Sébastien Carrier

Bio: Sébastien Carrier is an academic researcher from Université de Sherbrooke. The author has contributed to research in topics: Perspective (graphical) & Interdisciplinarity. The author has an hindex of 7, co-authored 19 publications receiving 143 citations.

Les pratiques de coordination en gestion de cas dans le secteur du soutien à domicile pour les personnes en perte d'autonomie liée au vieillissement, une analyse conventionnaliste

Abstract: The objective of this article is to understand coordination as it unfolds in case management practices in the context of integrated care networks devoted to frail elderly individuals. More specifically, we describe practical coordination processes. We conducted a qualitative exploratory study using an embedded case study design. Our study covers three health and social service centers in Quebec. We noted that coordination produces convention in case management practices through a process of bringing together different types of compromise in home care situations where multidimensionality appears to be more or less important. We constructed four different types of compromise-producing convention with regard to coordination in case management practices: compromise at the interface, scheduling compromise, compromise of opportunity, and compromising change.

« Menaces et opportunités pour le travail social de l'intégration des services dans le cadre des réformes actuelles : une exploration à partir du dispositif de gestion de cas »

Abstract: Dans cet article, l'A se penche sur les effets de la Loi 25, Loi sur les agences de developpement de reseaux locaux visant a l'integration des services dans le reseau de sante et des services sociaux qu Quebec. L'A analyse les opportunites et les menaces qui pesent sur le dispositif de gestion de cas pour les travailleurs sociaux, entre denaturation de la profession par le courtage des services, et travail en reseaux avec les partenaires professionnels

L’étude de trajectoires d’implantation de baromètre, un outil numérique visant à actualiser l’approche de personnalisation des services sociaux

Abstract: La personnalisation des services sociaux propose une approche de plus en plus valorisee dans les pratiques. Elle vise a offrir plus de choix et de controle aux personnes en misant sur leurs forces pour coproduire l’intervention. Pour accompagner le changement de culture qu’exige ce type d’approche, un outil d’intervention informatise et interactif a ete developpe, nomme Barometre. Comment une technologie numerique comme Barometre peut-elle agir comme condition sociotechnique contribuant au changement de culture? Nous avons realise une recherche qualitative utilisant une strategie d’etude de cas multiples. Quatre milieux de pratique nous ont servi d’observatoires : deux organismes communautaires en sante mentale, un departement de psychiatrie et un centre de formation pour adultes. Trois types de collecte de donnees ont ete utilises : des entretiens individuels semi-directifs aupres des usagers, des entretiens d’explicitation de la pratique aupres d’intervenants pour produire des histoires d’utilisation, des entretiens de groupe aupres d’usagers et d’intervenants. Nous avons analyse les donnees au moyen d’un modele des forces croisant quatre modes operatoires d’experimentation : generaliste, expansionniste, particulariste et deliquescent. L’analyse permet d’observer une tendance a la deliquescence des experimentations-pilotes. Or, la deliquescence n’est pas causee par la technologie en elle-meme, mais par les conditions contextuelles des experimentations.

Prior conceptions of integration and coordination as modulators of an innovation's adoption: the case of a pilot project targeting the implementation of a services' integration device in France

Abstract: Purpose: Recent work on diffusion of innovation insists on the importance of the processual dimensions of an innovation’s adoption. Context: In the course of a pilot-project aiming to implement three service integration networks for people losing their autonomy, we performed an analysis of the prior conceptions the various actors held of two founding principals: integration and coordination. This research aims to identify the prior conceptions held by the actors and to elucidate the adjustments they do to sustain the adoption of the innovation. Data sources: We conducted 32 interviews with the various key actors pertaining, as well to the strategic, tactical and operational levels of the three different sites. Case description: A content analysis of the conflicts of conception and adjustments elaborated by the adoptants during the course of the interviews was conducted. Conclusion: We notice differences in regards to the operational conceptions of the actors about the founding principles of the innovation. The capacity of working out compromises between these different conceptions is considered as predictive of the adoption of the innovation. Discussion: The adjustments they have elaborated favour a progressive adoption of the innovation and found the next step of the process of diffusion of innovation, which is local appropriation.

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

Abstract: 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.

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

Abstract: 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.

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

Abstract: 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.