The Canadian healthcare system is currently experiencing important organizational transformations through the reform of primary healthcare (PHC). These reforms vary in scope but share a common feature of proposing the transformation of PHC organizations by implementing new models of PHC organization. These models vary in their performance with respect to client affiliation, utilization of services, experience of care and perceived outcomes of care.
In early 2005 we conducted a study in the two most populous regions of Quebec province (Montreal and Montérégie) which assessed the association between prevailing models of primary healthcare (PHC) and population-level experience of care. The goal of the present research project is to track the evolution of PHC organizational models and their relative performance through the reform process (from 2005 until 2010) and to assess factors at the organizational and contextual levels that are associated with the transformation of PHC organizations and their performance.
This study will consist of three interrelated surveys, hierarchically nested. The first survey is a population-based survey of randomly-selected adults from two populous regions in the province of Quebec. This survey will assess the current affiliation of people with PHC organizations, their level of utilization of healthcare services, attributes of their experience of care, reception of preventive and curative services and perception of unmet needs for care. The second survey is an organizational survey of PHC organizations assessing aspects related to their vision, organizational structure, level of resources, and clinical practice characteristics. This information will serve to develop a taxonomy of organizations using a mixed methods approach of factorial analysis and principal component analysis. The third survey is an assessment of the organizational context in which PHC organizations are evolving. The five year prospective period will serve as a natural experiment to assess contextual and organizational factors (in 2005) associated with migration of PHC organizational models into new forms or models (in 2010) and assess the impact of this evolution on the performance of PHC.
The results of this study will shed light on changes brought about in the organization of PHC and on factors associated with these changes.
This study evaluated the housing preferences of a representative sample of consumers with serious mental illness living in seven types of housing in Montreal, Quebec, and compared these with their case managers' housing preferences for them.
An inventory of all housing for this population was developed in consultation with administrators of three psychiatric hospitals and the regional health board. The inventory included seven categories: housing in a hospital setting, hostels, group homes, foster homes, supervised apartments, social housing (low-income housing or cooperative), and private rooming homes. A stratified random sample of 48 consumers was selected in each category. In all, 315 consumers and their case managers completed the Consumer Housing Preference Survey.
Most consumers preferred living in housing that offered them more autonomy than the housing in which they were currently living. Case managers preferred housing that offered some structure, such as supervised apartments. Forty-four percent of consumers preferred to live in their own apartment. More than a third of consumers preferred to live in their current housing.
When evaluating housing preferences, it is important to elicit the viewpoints of mental health consumers as well as their case managers. Special attention should be given to the type of housing where consumers currently live. A variety of housing, not just autonomous housing, is needed to meet the specific housing preferences of individuals with serious mental illness.
This article presents the results of an exploratory study on housing preferences of 315 people with serious mental illness living in seven types of housing in Montreal. The overall portrait that emerged from the study revealed that 22,0 % of the participants prefer to live in their own apartment, 16,0 % in HLM or OSBL, 14,1 % in a supervised apartment, and 11,5 % in a foster home. In addition, 31,7 % prefer the type of housing they were living in at the time of the study. The authors conclude that a variety of housing resources are necessary to meet the diverse needs of consumers.
The objective of this study was to explore the meaning of recovery from the perspectives of consumers receiving mental health services in Canada.
Sixty semi-structured interviews were conducted with 54 mental health consumers in Montreal, Québec City and Waterloo-Guelph, Ontario.
Two contrasting meanings of recovery emerged. The first definition strongly attached recovery to illness while the second definition linked recovery to self-determination and taking responsibility for life.
The prominence of biomedical definitions of recovery suggests the need to find common ground between these two perspectives, if conceptualizations of recovery are to include the views of consumers who routinely experience the mental health system.