This paper aims to identify challenges and opportunities related to the integration of social determinants of health (SDH) into primary healthcare at an international symposium in Orford, Quebec, Canada. A descriptive qualitative approach was conducted. Three focus groups on different topics were led by international facilitators. Two research team members took notes during the focus groups. All the material was analyzed using a thematic analysis according to an inductive method. Many challenges were identified, leading to the identification of potential opportunities: integrate the concept of SDH in all phases of the training curriculum for health professionals to foster interprofessional and intersectoral collaboration and sociocultural skills; organize healthcare for better outreach to vulnerable populations; organize local and regional committees to develop management frameworks to produce and use territory-specific data; develop dashboards for primary healthcare providers describing the composition of their territory’s population; work collaboratively, rallying primary healthcare providers, community organization delegates, patient partners, citizens, and municipality representatives around common projects. Discussions prompted new directions for further primary healthcare research, among which are building on best practices in the literature and in the field, and engaging various stakeholders in research, including vulnerable populations, while focusing on patient experience.

Les espaces ruraux en dépeuplement ont été peu explorés du point de vue de l’offre de soins de premiers recours et des besoins des populations résidentes, alors que ces questions y occupent une place importante. Ce travail caractérise les espaces en dépeuplement comparativement aux autres espaces ruraux à partir d’une typologie socio-sanitaire et d’une approche statistique nationale. Il met en évidence le déclin plus prononcé de l’offre de médecins généralistes libéraux dans ces espaces, alors que les besoins sanitaires demeurent élevés. Cette contribution évalue également les effets des maisons de santé mises en place pour attirer et maintenir des médecins généralistes dans les zones sous-dotées. Les maisons de santé permettent de diminuer l’érosion de l’offre de médecins généralistes dans certains espaces en dépeuplement, mais pas dans l’ensemble de ceux-ci appelant à des mesures plus larges ou spécifiques.

Introduction : Face à la COVID-19, la plupart des pays ont d’abord réagi en associant des mesures de confinement de la population à un renforcement des soins aigus. Les soins primaires ont ensuite été mobilisés de façon variable et plus ou moins coordonnée. But de l’étude : Comparer l’implication des soins primaires dans la gestion de la pandémie de COVID pour en dégager des enseignements sur les orientations futures à donner aux systèmes sanitaires. Résultats : La mobilisation des acteurs de soins primaires a été importante, hétérogène et variait selon l’existence de dynamiques d’organisations locales préexistantes en équipes, à l’échelon territorial ou dans un cadre plus régulé comme au Québec. La spécialisation de centres COVID était soit systématique, « cliniques chaudes » au Québec, soit à l’initiative des acteurs locaux plus ou moins soutenus par les autorités de santé. La téléconsultation, largement dominée par l’usage du téléphone, a pu être mise en place partout, généralement soutenue par une tarification souple et adaptée. La réalisation des tests diagnostiques comme la vaccination par de nouveaux professionnels, dans un cadre juridique, financier, et de formation simple, est un axe d’amélioration majeur à approfondir. Les systèmes d’information pour évaluer les besoins locaux ont été partout insuffisants. Conclusion : La définition des modalités de gouvernance des soins primaires et, notamment, l’articulation des professionnels avec les opérateurs de l’action publique en santé dans les quatre pays étudiés constitue un enjeu d’amélioration prioritaire à l’échelon local comme à l’échelon national.

Introduction: Facing COVID-19, most of health care system first responded with the confinement of the population and an increase of intensive care resources. Primary care was then mobilized variably and more or less coordinated. Purpose of research: Comparing the involvement of primary care in four francophone regions with similar primary care to draw lessons for reforms directions in light of the COVID experience. Results: Mobilization of primary care actors was important, heterogeneous and linked to local context and previous dynamics at the territorial level or the practice level except in Quebec where primary care is governed by health authorities. The creation of COVID centers was systematic as “warm practices” in Quebec or left to the initiative of local stakeholders more or less supported by health authorities. Teleconsultation, largely dominated by the use of the telephone, was implemented everywhere, generally supported by flexible and adapted pricing. The performance of diagnostic tests such as vaccination by new professionals within a legal, financial and simple training framework is a major area for improvement. Information systems to assess local needs were insufficient everywhere. Conclusion: The definition of primary care governance methods and, in particular, the link between professionals and public health operators in the four areas studied is a priority area for improvement at both local and national levels.

In France, towards the end of the first lockdown, COVID-19 management was largely transferred from hospitals to primary care. Primary care actors adapted their practices to ensure patients’ access to care, while limiting contamination. In this study, we aimed to identify patterns of adaptations implemented by French general practitioners (GPs) in May 2020 for outpatients with confirmed or suspected COVID-19, and factors associated with these adaptions. A French survey concerning care organization adaptations, and individual, organizational, and territorial characteristics, was sent to GPs. Data were analyzed by multiple correspondence analysis followed by agglomerative hierarchical clustering to identify GPs’ adaptation clusters. A multinomial logistic regression model estimated the associations between clusters and individual, organizational, and territorial factors. Finally, 3068 surveys were analyzed (5.8% of French GPs). Four GPs’ adaptation clusters were identified: autonomous medical reorganization (64.2% of responders), interprofessional reorganization (15.9%), use of hospital (5.1%), and collaboration with COVID-19 outpatient centers (14.8%). Age, practice type and size, and territorial features were significantly associated with adaptation clusters. Our results suggest that healthcare systems should consider organizational features of primary care to effectively deal with future challenges, including healthcare crises, such as the COVID-19 pandemic, but also those linked to epidemiologic and societal changes.