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Goethals L, Barth N, Martinez L, Lacour N, Tardy M, Bohatier J, Bonnefoy M, Annweiler C, Dupre C, Bongue B, Celarier T. Decreasing hospitalizations through geriatric hotlines: a prospective French multicenter study of people aged 75 and above. BMC Geriatr 2023; 23:783. [PMID: 38017388 PMCID: PMC10685561 DOI: 10.1186/s12877-023-04495-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND The Emergency unit of the hospital (Department) (ED) is the fastest and most common way for most French general practitioners (GPs) to respond to the complexity of managing older adults patients with multiple chronic diseases. In 2013, French regional health authorities proposed to set up telephone hotlines to promote interactions between GP clinics and hospitals. The main objective of our study was to analyze whether the hotlines and solutions proposed by the responding geriatrician reduced the number of hospital admissions, and more specifically the number of emergency room admissions. METHODS We conducted a multicenter observational study from April 2018 to April 2020 at seven French investigative sites. A questionnaire was completed by all hotline physicians after each call. RESULTS The study population consisted of 4,137 individuals who met the inclusion and exclusion criteria. Of the 4,137 phone calls received by the participants, 64.2% (n = 2 657) were requests for advice, and 35.8% (n = 1,480) were requests for emergency hospitalization. Of the 1,480 phone calls for emergency hospitalization, 285 calls resulted in hospital admission in the emergency room (19.3%), and 658 calls in the geriatric short stay (44.5%). Of the 2,657 calls for advice/consultation/delayed hospitalization, 9.7% were also duplicated by emergency hospital admission. CONCLUSION This study revealed the value of hotlines in guiding the care of older adults. The results showed the potential effectiveness of hotlines in preventing unnecessary hospital admissions or in identifying cases requiring hospital admission in the emergency room. Hotlines can help improve the care pathway for older adults and pave the way for future progress. TRIAL REGISTRATION Registered under Clinical Trial Number NCT03959475. This study was approved and peer-reviewed by the Ethics Committee for the Protection of Persons of Sud Est V of Grenoble University Hospital Center (registered under 18-CETA-01 No.ID RCB 2018-A00609-46).
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Affiliation(s)
- Luc Goethals
- SAINBIOSE laboratory, U1059 INSERM - University of Jean Monnet, Saint-Etienne, France.
- Chaire Santé des Ainés, University of Jean Monnet, Saint-Etienne, France.
| | - Nathalie Barth
- SAINBIOSE laboratory, U1059 INSERM - University of Jean Monnet, Saint-Etienne, France
- Chaire Santé des Ainés, University of Jean Monnet, Saint-Etienne, France
- Gerontopole Auvergne-Rhône-Alpes, Saint-Etienne, France
| | - Laure Martinez
- Department of Clinical Gerontology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Noémie Lacour
- Department of Clinical Gerontology, Firminy Hospital, Firminy, France
| | - Magali Tardy
- Department of Clinical Gerontology, Saint-Chamond Hospital, Saint-Chamond, France
| | - Jérôme Bohatier
- Department of Clinical Gerontology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Marc Bonnefoy
- Department of Clinical Gerontology, Lyon Sud University Hospital, Lyon, France
| | - Cédric Annweiler
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital of Angers, Angers, France
- UPRES EA 4638, University of Angers, Angers, France
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Robarts Research Institute, University of Western Ontario, London, ON, Canada
| | - Caroline Dupre
- SAINBIOSE laboratory, U1059 INSERM - University of Jean Monnet, Saint-Etienne, France
- Chaire Santé des Ainés, University of Jean Monnet, Saint-Etienne, France
| | - Bienvenu Bongue
- SAINBIOSE laboratory, U1059 INSERM - University of Jean Monnet, Saint-Etienne, France
- Chaire Santé des Ainés, University of Jean Monnet, Saint-Etienne, France
- Support and Education Technical Centre of Health Examination Centres (CETAF), Saint-Etienne, France
| | - Thomas Celarier
- Chaire Santé des Ainés, University of Jean Monnet, Saint-Etienne, France
- Gerontopole Auvergne-Rhône-Alpes, Saint-Etienne, France
- Department of Clinical Gerontology, Saint-Etienne University Hospital, Saint-Etienne, France
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Laustsen CE, Petersson P, Westergren A, Haak M. Involvement of professionals in research: knowledge integration, development of practice, and challenges: a group concept mapping study. Health Res Policy Syst 2021; 19:115. [PMID: 34380506 PMCID: PMC8408930 DOI: 10.1186/s12961-021-00763-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/20/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Research and practice are often considered as two different worlds with different values, which causes a gap between them. Involving professionals such as practitioners, managers, decision-makers, and policy-makers in research on ageing and health might address the gap between research and practice, strengthen the healthcare system, and increase older people's possibilities for healthy ageing. The aim of this study was to conceptualize professionals' involvement in research on ageing and health from the perspective of the professionals themselves. METHODS A mixed method called group concept mapping was used. Professionals with experience being involved in research on ageing and health participated in qualitative data collection through brainstorming sessions (n = 29) and by sorting statements (n = 29). Afterwards, they participated in a quantitative data collection by rating statements according to how much each statement strengthened practice (n = 30) and strengthened research (n = 28). Multidimensional scaling analysis and hierarchical cluster analysis were used to conduct quantitative analysis. Latent qualitative analysis was also conducted. RESULTS Analysis resulted in eight clusters which illustrated conceptual areas of professionals' involvement in research projects. The qualitative latent construct of the cluster map resulted in the themes: challenges for professionals; prerequisites and professionals' learning can contribute to development of practice; and integrated knowledge benefits older people. There was a strong correlation between what strengthens practice and research (r = 0.92). CONCLUSIONS This study illustrates conceptual areas of professionals' own perspectives on what their involvement in research can lead to. Their involvement may lead to knowledge being integrated, and the professionals may learn through their involvement, which can contribute to the development of practice. However, there can also be challenges that need to be handled when professionals are involved in research. The study can be useful for improving the understanding of and actual involvement of professionals in research, and for optimizing the involvement of professionals.
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Affiliation(s)
- Christine E. Laustsen
- Research Platform for Collaboration for Health, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Pia Petersson
- Research Platform for Collaboration for Health, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Albert Westergren
- Research Platform for Collaboration for Health, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Maria Haak
- Research Platform for Collaboration for Health, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Martinez L, Lacour N, Gonthier R, Bonnefoy M, Goethals L, Annweiler C, Salles N, Jomard N, Bohatier J, Tardy M, Ojardias E, Jugand R, Bongué B, Celarier T. Impact of Geriatric Hotlines on Health Care Pathways and Health Status in Patients Aged 75 Years and Older: Protocol for a French Multicenter Observational Study. JMIR Res Protoc 2020; 9:e15423. [PMID: 32053116 PMCID: PMC7055780 DOI: 10.2196/15423] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 12/20/2022] Open
Abstract
Background In France, emergency departments (EDs) are the fastest and most common means for general practitioners (GPs) to cope with the complex issues presented by elderly patients with multiple conditions. EDs are overburdened, and studies show that being treated in EDs can have a damaging effect on the health of elderly patients. Outpatient care or planned hospitalizations are possible solutions if appropriate geriatric medical advice is provided. In 2013, France’s regional health authorities proposed creating direct telephone helplines, “geriatric hotlines,” staffed by geriatric specialists to encourage interactions between GP clinics and hospitals. These hotlines are designed to improve health care pathways and the health status of the elderly. Objective This study aims to describe the health care pathways and health status of patients aged 75 years and older hospitalized in short-stay geriatric wards following referral from a geriatric hotline. Methods The study will be conducted over 24 months in seven French university hospital centers. It will include all patients aged 75 and older, living in their own homes or nursing homes, who are admitted to short-stay geriatric wards following hotline consultation. Two questionnaires will be filled out by medical staff at specific time points: (1) after conducting the telephone consultation and (2) on admitting the patient to a short-stay geriatric medical care. The primary endpoint will be mean hospitalization duration. The secondary endpoints will be intrahospital mortality rate, the characteristics of patients admitted via the hotline, and the types of questions asked and responses given via the hotline. Results The study was funded by the National School for Social Security Loire department (École Nationale Supérieure de Sécurité Sociale) and the Conference for funders of prevention of autonomy loss for the elderly of the Loire department in November 2017. Institutional review board approval was obtained in April 2018. Data collection started in May 2018; the planned end date for data collection is May 2020. Data analysis will take place in the summer of 2020, and the first results are expected to be published in late 2020. Conclusions The results will reveal whether geriatric hotlines provide the most effective management of elderly patients, as indicated by shorter mean hospitalization durations. Shorter hospital durations could lead to a reduced risk of complications—geriatric syndromes—and the domino chain of geriatric conditions that follow. We will also describe different geriatric hotlines from different cities and compare how they function to improve the health care of the elderly and pave the way toward new advances, especially in the organization of the care path. Trial Registration ClinicalTrials.gov NCT03959475; https://clinicaltrials.gov/ct2/show/NCT03959475 International Registered Report Identifier (IRRID) DERR1-10.2196/15423
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Affiliation(s)
- Laure Martinez
- Department of Clinical Gerontology, University Hospital of Saint-Etienne, Saint Etienne, France
| | - Noémie Lacour
- Department of Clinical Gerontology, Firminy Hospital, Firminy, France
| | - Régis Gonthier
- Department of Clinical Gerontology, University Hospital of Saint-Etienne, Saint Etienne, France
| | - Marc Bonnefoy
- Department of Clinical Gerontology, University Hospital of Lyon Sud, Lyon, France
| | - Luc Goethals
- Jean Monnet University Saint-Etienne, Chaire Santé des Ainés, Saint Etienne, France.,Support and Education Technic Centre of Health Examination Centres (CETAF), Saint Etienne, France
| | - Cedric Annweiler
- Department of Clinical Gerontology, Angers University Hospital; Angers University Memory Clinic, Research Center on Autonomy and Longevity, University of Angers, Angers, France.,School of Medicine, Health Faculty, University of Angers, Angers, France.,Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Nathalie Salles
- Department of Clincal Gerontology, Bordeaux University Hospital, Pessace, France
| | - Nathalie Jomard
- Department of Clinical Gerontology, University Hospital of Lyon Sud, Lyon, France
| | - Jérôme Bohatier
- Department of Clinical Gerontology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Magali Tardy
- Department of Clinical Gerontology, Saint Chamond Hospital, Saint Chamond, France
| | - Etienne Ojardias
- Department of Clinical Gerontology, University Hospital of Saint-Etienne, Saint Etienne, France
| | - Romain Jugand
- Department of Clinical Gerontology, University Hospital of Saint-Etienne, Saint Etienne, France
| | - Bienvenu Bongué
- Jean Monnet University Saint-Etienne, Chaire Santé des Ainés, Saint Etienne, France.,Support and Education Technic Centre of Health Examination Centres (CETAF), Saint Etienne, France.,Jean Monnet University Saint-Etienne Autonomic Nervous System Research Laboratory, University of Lyon, Saint Etienne, France
| | - Thomas Celarier
- Department of Clinical Gerontology, University Hospital of Saint-Etienne, Saint Etienne, France.,Jean Monnet University Saint-Etienne, Chaire Santé des Ainés, Saint Etienne, France.,Gerontopôle AURA, Saint Etienne, France
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Looman WM, Huijsman R, Fabbricotti IN. The (cost-)effectiveness of preventive, integrated care for community-dwelling frail older people: A systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:1-30. [PMID: 29667259 PMCID: PMC7379491 DOI: 10.1111/hsc.12571] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/19/2018] [Indexed: 05/28/2023]
Abstract
Integrated care is increasingly promoted as an effective and cost-effective way to organise care for community-dwelling frail older people with complex problems but the question remains whether high expectations are justified. Our study aims to systematically review the empirical evidence for the effectiveness and cost-effectiveness of preventive, integrated care for community-dwelling frail older people and close attention is paid to the elements and levels of integration of the interventions. We searched nine databases for eligible studies until May 2016 with a comparison group and reporting at least one outcome regarding effectiveness or cost-effectiveness. We identified 2,998 unique records and, after exclusions, selected 46 studies on 29 interventions. We assessed the quality of the included studies with the Effective Practice and Organization of Care risk-of-bias tool. The interventions were described following Rainbow Model of Integrated Care framework by Valentijn. Our systematic review reveals that the majority of the reported outcomes in the studies on preventive, integrated care show no effects. In terms of health outcomes, effectiveness is demonstrated most often for seldom-reported outcomes such as well-being. Outcomes regarding informal caregivers and professionals are rarely considered and negligible. Most promising are the care process outcomes that did improve for preventive, integrated care interventions as compared to usual care. Healthcare utilisation was the most reported outcome but we found mixed results. Evidence for cost-effectiveness is limited. High expectations should be tempered given this limited and fragmented evidence for the effectiveness and cost-effectiveness of preventive, integrated care for frail older people. Future research should focus on unravelling the heterogeneity of frailty and on exploring what outcomes among frail older people may realistically be expected.
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Affiliation(s)
- Wilhelmina Mijntje Looman
- Department Health Services Management & OrganisationErasmus School of Health Policy & ManagementErasmus UniversityRotterdamThe Netherlands
| | - Robbert Huijsman
- Department Health Services Management & OrganisationErasmus School of Health Policy & ManagementErasmus UniversityRotterdamThe Netherlands
| | - Isabelle Natalina Fabbricotti
- Department Health Services Management & OrganisationErasmus School of Health Policy & ManagementErasmus UniversityRotterdamThe Netherlands
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Implementation of a Standardized Comprehensive Assessment Tool in France: A Case Using the InterRAI Instruments. Int J Integr Care 2018; 18:5. [PMID: 30127689 PMCID: PMC6095084 DOI: 10.5334/ijic.3297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: The improvement of quality of care requires a standardized and comprehensive assessment tool but implementation is challenging. Purpose: We have reported on the development of the interRAI instruments in France from the onset to the mandatory use at the national level. We also have identified in the literature and in practices, incentives and barriers for the implementation of this integrated clinical information system in long term care. Results: Three periods in the interRAI instruments development were identified over the last twenty years. The first one was a research approach about improving quality of long term care. The second one was an experimental clinical use into an integrated care model with case management. The third one was a call for tenders issued by a French national agency, and the choice to use the interRAI-HC (Home Care) for all case managers. The main incentives and barriers that were identified include the national context, the target population, the providers involved and the impact on their practice, the interRAI instrument characteristics, training and leadership. Conclusion: This historical overview of the development of interRAI instruments in France gives health care organizations pertinent information to guide the implementation of a standardized and comprehensive assessment tool.
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Heim N, Rolden H, van Fenema EM, Weverling-Rijnsburger AWE, Tuijl JP, Jue P, Oleksik AM, de Craen AJM, Mooijaart SP, Blauw GJ, Westendorp RGJ, van der Mast RC, van Everdinck IEC. The development, implementation and evaluation of a transitional care programme to improve outcomes of frail older patients after hospitalisation. Age Ageing 2016; 45:643-51. [PMID: 27298381 DOI: 10.1093/ageing/afw098] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 04/05/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND fragmented healthcare systems are poorly suited to treat the increasing number of older patients with multimorbidity. OBJECTIVE to report on the development, implementation and evaluation of a regional transitional care programme, aimed at improving the recovery rate of frail hospitalised older patients. METHODS the programme was drafted in co-creation with organisations representing older adults, care providers and knowledge institutes. Conducting an action research project, the incidence of adverse outcomes within 3 months after hospital admission, and long-term care expenses (LTCE) were compared between samples in 2010-11 (pre-programme) and 2012-13 (post-programme) in frail and non-frail patients. Hospitalised patients aged ≥70 years were included in four hospitals in the targeted region. RESULTS developed innovations addressed (i) improved risk management; (ii) delivery of integrated, function-oriented care; (iii) specific geriatric interventions; and (iv) optimisation of transfers. The incidence of adverse outcomes was compared in 813 and 904 included patients respectively in the two samples. In frail patients, the incidence of adverse outcomes decreased from 49.2% (149/303) in the pre-programme sample to 35.5% (130/366) in the post-programme sample. The risk ratio (RR), adjusted for heterogeneity between hospitals, was 0.72 (95% CI: 0.60-0.87). In non-frail patients the incidence of adverse outcomes remained unchanged (RR: 1.02, 95% CI: 0.76-1.36). LTCE were similar in the two samples. CONCLUSIONS by involving stakeholders in designing and developing the transitional care programme, commitment of healthcare providers was secured. Feasible innovations in integrated transitional care for frail older patients after hospitalisation were sustainably implemented from within healthcare organisations.
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Affiliation(s)
- Noor Heim
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Herbert Rolden
- Institute for Health Sciences, Radboudumc, Nijmegen, Netherlands
| | - Esther M van Fenema
- Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
| | | | - Jolien P Tuijl
- Department of Geriatrics, Bronovo Hospital, The Hague, Netherlands
| | - Peter Jue
- Department of Geriatric Medicine, Rijnland Hospital, Leiderdorp, Netherlands
| | - Anna M Oleksik
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Anton J M de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Simon P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Gerard Jan Blauw
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, Netherlands Department of Geriatrics, Bronovo Hospital, The Hague, Netherlands
| | - Rudi G J Westendorp
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, Netherlands Department of Public Health and Center of Healthy Ageing, University of Copenhagen, Copenhagen, Denmark
| | - Roos C van der Mast
- Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
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Looman WM, Fabbricotti IN, de Kuyper R, Huijsman R. The effects of a pro-active integrated care intervention for frail community-dwelling older people: a quasi-experimental study with the GP-practice as single entry point. BMC Geriatr 2016; 16:43. [PMID: 26879893 PMCID: PMC4755064 DOI: 10.1186/s12877-016-0214-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/01/2016] [Indexed: 12/19/2022] Open
Abstract
Background This study explored the effectiveness of a pro-active, integrated care model for community-dwelling frail older people compared to care as usual by evaluating the effects on a comprehensive set of outcomes: health outcomes (experienced health, mental health and social functioning); functional abilities; and quality of life (general, health-related and well-being). Methods The design of this study was quasi-experimental. In this study, 184 frail older patients of three GP practices that implemented the Walcheren Integrated Care Model were compared with 193 frail older patients of five GP practices that provided care as usual. In the Walcheren Integrated Care Model, community-dwelling elderly were pro-actively screened for frailty from the GP practice using the Groningen Frailty Indicator, and care needs were assessed with the EASYcare instrument. The GP practice functioned as single entry point from which case management was provided, and the GP was the coordinator of care. The entire process was supported by multidisciplinary meetings, multidisciplinary protocols and web-based patient files. The outcomes of this study were obtained at baseline, after 3 months and after 12 months and analyzed with linear mixed models of repeated measures. Results The Walcheren Integrated Care Model had a positive effect on love and friendship and a moderately positive effect on general quality of life. The ability to receive love and friendship and general quality of life decreased in the control group but was preserved in the experimental group. No significant differences were found on health outcomes such as experienced health, mental health, social functioning and functional abilities. Conclusions The results indicated that pro-active, integrated care can be beneficial for frail older people in terms of quality of life and love and friendship but not in terms of health outcomes and functional abilities. Recommendations for future research are to gain greater insight into what specific outcomes can be achieved with proactive and integrated care, considering the specific content of this care, and to allow for the heterogeneity of frail older people in evaluation research. Trial registration Current Controlled Trials ISRCTN05748494. Registration date: 14/03/2013.
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Affiliation(s)
- Wilhelmina Mijntje Looman
- Erasmus University Rotterdam, Institute of Health Policy and Management, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands.
| | - Isabelle Natalina Fabbricotti
- Erasmus University Rotterdam, Institute of Health Policy and Management, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
| | - Ruben de Kuyper
- Erasmus University Rotterdam, Institute of Health Policy and Management, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
| | - Robbert Huijsman
- Erasmus University Rotterdam, Institute of Health Policy and Management, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
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de Stampa M, Bagaragaza E, Herr M, Aegerter P, Vedel I, Bergman H, Ankri J. [Use of social and health primary care services for older people with complex needs: Comparison of three types of gerontological coordination]. Rev Epidemiol Sante Publique 2014; 62:315-22. [PMID: 25444839 DOI: 10.1016/j.respe.2014.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 08/26/2014] [Accepted: 09/05/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Older people with complex needs live mainly at home. Several types of gerontological coordinations have been established on the French territory to meet their needs and to implement social and primary health care services. But we do not have any information on the use of these services at home as a function of the coordination method used. METHODS We compared the use of home care services for older people with complex needs in three types of coordination with 12 months' follow-up. The three coordinations regrouped a gerontological network with case management (n=105 persons), a nursing home service (SSIAD) with a nurse coordination (n=206 persons) and an informal coordination with a non-professional caregiver (n=117 persons). RESULTS At t0, the older people addressed to the gerontological network had less access to the services offered at home; those followed by the SSIAD had the highest number of services and of weekly interventions. Hours of weekly services were two-fold higher in those with the informal coordination. At t12, there was an improvement in access to services for the network group with case management and an overall increase in the use of professional services at home with no significant difference between the three groups. CONCLUSION The use of social and primary health care services showed differences between the three gerontological coordinations. The one-year evolution in the use of home services was comparable between the groups without an explosion in the number of services in the network group with case management.
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Affiliation(s)
- M de Stampa
- Laboratoire santé environnement vieillissement, EA 2506, université de Versailles Saint-Quentin, hôpital Sainte-Perine, AP-HP, Paris, France.
| | - E Bagaragaza
- Laboratoire santé environnement vieillissement, EA 2506, université de Versailles Saint-Quentin, hôpital Sainte-Perine, AP-HP, Paris, France
| | - M Herr
- Laboratoire santé environnement vieillissement, EA 2506, université de Versailles Saint-Quentin, hôpital Sainte-Perine, AP-HP, Paris, France
| | - P Aegerter
- Département information hospitalière et de santé publique, unité de recherche clinique, laboratoire santé environnement vieillissement, EA 2506, hôpital Ambroise-Paré, AP-HP, Boulogne, France
| | - I Vedel
- Groupe de recherche Solidage sur la fragilité et le vieillissement, université de McGill et de Montréal, Lady Davis Institute, hôpital Général Juif, Montréal, Québec, Canada
| | - H Bergman
- Groupe de recherche Solidage sur la fragilité et le vieillissement, université de McGill et de Montréal, Lady Davis Institute, hôpital Général Juif, Montréal, Québec, Canada
| | - J Ankri
- Laboratoire santé environnement vieillissement, EA 2506, université de Versailles Saint-Quentin, hôpital Sainte-Perine, AP-HP, Paris, France
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Impact on hospital admissions of an integrated primary care model for very frail elderly patients. Arch Gerontol Geriatr 2014; 58:350-5. [PMID: 24508468 DOI: 10.1016/j.archger.2014.01.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 10/02/2013] [Accepted: 01/11/2014] [Indexed: 11/22/2022]
Abstract
Very frail elderly patients living in the community, present complex needs and have a higher rate of hospital admissions with emergency department (ED) visits. Here, we evaluated the impact on hospital admissions of the COPA model (CO-ordination Personnes Agées), which provides integrated primary care with intensive case management for community-dwelling, very frail elderly patients. We used a quasi-experimental study in an urban district of Paris with four hundred twenty-eight very frail patients (105 in the intervention group and 323 in the control group) with one-year follow-up. The primary outcome measures were the presence of any unplanned hospitalization (via the ED), any planned hospitalizations (direct admission, no ED visit) and any hospitalization overall. Secondary outcome measures included health parameters assessed with the RAI-HC (Resident Assessment Instrument-Home Care). Comparing the intervention group with the control group, the risk of having at least one unplanned hospital admission decreased at one year and the planned hospital admissions rate increased, without a significant change in total hospital admissions. Among patients in the intervention group, there was less risk of depression and dyspnea. The COPA model improves the quality of care provided to very frail elderly patients by reducing unplanned hospitalizations and improving some health parameters.
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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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de Stampa M, Vedel I, de Montgolfier S, Buyck JF, THOREZ DELPHINE, Gazou F, Henrard JC, Bergman H, Ankri J. Un guichet unique dans un réseau gérontologique pour l'orientation des personnes âgées. SANTE PUBLIQUE 2013. [DOI: 10.3917/spub.131.0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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12
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Cassidy L. Online communities of practice to support collaborative mental health practice in rural areas. Issues Ment Health Nurs 2011; 32:98-107. [PMID: 21247275 DOI: 10.3109/01612840.2010.535648] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The provision of quality mental health services in rural areas continues to be an ongoing challenge for nurses and the patients they serve. The use of computer mediated communication to construct collaborative learning environments similar to those suggested in Wenger's community of practice framework has the potential to mitigate a number of the difficulties faced by rural health care providers. The author presents a brief discussion of social learning theories, the communities of practice framework, and related concepts. Examples of current online communities of practice used as a means for knowledge construction in various professional disciplines are presented in building the case for the fit between online communities of practice and the needs of nurses in rural mental health. Nurses providing mental health care in rural areas have documented needs for interdisciplinary teamwork, access to a collaborative learning environment, and ongoing contact with expert resources. The construction of online communities of practice could potentially address a multitude of concerns identified by nurses practicing mental health care in rural areas.
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Affiliation(s)
- Laurel Cassidy
- College of Nursing, University of Tennessee-Knoxville, Knoxville, TN, USA.
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de Stampa M, Vedel I, Mauriat C, Bagaragaza E, Routelous C, Bergman H, Lapointe L, Cassou B, Ankri J, Henrard JC. Diagnostic study, design and implementation of an integrated model of care in France: a bottom-up process with continuous leadership. Int J Integr Care 2010; 10:e034. [PMID: 20216954 PMCID: PMC2834925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2004] [Revised: 12/22/2004] [Accepted: 01/07/2004] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Sustaining integrated care is difficult, in large part because of problems encountered securing the participation of health care and social service professionals and, in particular, general practitioners (GPs). PURPOSE To present an innovative bottom-up and pragmatic strategy used to implement a new integrated care model in France for community-dwelling elderly people with complex needs. RESULTS In the first step, a diagnostic study was conducted with face-to-face interviews to gather data on current practices from a sample of health and social stakeholders working with elderly people. In the second step, an integrated care model called Coordination Personnes Agées (COPA) was designed by the same major stakeholders in order to define its detailed characteristics based on the local context. In the third step, the model was implemented in two phases: adoption and maintenance. This strategy was carried out by a continuous and flexible leadership throughout the process, initially with a mixed leadership (clinician and researcher) followed by a double one (clinician and managers of services) in the implementation phase. CONCLUSION The implementation of this bottom-up and pragmatic strategy relied on establishing a collaborative dynamic among health and social stakeholders. This enhanced their involvement throughout the implementation phase, particularly among the GPs, and allowed them to support the change practices and services arrangements.
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Affiliation(s)
- Matthieu de Stampa
- Assistance Publique Hôpitaux de Paris, Hôpital Sainte Périne, Pole Ambulatoire Diagnostic et Intervention en Santé, 49 rue Mirabeau, 75781 Paris Cedex 16, France
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