1
|
Beauregard MÈ, Provost S, Pineault R, Grimard D, Pérez J, Fournier M. Effects on patients of variations in the implementation of a cardiometabolic risk intervention program in Montréal. Health Promot Chronic Dis Prev Can 2018; 38:64-77. [PMID: 29443486 PMCID: PMC5833637 DOI: 10.24095/hpcdp.38.2.03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION In 2011, the Agence de la santé et des services sociaux de Montréal (ASSSM), in partnership with the region's Centres de santé et de services sociaux (CSSS), coordinated the implementation of a program on cardiometabolic risk based on the Chronic Care Model. The program, intended for patients suffering from diabetes or hypertension, involved a series of individual follow-up appointments, group classes and exercise sessions. Our study assesses the impact on patient health outcomes of variations in the implementation of some aspects of the program among the six CSSSs taking part in the study. METHODS The evaluation was carried out using a quasi-experimental "before and after" design. Implementation variables were constructed based on data collected during the implementation analysis regarding resources, compliance with the clinical process set out in the regional program, the program experience and internal coordination within the care team. Differences in differences using propensity scores were calculated for HbA1c results, achieving the blood pressure (BP) target, and two lifestyle targets (exercise level and carbohydrate distribution) at the 6- and 12-month follow-ups, based on greater or lesser patient exposure to the implementation of various aspects of the program under study. RESULTS The results focus on 1185 patients for whom we had data at the 6-month follow- up and the 992 patients from the 12-month follow-up. The difference in differences analysis shows no clear association between the extent of implementation of the various aspects of the program under study and patient health outcomes. CONCLUSION The program produces effects on selected health indicators independent of variations in program implementation among the CSSSs taking part in the study. The results suggest that the effects of this type of program are more highly dependent on the delivery of interventions to patients than on the organizational aspects of its implementation.
Collapse
Affiliation(s)
| | - Sylvie Provost
- Direction de santé publique du CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada
- Research Centre, Centre hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
- Institut de recherche en santé publique de l'Université de Montréal, Montréal, Quebec, Canada
| | - Raynald Pineault
- Direction de santé publique du CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada
- Research Centre, Centre hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
- Institut de recherche en santé publique de l'Université de Montréal, Montréal, Quebec, Canada
- Institut national de santé publique du Québec, Montréal, Quebec, Canada
| | - Dominique Grimard
- Direction de santé publique du CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada
| | - José Pérez
- Direction de santé publique du CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada
- Research Centre, Centre hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Michel Fournier
- Direction de santé publique du CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada
| |
Collapse
|
2
|
Provost S, Pineault R, Grimard D, Pérez J, Fournier M, Lévesque Y, Desforges J, Tousignant P, Borgès Da Silva R. Implementation of an integrated primary care cardiometabolic risk prevention and management network in Montréal: does greater coordination of care with primary care physicians have an impact on health outcomes? HEALTH PROMOTION AND CHRONIC DISEASE PREVENTION IN CANADA-RESEARCH POLICY AND PRACTICE 2017; 37:105-113. [PMID: 28402799 DOI: 10.24095/hpcdp.37.4.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Chronic disease management requires substantial services integration. A cardiometabolic risk management program inspired by the Chronic Care Model was implemented in Montréal for patients with diabetes or hypertension. One of this study's objectives was to assess the impact of care coordination between the interdisciplinary teams and physicians on patient participation in the program, lifestyle improvements and disease control. METHODS We obtained data on health outcomes from a register of clinical data, questionnaires completed by patients upon entry into the program and at the 12-month mark, and we drew information on the program's characteristics from the implementation analysis. We conducted multiple regression analyses, controlling for patient sociodemographic and health characteristics, to measure the association between interdisciplinary team coordination with primary care physicians and various health outcomes. RESULTS A total of 1689 patients took part in the study (60.1% participation rate). Approximately 40% of patients withdrew from the program during the first year. At the 12-month follow-up (n = 992), we observed a significant increase in the proportion of patients achieving the various clinical targets. The perception by the interdisciplinary team of greater care coordination with primary care physicians was associated with increased participation in the program and the achievement of better clinical results. CONCLUSION Greater coordination of patient services between interdisciplinary teams and primary care physicians translates into benefits for patients.
Collapse
Affiliation(s)
- Sylvie Provost
- Direction de santé publique du Centre intégré universitaire de santé et services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Quebec, Canada.,Institut de recherche en santé publique de l'Université de Montréal, Montréal, Quebec, Canada
| | - Raynald Pineault
- Direction de santé publique du Centre intégré universitaire de santé et services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Quebec, Canada.,Institut de recherche en santé publique de l'Université de Montréal, Montréal, Quebec, Canada.,Institut national de santé publique du Québec, Montréal, Quebec, Canada
| | - Dominique Grimard
- Direction de santé publique du Centre intégré universitaire de santé et services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada
| | - José Pérez
- Direction de santé publique du Centre intégré universitaire de santé et services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Michel Fournier
- Direction de santé publique du Centre intégré universitaire de santé et services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada
| | - Yves Lévesque
- Direction de santé publique du Centre intégré universitaire de santé et services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada
| | - Johanne Desforges
- CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada.,Groupe de médecine de famille et Unité de médecine familiale de Verdun, Montréal, Quebec, Canada
| | - Pierre Tousignant
- Direction de santé publique du Centre intégré universitaire de santé et services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Quebec, Canada.,Institut de recherche en santé publique de l'Université de Montréal, Montréal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec, Canada
| | - Roxane Borgès Da Silva
- Institut de recherche en santé publique de l'Université de Montréal, Montréal, Quebec, Canada.,Faculté des sciences infirmières de l'Université de Montréal, Montréal, Quebec, Canada
| |
Collapse
|
3
|
Ahmed S, Ware P, Visca R, Bareil C, Chouinard MC, Desforges J, Finlayson R, Fortin M, Gauthier J, Grimard D, Guay M, Hudon C, Lalonde L, Lévesque L, Michaud C, Provost S, Sutton T, Tousignant P, Travers S, Ware M, Gogovor A. The prevention and management of chronic disease in primary care: recommendations from a knowledge translation meeting. BMC Res Notes 2015; 8:571. [PMID: 26471509 PMCID: PMC4608115 DOI: 10.1186/s13104-015-1514-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 09/21/2015] [Indexed: 12/29/2022] Open
Abstract
Background Seven chronic disease prevention and management programs were implemented across Quebec with funding support from a provincial-private industry funding initiative. Given the complexity of implementing integrated primary care chronic disease management programs, a knowledge transfer meeting was held to share experiences across programs and synthesize common challenges and success factors for implementation. Methods The knowledge translation meeting was held in February 2014 in Montreal, Canada. Seventy-five participants consisting of 15 clinicians, 14 researchers, 31 knowledge users, and 15 representatives from the funding agencies were broken up into groups of 10 or 11 and conducted a strengths, weaknesses, opportunities, and threats analysis on either the implementation or the evaluation of these chronic disease management programs. Results were reported back to the larger group during a plenary and recorded. Audiotapes were transcribed and summarized using pragmatic thematic analysis. Results and discussion Strengths to leverage for the implementation of the seven programs include: (1) synergy between clinical and research teams; (2) stakeholders working together; (3) motivation of clinicians; and (4) the fact that the programs are evidence-based. Weaknesses to address include: (1) insufficient resources; (2) organizational change within the clinical sites; (3) lack of referrals from primary care physicians; and (4) lack of access to programs. Strengths to leverage for the evaluation of these programs include: (1) engagement of stakeholders and (2) sharing of knowledge between clinical sites. Weaknesses to address include: (1) lack of referrals; (2) difficulties with data collection; and (3) difficulties in identifying indicators and control groups. Opportunities for both themes include: (1) fostering new and existing partnerships and stakeholder relations; (2) seizing funding opportunities; (3) knowledge transfer; (4) supporting the transformation of professional roles; (5) expand the use of health information technology; and (6) conduct cost evaluations. Fifteen recommendations related to mobilisation of primary care physicians, support for the transformation of professional roles, and strategies aimed at facilitating the implementation and evaluation of chronic disease management programs were formulated based on the discussions at this knowledge translation event. Conclusion The results from this knowledge translation day will help inform the sustainability of these seven chronic disease management programs in Quebec and the implementation and evaluation of similar programs elsewhere. Electronic supplementary material The online version of this article (doi:10.1186/s13104-015-1514-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sara Ahmed
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada. .,Constance-Lethbridge Rehabilitation Center, Centre de recherche interdisciplinaire en réadaptation (CRIR), 7005 Boulevard De Maisonneuve O, Montréal, Quebec, H4B 1T3, Canada. .,Clinical Epidemiology, McGill University Health Center, 687 Pine Ave W, Montreal, QC, H3A 1A1, Canada.
| | - Patrick Ware
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada.
| | - Regina Visca
- Centre for Expertise in Chronic Pain of the Réseau universitaire intégré de santé McGill, 2155 Guy, Montreal, QC, H3H 2R9, Canada.
| | - Celine Bareil
- Department of Management, HEC Montreal, 3000, chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 2A7, Canada.
| | - Maud-Christine Chouinard
- Département des sciences de la santé, Université du Québec à Chicoutimi, 555 boul. de l'Université, Chicoutimi, QC, G7H 2B1, Canada. .,Centre de santé et de services sociaux de Chicoutimi, 305 St-Vallier, Chicoutimi, QC, G7H 5H6, Canada.
| | - Johanne Desforges
- Groupe de médecine de famille de Verdun, 4000, boulevard Lasalle, Verdun, QC, H4G 2A3, Canada.
| | - Roderick Finlayson
- Centre for Expertise in Chronic Pain of the Réseau universitaire intégré de santé McGill, 2155 Guy, Montreal, QC, H3H 2R9, Canada.
| | - Martin Fortin
- Centre de santé et de services sociaux de Chicoutimi, 305 St-Vallier, Chicoutimi, QC, G7H 5H6, Canada. .,Département de médecine de famille et médecine d'urgence, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001 12ème avenue Nord, Fleurimont, QC, J1H 5N4, Canada.
| | - Josée Gauthier
- Institut national de santé publique du Quebec, Consortium InterEst Santé, Département des sciences infirmières, Université du Québec à Rimouski, 300 Allée des Ursulines, Bureau K-310, Rimouski, QC, G5L 3A1, Canada.
| | - Dominique Grimard
- Direction de santé publique de l'Agence de la santé et des services sociaux de Montréal, 1301 Sherbrooke Est, Montreal, QC, H2L 1M3, Canada.
| | - Maryse Guay
- Département des sciences de la santé communautaire, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada. .,Direction de santé publique de l'Agence de la santé et des services sociaux de la Montérégie, 1255 Beauregard, Longueuil, J4H 2M3, Canada.
| | - Catherine Hudon
- Département de médecine de famille et médecine d'urgence, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001 12ème avenue Nord, Fleurimont, QC, J1H 5N4, Canada.
| | - Lyne Lalonde
- Faculté de pharmacie, Université de Montréal, pavillion Jean-Coutu, Montreal, QC, H3C 3J7, Canada. .,Centre de santé et de services sociaux de Laval, 1755 boulevard René-Laennec, Laval, QC, H7M 3L9, Canada.
| | - Lise Lévesque
- Centre de santé et de services sociaux de Laval, 1755 boulevard René-Laennec, Laval, QC, H7M 3L9, Canada.
| | - Cecile Michaud
- Faculté de médecine et des sciences de la santé, École des sciences infirmières, Université de Sherbrooke, Campus de Longueil, 150, Place Charles LeMoyne, Bureau 200, Sherbrooke, QC, J4K 0A8, Canada.
| | - Sylvie Provost
- Direction de santé publique de l'Agence de la santé et des services sociaux de Montréal, 1301 Sherbrooke Est, Montreal, QC, H2L 1M3, Canada.
| | - Tim Sutton
- Centre de santé et de services sociaux du Roché-Percé, 451, rue MGR-Ross Est, C.P. 3300, Chandler, QC, G0C 1K0, Canada.
| | - Pierre Tousignant
- Direction de santé publique de l'Agence de la santé et des services sociaux de Montréal, 1301 Sherbrooke Est, Montreal, QC, H2L 1M3, Canada.
| | - Stella Travers
- Centre de santé et de services sociaux du Roché-Percé, 451, rue MGR-Ross Est, C.P. 3300, Chandler, QC, G0C 1K0, Canada.
| | - Mark Ware
- Alan Edwards Pain Management Unit of the McGill University Health Centre, 650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada.
| | - Amede Gogovor
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada.
| |
Collapse
|
6
|
Volker N, Davey RC, Cochrane T, Williams LT, Clancy T. Improving the prevention of cardiovascular disease in primary health care: the model for prevention study protocol. JMIR Res Protoc 2014; 3:e33. [PMID: 25008232 PMCID: PMC4115264 DOI: 10.2196/resprot.2882] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 03/13/2014] [Accepted: 03/14/2014] [Indexed: 11/13/2022] Open
Abstract
Background Cardiovascular disease (CVD) is the leading cause of death globally, and accounted for nearly 31% of all deaths in Australia in 2011. The primary health care sector is at the frontline for addressing CVD, however, an evidence-to-practice gap exists in CVD risk assessment and management. General practice plays a key role in CVD risk assessment and management, but this sector cannot provide ongoing lifestyle change support in isolation. Community-based lifestyle modification services and programs provided outside the general practice setting have a key role in supporting and sustaining health behavior change. Fostering linkages between the health sector and community-based lifestyle services, and creating sustainable systems that support these sectors is important. Objective The objective of the study Model for Prevention (MoFoP) is to take a case study approach to examine a CVD risk reduction intervention in primary health care, with the aim of identifying the key elements required for an effective and sustainable approach to coordinate CVD risk reduction across the health and community sectors. These elements will be used to consider a new systems-based model for the prevention of CVD that informs future practice. Methods The MoFoP study will use a mixed methods approach, comprising two complementary research elements: (1) a case study, and (2) a pre/post quasi-experimental design. The case study will consider the organizations and systems involved in a CVD risk reduction intervention as a single case. The pre/post experimental design will be used for HeartLink, the intervention being tested, where a single cohort of patients between 45 and 74 years of age (or between 35 and 74 years of age if Aboriginal or Torres Strait Islander) considered to be at high risk for a CVD event will be recruited through general practice, provided with enhanced usual care and additional health behavior change support. A range of quantitative and qualitative data will be collected. This will include individual health and well being data collected at baseline and again at 12 months for HeartLink participants, and systems related data collected over the period of the intervention to inform the case study. Results The intervention is currently underway, with results expected in late 2015. Conclusions Gaining a better understanding of CVD prevention in primary health care requires a research approach that can capture and express its complexity. The MoFoP study aims to identify the key elements for effective CVD prevention across the health and community sectors, and to develop a model to better inform policy and practice in this key health priority area for Australia.
Collapse
Affiliation(s)
- Nerida Volker
- Center for Research and Action in Public Health, University of Canberra, Canberra, Australia.
| | | | | | | | | |
Collapse
|