Analyse de la logique d’intervention d’une adaptation québécoise d’un modèle de soins centré sur le patient appuyé par un dossier médical personnel dans les suivis pédiatriques au sein d’un groupe de médecine de famille
In order to improve the performance of primary care services, a project in Quebec to develop an adaptation of a patient-centered care model supported by a personal health record (PHR) has been implemented in a urban family medicine group (FMG). Thus, this thesis is a comparative analysis between the logic of intervention as it is described in the literature on patient centered model and integrated PHR, and the empirical results obtained in the FMG of the project. More specifically, the analysis takes place during the pre-deployment phase of the intervention. Furthermore, it is an organizational analysis. The main results revealed that the logic of intervention applied in the project is relatively far from what is known as the «best» models in the literature on patient-centered care and integrated PHR. This is in part explainable by the resistance to change of the different stakeholders (eg. doctors, nurses, etc.) concerned by the project, which is coherent with what we found on the subject in the literature. Otherwise, the main effects expected by the actors involved in the project are the improvement of informational continuity, service efficiency, comprehensiveness and overall productivity. Furthermore, in the current structural context of Quebec's health care system, the implementation of a patient-centered model supported by a PHR would involve important structural changes such as a revision of the health care professionals remuneration model and the legislative framework (eg. medical liability), otherwise, significant effects on performance dimensions such as accessibility, quality, continuity, comprehensiveness, efficiency, effectiveness and responsiveness could be significantly limited. These structural arrangements should promote, among others, interprofessional collaboration, systems interconnectivity, improved multi-directional communication between the patient and the health care professionals and a culture in which the patient actively participates in the management of his health and where the health care professional gives him the necessary support (eg. education, prevention, transparency).
Personal health record (PHR) Patient-centered medical home Primary care Patient centered care model Health care performance Interconnectivity PHR-EHR Family medicine group Accessibility Quality Continuity Efficiency