui a ete realisee a partir de plusieurs bases de donnees (Medline, Cinahl, Embase, Social Work, SocIndex) a couvert l’ensemble des pays de l’OCDE et a porte sur une periode de 10 ans (2005-2015). Un total de 26 articles a ete inclus dans la revue.Resultats : La synthese thematique a permis d’identifier plusieurs categories d’innovations comme les services de navigation, l’offre de soins en « strategie avancee » et les cliniques offrant des soins adaptes. Elle a aussi permis de mettre en exergue des caracteristiques essentielles qui ont contribue a la performance de ces innovations et a la satisfaction des patients comme, la connaissance et la maitrise du contexte par l’intervenant, la collaboration inter-organisationnelle et interprofessionnelle, le respect dans la fourniture des soins et enfin la perennite du financement.Conclusion : L’un des principaux enseignements de cette revue est que l’offre de soins donnee de facon compatissante est un determinant de l’acces aux soins des personnes vulnerables.

The COVID pandemic was an acute test of public health capacities worldwide. Many will hail the successes obtained and stress the importance of the discipline. On the contrary, this commentary defends the idea that the COVID pandemic response forced public health to enter in a Faustian bargain with governments and realpolitik that threaten the very core of the discipline’s principles.

Public health is critical to a healthy, fair, and sustainable society. Realizing this vision requires imagining a public health community that can maintain its foundational core while adapting and responding to contemporary imperatives such as entrenched inequities and ecological degradation. In this commentary, we reflect on what tomorrow’s public health might look like, from the point of view of our collective experiences as researchers in Canada who are part of an Applied Public Health Chairs program designed to support “innovative population health research that improves health equity for citizens in Canada and around the world.” We view applied public health research as sitting at the intersection of core principles for population and public health: namely sustainability, equity, and effectiveness. We further identify three attributes of a robust applied public health research community that we argue are necessary to permit contribution to those principles: researcher autonomy, sustained intersectoral research capacity, and a critical perspective on the research-practice-policy interface. Our intention is to catalyze further discussion and debate about why and how public health matters today and tomorrow, and the role of applied public health research therein.

This research note discusses opportunities and challenges of using online survey engines for social network analysis (SNA) data collection and assessing sample size and representativeness. The disc...

À partir d'une analyse de la validité scientifique et du niveau de mise en œuvre des recommandations des commissions publiques qui ont été nommées pour aviser le gouvernement du Québec sur l'avenir de son système de santé, nous discutons ici des obstacles qui entravent la mise en œuvre des réformes nécessaires pour l'avenir de ce système. Notre analyse montre que les principaux obstacles ne sont pas tant programmatiques (quoi faire), que politiques (comment faire). Nous nous appuyons ensuite sur la théorie néo-institutionaliste pour discuter des implications de ce constat. In this paper, we analyze recommendations of past governmental commissions and their implementation in Quebec as a case to discuss the obstacles that litter the road to healthcare system reform. Our analysis shows that the obstacles to tackling the healthcare system’s main problems may have less to do with programmatic (what to do) than with political and governance (how to do it) questions. We then draw on neo-institutional theory to discuss the causes and effects of this situation.

International audience; The article "Why public health matters today and tomorrow: the role of applied public health research," written by Lindsay McLaren et al., was originally published Online First without Open Access.

The use of electronic clinical and administrative data can be an advantageous source of information for assessing nursing performance in primary care. In Québec (Canada), the I-CLSC electronic database could be used to measure performance indicators. However, little is known about the reliability of the data contained in this database. The objective of this study was to assess the reliability of the clinical and administrative data contained in the I-CLSC electronic database based on the data entered in medical records.We used a longitudinal design for this study. A sample of 100 patients who had experienced 107 episodes of wound care were randomly selected from all patients who had two or more consultations during the year 2015. The paper records were used as reference. We collected data regarding eight nursing sensitive indicators from both sources. We assessed the concordance between the electronic data and the paper records by measuring inter-rater agreement.Six of the eight indicators showed a percentage agreement ≥ 85%, and kappa scores between 0.7 and 1.00 (p 0.001), indicating high to perfect levels of agreement between the two data sources. Two indicators presented fair kappa scores.This database provides reliable data relating to the organization of care but shows lower reliability for specific acts performed by nurses in primary care. This existing database can be used to assess, manage and improve certain dimensions of nursing performance in primary care.

Funding agencies and universities are increasingly searching for effec-tive ways to support and strengthen a dynamic and competitive scientific research capacity. Many of their funding policies are based on the hypothesis that increased collaboration and networking between researchers and between institutions lead to improved scientific productivity. Although many studies have found positive correlations between academic collaborations and research performance, it is less clear how formal institutional networks contribute to this effect. Using social net-work analysis (SNA) methods, we highlight the distinction between what we define as “formal” institutional research networks and “organic” researcher networks. We also analyze the association between researchers’ actual structural position in such networks and their scientific performance. The data used come from cur-riculum vitae information of 125 researchers in two provincially funded research networks in Quebec, Canada. Our findings confirm a positive correlation between collaborations and research productivity. We also demonstrate that collaborations within the formal networks in our study constitute a relatively small component of the underlying organic network of collaborations. These findings contribute to the literature on evaluating policies and programs that pertain to institutional research networks and should stimulate research on the capacity of such networks to foster research productivity. Resume : Les universites et les agences de financement cherchent de plus en plus a renforcer de facon efficace une capacite de recherche scientifique dynamique et concurrentielle. Bon nombre de leurs politiques de financement sont fondees sur l’hypothese qu’une amelioration de la collaboration et du reseautage entre les chercheurs et entre les etablissements mene a une productivite scientifique accrue. De nombreuses etudes ont note une correlation positive entre les collaborations de recherche et le rendement en recherche, mais la contribution des reseaux institution-nels officiels a ce resultat reste nebuleuse. A l’aide de methodes d’analyse des reseaux sociaux, nous mettons l’accent sur la distinction entre ce que nous definissons comme les reseaux institutionnels de recherche « officiels » et les reseaux « organiques » de chercheurs. Nous analysons aussi l’association entre les positions structurelles reelles

Access to a regular primary care provider is essential to quality care. In Canada, where 15 % of patients are unattached (i.e., without a regular provider), centralized waiting lists (CWLs) help attach patients to a primary care provider (family physician or nurse practitioner). Previous studies reveal mechanisms needed for CWLs to work, but focus mostly on CWLs for specialized health care. We aim to better understand how to design CWLs for unattached patients in primary care. In this study, a logic analysis compares empirical evidence from a qualitative case study of CWLs for unattached patients in seven Canadian provinces to programme theory derived from a realist review on CWLs. Data is analyzed using context-intervention-mechanism-outcome configurations. Results identify mechanisms involved in three components of CWL design: patient registration, patient prioritization, and patient assignment to a provider for attachment. CWL programme theory is revised to integrate mechanisms specific to primary care, where patients, rather than referring providers, are responsible for registering on the CWL, where prioritization must consider a broad range of conditions and characteristics, and where long-term acceptability of attachment is important. The study provides new insight into mechanisms that enable CWLs for unattached patients to work.

La prévalence des troubles mentaux courants (TMC) augmente tant dans la population québécoise que mondiale. Les gouvernements, les chercheurs et les cliniciens cherchent les meilleures pratiques à appliquer pour améliorer les services offerts à la clientèle souffrant de TMC. Les données suggèrent que ces services devraient être principalement offerts en première ligne (PL), mais leur organisation actuelle, au Québec, ne permet pas de répondre de façon optimale aux besoins des personnes souffrant de TMC ainsi qu’à ceux de leurs proches. Au cours des prochaines années, différents types d’infirmières occuperont un rôle élargi en PL et représenteront une portion plus importante des effectifs à ce niveau améliorant potentiellement l’accessibilité aux services. Les infirmières et les autres cliniciens ne connaissent pas toujours le rôle des infirmières quant à la santé mentale ni leur contribution durant toutes les phases du continuum de soins. La collaboration interprofessionnelle constitue un élément fondamental pour améliorer les services de PL en santé mentale. Celle-ci repose sur une compréhension juste des rôles et de leurs partages parmi tous les membres d’une équipe. Les objectifs de cet article sont de : 1) décrire les meilleures pratiques de collaboration interprofessionnelle en santé mentale et en PL ; 2) discuter des rôles des infirmières quant aux TMC ; et 3) présenter des pistes d’intervention pour déployer ces rôles. Une conceptualisation des rôles infirmiers bien intégrés dans un contexte multiprofessionnel de première ligne en santé mentale est présentée dans cet article., The prevalence of common mental disorders (CMD) increases both in Quebec and in the world. Governments, researchers and clinicians are in search of the best practices to improve the services offered to clients with CMD. The data suggest that these services should be primarily offered in primary care, but their current organization in Quebec does not adequately address the needs of people with CMD as well as those of their relatives. Over the next few years, different types of nurses will have an expanded role in primary care and will represent a larger portion of the workforce at this level, potentially improving access to services. Nurses and other clinicians are not always aware of the role of nurses in mental health and their contribution to all phases of the continuum of care. Interprofessional collaboration is fundamental to improving mental primary care services and is based on a fair understanding of roles among all members of a team. The objectives of this article are to: 1) describe best practices in primary care for interprofessional collaboration in mental health; 2) discuss the roles of nurses in CMD; and (3) to present avenues of intervention to extend these roles. A conceptualization of nursing roles well integrated into an multiprofessional primary care practice in mental health is presented in this article.

Canada has the lowest rate of attachment to primary care providers among OECD countries, which makes access and continuity of care problematic. To address this important issue, seven Canadian provinces have implemented centralized waiting lists (CWLs) for unattached patients in primary care. Introduced at different times, no two provinces' CWLs are exactly alike. The main goal of these CWLs is to reduce the number of unattached patients. In some provinces, CWLs also serve to monitor primary care activity or prioritize vulnerable patients. Societal pressure and broader primary care reform influenced the implementation of the CWLs in each province. Monitoring, in terms of data collected and purpose, differs between provinces. The interprovincial comparison enables identification of strengths, weaknesses, opportunities and threats during implementation and at each step of the CWLs: registration, patient assessment and attachment. Common issues with CWLs across provinces include the importance of monitoring to facilitate implementation, the need for specific measures to ensure access for vulnerable and complex patients, and the shortage of primary care providers. Le taux d'inscription a un professionnel de la sante en premiere ligne au Canada est le plus bas parmi les pays de l'OCDE, ce qui souleve un important probleme d'accessibilite et de continuite aux soins de premiere ligne. Pour repondre a cette preoccupation, sept provinces canadiennes ont mis en place des listes d'attente centralisees (LAC) pour les patients non-affilies a un professionnel de la sante en premiere ligne. Les LAC ont ete implantees a differents moments, et different beaucoup d'une province a l'autre. Le principal objectif des LAC est de diminuer le nombre de patients non-affilies, mais dans certaines provinces elles peuvent egalement servir a surveiller les activites de la premiere ligne ou a prioriser les patients vulnerables. La pression sociale et d'importantes reformes des soins de premiere ligne ont influence l'implantation des LAC. Le monitorage, en termes de donnees collectees et d'utilisation, differe d'une province a l'autre. La comparaison interprovinciale permet l'identification des forces, faiblesses, opportunites et menaces a l'implantation et a chaque etape de la LAC : l'enregistrement, l'evaluation du patient et l'affiliation. L'importance de la surveillance afin de faciliter l'implantation, le besoin d'interventions specifiques pour garantir l'acces pour les patients vulnerables et complexes et le manque de prestataire de soins de premiere ligne sont quelques exemples des problematiques des LAC communes a toutes les provinces.

Context Significant reforms are needed to improve healthcare system performance in Quebec. Even though the characteristics of high-performing healthcare systems are well-known, Quebec's reforms have not succeeded in implementing many critical elements. Converging evidence from political science models suggests stakeholders' preferences are central in determining policy content, adoption, and implementation. Objective To analyze whether doctors', nurses', pharmacists' and health administrators' preferences could explain the observed inability to implement known characteristics of high-performing healthcare systems. Design A questionnaire on various propositions identified in the scientific literature was sent to 2,491 potential respondents. Results Overall response rate was 37%. There was considerable consensus on identified solutions to improve the healthcare system. Resistance was observed in two major areas: information systems and changes directly affecting doctors' practice. The groups' positions cannot explain the inability to implement important characteristics of high-performing systems. The findings raise new questions on the actual sources of resistance.

Background The complexity and difficulties involved in the development and implementation of health innovations, such as advanced practice nursing roles, result in slow and sporadic international acceptance. To manage this complexity, it is advisable to deepen understanding of the context in which these innovation processes take place. However, there is little research specifically concerned with contextual factors that influence the implementation of advanced practice nursing roles. Purpose To integrate results and develop a comprehensive understanding of the contextual factors that influence the development and implementation of advanced practice nursing in two countries, Canada and Spain. Methods The research method used was qualitative, descriptive, and explanatory. Different qualitative methods, a novel data-collection process, and perspectives from participants in various professional groups were used to triangulate the findings from both settings. Participants with diverse perspectives on practice, organization, and health and regulatory environments were engaged to participate in semistructured focus groups in Catalonia and individual interviews in Quebec. Data gathered were to provide information on a variety of context dimensions: understanding of advanced practice nursing; perceived needs to develop the role; and perceived barriers and facilitators present in the Catalan and Quebec contexts. Thematic analysis was carried out based on the theoretical proposals from the framework and triangulated for both sides. Findings Thirty interviews were conducted in Quebec and 44 in Catalonia. Integration of findings reflected a vast predominance of convergent themes despite differences in context and population characteristics. The study identified common and divergent contextual factors in advanced practice development and implementation in these settings. The same perceived barriers and facilitators were prominent almost evenly across all groups, although organizational and environmental themes were the most coded and discussed during interviews. Discussion Understanding contextual factors will ultimately allow better understanding of complex phenomena in health care. Further reporting of contextual factors that influence the development and implementation of advanced practice nursing roles in other countries is required to compare innovative processes.

Introduction. With community-dwelling elders waiting to adapt their bathroom, Health and Social Services Centers in Quebec (Canada) combined human resources through cross-skilling within interdisciplinary teams. To this end, occupational therapists implemented in-house “tools” to support nonoccupational therapists in selecting bathing equipment. However, unknown psychometric properties of those in-house “tools” cast doubt on the quality of service provided to elders. Little is also known about the best processes to use to support the deimplementation of such nonevidence-based practices. This study presents the effect of a knowledge transfer and exchange intervention designed to deimplement in-house “tools” and replace them with an evidence-based tool (Algo). Methods. Censuses were conducted with the 94 Health and Social Services Centers of Quebec providing homecare services, before and after the knowledge transfer and exchange intervention (2009-2013). In 2013, the deimplementation of in-house “tools” and their replacement by Algo were measured with Knott and Wildavsky’s levels of utilization. Results. Cross-skilling within interdisciplinary teams increased between censuses (87% to 98%), as did use of in-house “tools” (67% to 81%). Algo’s uptake started during the knowledge transfer and exchange process as 25 Health and Social Services Centers achieved the first level of utilization. Nonetheless, no Health and Social Services Center deimplemented the in-house “tools” to use Algo. Conclusion. The knowledge transfer and exchange process led to the development of a scientifically sound clinical tool (Algo) and challenged the status quo in clinical settings regarding the use of nonevidence-based practices. However, the deimplementation of in-use practices has not yet been observed. This study highlights the need to act proactively on the deimplementation and implementation processes.

Background There is only limited evidence to support care redefinition and role optimization processes needed for scaling up of a stronger primary care capacity. Methods Data collection was based on a keyword search in MEDLINE, EMBASE and CINAHL databases. Three thousand, two hundred and twenty-nine documents were identified, 1851 met our inclusion criteria, 71 were retained for full-text assessment and 52 included in the final selection. The analysis process was done in four steps. In the end, the elements that were identified as particularly central to the process of transforming primary care provision were used as the basis of two typologies. Results The first typology is based on two structural dimensions that characterize promising multiprofessional primary care teams. The first is the degree to which the division of tasks in the team was formalized. The second dimension is the centrality and autonomy of nurses in the care model. The second typology offers a refined definition of comprehensiveness of care and its relationship with the optimization of professional roles. Conclusions The literature we analyzed suggests there are several plausible avenues for coherently articulating the relationships between patients, professionals, and care pathways. The expertise, preferences, and numbers of available human resources will determine the plausibility that a model will be a coherent response that is appropriate to the needs and environmental constraints (funding models, insurance, etc.). The typologies developed can help assess existing care models analytically or evaluatively and to propose, prospectively, some optimal operational parameters for primary care provision.

Rationale Optimal, early management following a spinal cord injury (SCI) can limit individuals' disabilities and costs related to their care. Several knowledge syntheses were recently published to guide health care professionals with regard to early interventions in SCI patients. However, no knowledge translation (KT) intervention, selected according to a behaviour change theory, has been proposed to facilitate the use of SCI guidelines in an acute care setting. Objectives To develop theory-informed KT interventions to promote the application of evidence-based recommendations on the acute care management of SCI patients. Methods The first four phases of the knowledge-to-action model were used to establish the study design. Knowledge selection was based on the Grading of Recommendations Assessment, Development and Evaluation system. Knowledge adaptation to the local context was sourced from the ADAPTE process. The theoretical domains framework oriented the selection and development of the interventions based on an assessment of barriers and enablers to knowledge application. Results Twenty-nine recommendations were chosen and operationalized in measurable clinical indicators. Barriers related to knowledge, skills, perceived capacities, beliefs about consequences, social influences, and the environmental context and resources theoretical domains were identified. The mapping of behaviour change techniques associated with those barriers led to the development of an online educational curriculum, interdisciplinary clinical pathways as well as policies and procedures. Conclusions This research project allowed us developing KT interventions according to a thorough behavioural change methodology. Exposure to the generated interventions will support health care professionals in providing the best care to SCI patients.

Background: Health systems worldwide struggle to identify, adopt, and implement in a timely and system-wide manner the best—evidence-informed—policy-level practices. Yet, there is still only limited evidence about individual and institutional best practices for fostering the use of scientific evidence in policy-making processes The present project is the first national-level attempt to (1) map and structurally analyze—quantitatively—health-relevant policy-making networks that connect evidence production, synthesis, interpretation, and use; (2) qualitatively investigate the interaction patterns of a subsample of actors with high centrality metrics within these networks to develop an in-depth understanding of evidence circulation processes; and (3) combine these findings in order to assess a policy network’s “absorptive capacity” regarding scientific evidence and integrate them into a conceptually sound and empirically grounded framework. Methods: The project is divided into two research components. The first component is based on quantitative analysis of ties (relationships) that link nodes (participants) in a network. Network data will be collected through a multi-step snowball sampling strategy. Data will be analyzed structurally using social network mapping and analysis methods. The second component is based on qualitative interviews with a subsample of the Web survey participants having central, bridging, or atypical positions in the network. Interviews will focus on the process through which evidence circulates and enters practice. Results from both components will then be integrated through an assessment of the network’s and subnetwork’s effectiveness in identifying, capturing, interpreting, sharing, reframing, and recodifying scientific evidence in policy-making processes. Discussion: Knowledge developed from this project has the potential both to strengthen the scientific understanding of how policy-level knowledge transfer and exchange functions and to provide significantly improved advice on how to ensure evidence plays a more prominent role in public policies.

Healthcare systems performance is the focus of intense policy and media attention in most countries. Quebec (Canada) is no exception, where successive governments have struggled for decades with apparently intractable problems in care accessibility overall, poor performance, and rising costs. This article explores the underlying causes of the disconnection between the high salience of healthcare system dysfunctions in both media and policy debates and the lack of policy change likely to remedy those dysfunctions. Academically, public policies’ evolution is usually conceptualized as the product of complex, long-term interactions among diverse groups with specific power sources and preferences. In this context, we wanted to examine empirically whether divergences in stakeholders’ views concerning various healthcare reform options could explain why certain policy changes are not implemented despite consensus on their programmatic coherence. The research design was an exploratory sequential design. Data were analyzed narratively as well as graphically using a method derived from social network analysis and graph theory. Results showed striking intergroup convergence around a programmatically sound policy package centred on the general objective of strengthening primary care delivery capacities. Those results, interpreted in light of political science elitist perspectives on the policy process, suggest that the incapacity to reform the system might be explained by one or two groups’ having a de facto veto in policy-making.

The prevalence of common mental disorders (CMD) increases both in Quebec and in the world. Governments, researchers and clinicians are in search of the best practices to improve the services offered to clients with CMD. The data suggest that these services should be primarily offered in primary care, but their current organization in Quebec does not adequately address the needs of people with CMD as well as those of their relatives. Over the next few years, different types of nurses will have an expanded role in primary care and will represent a larger portion of the workforce at this level, potentially improving access to services. Nurses and other clinicians are not always aware of the role of nurses in mental health and their contribution to all phases of the continuum of care. Interprofessional collaboration is fundamental to improving mental primary care services and is based on a fair understanding of roles among all members of a team. The objectives of this article are to: 1) describe best practices in primary care for interprofessional collaboration in mental health; 2) discuss the roles of nurses in CMD; and (3) to present avenues of intervention to extend these roles. A conceptualization of nursing roles well integrated into an multiprofessional primary care practice in mental health is presented in this article.

Background Having a regular primary care provider (i.e., family physician or nurse practitioner) is widely considered to be a prerequisite for obtaining healthcare that is timely, accessible, continuous, comprehensive, and well-coordinated with other parts of the healthcare system. Yet, 4.6 million Canadians, approximately 15% of Canada’s population, are unattached; that is, they do not have a regular primary care provider. To address the critical need for attachment, especially for more vulnerable patients, six Canadian provinces have implemented centralized waiting lists for unattached patients. These waiting lists centralize unattached patients’ requests for a primary care provider in a given territory and match patients with providers. From the little information we have on each province’s centralized waiting list, we know the way they work varies significantly from province to province. The main objective of this study is to compare the different models of centralized waiting lists for unattached patients implemented in six provinces of Canada to each other and to available scientific knowledge to make recommendations on ways to improve their design in an effort to increase attachment of patients to a primary care provider. Methods A logic analysis approach developed in three steps will be used. Step 1: build logic models that describe each province’s centralized waiting list through interviews with key stakeholders in each province; step 2: develop a conceptual framework, separate from the provincially informed logic models, that identifies key characteristics of centralized waiting lists for unattached patients and factors influencing their implementation through a literature review and interviews with experts; step 3: compare the logic models to the conceptual framework to make recommendations to improve centralized waiting lists in different provinces during a pan Canadian face-to-face exchange with decision-makers, clinicians and researchers. Discussion This study is based on an inter-provincial learning exchange approach where we propose to compare centralized waiting lists and analyze variations in strategies used to increase attachment to a regular primary care provider. Fostering inter-provincial healthcare systems connectivity to improve centralized waiting lists’ practices across Canada can lever attachment to a regular provider for timely access to continuous, comprehensive and coordinated healthcare for all Canadians and particular for those who are vulnerable. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2007-8) contains supplementary material, which is available to authorized users.

The collective impact of major shifts in public health infrastructure and numerous new chronic disease prevention (CDP) capacity-building initiatives that have taken place in Canada over the last decade is unknown. The objective of this study was to determine if CDP capacity (i.e., skills and resources) and involvement in CDP programming improved in public health organizations in Canada from 2004 to 2010. Data for this repeated cross-sectional study were drawn from two waves of a national census of organizations mandated to carry out primary prevention of chronic disease and/or promotion of healthy eating, physical activity and tobacco control. Medians for continuous variables and frequencies for categorical variables were compared across time. Neither resources nor level of priority for CDP increased over time. There was little difference in the proportion of organizations with high levels of skills and involvement in core CDP practices (i.e., needs assessment, identification of relevant practices, planning, evaluation). Skills and involvement in CDP risk factor programming showed some gains, some steady states and some losses. Specifically, skill and involvement in tobacco control programming declined markedly while the proportion of organizations involved in healthy eating and physical activity programming increased. Skills to address and involvement in programming related to social determinants of health remained low over time as did involvement in programming addressing multiple risk factors concurrently. The lack of marked improvement in CDP capacity between 2004 and 2010 against a backdrop of initiatives favourable to strengthening the preventive health system in Canada suggests that efforts may have fallen short.

Role clarity is a crucial issue for effective interprofessional collaboration. Poorly defined roles can become a source of conflict in clinical teams and reduce the effectiveness of care and services delivered to the population. Our objective in this paper is to outline processes for clarifying professional roles when a new role is introduced into clinical teams, that of the primary healthcare nurse practitioner (PHCNP). To support our empirical analysis we used the Canadian National Interprofessional Competency Framework, which defines the essential components for role clarification among professionals. A qualitative multiple-case study was conducted on six cases in which the PHCNP role was introduced into primary care teams. Data collection included 34 semistructured interviews with key informants involved in the implementation of the PHCNP role. Our results revealed that the best performing primary care teams were those that used a variety of organizational and individual strategies to carry out role clarification processes. From this study, we conclude that role clarification is both an organizational process to be developed and a competency that each member of the primary care team must mobilize to ensure effective interprofessional collaboration., Cet article s'intéresse aux processus de clarification des rôles professionnels lors de l'intégration d'une infirmière praticienne spécialisée dans les équipes de première ligne au Québec.

In recent decades, there has been a growing interest in the design and implementation of systems using public reporting of performance measures to improve performance. In their simplest form, such interventions rest on the market-based logic of consumers using publicly released information to modify their behavior, thereby penalizing poor performers. However, evidence from large-scale efforts to use public reporting of performance measures as an instrumental performance improvement tool suggests that the causal mechanisms involved are much more complex. This article offers a typology of four different plausible causal pathways linking public reporting of performance measures and performance improvement. This typology rests on a variety of conceptual models and a review of available empirical evidence. We then use this typology to discuss the core elements that need to be taken into account in efforts to use public reporting of performance measures as a performance improvement tool.