Introduction Community-integrated care initiatives are increasingly being used for social and health service delivery and show promising outcomes. Nevertheless, it is unclear what structures and underlining causal agents (generative mechanisms) are responsible for explaining how and why they work or not. Methods and analysis Critical realist synthesis, a theory-driven approach to reviewing and synthesising literature based on the critical realist philosophy of science, underpinned the study. Two lenses guided our evidence synthesis, the community health system and the patient-focused perspective of integrated care. The realist synthesis was conducted through the following steps: (1) concept mining and framework formulation, (2) searching for and scrutinising the evidence, (3) extracting and synthesising the evidence (4) developing the narratives from causal explanatory theories, and (5) disseminate, implement and evaluate. Results Three programme theories, each aligning with three groups of stakeholders, were unearthed. At the systems level, three bundles of mechanisms were identified, that is, (1) commitment and motivation, (2) willingness to address integrated health concerns and (3) shared vision and goals. At the provider level, five bundles of mechanisms critical to the successful implementation of integrated care initiatives were abstracted, that is, (1) shared vision and buy-in, (2) shared learning and empowerment, (3) perceived usefulness, (4) trust and perceived support and (5) perceived role recognition and appreciation. At the user level, five bundles of mechanisms were identified, that is, (1) motivation, (2) perceived interpersonal trust, (3) user-empowerment, (4) perceived accessibility to required services and (5) self-efficacy and self-determination. Conclusion We systematically captured mechanism-based explanatory models to inform practice communities on how and why community-integrated models work and under what health systems conditions. PROSPERO registration number CRD42020210442.

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Unpacking the design, implementation and uptake of community-integrated health care services: a critical realist synthesis

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.

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

L’intervention de proximité est de plus en plus utilisée dans les Habitations à loyer modique (HLM) du Québec pour rejoindre les résidents et les amener à recourir aux services offerts par la communauté. Cet article présente les résultats d’une recherche portant sur les réseaux locaux, l’intervention de proximité et les retombées de ce type d’action auprès des résidents de six plans HLM à Montréal et à Québec. À l’aide de la théorie de l’acteur-réseau et en interrogeant les acteurs locaux, les intervenants et les locataires, il documente le déploiement de ces interventions, leurs défis et leurs retombées. 

Intervention de proximité auprès de résidents d’habitations à loyer modique de Montréal et Québec

AIM To establish and assess an intersectoral local network focused on the roles of registered nurses and primary healthcare nurse practitioners to ensure the continuity of care and service pathways for refugees in Quebec. DESIGN Developmental evaluation with a mixed methodology. METHODS The qualitative component will include: (1) a document review; (2) observations of participants during meetings of different governance structures; (3) semi-structured interviews with key actors (n = 40; 20/neighbourhood interventions); and (4) focus groups with end users of the services (refugees) (n = 4; 6 to 8 participants per group). The quantitative component will be based on: (1) a data sheet on health and social interventions for refugees users filled in by registered nurses, primary healthcare nurse practitioners and physicians and (2) data analysis of the clinical-administrative database since 2012. This study received funding in June 2019 and Research Ethics Committee approval was granted in July 2020. DISCUSSION In Quebec, refugee vulnerability is exacerbated by the lack of integration of existing resources and the lack of access to care and continuity of services. To address these issues, an integrated local network for refugees must be developed. Additionally, we will explore the role of registered nurses and their collaboration with primary healthcare nurse practitioners. IMPACT This study will provide recommendations on how to optimize the scopes of practice of registered nurses and primary healthcare nurse practitioners, adapt care and services and develop a local intersectoral network to better meet the complex needs of refugees. It will evaluate the use and the appreciation of new services for targeted populations (neighbourhoods and refugees) and aim to improve the accessibility, continuity and user experience of all health services for those populations.

Implementation of an intersectoral outreach and community nursing care intervention with refugees in Quebec: A protocol study.

Introduction: Integrated Community Care (ICC) is defined as an interweaving of territory scale and time scale health care and social care interventions implemented in proximity (spatial and relational) in an interdisciplinary and cross-sectoral manner. However, the deployment of in public health and social care networks can be complex owing to their broad mandate and the complexity of their management and accountability. Therefore, we aim to describe integrated community care in order to shed light on how they work, for whom and in what circumstances. Theory and methods: We will conduct a realist synthesis to design a flexible and scalable theory of the functioning of ICC deployed by public health and social care networks. To do so, a two-phase approach will be used: a systematic review on the topic of interest; and co-development and refinement of theory with local and international stakeholders. This data will be analyzed using both qualitative and quantitative methods. Dissemination of results: The results will be disseminated through peer-reviewed publications, academic presentations and a policy brief. This last document will include evidence on how ICC can be deployed by public health and social care networks to produce the impacts targeted.

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Integrated Community Care Delivered by Public Health Care and Social Care Systems: Protocol for a Realist Synthesis.

Introduction: The various health and social care services provided in a given local area (ie, place-based) must not only deliver primary care in proximity to the population, but act upstream on the social determinants of health This type of care, when provided in a holistic and integrated manner, aims to improve the physical and mental health—but also the well-being and social capital—of individuals, families, groups and communities This type of approach is known as Integrated Community Care (ICC) Theory and methods: This article was developed from a non-systematic review of scientific and grey literature followed by a qualitative analysis and researcher reflections on ICC Results: The article presents the core concepts of ICC, namely temporality, local area, health care, social care, proximity and integration These concepts are unpacked and a conceptual diagram is set forth to put the dynamic links between the concepts into perspective Discussion and conclusion: The purpose of the article is to provide a conceptual clarification of ICC Three examples of practise (from Switzerland, Quebec [Canada] and Italy) are used as illustrations to provide a better understanding of ICC and to open up horizons

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Suzanne Garon

Papers

A Conceptual Framework for Integrated Community Care.

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

Integrated Community Care Delivered by Public Health Care and Social Care Systems: Protocol for a Realist Synthesis.