The Population's Experience of Care : Portrait of Intra-regional Variations In Montréal and Montérégie

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Based on the indicators described, the report suggests that:

A large majority of the population (86.6%) had had contacts with the health system in the two years preceding the study. While 15% of individuals reported being hospitalised and 31% going to an emergency department, 51% of individuals said they visited primary care organisations only.
In the six months preceding the survey, 18% of interviewees reported that some of their perceived need for health care were not met, that is, they felt they needed to see a physician but did not seen one. The proportion of unmet health care needs varied from one CSSS territory to another. We observe a decreasing gradient from relatively high proportions of unmet needs in central Montréal (24.3% at CSSS de Jeanne-Mance) to decreasing proportions of unmet needs as we move towards more rural CSSS territories and smaller regional towns in Montérégie. Indeed, the proportion of unmet needs for the CSSS de la Pommeraie and CSSS du Haut-Saint-Laurent is below 12%.
When both regions are grouped together, 69% of individuals reported having a family physician. This proportion is lower in CSSS territories in central Montréal and much higher in the rural areas and small towns in Montérégie. Less than 60% of people living in the territories of the CSSS de la Montagne, Coeur de l’Ile and Jeanne Mance have family physicians, while the figures range from 69% to nearly 88% for Montérégie CSSSs.
It appears that the proportion of unmet needs is inversely related to the percentage of people who report having a family physician.
Regular sources of primary care also vary between CSSS territories in Montréal and those in Montérégie. For example, more people living in Montérégie than in Montréal reported a private practice as their regular source of primary care (72.1% vs. 62.5%).
Overall, individuals rated favourably their experience of care at their regular source, especially with regards to responsiveness, that is, response to people’s expectations of how they should be treated. A total of 86% of users reported that they are well respected at their regular source of primary care. However, despite high overall satisfaction in both regions, respondents in Montérégie perceived their experience of care to be better than those in Montréal, where the indicators for some territories were below the overall average (see Summary Table).
With regards to accessibility of health services from the regular source of care, we note that one out of four people had to wait more than 4 weeks for an appointment (32.0% in Montérégie vs. 19.2% in Montréal). Access through appointments, in terms of the period of time elapsed between taking an appointment and the actual medical consultation, is not as good in Montérégie as it is in Montréal. Furthermore, it is difficult to talk to a physician over the telephone, even when the clinic is open. Twothirds of individuals reported being in this situation. Finally, a sizeable proportion of people had to pay for laboratory tests (29.1%) or medical services (25.6%). Close to 40% of these individuals considered the amounts paid to be high.
In terms of comprehensiveness of services, the level of satisfaction with services received from the regular source of primary care is lower than for other concepts analysed. For example, while 73% of participants said they could see a physician at their regular source of care for a chronic problem, only 59% considered that all their health problems are looked after.
A few indicators suggest results of care received from regular sources should be improved. Indeed, only 56% of users reported that the services delivered enabled them to prevent certain health problems; 68% stated that the professionals at their regular source inspire them to adopt a healthy lifestyle. Accordingly, primary care clinical prevention practices could be improved.
A synthesis of 84 indicators presented in this report and broken down by 23 CSSS territories under study suggests that the experience of primary care is best for people living in more rural areas and small regional towns compared with those of residents of urban and suburban areas. Interestingly, the impact of life circumstances also seems to have an influence on the relationship between being economically disadvantaged and experiences of care. Indeed the best experiences of care observed were those reported by people living in rural areas of Montérégie, where poverty levels are rather high. On the other hand, results for residents in low-income areas of Montréal were not as good.
Future analyses will look at the degree to which these observations are due to the organisation of primary care service, to the regular sources of care provision to which people have access, or to other characteristics linked to individuals’ life circumstances.
A degree of caution is required when interpreting this cross-sectional study results. The indicators presented here reflect the experience of care experience of residents in different CSSS territories and not those of users of the primary care services in these territories. This is largely due to the fact that in numerous cases, a substantial proportion of individuals refer to a regular source of primary care that is located in a territory other than the one in which they live.