Implementation of a new clinical and organisational practice to improve access to primary care services: a protocol for an effectiveness-implementation hybrid study.

INTRODUCTION: In Canada, as in most Organisation for Economic Co-operation and Development countries, healthcare systems face significant challenges in ensuring better access to primary care. A regional healthcare organisation in Quebec (Canada) serving a population of approximately 755 459 citizens has implemented a standardised access approach to primary care services for this population. The objective of this new clinical and organisational practice is to ensure that users benefit from the same referral process, regardless of the entry point, in order to be directed to the right services. This new practice integrates a shared decision-making process between the user and the professional, and a collaborative process between different health professionals within and between services. The objective of our research is to identify and characterise the conditions of implementation of this practice. METHODS: This effectiveness-implementation hybrid investigation will use an embedded single-case study, defined in this case as the process of implementing a clinical and organisational practice within a healthcare organisation. Further to an evaluation conducted during a preliminary phase of the project, this study consists of evaluating the implementation of this new practice in four medical clinics (family medicine groups). A qualitative analysis of the data and a quantitative preimplementation and postimplementation analysis based on performance indicators will be conducted. This study is ultimately situated within a participatory organisational approach that involves various stakeholders and users at each step of the implementation and evaluation process. ETHICS AND DISSEMINATION: This study was approved by the Ethics Committee of the Sectoral Research in Population Health and Primary Care of the Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (#2020-1800). The results of the investigation will be presented to the stakeholders involved in the advisory committees and at several scientific conferences. Manuscripts will be submitted to peer-reviewed journals.

Implications of climate change for economic development in northern Canada: energy, resource, and transportation sectors.

Northern Canada is projected to experience major changes to its climate, which will have major implications for northern economic development. Some of these, such as mining and oil and gas development, have experienced rapid expansion in recent years and are likely to expand further, partly as the result of indirect effects of changing climate. This article reviews how a changing climate will affect several economic sectors including the hydroelectric, oil and gas, and mining industries as well as infrastructure and transportation, both marine and freshwater. Of particular importance to all sectors are projected changes in the cryosphere, which will create both problems and opportunities. Potential adaptation strategies that could be used to minimize the negative impacts created by a climate change are also reviewed.