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Lamontagne ME, Richards C, Azzaria L, Rosa-Goulet M, Clément L, Pelletier F. Perspective of patients and caregivers about stroke rehabilitation: the Quebec experience. Top Stroke Rehabil 2018; 26:39-48. [PMID: 30320537 DOI: 10.1080/10749357.2018.1534453] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The unique perspectives of patients and caregivers on their experiences as users of rehabilitation services help identify areas for improvement for the continuum from acute care to community integration. OBJECTIVE This study reports perceptions of persons with stroke and their caregivers in an existing continuum of stroke care, social services, and rehabilitation in the Province of Quebec. METHODS A total of 10 focus groups were held, 5 with persons with stroke (n = 37, mean age 59.6 years (SD = 11.6); 21 men) and 5 others with caregivers (n = 31; mean age 58.8 years (SD = 15.1); 8 men). Discussions were transcribed and were the object of thematic content analysis using Nvivo. RESULTS Participants expressed their general satisfaction toward the care received in inpatient, hospital, and rehabilitation settings. The information received about acute care, however, was deemed insufficient and fragmented, and access of rehabilitation services was often perceived to be difficult. In the community integration phase of the continuum, most participants stated that they had experienced poor accessibility to services of any kind. CONCLUSIONS Persons with stroke and their relatives' perspectives about the services that they obtained throughout the rehabilitation continuum vary importantly according to the services examined. Adopting a continuum perspective is helpful to target priorities for improvement.
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Affiliation(s)
- Marie-Eve Lamontagne
- a Center for Interdisciplinary Research in Rehabilitation and Social Integration , Centre intégré universitaire de santé et de services sociaux de la Capitale Nationale - site Institut de réadaptation en déficience physique de Québec (CIUSSS-CN - IRDPQ) , Québec , QC , Canada
| | - Carol Richards
- a Center for Interdisciplinary Research in Rehabilitation and Social Integration , Centre intégré universitaire de santé et de services sociaux de la Capitale Nationale - site Institut de réadaptation en déficience physique de Québec (CIUSSS-CN - IRDPQ) , Québec , QC , Canada
| | - Leila Azzaria
- a Center for Interdisciplinary Research in Rehabilitation and Social Integration , Centre intégré universitaire de santé et de services sociaux de la Capitale Nationale - site Institut de réadaptation en déficience physique de Québec (CIUSSS-CN - IRDPQ) , Québec , QC , Canada
| | | | - Louise Clément
- c Ministère de la santé et des services sociaux du Québec , Québec , QC , Canada
| | - France Pelletier
- a Center for Interdisciplinary Research in Rehabilitation and Social Integration , Centre intégré universitaire de santé et de services sociaux de la Capitale Nationale - site Institut de réadaptation en déficience physique de Québec (CIUSSS-CN - IRDPQ) , Québec , QC , Canada
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Abstract
BACKGROUND Few studies have tracked stroke survivors through transitions across the health system and identified the most common trajectories and quality of care received. The objectives of our study were to examine the trajectories that incident stroke patients experience and to quantify the extent to which their care adhered to the best practices for stroke care. METHODS A population-based cohort of first-ever stroke/transient ischemic attack (TIA) patients from the 2012/13 Ontario Stroke Audit was linked to administrative databases using an encrypted health card number to identify dominant trajectories (N=12,362). All trajectories began in the emergency department (ED) and were defined by the transitions that followed immediately after the ED. Quality indicators were calculated to quantify best practice adherence within trajectories. RESULTS Six trajectories of stroke care were identified with significant variability in patient characteristics and quality of care received. Almost two-thirds (64.5%) required hospital admission. Trajectories that only involved the ED had the lowest rates of brain and carotid artery imaging (91.5 and 44.2%, respectively). Less than 20% of patients in trajectories involving hospital admissions received care on a stroke unit. The trajectory involving inpatient rehabilitation received suboptimal secondary prevention measures. CONCLUSIONS There are six main trajectories stroke patients follow, and adherence to best practices varies by trajectory. Trajectories resulting in patients being transitioned to home care following ED management only are least likely and those including inpatient rehabilitation are most likely to receive stroke best practices. Increased time in facility-based care results in greater access to best practices. Stroke patients receiving only ED care require closer follow-up by stroke specialists.
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Turcotte PL, Larivière N, Desrosiers J, Voyer P, Champoux N, Carbonneau H, Carrier A, Levasseur M. Participation needs of older adults having disabilities and receiving home care: met needs mainly concern daily activities, while unmet needs mostly involve social activities. BMC Geriatr 2015; 15:95. [PMID: 26231354 PMCID: PMC4522124 DOI: 10.1186/s12877-015-0077-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 06/23/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Participation is a key determinant of successful aging and enables older adults to stay in their homes and be integrated into the community. Assessing participation needs involves identifying restrictions in the accomplishment of daily and social activities. Although meeting participation needs involves older adults, their caregivers and healthcare providers, little is known about their respective viewpoints. This study thus explored the participation needs of older adults having disabilities as perceived by the older adults themselves, their caregivers and healthcare providers. METHODS A qualitative multiple case study consisted of conducting 33 semi-structured interviews in eleven triads, each composed of an older adult, his/her caregiver and a healthcare provider recruited in a Health and Social Services Centre (HSSC) in Québec, Canada. Interview transcripts and reviews of clinical records were analyzed using content analysis and descriptive statistics based on thematic saliency analysis methods. RESULTS Aged 66 to 88 years, five older adults had physical disabilities, five had mild cognitive impairment and one had psychological problems, leading to moderate to severe functional decline. Caregivers and healthcare providers were mainly women, respectively retired spouses and various professionals with four to 32 years of clinical experience. Participation needs reported by each triad included all domains of participation. Needs related to daily activities, such as personal care, nutrition, and housing, were generally met. Regarding social activities, few needs were met by various resources in the community and were generally limited to personal responsibilities, including making decisions and managing budgets, and some community life activities, such as going shopping. Unmet needs were mainly related to social activities, involving leisure, other community life activities and interpersonal relationships, and some daily activities, including fitness and mobility. CONCLUSIONS This study highlights the complexity of older adults' participation needs, involving daily as well as social activities. Properly assessing and addressing these needs is thus necessary to improve older adults' health and well-being. Discrepancies in the various actors' perceptions of participation needs must be further explored. Additional research would help better understand how to optimize the contribution of community organizations and caregivers.
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Affiliation(s)
- Pier-Luc Turcotte
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada.
- Research Centre on Aging, Health and Social Services Centre-University Institute of Geriatrics of Sherbrooke, Sherbrooke, Québec, Canada.
| | - Nadine Larivière
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada.
| | - Johanne Desrosiers
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada.
- Research Centre on Aging, Health and Social Services Centre-University Institute of Geriatrics of Sherbrooke, Sherbrooke, Québec, Canada.
| | - Philippe Voyer
- Faculty of Nursing Sciences, Université Laval, Québec City, Québec, Canada.
- Québec Centre for Excellence in Aging, Québec City, Québec, Canada.
| | - Nathalie Champoux
- Department of Family Medicine, Université de Montréal, Montréal, Québec, Canada.
- Research Centre of the University Institute of Geriatrics of Montreal, Montréal, Québec, Canada.
| | - Hélène Carbonneau
- Department of Leisure, Culture and Tourism Studies, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada.
| | - Annie Carrier
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada.
- Research Centre on Aging, Health and Social Services Centre-University Institute of Geriatrics of Sherbrooke, Sherbrooke, Québec, Canada.
| | - Mélanie Levasseur
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada.
- Research Centre on Aging, Health and Social Services Centre-University Institute of Geriatrics of Sherbrooke, Sherbrooke, Québec, Canada.
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