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[General practitioners: practices and integration of mental health care in Québec].

https://arctichealth.org/en/permalink/ahliterature150729
Source
Sante Ment Que. 2009;34(1):55-76
Publication Type
Article
Date
2009
Author
Armelle Imboua
Marie-Josée Fleury
Author Affiliation
Centre de recherche de l'Hôpital Douglas, Montréal.
Source
Sante Ment Que. 2009;34(1):55-76
Date
2009
Language
French
Publication Type
Article
Keywords
Adult
Aged
Family Practice - organization & administration
Female
Health Services Accessibility
Humans
Male
Mental Disorders - therapy
Mental Health Services - organization & administration
Middle Aged
Physicians, Family
Quebec
Questionnaires
Abstract
This article examines the socio-demographic profile of general practitioners (GPs), their role in the management of (transient/moderate, severe/chronic) mental health disorders in different areas (urban, semi-urban, and rural) of Quebec as well as if their clinical practice and collaboration are oriented towards integration of mental health services. This crosswise study is based on 398 GPs representative of all Quebec GPs who answered a questionnaire. The study shows that GPs play a central role in mental health. According to territories, they have different socio-demographic and practice profiles. The types of territory and the degree of severity of mental health illnesses influence the propensity of GPs to integrate mental health care. Finally, GPs practiced mostly in silo, but they support greater integration of mental health services. The authors conclude that to improve mental health services integration, more proactive incentives should be favoured by political elites, adapted to the severity of the case and environments (urban, semi-urban or rural). However, the shortage of resources that is particularly striking in rural areas as well as inadequate mechanisms for clinical decision, reduce inter-relations and seriously limit the integration of healthcare.
PubMed ID
19475194 View in PubMed
Less detail

GP group profiles and involvement in mental health care.

https://arctichealth.org/en/permalink/ahliterature139005
Source
J Eval Clin Pract. 2012 Apr;18(2):396-403
Publication Type
Article
Date
Apr-2012
Author
Marie-Josée Fleury
Jean-Marie Bamvita
Lambert Farand
Denise Aubé
Louise Fournier
Alain Lesage
Author Affiliation
Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre (DMHUIRC), Montréal, Québec, Canada. flemar@douglas.mcgill.ca
Source
J Eval Clin Pract. 2012 Apr;18(2):396-403
Date
Apr-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Bayes Theorem
Cluster analysis
Cross-Sectional Studies
Disease Management
Female
Humans
Male
Mental Disorders - therapy
Mental Health Services - organization & administration
Middle Aged
Physician's Practice Patterns - statistics & numerical data
Physician's Role
Physicians, Family
Quebec
Questionnaires
Abstract
Mental health is one of the leading causes of morbidity worldwide. Its impact in terms of cost and loss of productivity is considerable. Improving the efficiency of mental health care system has thus been a high priority for decision makers. In the context of current reforms that privilege the reinforcement of primary mental health care and integration of services, this article brings new lights on the role of general practitioners (GPs) in managing mental health, and shared-care initiatives developed to deal with more complex cases. The study presents a typology of GPs providing mental health care, by identifying clusters of GP profiles associated with the management of patients with common or serious mental disorders (CMD or SMD).
GPs in Quebec (n = 398) were surveyed on their practice, and socio-demographic data were collected.
Cluster analysis generated five GP profiles, including three that were closely tied to mental health care (labelled, respectively: group practice GPs, traditional pro-active GPs and collaborative-minded GPs), and two not very implicated in mental health (named: diversified and low-implicated GPs, and money-making GPs).
The study confirmed the central role played by GPs in the treatment of patients with CMD and their relative lack of involvement in the care of patients with SMD. Study results support current efforts to strengthen collaboration among primary care providers and mental health specialists, reinforce GP training, and favour multi-modal clinical and collaborative strategies in mental health care.
PubMed ID
21114798 View in PubMed
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Integrated local networks as a model for organizing mental health services.

https://arctichealth.org/en/permalink/ahliterature186923
Source
Adm Policy Ment Health. 2002 Sep;30(1):55-73
Publication Type
Article
Date
Sep-2002
Author
Marie-Josée Fleury
Céline Mercier
Author Affiliation
Department of Psychiatry, McGill University, Montreal, Quebec, Canada. flemar@douglas.mcgill.ca
Source
Adm Policy Ment Health. 2002 Sep;30(1):55-73
Date
Sep-2002
Language
English
Publication Type
Article
Keywords
Community Mental Health Services - organization & administration
Community Networks - organization & administration
Delivery of Health Care, Integrated - organization & administration
Health Plan Implementation
Humans
Models, organizational
Organizational Innovation
Quebec
Abstract
Organizing services in an integrated network as a model for transforming healthcare systems is often presented as a potential remedy for service fragmentation that should enhance system efficiency. In the mental health sector, integration is also part of a diversified response to the multiple needs of the clients, particularly people with serious mental health disorders. The authors describe how the notion of integrated service networks came to serve as a model for transforming the mental health system in Quebec, and they propose a frame of reference for this notion. They also address the challenges and issues raised by this mode of service organization in the mental health sector and more generally in a context of transforming healthcare systems.
PubMed ID
12546256 View in PubMed
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Integrated service networks: the Quebec case.

https://arctichealth.org/en/permalink/ahliterature168279
Source
Health Serv Manage Res. 2006 Aug;19(3):153-65
Publication Type
Article
Date
Aug-2006
Author
Marie-Josée Fleury
Author Affiliation
Department of Psychiatry, McGill University, Douglas Hospital Research Centre, Verdun (Quebec), Canada. flemar@douglas.mcgill.ca
Source
Health Serv Manage Res. 2006 Aug;19(3):153-65
Date
Aug-2006
Language
English
Publication Type
Article
Keywords
Community Mental Health Services - organization & administration
Delivery of Health Care, Integrated - organization & administration
Health Services Research
Humans
National health programs - organization & administration
Organizational Case Studies
Quebec
Abstract
In the current context of health-care reform, integrated service networks are presented as main solutions to enhance efficiency. During the past few years, there has been an abundance of literature focusing on integration and the underlying implementation issues. However, the concept of integrated service networks remains fluid, and there are few typologies on health-care inter-organizational relations. The Quebec health-care system offers fertile ground for furthering our understanding of this concept because of its public system of funding, its integration of health and social missions, and the present reform's state of development. On the basis of a review of the literature and empirical studies, this article intends to clarify the concept of integrated service networks. A typology of inter-organizational relations and the main parameters for organizing integrated service networks are presented. The article also discusses the effectiveness of integration models.
PubMed ID
16848956 View in PubMed
Less detail

Management of mental health problems by general practitioners in Quebec.

https://arctichealth.org/en/permalink/ahliterature118080
Source
Can Fam Physician. 2012 Dec;58(12):e732-8, e725-31
Publication Type
Article
Date
Dec-2012
Author
Marie-Josée Fleury
Lambert Farand
Denise Aubé
Armelle Imboua
Author Affiliation
Department of Psychiatry, McGill University in Montreal, Quebec, Canada. flemar@douglas.mcgill.ca
Source
Can Fam Physician. 2012 Dec;58(12):e732-8, e725-31
Date
Dec-2012
Language
English
French
Publication Type
Article
Keywords
Adult
Aged
Clinical Competence
Female
General Practice - organization & administration - statistics & numerical data
Health Care Surveys
Humans
Interprofessional Relations
Interviews as Topic
Male
Mental Disorders - diagnosis - epidemiology - therapy
Mental Health Services - organization & administration - statistics & numerical data - utilization
Middle Aged
Physician's Practice Patterns - statistics & numerical data
Primary Health Care - organization & administration - statistics & numerical data - utilization
Qualitative Research
Quality Improvement
Quebec - epidemiology
Questionnaires
Referral and Consultation - statistics & numerical data
Abstract
To document the management of mental health problems (MHPs) by general practitioners.
A mixed-method study consisting of a self-administered questionnaire and qualitative interviews. An analysis was also performed of Régie de l'assurance maladie du Québec administrative data on medical procedures.
Quebec.
Overall, 1415 general practitioners from different practice settings were invited to complete a questionnaire; 970 general practitioners were contacted. A subgroup of 60 general practitioners were contacted to participate in interviews.
The annual frequency of consultations over MHPs, either common (CMHPs) or serious (SMHPs), clinical practices, collaborative practices, factors that either support or interfere with the management of MHPs, and recommendations for improving the health care system.
The response rate was 41% (n = 398 general practitioners) for the survey and 63% (n = 60) for the interviews. Approximately 25% of visits to general practitioners are related to MHPs. Nearly all general practitioners manage CMHPs and believed themselves competent to do so; however, the reverse is true for the management of SMHPs. Nearly 20% of patients with CMHPs are referred (mainly to psychosocial professionals), whereas nearly 75% of patients with SMHPs are referred (mostly to psychiatrists and emergency departments). More than 50% of general practitioners say that they do not have any contact with resources in the mental health field. Numerous factors influence the management of MHPs: patients' profiles (the complexity of the MHP, concomitant disorders); individual characteristics of the general practitioner (informal network, training); the professional culture (working in isolation, formal clinical mechanisms); the institutional setting (multidisciplinarity, staff or consultant); organization of services (resources, formal coordination); and environment (policies).
The key role played by general practitioners and their support of the management of MHPs were evident, especially for CMHPs. For more optimal management of primary mental health care, multicomponent strategies, such as shared care, should be used more often.
Notes
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Cites: BMC Fam Pract. 2009;10:5219619278
Cites: CMAJ. 1998 Oct 6;159(7):795-69805026
Cites: Br J Psychiatry. 2005 Jan;186:11-715630118
Cites: Aust J Rural Health. 2005 Feb;13(1):21-715720311
Cites: Can J Psychiatry. 2005 Jun;50(7):398-40616086537
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Cites: Can J Psychiatry. 2006 May;51(6 Suppl 1):7S-72S16786824
Cites: PLoS Med. 2006 Nov;3(11):e44217132052
Cites: Gen Hosp Psychiatry. 2007 Mar-Apr;29(2):91-11617336659
Cites: Br J Gen Pract. 2007 Mar;57(536):196-20317359606
Cites: J Psychosom Res. 2009 Dec;67(6):607-1119913665
Cites: Chronic Dis Can. 2010 Jun;30(3):84-9420609292
Cites: J Eval Clin Pract. 2012 Apr;18(2):396-40321114798
Cites: BMC Fam Pract. 2012;13:1922423592
Cites: BMC Fam Pract. 2007;8:3717598879
Cites: Evid Rep Technol Assess (Full Rep). 2008 Nov;(173):1-36219408966
Cites: Sante Ment Que. 2009 Spring;34(1):35-5319475193
Cites: Sante Ment Que. 2009 Spring;34(1):161-7219475199
Cites: JAMA. 2004 Jun 2;291(21):2581-9015173149
PubMed ID
23242904 View in PubMed
Less detail

[Mental healthcare system transformation: international tendencies and Québec-France perspectives].

https://arctichealth.org/en/permalink/ahliterature105686
Source
Sante Ment Que. 2013;38(1):17-41
Publication Type
Article
Date
2013
Author
Marie-Josée Fleury
Saïd Acef
Author Affiliation
Université McGill; Centre de recherche du Douglas Institut universitaire en santé mentale; FRQ-S, Centre de réadaptation en dépendance de Montréal - Institut universitaire.
Source
Sante Ment Que. 2013;38(1):17-41
Date
2013
Language
French
Publication Type
Article
Keywords
Delivery of Health Care - organization & administration - trends
France
Health Care Reform
Humans
Mental Health Services - organization & administration - trends
Quebec
Abstract
This article is an overview of international tendencies on current mental healthcare transformation. It describes best practices based models and strategies aimed at improving efficiency of mental healthcare systems. To illustrate reforms in Quebec and France, the article reviews current literature and ongoing research on mental health care and service organization. During the last decade, primary care reinforcement, including best-practices and service integration, has been at the core of the mental healthcare system transformation. However, challenges regarding implementation appear to undermine the transformation's success. This article discusses mental healthcare services planning in order to improve their efficiency and allow the transfer of knowledge acquired through these reforms.
PubMed ID
24336988 View in PubMed
Less detail
Source
Sante Ment Que. 2009;34(1):19-34
Publication Type
Article
Date
2009

[Profiles of agencies serving the homeless or those at risk of homelessness in the region of Montreal].

https://arctichealth.org/en/permalink/ahliterature105683
Source
Sante Ment Que. 2013;38(1):119-41
Publication Type
Article
Date
2013
Author
Guy Grenier
Marie-Josée Fleury
Armelle Imboua
André Ngui
Author Affiliation
Institut universitaire en santé mentale Douglas, Montréal.
Source
Sante Ment Que. 2013;38(1):119-41
Date
2013
Language
French
Publication Type
Article
Keywords
Homeless Persons
Humans
Mental Health Services - organization & administration
Quebec
Risk factors
Abstract
This article presents a study of organizations serving people who are homeless or at risk of becoming homeless (PHRH) in Montreal, as well as the determinants of their inter-organizational relationships. The study shows that greater inter-organizational collaboration is needed, particularly within the network of health and social services (NHSS), to deal with the concomitant problems faced by PHRH. Among determinants that have an impact on the extent of inter-organizational relationships are the number of services offered, the appreciation of the relationships between organizations within the NHSS, and the ratio of Anglophones among the homeless and of individuals with gambling problems.
PubMed ID
24336993 View in PubMed
Less detail

The role of regional planning and management strategies in the transformation of the healthcare system.

https://arctichealth.org/en/permalink/ahliterature186341
Source
Health Serv Manage Res. 2003 Feb;16(1):56-69
Publication Type
Article
Date
Feb-2003
Author
Marie-Josée Fleury
Jean-Louis Denis
Claude Sicotte
Author Affiliation
Psychiatry Department, McGill University, Montreal, Canada. flemar@douglas.mcgill.ca
Source
Health Serv Manage Res. 2003 Feb;16(1):56-69
Date
Feb-2003
Language
English
Publication Type
Article
Keywords
Community Health Planning - organization & administration
Health Care Reform
Health Plan Implementation - organization & administration
Health services needs and demand
Humans
Mental Health Services - organization & administration
Models, organizational
Organizational Case Studies
Quality of Health Care
Quebec
Regional Health Planning - organization & administration
Social Work, Psychiatric - organization & administration
Abstract
Drawing on a case study, this article questions the role of planning and management strategies in the process of transforming a regional public healthcare system that involves a number of organizations and is characterized by fluidity in its functions and division of power. It examines the efficacy of the Regional Plan for the Organization of Health Services (PROS) in reforming the mental health sector in a health and social service district in Quebec, in terms of integrated regional management of mental healthcare and activities at the local level. The regional planning procedure involves a major transformation in management of the mental health system, organizational roles and clinical and professional practices. Our assessment of PROS highlights the importance of taking into account the context of implementation and the instrumental value of planning, before judging its efficacy. To transform a complex healthcare system at the regional and local level, the study suggests a revised conception of the main roles played by planning and of the process shaping its implementation. Our study concludes in favour of developing management strategies at the operational, clinical and professional levels, and integrating them as a planning aid that allows a more corporate and matrix-based system to be set up.
PubMed ID
12626027 View in PubMed
Less detail

[The implementation of integrated networks of mental health services in Quebec: context of introduction, state of implementation and the views of general practitioners].

https://arctichealth.org/en/permalink/ahliterature126654
Source
Sante Publique. 2011 Nov-Dec;23 Suppl 6:S155-9
Publication Type
Article
Author
Marie-Josée Fleury
Author Affiliation
Departement de psychiatrie, Universite McGill, Montreal, Canada.
Source
Sante Publique. 2011 Nov-Dec;23 Suppl 6:S155-9
Language
French
Publication Type
Article
Keywords
Attitude of Health Personnel
Community Mental Health Services - organization & administration
Community Networks
General practitioners
Health Care Reform
Humans
Quebec
Abstract
This paper presents the emerging context of integrated service networks (ISN), clarifies the concept of ISN, and highlights some of the key factors in the successful implementation of ISNs. The Quebec healthcare reform illustrates the current state of development of integrated care. The main targets of the reform are the consolidation of primary care and the development of collaborative models of mental health care (or shared care). Since they are very complex to operate (insofar as they require major system changes), ISNs are not widely developed. General practitioners are at the heart of the current reforms since they have a key role to play in the successful implementation of integrated care models, including ISN models.
PubMed ID
22370080 View in PubMed
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10 records – page 1 of 1.