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.

/pdf/health-professionals-patients-and-chronic-illness-policy-a-gq239eoss7.pdf

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

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

User-led approaches are increasingly common in the field of social services and call for significant change in social service culture and practices. This research1 aims to study the implementation ...

New Technologies Supporting the Shift to User-Led Approaches in Social Services: A Study of the Implementation of Baromètre

Le projet baromètre, améliorer ma qualité de vie: un outil numérique québécois au service de la personnalisation en santé et services sociaux

Liste des encadrés, des figures et des tableaux

Purpose: This presentation concerns the contribution of family caregivers to the coordination of services for the frail elderly. Theory: The role of family caregivers is partly conditioned by the conjuncture of health and social care organization. In recent years, many efforts were devoted to the creation of services integration devices which aim to improve user experience in particularly fragmented services organization [1]. In this context, family caregivers increasingly draw from their personal resources to care for their loved ones. In fact, Ducharme and colleagues [2] estimated that 80% of the care received is dispensed by family caregivers. Therefore, a better understanding of the contribution of family caregivers to coordinated care was deemed pertinent. Methods: Our exploratory study consisted of 12 interviews with family caregivers and frail elderly users concerning their coordination experience. Results and conclusions: In all circumstances, family caregivers have an important contribution to coordination. In fact, they absorb the coordination surplus required during the pre-installation phase of case management or during the users’ episodes of transforming needs. This reveals a temporal gap between the need for coordination and the effective deployment of case management. Therefore, they appear as the primary bearers of services coordination.

/pdf/contributions-of-family-caregivers-to-the-coordination-of-547s307mwx.pdf

Contributions of family caregivers to the coordination of services for the frail elderly

Evidence-based practice, first developed in medicine as a response to the exponential growth in the knowledge required to exercise clinical judgment, is now seen as way to rationalize professional practice in the fields of health and social services. However, correctly assessing its contributions requires understanding its limitations, which are the result of a series of methological reductions. These reductions are analyzed in relation to the more or less voluntary introduction of the evidence-based practice perspective into a new philosophy of public service management. 

Sébastien Carrier

Papers

New Technologies Supporting the Shift to User-Led Approaches in Social Services: A Study of the Implementation of Baromètre

Le projet baromètre, améliorer ma qualité de vie: un outil numérique québécois au service de la personnalisation en santé et services sociaux

Liste des encadrés, des figures et des tableaux

Contributions of family caregivers to the coordination of services for the frail elderly

Managing professional conduct from an evidence-based perspective: A critical analysis