Innovations Implemented to Improve Access to Outpatient Rehabilitation Services for Persons Presenting Physical Disabilities: Results of an Environmental Scan in Québec, Canada

Vollständiger Abstract

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Background Difficulties in accessing healthcare services represent a major preoccupation in many countries. These difficulties have been shown to negatively affect the well-being and quality of life of people living with physical disabilities. Nonetheless, research on access to services within rehabilitation remains limited, especially regarding strategies for improvement. Objectives To identify and characterize innovations implemented to improve access to publicly funded outpatient rehabilitation services for people experiencing physical disabilities, and to explore main barriers and facilitators to implementation. Design An environmental scan was conducted in the province of Québec (Canada), combining an online search and semi-structured interviews with key informants. Methods Innovations were identified through searching grey literature. For each identified innovation, data on implementation context, targeted access issue(s), and indicators used to measure impact were extracted and analyzed descriptively. Interviews were carried out to provide complementary data on the innovations and to identify barriers and facilitators. They were transcribed and then analyzed using a mixed inductive/deductive thematic approach. Results Twenty-seven innovations, implemented in various regions and settings, were identified. Most of these targeted individuals with musculoskeletal disorders and addressed issues such as long wait times, geographical inequalities, and inappropriate care. Interviews were conducted with informants (n = 26) involved in 20 of the innovations. Main barriers to implementation included divergences between actors’ perspectives on the relevance of innovations, their complexity and insufficient resources. Main facilitators were having strong planification and individual’s engagement in the implementation. Conclusions This study enhances our understanding of the nature and purpose of innovations aimed at improving access to outpatient rehabilitation for people with physical disabilities. Implementation is a complex process that requires careful consideration of multiple factors.