Open Access Highly Accessed Study protocol

What makes primary care effective for people in poverty living with multiple chronic conditions?: study protocol

Christine Loignon1*, Jeannie L Haggerty2, Martin Fortin1, Christophe P Bedos3, David Barbeau4 and Dawn Allen5

Author Affiliations

1 Centre de recherche de l'Hôpital Charles LeMoyne, Université de Sherbrooke (150 Place Charles Lemoyne), Longueuil (J4K 0A8), Canada

2 Department of Family Medicine, St-Mary's Hospital, McGill University (3777 Jean Brillant), Montréal, (H3T 1M5), Canada

3 Faculty of Dentistry, McGill University (3550 University), Montréal (H3A 2A7) Canada

4 Department of Family Medicine, Université de Montréal (2900 Édouard Montpetit), Montréal (H3T 1J4), Canada

5 Programs in Whole Person Care, McGill University (1650 Cedar Avenue), Montréal (H3G 1A4), Canada

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BMC Health Services Research 2010, 10:320  doi:10.1186/1472-6963-10-320

Published: 30 November 2010



The inverse care law persists: people living in poverty have the greatest needs and face considerable challenges in getting the care they need. Evidence reveals that GPs encounter difficulties in delivering care to poor patients, while many of those patients feel stigmatized by healthcare professionals. Patients living in poverty report negative healthcare experiences and unmet healthcare needs. Indeed, there is a growing recognition in primary care research of the importance of addressing the capabilities and social conditions of the poor when delivering care. Few studies have looked at the factors contributing to effective and "socially responsive" care for people living in poverty.


Our study adopts a qualitative ethnographic approach in four healthcare organizations in deprived areas of metropolitan Montreal (Québec, Canada), using patient shadowing techniques and interviews. Data will be collected through fieldwork observations and informal interviews with patients before and after consultations. We will observe medical consultations, care organization activities, and waiting areas and reception of patients. We will conduct a total of 36 individual interviews with 12 GPs and 24 patients. The interviews will be audio-recorded and transcribed for purposes of analysis. The analysis consists of debriefing sessions, coding and interpretive analysis.


This study aims to investigate how positive healthcare interactions between physicians and patients can improve the management of chronic conditions. We hypothesize that factors related to care organization, to healthcare professionals' experience and to patients may enhance the quality of healthcare interactions, which may have positive impacts for preventing and managing chronic conditions. Our study will provide a unique set of data grounded in the perspectives of healthcare professionals and of patients living in poverty.