Marie-Dominique Beaulieu's research while affiliated with Université de Montréal and other places

Publications (140)

Article
Full-text available
Background Nurse practitioners (NPs) have been added to primary healthcare teams to improve access to care. Team processes, including communication and decision-making, explicate how patients and families view team functioning. Yet, important gaps exist in our understanding of patient-reported experience and outcomes at the level of the healthcare...
Article
Full-text available
The objective was to report on issues related to patients with complex care needs and recommendations identified by 160 key participants at a summit in Quebec City about better integration of primary health care services for patients with chronic diseases and complex care needs. A descriptive qualitative approach was used. While focus groups were l...
Article
Full-text available
Introduction : Le rôle de l’infirmière praticienne spécialisée en soins de première ligne (IPSPL) est relativement récent au Québec. Il y a peu de données sur le déploiement de ce rôle. Objectif : Cette étude vise à décrire le temps passé dans les activités de soins selon les différentes dimensions cliniques et non-cliniques du rôle des IPSPL. Méth...
Article
Full-text available
Aim Describe brief (less than half a day) interventions aimed at improving healthcare team functioning. Methods A systematic review on brief team interventions aimed at role clarification and team functioning (PROSPERO Registration Number: CRD42018088922). Experimental or quasi-experimental studies were included. Database searches included CINAHL,...
Article
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 centra...
Article
Full-text available
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 disco...
Article
Objectives: To examine and compare the experiences and attitudes of primary care physicians in three different regulatory environments (United States, Canada, and France) towards interactions with pharmaceutical sales representatives, particularly their perspectives on safety information provision and self-reported influences on prescribing. Meth...
Article
Full-text available
Introduction: Patients with complex care needs (PCCNs) often suffer from combinations of multiple chronic conditions, mental health problems, drug interactions and social vulnerability, which can lead to healthcare services overuse, underuse or misuse. Typically, PCCNs face interactional issues and unmet decisional needs regarding possible options...
Article
Objective: To evaluate the changes in accessibility, patients' care experiences, and quality-of-care indicators following a clinic's transformation into a fully integrated network clinic. Design: Mixed-methods study. Setting: Verdun, Que. Participants: Data on all patient visits were used, in addition to 2 distinct patient cohorts: 134 patie...
Article
Objective: The study's aim was to test prospective associations between information, motivation, and behavioral skills (IMB model) and self-care behaviors (diet, exercise, and blood glucose testing) among patients with type 2 diabetes. Methods: 295 participants were surveyed one (T1), six (T2), and 12 (T3) months after a diabetes course. Cross-l...
Article
Full-text available
The ageing of the population and the increasing need for long-term care services are global issues. Some countries have adapted homecare programs by introducing an intervention called reablement, which is aimed at optimizing independence. The effectiveness of reablement, as well as its different service models, was examined. A systematic literature...
Article
Full-text available
Objective The purpose of this study is to examine the contribution of health behaviors (self-management and coping), quality of care, and individual characteristics (depressive symptoms, self-efficacy, illness representations) as mediators in the relationship between socioeconomic status (SES) and glycemic control. Methods A sample of 295 adult pat...
Article
This article presents the results of a project conducted by the Institut national d'excellence en santé et en services sociaux of Québec to develop quality of care indicators for the management of six chronic illnesses. Indicators were identified through literature searches and analysis of clinical practice guidelines (CPGs). Interdisciplinary expe...
Article
Full-text available
Purpose: Governments everywhere are implementing reform to improve primary care. However, the existence of a high degree of professional autonomy makes large-scale change difficult to achieve. The purpose of this paper is to elucidate the change dynamics and the involvement of professionals in a primary healthcare reform initiative carried out in...
Article
Introduction : Cet article présente le résultat de la démarche suivie par l’Institut national d’excellence en santé et en services sociaux du Québec pour élaborer des indicateurs de qualité de la prise en charge de six maladies chroniques fréquentes.Méthodes : Les indicateurs furent générés à partir d’une révision des guides de pratique clinique et...
Article
Full-text available
Background: Integrating Nurse Practitioners into primary care teams is a process that involves significant challenges. To be successful, nurse practitioner integration into primary care teams requires, among other things, a redefinition of professional boundaries, in particular those of medicine and nursing, a coherent model of inter- and intra- pr...
Article
Aim: To better understand the associations between changes in self-management behaviours and glycaemic control. Methods: We conducted a prospective observational study of 295 adult patients with Type 2 diabetes evaluated at baseline, 6 and 12 months. Four self-management behaviours were evaluated using the Summary of Diabetes Self-Care Activitie...
Article
Full-text available
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...
Article
Full-text available
Purpose: In a primary care context favoring group practices, we assessed the validity of 2 new continuity measures (both versions of known provider continuity, KPC) that capture the concentration of care over time from multiple physicians (multiple provider continuity, KPC-MP) or from the physician seen most often (personal provider continuity, KP...
Article
Full-text available
To gain a deeper understanding of how primary care (PC) practices belonging to different models manage resources to provide high-quality care. Multiple-case study embedded in a cross-sectional study of a random sample of 37 practices. Three regions of Quebec. Health care professionals and staff of 5 PC practices. Five cases showing above-average re...
Article
Full-text available
Purpose: Evaluate the psychometric properties of the French version of the short 19-item Team Climate Inventory (TCI) and explore the contributions of individual and organizational characteristics to perceived team effectiveness. Method: The TCI was completed by 471 of the 618 (76.2%) healthcare professionals and administrative staff working in...
Article
Full-text available
Introduction. Solo practices have generally been viewed as forming a homogeneous group. However, they may differ on many characteristics. The objective of this paper is to identify different forms of solo practice and to determine the extent to which they are associated with patient experience of care. Methods. Two surveys were carried out in two r...
Article
Full-text available
Background: No primary practice care model has been shown to be superior in achieving high-quality primary care. We aimed to identify the organizational characteristics of primary care practices that provide high-quality primary care. Methods: We performed a cross-sectional observational study involving a stratified random sample of 37 primary c...
Article
Shared decision making is now making inroads in health care professionals' continuing education curriculum, but there is no consensus on what core competencies are required by clinicians for effectively involving patients in health-related decisions. Ready-made programs for training clinicians in shared decision making are in high demand, but exist...
Article
Full-text available
Introduction: The information provided by pharmaceutical sales representatives has been shown to influence prescribing. To enable safe prescribing, medicines information must include harm as well as benefits. Regulation supports this aim, but relative effectiveness of different approaches is not known. The United States (US) and France directly re...
Article
To evaluate chronic illness care delivery from the patient's perspective and to examine its main correlates. Cross-sectional, descriptive study using questionnaires and medical chart review. Nine teaching family practices in Quebec. A total of 364 patients with diabetes, hypertension, or chronic obstructive pulmonary disease. Score on the Patient A...
Article
BACKGROUND: Treatment preferences of patients suffering from depression may affect adherence and clinical outcomes. This study examines associations between patients' treatment preferences, their characteristics and illness representations of depression. METHODS: Illness representations of depression (IPQ-R), treatment acceptability and preferences...
Conference Paper
Purpose: An environmental scan of shared decision making (SDM) training programs for healthcare professionals showed that they vary widely in how and what they deliver. We sought to identify a list of core competencies for SDM training programs. Method: In April 2012, we convened an interdisciplinary and international group of educators, policy-m...
Article
Full-text available
Primary healthcare in developed countries is undergoing important reforms, and these require evaluation strategies to assess how well the population's expectations are being met. Although numerous instruments are available to evaluate primary healthcare (PHC) from the patient perspective, they do not all measure the same range of constructs. To ana...
Article
Full-text available
The operational definition of interpersonal communication is "the ability of the provider to elicit and understand patient concerns, to explain healthcare issues and to engage in shared decision-making if desired." To examine how well interpersonal communication is captured in validated instruments that evaluate primary healthcare from the patient'...
Article
Full-text available
Management continuity, operationally defined as "the extent to which services delivered by different providers are timely and complementary such that care is experienced as connected and coherent," is a core attribute of primary healthcare. Continuity, as experienced by the patient, is the result of good care coordination or integration. To provide...
Article
Full-text available
Patient evaluations are an important part of monitoring primary healthcare reforms, but there is little comparative information available to guide evaluators in the choice of instruments or to determine their relevance for Canada. To compare values and the psychometric performances of validated instruments thought to be most pertinent to the Canadi...
Article
Full-text available
Comprehensiveness relates both to scope of services offered and to a whole-person clinical approach. Comprehensive services are defined as "the provision, either directly or indirectly, of a full range of services to meet most patients' healthcare needs"; whole-person care is "the extent to which a provider elicits and considers the physical, emoti...
Article
Full-text available
The aim of this study was to rate the importance of primary healthcare (PHC) attributes in evaluations of PHC organizational models in Canada. Using the Delphi process, we conducted a consensus consultation with 20 persons recognized by peers as Canadian PHC experts, who rated the importance of PHC attributes within professional and community-orien...
Article
Full-text available
Respectfulness is one measurable and core element of healthcare responsiveness. The operational definition of respectfulness is "the extent to which health professionals and support staff meet users' expectations about interpersonal treatment, demonstrate respect for the dignity of patients and provide adequate privacy." To examine how well respect...
Article
Full-text available
The operational definition of relational continuity is "a therapeutic relationship between a patient and one or more providers that spans various healthcare events and results in accumulated knowledge of the patient and care consistent with the patient's needs." To examine how well relational continuity is measured in validated instruments that eva...
Article
Full-text available
This paper presents an overview of the analytic approaches that we used to assess the performance and structure of measures that evaluate primary healthcare; six instruments were administered concurrently to the same set of patients. The purpose is (a) to provide clinicians, researchers and policy makers with an overview of the psychometric methods...
Article
Full-text available
The operational definition of first-contact accessibility is "the ease with which a person can obtain needed care (including advice and support) from the practitioner of choice within a time frame appropriate to the urgency of the problem"; accommodation is "the way healthcare resources are organized to accommodate a wide range of patients' abiliti...
Article
Full-text available
Massive efforts in Canada have been made to renew primary healthcare. However, although early evaluations of initiatives and research on certain aspects of the reform are promising, none have examined the link between patient assessments of care and health outcomes or the impacts at a population level. The goal of this project is to examine the eff...
Article
The authors describe a national training program in Canada focusing on research in primary health care (PHC). The program, sponsored by the Canadian Institutes of Health Research's Strategic Training in Health Research Program, is called Transdisciplinary Understanding and Training on Research-Primary Health Care (TUTOR-PHC); it began in 2002 and i...
Article
This article presents and discusses five challenges encountered in conducting a knowledge synthesis on primary healthcare, commissioned by the Canadian Health Services Research Foundation. These challenges are (1) conceptualizing, defining and operationalizing complex interventions; (2) integrating quantitative and qualitative studies and assessing...
Article
Full-text available
The aim of this study was to measure the quality of medical follow-up of depression in a universal-access health care system and identify its main correlates. This retrospective cohort study of adult patients who received diagnoses of depression between April 2003 and March 2005 in Montreal used administrative data to measure the quality of medical...
Article
Despite increasing interest in health economic evaluation, investigations have shown limited use by micro (clinical) level decision-makers. A considerable amount of health decisions take place daily at the point of the clinical encounter; especially in primary care. Since every decision has an opportunity cost, ignoring economic information in fami...
Article
Full-text available
To explore the conceptions that family medicine residents from 3 countries have of the roles and responsibilities of family physicians in order to gain a better understanding of challenges that might transcend the specific contexts of different health care systems. Qualitative study using focus groups. Resident training programs in France, Belgium,...
Article
Full-text available
A considerable amount of resource allocation decisions take place daily at the point of the clinical encounter; especially in primary care, where 80 percent of health problems are managed. Ignoring economic evaluation evidence in individual clinical decision-making may have a broad impact on the efficiency of health services. To date, almost all st...
Article
Full-text available
Although the discovery of mutations on BRCA1 and BRCA2 genes associated with high breast cancer risk has given rise to screening and surveillance initiatives, there is little documentation on why high-risk women choose to enter screening programs. The objective of this qualitative study was to develop a detailed understanding of the experiences and...
Article
Full-text available
Collaboration between physicians in different specialties is often taken for granted. However, poor interactions between family physicians and specialists contribute significantly to the observed discontinuity between primary and specialty care. The objective of this study was to explore how collaboration between family physicians and specialists w...
Article
With increasingly fewer family physicians in many countries and students less interested in primary care careers, generalists are becoming an endangered species. This situation is a major health care resource management challenge. In a rapidly changing health care environment, family medicine is struggling for a clear identity -- a matter which is...
Article
Retention of general practitioners (GPs) is crucial to ensure appropriate primary care. However, some recently qualified GPs feel unprepared for practice, which may lead them to leave the profession or restrict their scope of practice. The development of self-efficacy beliefs during vocational training may be an important factor in this phenomenon....
Article
The purpose of the study was to analyze the development of nursing practice in family medicine groups (FMGs). The two-year case study consisted of 73 semi-directed interviews ofnurses, physicians and managers in five FMGs. The findings led to three main observations: nursing practice varies considerably from one FMG to another, the development of n...
Article
The objectives of this study were to explore the meaning of scientific evidence as it is understood by primary care physicians. Individual interviews were conducted with actors chosen for their roles in the production and use of knowledge: 22 family physicians, 13 specialist physicians, and 6 researchers. Two situations served as points of referenc...
Article
Full-text available
On the eve of major primary health care reforms, we conducted a multilevel survey of primary health care clinics to identify attributes of clinic organization and physician practice that predict accessibility, continuity, and coordination of care as experienced by patients. Primary health care clinics were selected by stratified random sampling in...
Article
Full-text available
To investigate variations in accessibility, continuity of care, and coordination of services as experienced by patients in Quebec on the eve of major reforms, and to provide baseline information against which reforms could be measured. Multilevel cross-sectional survey of practice. One hundred primary health care settings were randomly selected in...
Article
Full-text available
In 2004, we undertook a consultation with Canadian primary health care experts to define the attributes that should be evaluated in predominant and proposed models of primary health care in the Canadian context. Twenty persons considered to be experts in primary health care or recommended by at least 2 peers responded to an electronic Delphi proces...
Article
The objectives of this study were to track changes in medical students' interest in obstetrics from the beginning of their studies in medicine to the end of their pre-clinical clerkships and to identify factors that influenced this interest. This was a cohort study of all Québec medical students who, in 2003, were about to begin their clerkships (n...