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BMJ Open. 2017 Aug 17;7(8):e016039. doi: 10.1136/bmjopen-2017-016039.

Rural emergency care 360°: mobilising healthcare professionals, decision-makers, patients and citizens to improve rural emergency care in the province of Quebec, Canada: a qualitative study protocol.

Author information

Department of Family and Emergency Medicine, Université Laval, Quebec City, Québec, Canada.
Research Chair in Emergency Medicine, CHAU-Hôtel-Dieu de Lévis (Université Laval), Lévis, Québec, Canada.
Institut universitaire de première ligne en santé et services sociaux -Université Laval, Québec city, Québec, Canada.
Department of Psychology, Université du Québec à Montréal, Montreal, Québec, Canada.
Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada.
CHU Sainte-Justine, Université de Montréal, Montréal, Canada.
Department of Political Science, Université Laval, Quebec City, Québec, Canada.
Department of Family Medicine and Emergency Medicine, Knowledge Transfer and Health Technology Assessment Group of the CHU de Québec Research Centre, Unité de Recherche Évaluative, Université Laval, Quebec City, Québec, Canada.



Emergency departments (EDs) are an important safety net for rural populations. Results of our earlier studies suggest that rural Canadian hospitals have limited access to advanced imaging services and intensive care units and that patients are transferred over large distances. They also revealed significant geographical variations in rural services. In the absence of national standards, our studies raise questions about inequities in rural access to emergency services and the risks for citizens. Our goal is to build recommendations for improving services by mobilising stakeholders interested in rural emergency care. With help and full engagement of stakeholders, we will (1) identify solutions for improving quality and performance in rural EDs; (2) formulate and prioritise recommendations; (3) transfer knowledge of the recommendations to rural EDs and support operationalisation and (4) assess knowledge transfer and explore further impacts of this participatory action research project.


We will use a participatory action research approach. We will plan for a governance structure that includes all stakeholders’ representatives, so throughout this project, stakeholders are fully engaged at every step. Our sample will be 26 EDs in rural Quebec. We will conduct semistructured individual and focus group interviews with relevant and representative participants, including patients and citizens (estimated n=200). Interviews will be thematically analysed to extract potential solutions and other qualitative information.An expert panel (±15) will use an analysis grid to develop consensus recommendations from solutions suggested and will evaluate feasibility, impacts, costs, conditions for implementation and establish monitoring indicators. Recommendations will be transferred to stakeholders using tailored knowledge translation strategies (web platform, meetings and so on).


This study will result in a comprehensive consensus list of feasible and high-priority recommendations enabling decision-makers in emergency care to implement improvements in rural emergency care in Quebec.


This protocol has been approved by the CSSS Alphonse-Desjardins research ethics committee (Project number: MP 2017-009). The qualitative material will be kept confidential and the data will be presented in a way that respects confidentiality. The dissemination plan for the study includes publications in scientific and professional journals. We will also use social media to disseminate our findings and activities such as communications in public conferences.


Health care; Participatory action research; Performance; Rural emergency departments; Unwarranted variations in practice

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