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Biomedical subjects

R Blais

Publications and source records attributed to R Blais.

43 records · Page 3Linked to original sources
PubMedDate not supplied

Comparison of midwifery care to medical care in hospitals in the Quebec pilot projects study: clinical indicators. L'Equipe dEvaluation des Projets-Pilotes Sages-Femmes.

The purpose of this study was to compare indicators of process and outcome of midwifery services provided in the Quebec pilot projects to those associated with standard hospital-based medical services. Women receiving each type of care (961 per group) were matched on the basis of socio-demographic characteristics and level of obstetrical risk. We found midwifery care to be associated with less obstetrical intervention and a reduction in selected indicators of maternal morbidity (caesarean section and severe perineal injury). For neonatal outcome indicators, midwifery care was associated with a mixture of benefits and risks: fewer babies with preterm birth and low birthweight, but a trend toward a higher stillbirth ratio and more frequent requirement for neonatal resuscitation. The study design does not permit to conclude that the associations were causal in nature. However, the high stillbirth rate observed in the group of women who were selected for midwife care raises concerns both regarding the appropriateness of the screening procedures for admission to such care and regarding the quality of care itself.

Adult↗
PubMedDate not supplied

Cost-effectiveness of midwifery services vs. medical services in Quebec. LEquipe dEvaluation des Projets-Pilotes Sages-Femmes.

This study compared the cost-effectiveness of midwife services provided in birth centres operating as pilot projects with current hospital-based medical services in the province of Quebec. One thousand midwives' clients were matched with 1,000 physicians' clients on the basis of socio-demographic characteristics and obstetrical risk. Direct costs for the prenatal, intrapartum and postpartum periods were estimated. Effectiveness was assessed on the basis of three clinical indicators and four indices related to the individualization of care as assessed by women. Results show that the costs of midwife services were barely lower than or equal to those of physician services, but cost-effectiveness ratios were to the advantage of the midwife group, except for one clinical indicator (neonatal ventilation). Overall, this study provides rational support for the process of legalizing midwifery in the province.

Birthing Centers↗
PubMedDate not supplied

Integration of midwives into the Quebec health care system. L'Equipe d'Evaluation des Projets-Pilotes Sages-Femmes.

This paper reports on one aspect of the evaluation of the midwifery pilot projects in Quebec: the identification of the professional and organizational factors, as well as the mode of integrating midwives into the maternity care system, that would promote the best outcomes and the autonomy of midwives. The research strategy involved a multiple-case study, in which each midwifery pilot project represented a case. Based on a qualitative approach, the study employed various sources of data: individual interviews and focus groups with key informants, site observations and analyses of written documents. Results show that midwives were poorly integrated into the health care system during the evaluation. Four main reasons were identified: lack of knowledge about the practice of midwifery on the part of other health care providers; deficiencies in the legal and organizational structure of the pilot projects; competition over professional territories; and gaps between the midwives' and other providers' professional cultures. Recommendations are provided to facilitate the integration of midwives into the health care system.

Attitude of Health Personnel↗
PubMedDate not supplied

[Geographic variations: focal point for the re-evaluation of health services. Strategies of action].

This second article, in a series of two, proposes a number of strategies to deal with geographic variations in health care services and its main cause, professional uncertainty. These strategies, which call for a reassessment of health services, should be implemented in a non-punitive but educative context, where feedback should be constructive and where physicians should participate at every step. In order to be more effective, this process of health care reassessment should use international collaboration as much as possible.

Attitude of Health Personnel↗
PubMedDate not supplied

[Study of geographic variations: starting point in the reassessment of health services. The phenomenon, its causes and its implications].

This first article, in a series of two, reviews the evidence on geographic variations in the use of health care services. Large variations exist both between countries and between regions within countries. These variations cannot be explained satisfactorily by errors of data, population characteristics or health care system features. Rather, they seem to stem from the professional uncertainty surrounding the current use of health care procedures. In the absence of solid scientific knowledge regarding the relevance and the efficacy of various alternatives, different practice styles are acceptable. Geographic variations raise important questions concerning the cost of care, the health of the population and health policies. In order to deal with geographic variations and professional uncertainty, a major reassessment of health care services is warranted. Specific action strategies will be described in a second article.

Adult↗
PubMedDate not supplied

How different are users and non-users of alternative medicine?

PURPOSE: To determine whether users and non-users of alternative medicine in the province of Quebec differ in terms of demographic characteristics, health profile or utilization of medical services. METHODS: The Quebec Health Insurance Board (QHIB) medical service records of the Quebec Health Survey (1987) respondents for the 12 months before the survey were linked with respondents' survey answers. Those who saw an alternative medicine practitioner at their last professional consultation (the "users", n = 169) were matched by diagnosis and area of residence with those who saw a physician instead (the "non-users", n = 169). RESULTS: Users and non-users of alternative medicine differed in age, activity, education and income. After adjustment for age, education and income, the two groups had a similar health profile, but users of alternative medicine had made fewer medical visits in the previous year. CONCLUSION: Alternative medicine attracts a particular clientele. More research is needed to understand the reasons people look to alternative therapies instead of conventional medicine.

Adolescent↗