Typologie organisationnelle des équipes interprofessionnelles de soins de santé primaires au Québec et leur relation avec les caractéristiques populationnelles
Notice bibliographique
Résumé
Background: Interprofessional primary health care teams are groups of health care professionals who bring together different expertise to provide high quality care to patients in a coordinated, integrated, seamless and accessible manner. Interprofessional primary health care teams operationalize the main model of care organization currently being implemented in Quebec. Although this model of care is conceptualized as homogeneous in terms of organizational structure, the underlying characteristics of this structure can vary considerably. Little is known about the nature and extent of this variability and its relationship to the characteristics of the populations that interprofessional teams serve. Objective: This cross-sectional study aims to develop a typology of interprofessional primary health care teams, first by describing the different organizational profiles of these teams, and then by examining the association between the characteristics of the populations served and the organizational profiles. Methods: A mixture model analysis was performed to describe the different organizational profiles among the 368 interprofessional primary health care teams in Quebec. Administrative data from the Ministère de la Santé et des Services sociaux were used and the following organizational characteristics were considered: numbers of full-time equivalent nurse practitioners, regular nurses, social workers, and other health professionals, number of physicians, type of institution (network, academic, regular), sector (private, public, mixed), presence of a pharmacist, number of patients enrolled, attendance rate, and partnership with another health institution. The optimal number of profiles was determined by the Akaike and Bayesian information criterion and by clinical significance. Multinomial logistic regression was conducted to examine the association between the characteristics of the populations served and the organizational profiles. Variables assessed in the model were rurality and proportions of vulnerable patients, pregnant women, patients identified as disadvantaged, those receiving home support, and those living in a long-term care facility and a measure of rurality. Results: The analysis revealed that interprofessional primary care teams were heterogeneous in terms of their organizational structure and could be classified into five distinct profiles that varied in size, composition, and focus of the team, area, and degree of partnership with other health care facilities. The five profiles were ‘Very small, private, regular, high partnered, balanced team’ (n=99; 26.9%); ‘Small, private, regular, moderately partnered, balanced team’ (n=101; 27.5%); ‘Medium, public, academically- oriented, moderately partnered, practitioner-oriented’ (n=58; 15.8%); ‘Large, private, regular, very low partnered, balanced team’ (n=50; 13.6%); and ‘Very large, private, mixed, very low partnered, balanced team’ team (n=60; 16.3%). In addition, pregnant women (Odds Ratio [OR] = 2.78, 95% confidence interval [CI] 1.98-3.91), disadvantaged patients ([OR] = 1.62, [CI] 1.15-2.28), those receiving home care ([OR] = 1.85, [CI] 1.28-2, 66) were more likely to be served by teams in the ‘Medium, public, academically- oriented, moderately partnered, practitioner-oriented’ profile than by a team in the ‘Very small, private, regular, high partnered, balanced team’ profile. A significant association was found between the level of rurality and the size of the interprofessional primary care team ([OR] = 0.69, [CI] 1.74-3.80). Rural patients were less likely to be served by teams from the "Medium, public, academically oriented, low partnership, practitioner-oriented team" profile ([OR] = 0.66, [CI] 0.50-0.86) and by one of the "Very large, private, mixed, very low partnership, balanced team" profile teams ([OR] = 0.69, [CI] 0.53-0.90) , than by teams from the "Very small, private, regular, high partnered, balanced team" profile. There was no statistically significant association between patients living in long-term care facilities and organizational profiles. Conclusion: This study uncovered a complex organizational typology of interprofessional primary care teams currently implemented in Quebec. These findings may inform the development of health practices and policies to optimize the structure of interprofessional primary care teams to better meet the specific needs of their populations.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,016 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,004 | 0,005 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,003 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».