Yvon Brunelle - Academia.edu (original) (raw)
Papers by Yvon Brunelle
Pratiques et Organisation des Soins, 2009
Pratiques et Organisation des Soins, 2009
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 15, 1997
Budget constraints, technological advances and a growing elderly population have resulted in majo... more Budget constraints, technological advances and a growing elderly population have resulted in major reforms in health care systems across Canada. This has led to fewer and smaller acute care hospitals and increasing pressure on the primary care and continuing care networks. The present system of care for the frail elderly, who are particularly vulnerable, is characterized by fragmentation of services, negative incentives and the absence of accountability. This is turn leads to the inappropriate and costly use of health and social services, particularly in acute care hospitals and long-term care institutions. Canada needs to develop a publicly managed community-based system of primary care to provide integrated care for the frail elderly. The authors describe such a model, which would have clinical and financial responsibility for the full range of health and social services required by this population. This model would represent a major challenge and change for the existing system. D...
![Research paper thumbnail of [The implications of the hospitalist phenomenon]](https://attachments.academia-assets.com/80644051/thumbnails/1.jpg)
](Canadian family physician Medecin de famille canadien, 2007
OBJECTIVE To evaluate the effect of 2 different systems of hospital care by means of a literature... more OBJECTIVE To evaluate the effect of 2 different systems of hospital care by means of a literature review. QUALITY OF EVIDENCE Many areas remain unclear because several of the studies are opportunistic and report only isolated experiences or simple before-after observations. Few studies are really experimental, and all were conducted in academic settings, which limits their validity outside these settings. MAIN MESSAGE The evidence supports the use of hospitalists who devote a minimum of 2 months each year to hospital work and practice full-time on the wards. More often than not, costs are reduced and better education for residents is provided with the hospitalist system. An important point regarding quality of care is that mortality rates are similar with both systems. CONCLUSION Some questions remain unanswered. For example, what is the best type of training for preparing residents for hospital work and what is the best way for physicians to maintain their skills in this area?
OBJECTIVE To investigate variations in accessibility, continuity of care, and coordination of ser... more OBJECTIVE 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. DESIGN Multilevel cross-sectional survey of practice. SETTING One hundred primary health care settings were randomly selected in urban, suburban, rural, and remote locations in 5 health regions in Quebec. PARTICIPANTS In each clinic, we chose up to 4 physicians and 20 consecutive patients consulting each physician. MAIN OUTCOME MEASURES Patients' responses to a self-administered questionnaire, the Primary Care Assessment Tool, that assessed patient-provider affiliation, accessibility, relational continuity, coordination of primary and specialty care, and whether patients received health promotion and preventive services. RESULTS A total of 3441 patients participated (87% acceptance rate) in 100 clinics (64% response rate). Timely access ...
Sante publique (Vandoeuvre-les-Nancy, France), Jan 29, 2009
How a group of professionals, working together since years, do become a team? Surveys and deep in... more How a group of professionals, working together since years, do become a team? Surveys and deep interviews of physicians and nurses belonging to the new Family Medicine Groups help to understand modalities, time requirement and main issues of team work, all resulting in satisfaction at work. Data was collected in a multi-method approach led by the Quebec Ministry of health.
Canadian Family Physician Medecin De Famille Canadien, Jun 1, 2007
Sante Publique, Mar 29, 2009
Promotion Education, Feb 1, 2005
OBJECTIVE To evaluate the effect of 2 different systems of hospital care by means of a literature... more OBJECTIVE To evaluate the effect of 2 different systems of hospital care by means of a literature review. QUALITY OF EVIDENCE Many areas remain unclear because several of the studies are opportunistic and report only isolated experiences or simple before-after observations. Few studies are really experimental, and all were conducted in academic settings, which limits their validity outside these settings.
Promotion & education, 2005
The Forum Dialogue on national health systems which took place as a satellite meeting of the 2nd ... more The Forum Dialogue on national health systems which took place as a satellite meeting of the 2nd International Conference on Local and Regional Health Programmes compared four countries (Brazil, France, Switzerland and Canada) sustain "conditions to integrate prevention and promotion in health systems". Despite the diversity of the four systems presented, several similarities regarding difficulties faced and achievements obtained in the integration process have been extracted, which has allowed highlighting three perspectives of action. It is suggested that prevention and promotion can be integrated into health systems by mobilising the population and health professionals towards prevention, but with the condition that the promotion and prevention sector increase its credibility by developing practices of quality, organisation, discourse, and prevention practices adjusted to the health care context. Finally, exchange between the countries on this subject is the way forward...
Cahiers québécois de démographie, 2000
RÉSUMÉ Les indicateurs de type EVSI rendent compte d'une définition de la santé fonctionnelle... more RÉSUMÉ Les indicateurs de type EVSI rendent compte d'une définition de la santé fonctionnelle basée sur l'adaptation des individus à leur environnement. Leur constat est donc susceptible de varier dans le temps et l'espace. Plus le fonctionnement des individus considérés est large, c'est à dire plus on s'éloigne de formes très sévères de restriction tels le confinement ou l'absence de mobilité, plus ce constat est mouvant. Indépendamment des variations des modes d'observation et de calcul, les résultats varient selon l'activité considérée. Le système de soins de santé, à la recherche de nouvelles formes d'équité et de rationnement, demande de nouveaux indicateurs pour décrire les variations de la santé, estimer et prévoir les besoins en soins et services, et surtout justifier des choix quant au volume, à l'organisation et à la distribution des ressources (rationnement). Il a du mal cependant à intégrer les résultats contradictoires et les nuan...
OBJECTIVE To evaluate the effect of 2 different systems of hospital care by means of a literature... more OBJECTIVE To evaluate the effect of 2 different systems of hospital care by means of a literature review. QUALITY OF EVIDENCE Many areas remain unclear because several of the studies are opportunistic and report only isolated experiences or simple before-after observations. Few studies are really experimental, and all were conducted in academic settings, which limits their validity outside these settings.
Pratiques et Organisation des Soins, 2009
Pratiques et Organisation des Soins, 2009
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 15, 1997
Budget constraints, technological advances and a growing elderly population have resulted in majo... more Budget constraints, technological advances and a growing elderly population have resulted in major reforms in health care systems across Canada. This has led to fewer and smaller acute care hospitals and increasing pressure on the primary care and continuing care networks. The present system of care for the frail elderly, who are particularly vulnerable, is characterized by fragmentation of services, negative incentives and the absence of accountability. This is turn leads to the inappropriate and costly use of health and social services, particularly in acute care hospitals and long-term care institutions. Canada needs to develop a publicly managed community-based system of primary care to provide integrated care for the frail elderly. The authors describe such a model, which would have clinical and financial responsibility for the full range of health and social services required by this population. This model would represent a major challenge and change for the existing system. D...
Canadian family physician Medecin de famille canadien, 2007
OBJECTIVE To evaluate the effect of 2 different systems of hospital care by means of a literature... more OBJECTIVE To evaluate the effect of 2 different systems of hospital care by means of a literature review. QUALITY OF EVIDENCE Many areas remain unclear because several of the studies are opportunistic and report only isolated experiences or simple before-after observations. Few studies are really experimental, and all were conducted in academic settings, which limits their validity outside these settings. MAIN MESSAGE The evidence supports the use of hospitalists who devote a minimum of 2 months each year to hospital work and practice full-time on the wards. More often than not, costs are reduced and better education for residents is provided with the hospitalist system. An important point regarding quality of care is that mortality rates are similar with both systems. CONCLUSION Some questions remain unanswered. For example, what is the best type of training for preparing residents for hospital work and what is the best way for physicians to maintain their skills in this area?
OBJECTIVE To investigate variations in accessibility, continuity of care, and coordination of ser... more OBJECTIVE 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. DESIGN Multilevel cross-sectional survey of practice. SETTING One hundred primary health care settings were randomly selected in urban, suburban, rural, and remote locations in 5 health regions in Quebec. PARTICIPANTS In each clinic, we chose up to 4 physicians and 20 consecutive patients consulting each physician. MAIN OUTCOME MEASURES Patients' responses to a self-administered questionnaire, the Primary Care Assessment Tool, that assessed patient-provider affiliation, accessibility, relational continuity, coordination of primary and specialty care, and whether patients received health promotion and preventive services. RESULTS A total of 3441 patients participated (87% acceptance rate) in 100 clinics (64% response rate). Timely access ...
Sante publique (Vandoeuvre-les-Nancy, France), Jan 29, 2009
How a group of professionals, working together since years, do become a team? Surveys and deep in... more How a group of professionals, working together since years, do become a team? Surveys and deep interviews of physicians and nurses belonging to the new Family Medicine Groups help to understand modalities, time requirement and main issues of team work, all resulting in satisfaction at work. Data was collected in a multi-method approach led by the Quebec Ministry of health.
Canadian Family Physician Medecin De Famille Canadien, Jun 1, 2007
Sante Publique, Mar 29, 2009
Promotion Education, Feb 1, 2005
OBJECTIVE To evaluate the effect of 2 different systems of hospital care by means of a literature... more OBJECTIVE To evaluate the effect of 2 different systems of hospital care by means of a literature review. QUALITY OF EVIDENCE Many areas remain unclear because several of the studies are opportunistic and report only isolated experiences or simple before-after observations. Few studies are really experimental, and all were conducted in academic settings, which limits their validity outside these settings.
Promotion & education, 2005
The Forum Dialogue on national health systems which took place as a satellite meeting of the 2nd ... more The Forum Dialogue on national health systems which took place as a satellite meeting of the 2nd International Conference on Local and Regional Health Programmes compared four countries (Brazil, France, Switzerland and Canada) sustain "conditions to integrate prevention and promotion in health systems". Despite the diversity of the four systems presented, several similarities regarding difficulties faced and achievements obtained in the integration process have been extracted, which has allowed highlighting three perspectives of action. It is suggested that prevention and promotion can be integrated into health systems by mobilising the population and health professionals towards prevention, but with the condition that the promotion and prevention sector increase its credibility by developing practices of quality, organisation, discourse, and prevention practices adjusted to the health care context. Finally, exchange between the countries on this subject is the way forward...
Cahiers québécois de démographie, 2000
RÉSUMÉ Les indicateurs de type EVSI rendent compte d'une définition de la santé fonctionnelle... more RÉSUMÉ Les indicateurs de type EVSI rendent compte d'une définition de la santé fonctionnelle basée sur l'adaptation des individus à leur environnement. Leur constat est donc susceptible de varier dans le temps et l'espace. Plus le fonctionnement des individus considérés est large, c'est à dire plus on s'éloigne de formes très sévères de restriction tels le confinement ou l'absence de mobilité, plus ce constat est mouvant. Indépendamment des variations des modes d'observation et de calcul, les résultats varient selon l'activité considérée. Le système de soins de santé, à la recherche de nouvelles formes d'équité et de rationnement, demande de nouveaux indicateurs pour décrire les variations de la santé, estimer et prévoir les besoins en soins et services, et surtout justifier des choix quant au volume, à l'organisation et à la distribution des ressources (rationnement). Il a du mal cependant à intégrer les résultats contradictoires et les nuan...
OBJECTIVE To evaluate the effect of 2 different systems of hospital care by means of a literature... more OBJECTIVE To evaluate the effect of 2 different systems of hospital care by means of a literature review. QUALITY OF EVIDENCE Many areas remain unclear because several of the studies are opportunistic and report only isolated experiences or simple before-after observations. Few studies are really experimental, and all were conducted in academic settings, which limits their validity outside these settings.