Les Mots et Les Choses

Objectives . To evaluate the impact of a coordination-type integrated service delivery (ISD) model on health, satisfaction, empowerment, and services utilization of frail older people. Methods . Program of Research to Integrate Services for the Maintenance of Autonomy (PRISMA) is a populationbased, quasi-experimental study with three experimental and three comparison areas. From a random selection of people 75 years or older, 1,501 persons identifi ed at risk of functional decline were recruited (728 experimental and 773 comparison). Participants were measured over 4 years for disabilities (Functional Autonomy Measurement System), unmet needs, satisfaction with services, and empowerment. Information on utilization of health and social services was collected by bimonthly telephone questionnaires. Results . Over the last 2 years (when the implementation rate was over 70%), there were 62 fewer cases of functional decline per 1,000 individuals in the experimental group. In the fourth year of the study, the annual incidence of functional decline was lower by 137 cases per 1,000 in the experimental group, whereas the prevalence of unmet needs in the comparison region was nearly double the prevalence observed in the experimental region. Satisfaction and empowerment were signifi cantly higher in the experimental group. For health services utilization, a lower number of visits to emergency rooms and hospitalizations than expected was observed in the experimental cohort. Conclusion . The PRISMA model improves the effi cacy of the health care system for frail older people.

Impact of PRISMA, a Coordination-Type Integrated Service Delivery System for Frail Older People in Quebec (Canada): A Quasi-experimental Study

Background People suffering from dementia are particularly vulnerable to the gaps between the health and social service systems. Case management is a professional field that seeks to fill in these gaps and remedy this fragmentation. Methods We report the results of a systematic literature review of the impact of case management programs on clinical outcomes and the utilization of resources by persons with dementia. We focused on randomized controlled trials (RCTs) and attempted to identify the factors that might contribute to greater program efficacy. Because the evaluation methods in these studies varied, we used the effect size method to estimate the magnitude of the statistically significant effects reported. Results Our search strategy identified 17 references relating to six RCTs. Four of these six RCTs reported moderately statistically significant effects (effect size, 0.2–0.8) on their primary end point: the clinical outcome in three and resource utilization in one. Two of the RCTs reported weak or no effects (effect size, Conclusions Integration and case management intensity seem to determine the magnitude of the clinical effects in this new professional field. Further studies are needed to clarify the economic impact.

https://alzheimersanddementiajournal.net/article/S1552-5260(11)02654-9/pdf

Analysis of case management programs for patients with dementia: A systematic review

Background and objective  This study investigates health professionals’ reactions to patients’ perceptions of health issues – a little-researched topic vital to the reform of the care of chronic illness.



Methods  Focus groups were undertaken with doctors, nurses, allied health staff and pharmacists (n = 88) in two Australian urban regions. The focus groups explored responses to patient experiences of chronic illness (COPD, Diabetes, CHF) obtained in an earlier qualitative study. Content analysis was undertaken of the transcripts assisted by NVivo7 software.



Results  Health professionals and patients agreed on general themes: that competing demands in self-management, financial pressure and co-morbidity were problems for people with chronic illness. However where patients and carers focused on their personal challenges, health professionals often saw the patient experience as a series of failures relating to compliance or service fragmentation. Some saw this as a result of individual shortcomings. Most identified structural and attitudinal issues. All saw the prime solution as additional resources for their own activities. Fee for service providers (mainly doctors) sought increased remuneration; salaried professionals (mainly nurses and allied health professionals) sought to increase capacity within their professional group.



Conclusions  Professionals focus on their own resources and the behaviour of other professionals to improve management of chronic illness. They did not factor information from patient experience into their views about systems improvement. This inability to identify solutions beyond their professional sphere highlights the limitations of an over-reliance on the perspectives of health professionals. The views of patients and carers must find a stronger voice in health policy.

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Health professionals, patients and chronic illness policy : a qualitative study

Sustaining Collaboration: English-as-a-Second-Language, and Content-Area Teachers.

The best-known theories on interdisciplinarity in the health and social care field seek to identify personal characteristics and organizational predispositions favourable to interprofessionnal collaboration. This paper proposes a reversal of this positioning through the theorization of interdisciplinarity in the health and social care field as a condition of the work of its professionals rather than one of their peculiar attributes. To achieve this reversal, we set out the epistemological foundations of the current debate on interdisciplinarity.

The interdisciplinary condition of work in relational professions of the health and social care field: a theoretical standpoint.

Background The French health and services system to maintain at home is characterized by its fragmentation, whereas the need of the people for intervention is generally total. This fragmentation have consequences: delay in services delivery, inadequate transmission of information, redundant evaluation, service conditioned by the entrance point solicited rather than by the need of the person and inappropriate use of expensive resources by ignorance or difficulty of access to the less expensive resources. Presentation of the innovation The purpose of integration is to improve continuity of interventions for people in loss of autonomy. It consists in setting up a whole of organisational, managerial and clinical common tools. Organisational model “Projet et Recherches sur l’Integration des Services pour le Maintien de l’Autonomie” (Prisma) tested in Quebec showed a strong impact on the prevention of the loss of autonomy in term of public health on a population level. This model rests on six principal elements: partnership, single entry point, case-management, a multidimensional standardized tool for evaluation, an individualized services plan and a system for information transmission. Contextual analysis Thus, it was decided to try to implement in France this organisational model. The project is entitled Prisma France and is presented here. The analysis of the context of implementation of the innovation which represents integration in the field of health and services for frail older reveals obstacles (in particular because of diversity of professional concerned and a presentiment of complexity of the implementation of the model) and favourable conditions (in particular the great tension towards change in this field). Conclusion The current conditions in France appear mainly favourable to the implementation of integration. The establishment of Prisma model in France requires a partnership work of definition of a common language as well on the diagnoses as on the solutions. The strategic and operational dialogue is thus a key element of the construction of integration. This stage currently occurs in parallel in three areas contrasted in France. The results of associated qualitative research should make it possible to define the factors fostering or hindering the realization of integration according to each site (analyzes contrasted) and in all the sites (related to the particular context of care and French services as a whole).

Prisma France* : programme d’implantation d’une innovation dans un système de soins et de services aux personnes en perte d’autonomie. Adaptation d’un modèle d’intégration basé sur la gestion de cas

Issue du monde biomedical, la perspective des pratiques fondees sur les donnees probantes (evidence-based practice) se pose de plus en plus en condition du travail en travail social. Cette perspective, d’inspiration neopositiviste, questionne la scientificite de la discipline. Le present texte presente les contours du debat, notamment en ce qui concerne sa dimension epistemologique.

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« Pratiques fondées sur les données probantes en travail social : un débat émergent »

En provenance d’un monde medical en butte a une croissance exponentielle des savoirs necessaires au jugement clinique, la perspective des pratiques fondees sur les resultats probants, mieux connue sous le label Evidence Based Practice, se presente comme une solution pour rationaliser les pratiques professionnelles dans le secteur de la sante et des services sociaux. Cette perspective comporte cependant quelques limites decoulant notamment d’une serie de reductionnismes methodologiques qu’il est necessaire d’elucider pour bien identifier ce qu’elle peut apporter. Ces reductionnismes seront par la suite analyses au regard de l’inscription plus ou moins volontaire de la perspective Evidence Based Practice dans une nouvelle philosophie de gestion des services publics.

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Management des conduites professionnelles par les résultats probants de la recherche. Une analyse critique

Le present article analyse la receptivite en contexte francais d’un modele quebecois d’integration des services aux personnes âgees en perte d’autonomie a partir d’une etude de mise en oeuvre de projets pilotes sur trois sites francais. L’etude de la receptivite constitue un analyseur puissant des conditions de possibilite d’une mise a jour d’un systeme socio-sanitaire. Dans une perspective neo-institutionnaliste, l’article cherche a mieux comprendre comment se deploie pour un systeme socio-sanitaire particulier la capacite d’innover. Il se compose de trois parties. La premiere problematise la question de l’integration, la seconde analyse l’evolution du systeme socio-sanitaire francais, tandis que la derniere expose la receptivite d’un modele d’integration au regard de cette perspective neo-institutionnaliste. Cette analyse de la receptivite revele une tension entre deux logiques d’action publique en France en matiere d’integration des services, soit celle de la reduction de la complexite systemique et celle de son animation.

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Sébastien Carrier

Papers

The interdisciplinary condition of work in relational professions of the health and social care field: a theoretical standpoint.

Prisma France* : programme d’implantation d’une innovation dans un système de soins et de services aux personnes en perte d’autonomie. Adaptation d’un modèle d’intégration basé sur la gestion de cas

« Pratiques fondées sur les données probantes en travail social : un débat émergent »

Management des conduites professionnelles par les résultats probants de la recherche. Une analyse critique

Réceptivité d’un modèle québécois d’intégration des services aux personnes âgées en perte d’autonomie en France