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.
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.
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.
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.
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.
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.
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.
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.
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.
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.