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Balard F, Gely-Nargeot MC, Corvol A, Saint-Jean O, Somme D. Case management for the elderly with complex needs: cross-linking the views of their role held by elderly people, their informal caregivers and the case managers. BMC Health Serv Res 2016; 16:635. [PMID: 27825342 PMCID: PMC5101789 DOI: 10.1186/s12913-016-1892-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 11/01/2016] [Indexed: 11/22/2022] Open
Abstract
Background In 2009, case management interventions were a new social service in France implemented within the framework of the PRISMA-France program (2006–2010). People who had benefitted from case management intervention were individuals, over 60 years old living at home in situations deemed complex by professionals. Their informal caregivers were also considered as users of the service. This research accompanied the interventions during the implementation of PRISMA-France attempting to explore the users’ (old people and their informal caregivers) and case managers’ first experiences of case management. Its aim is to provide a thorough knowledge of the dispositive in order to reveal any initial failings and to ensure optimum conditions for the onset of full implementation. Methods The study had a qualitative explorative design. Cross-linked representations of case-management were obtained through opened-ended and guided interviews with three types of informants: old people (19), their informal caregivers (11) and the case managers (5) who participated in the program during the first 6 months. Thematic analysis of the data was carried out. Results The analysis revealed that each group of people generated its own representations of the case manager’s role, even though the three groups of informants shared the idea that the case manager is first and foremost a helper. The case managers insisted on their proximity to the old people and their role as coordinators. The informal caregivers saw the professional as a partner and potential provider of assistance in accompanying old people. The old people focused on the personal connections established with the case manager. Conclusion The innovative and experimental dimension of case management in France and the flexible nature of the role generated a broad spectrum of representations by those involved. These different representations are, in part, the fruit of each individual’s projected expectations of this social service. Analyzing the first representations of the case manager’s role during the implementation phase of the CM service appears as a necessary step before considering the effects of the services. The implementation and the success of a case management model have to be evaluated regarding the previous healthcare context and the expectations of the people involved.
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Affiliation(s)
- Frédéric Balard
- Laboratoire Lorrain de sciences sociales, Université de Lorraine, Nancy, France.
| | | | - Aline Corvol
- Centre Hospitalier de Rennes, Service de Gériatrie, Rennes, France
| | | | - Dominique Somme
- Université de Rennes 1, Centre Hospitalier de Rennes, Service de Gériatrie, Laboratoire CRAPE Centre de Recherches sur l'Action Politique en Europe, UMR 6051, Rennes, France
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Place du gériatre dans la prise en charge des patients âgés atteints de cancer. Cancer Radiother 2015; 19:377-81. [DOI: 10.1016/j.canrad.2015.07.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 07/21/2015] [Indexed: 11/24/2022]
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Jacob B, Macquet D, Natalis S. Une réforme globale des soins en santé mentale basée sur une approche communautaire : l’expérience belge. SANTE MENTALE AU QUEBEC 2014. [DOI: 10.7202/1025915ar] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Les évolutions qui ont marqué les soins en santé mentale en Belgique ces dernières années montrent qu’un certain nombre de jalons importants sont d’ores et déjà posés vers la mise en place des soins orientés vers la communauté. Nous vivons, actuellement, en Belgique, un moment que l’on peut qualifier d’historique, tant la réforme qui est proposée est ambitieuse mais aussi complexe.
En effet, on parle d’une réforme globale des soins en santé mentale qui associe dans un même mouvement les compétences fédérales, régionales et communautaires.
Elle a pour but de transformer une partie de l’offrehospitalière en une offre de soins orientée dans lacommunauté par, notamment, la créationd’équipes mobiles qui prendront place dans le dispositifcommunautaire déjà existant.
Dans le même temps, nous développons l’approche opérationnelle du travail en réseau organisé autour des besoins des usagers et de leur entourage.
Dans cet article, nous proposons de décrire le contenu de cette réforme, ses mécanismes et ses acteurs. Nous présentons l’état d’avancement de la phase exploratoire en insistant sur des aspects positifs qui mettent en avant le caractère évolutif de notre démarche mais aussi des difficultés que nous rencontrons dans sa mise en place.
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Affiliation(s)
- Bernard Jacob
- Chef de projet et coordinateur fédéral de la réforme des soins en santé mentale
| | - Donatien Macquet
- Adjoint au coordinateur fédéral de la réforme des soins en santé mentale
| | - Stéphanie Natalis
- Expert scientifique recherche participation usagers/familles dans le cadre de la réforme des soins en santé mentale
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de Stampa M, Vedel I, Trouvé H, Ankri J, Saint Jean O, Somme D. Multidisciplinary teams of case managers in the implementation of an innovative integrated services delivery for the elderly in France. BMC Health Serv Res 2014; 14:159. [PMID: 24708721 PMCID: PMC4021253 DOI: 10.1186/1472-6963-14-159] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 03/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The case management process is now well defined, and teams of case managers have been implemented in integrated services delivery. However, little is known about the role played by the team of case managers and the value in having multidisciplinary case management teams. The objectives were to develop a fuller understanding of the role played by the case manager team and identify the value of inter-professional collaboration in multidisciplinary teams during the implementation of an innovative integrated service in France. METHODS We conducted a qualitative study with focus groups comprising 14 multidisciplinary teams for a total of 59 case managers, six months after their recruitment to the MAIA program (Maison Autonomie Integration Alzheimer). RESULTS Most of the case managers saw themselves as being part of a team of case managers (91.5%). Case management teams help case managers develop a comprehensive understanding of the integration concept, meet the complex needs of elderly people and change their professional practices. Multidisciplinary case management teams add value by helping case managers move from theory to practice, by encouraging them develop a comprehensive clinical vision, and by initiating the interdisciplinary approach. CONCLUSIONS The multidisciplinary team of case managers is central to the implementation of case management and helps case managers develop their new role and a core inter-professional competency.
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Affiliation(s)
- Matthieu de Stampa
- Université Versailles St-Quentin, EA 2506 Laboratoire Santé-Environnement-Vieillissement, AP-HP, Hospitalisation à Domicile (HAD), 14 rue Vésale, 75005 Paris, France.
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Somme D, Trouvé H, Perisset C, Corvol A, Ankri J, Saint-Jean O, de Stampa M. Adapting the Quebecois method for assessing implementation to the French National Alzheimer Plan 2008-2012: lessons for gerontological services integration. Int J Integr Care 2014; 14:e016. [PMID: 24959112 PMCID: PMC4063544 DOI: 10.5334/ijic.1201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 05/13/2014] [Accepted: 05/14/2014] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Many countries face ageing-related demographic and epidemiological challenges, notably neurodegenerative disorders, due to the multiple care services they require, thereby pleading for a more integrated system of care. The integrated Quebecois method issued from the Programme of Research to Integrate Services for the Maintenance of Autonomy inspired a French pilot experiment and the National Alzheimer Plan 2008-2012. Programme of Research to Integrate Services for the Maintenance of Autonomy method implementation was rated with an evaluation grid adapted to assess its successive degrees of completion. DISCUSSION The approaching end of the president's term led to the method's institutionalization (2011-2012), before the implementation study ended. When the government changed, the study was interrupted. The results extracted from that 'lost' study (presented herein) have, nonetheless, 'found' some key lessons. KEY LESSONS/CONCLUSION It was possible to implement a Quebecois integrated-care method in France. We describe the lessons and pitfalls encountered in adapting this evaluation tool. This process is necessarily multidisciplinary and requires a test phase. A simple tool for quantitative assessment of integration was obtained. The first assessment of the tool was unsatisfactory but requires further studies. In the meantime, we recommend using mixed methodologies to assess the services integration level.
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Affiliation(s)
- Dominique Somme
- Department of Geriatrics, Université de Rennes 1, Rennes, France
| | | | | | | | - Joël Ankri
- Department of Geriatrics, Université de Versailles-Saint-Quentin, Laboratoire Santé Environnement Vieillissement, EA 2506, Centre de Gérontologie, Paris, France
| | | | - Matthieu de Stampa
- Université de Versailles-Saint-Quentin, Laboratoire Santé Environnement Vieillissement, EA 2506, Centre de Gérontologie, Paris, France
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de Stampa M, Vedel I, Trouvé H, Jean OS, Ankri J, Somme D. [Factors facilitating and impairing implementation of integrated care]. Rev Epidemiol Sante Publique 2013; 61:145-53. [PMID: 23473651 DOI: 10.1016/j.respe.2012.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 06/21/2012] [Accepted: 07/31/2012] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Better integration of healthcare is the focus of many current reforms in Western countries. The goal is to reduce fragmentation of health and social care delivery for patients with chronic diseases. In France, Alzheimer autonomy integration experimentations (Maison Autonomie Intégration Alzheimer [MAIA]) were introduced as part of the 2008-2012 National Alzheimer Plan. To date, implementation of such organizations remains challenging. It is thus paramount to identify factors obstructing, and on the contrary facilitating, implementation of integrated care. METHODS After an in-depth literature review of qualitative studies published from January 1995 to December 2010. We selected 10 qualitative studies on health care professionals' perceptions of barriers and facilitators to the implementation of integrated care. RESULTS Barriers and facilitating factors linked to the implementation of integrated care were identified at several levels: leadership; collaboration between services and clinicians; and funding and policy making. The operative strategy applied to change care delivery and the role of the leading pilot are key elements during the implementation phase. CONCLUSION Strong leadership and active involvement of a broad spectrum of professionals from clinical practitioners to healthcare managers is crucial for a successful implementation of integrated care services.
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Affiliation(s)
- M de Stampa
- EA 2506 laboratoire santé-environnement-vieillissement, université Versailles St-Quentin, hôpital Sainte-Perine, 49 rue Mirabeau, Paris, France.
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Corvol A, Moutel G, Somme D. [Case management in gerontology: new practice, new issue]. Med Sci (Paris) 2012; 28:321-4. [PMID: 22480658 DOI: 10.1051/medsci/2012283022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Aline Corvol
- Université Paris Descartes, laboratoire d'éthique médicale et de médecine légale, 75006 Paris, France.
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Somme D, Trouve H, Dramé M, Gagnon D, Couturier Y, Saint-Jean O. Analysis of case management programs for patients with dementia: a systematic review. Alzheimers Dement 2012; 8:426-36. [PMID: 22285637 DOI: 10.1016/j.jalz.2011.06.004] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 03/21/2011] [Accepted: 06/16/2011] [Indexed: 11/30/2022]
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, <0.2) on their primary end point. Because of the wide variety of the end points used, an overall effect size could not be calculated. Parameters that appear to be related to greater case management efficacy are the integration level between the health and social service organizations and the intensity of the case management. 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.
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Affiliation(s)
- Dominique Somme
- Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Gériatrie, Paris, France.
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Ten years of integrated care for the older in France. Int J Integr Care 2011; 11:e141. [PMID: 22375101 PMCID: PMC3284287 DOI: 10.5334/ijic.668] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 09/30/2011] [Accepted: 10/07/2011] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This paper analyzes progress made toward the integration of the French health care system for the older and chronically ill population. POLICIES Over the last 10 years, the French health care system has been principally influenced by two competing linkage models that failed to integrate social and health care services: local information and coordination centers, governed by the social field, and the gerontological health networks governed by the health field. In response to this fragmentation, Homes for the Integration and Autonomy for Alzheimer patients (MAIAs) is currently being implemented at experimental sites in the French national Alzheimer plan, using an evidence-based model of integrated care. In addition, the state's reforms recently created regional health agencies (ARSs) by merging seven strategic institutions to manage the overall delivery of care. CONCLUSION The French health care system is moving from a linkage-based model to a more integrated care system. We draw some early lessons from these changes, including the importance of national leadership and governance and a change management strategy that uses both top-down and bottom-up approaches to implement these reforms.
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Rapp T, Grand A, Cantet C, Andrieu S, Coley N, Portet F, Vellas B. Public financial support receipt and non-medical resource utilization in Alzheimer's disease results from the PLASA study. Soc Sci Med 2011; 72:1310-6. [PMID: 21463914 DOI: 10.1016/j.socscimed.2011.02.039] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Revised: 02/16/2011] [Accepted: 02/28/2011] [Indexed: 10/18/2022]
Abstract
A major health policy objective is to encourage and sustain informal caregiving networks for people with Alzheimer's disease (AD). This goal can be reached by providing financial assistance to patients facing difficulties in the accomplishment of activities of daily living, in order to encourage utilization of professional service and therefore alleviate informal caregiver burden. The main issue is to understand if and how financial assistance is correlated with the distribution between informal and professional care. We used a cross-sectional sample of 1131 French elderly patients (≥65) with mild to moderate AD. Informal and professional service resource use was measured in hours per month using a validated instrument, the Resource Use in Dementia questionnaire. Our results confirmed the utter dominance of informal care, which represented more than 80% of total care even among patients receiving public financial support. However financial support receipt was associated with differences in care utilization: higher use of total non-medical care (formal and informal) and lower proportion of informal care in total non-medical care. Our results suggested the presence of a threshold effect that would influence non-medical care demand decisions. Even if on average the use of informal care in total was 13.3% lower among patients receiving public financial support, informal care use represented more than 80% of total non-medical care use. Providing robust evidence of these associations is crucial to further identify the right dosage between professional service demand and informal care utilization that could be associated with a lower burden and therefore a lower probability of institutionalization.
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Affiliation(s)
- Thomas Rapp
- LIRAES, University of Paris Descartes, France; Gerontopôle of Toulouse, France.
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Yen L, Gillespie J, Jeon YH, Kljakovic M, Anne Brien J, Jan S, Lehnbom E, Pearce-Brown C, Usherwood T. Health professionals, patients and chronic illness policy: a qualitative study. Health Expect 2011; 14:10-20. [PMID: 20550589 PMCID: PMC5060561 DOI: 10.1111/j.1369-7625.2010.00604.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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.
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Affiliation(s)
- Laurann Yen
- Menzies Centre for Health Policy, The Australian National University, Acton, ACT, Westmead, NSW, Austalia.
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The path dependency theory: analytical framework to study institutional integration. The case of France. Int J Integr Care 2010; 10:e049. [PMID: 20689740 PMCID: PMC2916113 DOI: 10.5334/ijic.544] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 06/01/2010] [Accepted: 06/02/2010] [Indexed: 11/20/2022] Open
Abstract
Background The literature on integration indicates the need for an enhanced theorization of institutional integration. This article proposes path dependence as an analytical framework to study the systems in which integration takes place. Purpose PRISMA proposes a model for integrating health and social care services for older adults. This model was initially tested in Quebec. The PRISMA France study gave us an opportunity to analyze institutional integration in France. Methods A qualitative approach was used. Analyses were based on semi-structured interviews with actors of all levels of decision-making, observations of advisory board meetings, and administrative documents. Results Our analyses revealed the complexity and fragmentation of institutional integration. The path dependency theory, which analyzes the change capacity of institutions by taking into account their historic structures, allows analysis of this situation. The path dependency to the Bismarckian system and the incomplete reforms of gerontological policies generate the coexistence and juxtaposition of institutional systems. In such a context, no institution has sufficient ability to determine gerontology policy and build institutional integration by itself. Conclusion Using path dependence as an analytical framework helps to understand the reasons why institutional integration is critical to organizational and clinical integration, and the complex construction of institutional integration in France.
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Etheridge F, Couturier Y, Trouvé H, Saint-Jean O, Somme D. Is the PRISMA-France glass half-full or half-empty? The emergence and management of polarized views regarding an integrative change process. Int J Integr Care 2009; 9:e99. [PMID: 20087426 PMCID: PMC2807121 DOI: 10.5334/ijic.510] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 11/24/2009] [Accepted: 11/29/2009] [Indexed: 11/20/2022] Open
Abstract
AIM The PRISMA-France pilot project is aimed at implementing an innovative case management type integration model in the 20th district of Paris. This paper apprehends the emergence of two polarized views regarding the progression of the model's spread in order to analyze the change management enacted during the process and its effects. METHOD A qualitative analysis was conducted based on an institutional change model. RESULTS Our results suggest that, according to one view, the path followed to reach the study's current level of progress was efficient and necessary to lay the foundation of a new health and social services system while according to the other, change management shortcomings were responsible for the lack of progress. DISCUSSION While neither of these two views appears entirely justified, analyzing the factors underlying their differences pinpoints some of the challenges involved in managing the spread of an integrated service delivery network. Meticulous preparation for the change management role and communication of the time and effort required for a wholesale institutional change process may be significant factors for a successful integrative endeavor.
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Affiliation(s)
- Francis Etheridge
- Université de Sherbrooke, 1036, rue Belvédère Sud, Sherbrooke, Quebec, Canada J1H 4C4
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