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El Sherif R, Pluye P, Hong QN, Rihoux B. Using qualitative comparative analysis as a mixed methods synthesis in systematic mixed studies reviews: Guidance and a worked example. Res Synth Methods 2024; 15:450-465. [PMID: 38194944 DOI: 10.1002/jrsm.1698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/31/2023] [Accepted: 11/22/2023] [Indexed: 01/11/2024]
Abstract
Qualitative comparative analysis (QCA) is a hybrid method designed to bridge the gap between qualitative and quantitative research in a case-sensitive approach that considers each case holistically as a complex configuration of conditions and outcomes. QCA allows for multiple conjunctural causation, implying that it is often a combination of conditions that produces an outcome, that multiple pathways may lead to the same outcome, and that in different contexts, the same condition may have a different impact on the outcome. This approach to complexity allows QCA to provide a practical understanding for complex, real-world situations, and the context of implementing interventions. There are guides for conducting QCA in primary research and quantitative systematic reviews yet, to our knowledge, no guidance for conducting QCA in systematic mixed studies reviews (SMSRs). Thus, the specific objectives of this paper are to (1) describe a step-by-step approach for novice researchers for using QCA to integrate qualitative and quantitative evidence, including guidance on how to use software; (2) highlight specific challenges; (3) propose potential solutions from a worked example; and (4) provide recommendations for reporting.
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Affiliation(s)
- Reem El Sherif
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Pierre Pluye
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Quan Nha Hong
- School of Rehabilitation, Université de Montréal and Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada
| | - Benoît Rihoux
- Department of Political and Social Sciences, Institute of Political Science Louvain-Europe (ISPOLE), University of Louvain, Louvain-la-Neuve, Belgium
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Tsuda S, Toya J, Ito K. Collaborative Care Models of Primary Care Clinics for People with Early-Stage Dementia: A Cross-Sectional Survey of Primary Care Physicians in Japan. Int J Integr Care 2024; 24:21. [PMID: 38855029 PMCID: PMC11160391 DOI: 10.5334/ijic.7726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 05/21/2024] [Indexed: 06/11/2024] Open
Abstract
Objectives This study explored collaboration models between primary care physicians (PCPs) and care managers (CMs) and assessed each model's potential in meeting the support needs of individuals with early-stage dementia. Methods In 2022, a cross-sectional survey was conducted among the PCPs in Tokyo. The data regarding the participant and clinic characteristics and daily practices for individuals with early-stage dementia were collected. The clinical collaborative practice was classified using a latent class analysis; comparisons were made between the identified classes based on 14 items in seven domains of support. Results Two collaborative and one stand-alone models were identified. The former varied in the professionals' roles, with one led by PCPs and the other by CMs. We named them PCP-led, CM-led, and stand-alone models, accounting for 46.4%, 32.8%, and 20.6% of the clinics, respectively. The PCP-led clinics were significantly more likely to provide support than the stand-alone ones across five domains: cognitive function, care planning, carers' support, information, and social health. The CM-led model clinics generally fell between those of the other two models. Conclusion Different leadership styles exist in the PCP-CM collaborations in care delivery for people with early-stage dementia. This collaboration offers distinct advantages for clinics in addressing their needs.
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Affiliation(s)
- Shuji Tsuda
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi, Tokyo 173-0015, Japan
| | - Junichiro Toya
- Sakurashinmachi Urban Clinic, 3-21-1-2F Shinmachi, Setagaya, Tokyo 154-0014, Japan
| | - Kae Ito
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi, Tokyo 173-0015, Japan
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Tseng LO, Newton C, Hall D, Lee EJ, Chang H, Poureslami I, Vasarhelyi K, Lacaille D, Mitton C. Primary care family physicians' experiences with clinical integration in qualitative and mixed reviews: a systematic review protocol. BMJ Open 2023; 13:e067576. [PMID: 37433736 DOI: 10.1136/bmjopen-2022-067576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
INTRODUCTION Clinical (service) integration in primary care settings describes how comprehensive care is coordinated by family physicians (FPs) over time across healthcare contexts to meet patient care needs. To improve care integration and healthcare service planning, a systematic approach to understanding its numerous influencing factors is paramount. The objective of this study is to generate a comprehensive map of FP-perceived factors influencing clinical integration across diseases and patient demographics. METHODS AND ANALYSIS We developed the protocol with the guidance of the Joanna Briggs Institute systematic review methodology framework. An information specialist built search strategies for MEDLINE, EMBASE and CINAHL databases using keywords and MeSH terms iteratively collected from a multidisciplinary team. Two reviewers will work independently throughout the study process, from article selection to data analysis. The identified records will be screened by title and abstract and reviewed in the full text against the criteria: FP in primary care (population), clinical integration (concept) and qualitative and mixed reviews published in 2011-2021 (context). We will first describe the characteristics of the review studies. Then, we will extract qualitative, FP-perceived factors and group them by content similarities, such as patient factors. Lastly, we will describe the types of extracted factors using a custom framework. ETHICS AND DISSEMINATION Ethics approval is not required for a systematic review. The identified factors will help generate an item bank for a survey that will be developed in the Phase II study to ascertain high-impact factors for intervention(s), as well as evidence gaps to guide future research. We will share the study findings with various knowledge users to promote awareness of clinical integration issues through multiple channels: publications and conferences for researchers and care providers, an executive summary for clinical leaders and policy-makers, and social media for the public.
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Affiliation(s)
- L Olivia Tseng
- Department of Family Practice, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Centre for Clinical Epidemiology and Evaluation (C2E2), Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Christie Newton
- Department of Family Practice, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - David Hall
- Department of Family Practice, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Department of Family & Community Practice, Vancouver Coastal Health Authority (VCHA), Vancouver, British Columbia, Canada
| | - Esther J Lee
- Complex Care Program, BC Children's Hospital, Vancouver, British Columbia, Canada
- Department of Pediatrics, Division of General Pediatrics, UBC, Vancouver, British Columbia, Canada
| | - Howard Chang
- Department of Family Practice, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Iraj Poureslami
- Respiratory Medicine Division, University of British Columbia, Vancouver, British Columbia, Canada
| | - Krisztina Vasarhelyi
- Department of Family & Community Practice, Vancouver Coastal Health Authority (VCHA), Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Diane Lacaille
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Department of Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Craig Mitton
- Centre for Clinical Epidemiology and Evaluation (C2E2), Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- The University of British Columbia School of Population and Public Health, Vancouver, British Columbia, Canada
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Moreo K, Llewellyn A, Sands J, Luttrell J, Prince M, Owen M. Can History Change Our Future Course? Lessons From Case Managers Across Time. Prof Case Manag 2023; 28:194-200. [PMID: 37219329 DOI: 10.1097/ncm.0000000000000654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Kathleen Moreo
- Kathleen Moreo, BSN, BHSA, RN, CMGT-BC, CCM, CDMS, is the founder of PRIME Education, LLC, with a 30-year career in educating and mentoring case managers and other members of the health care team. She has been conducting and publishing the results of research-informed quality improvement projects involving case managers in health systems, payer organizations, and community clinics for the past 10 years
- Anne Llewellyn, MS, BHSA, RN, CCM, CRRN, CMGT-BC, BCPA, FCM, is a past president of CMSA with more than 40 years of experience in critical care, risk management, case management, patient advocacy, health care publications, and training and development. Since 2010, she has been a leader in patient advocacy and writes a weekly blog, Nurse Advocate, to empower and educate others
- Judith Sands, RN, MSL, BSN, CPHRM, CPHQ, CCM, ARM, has more than 30 years of experience in hospitals, managed care, specialty networks, academia, and health IT organizations, as well as hospice care. Her book, Home Hospice Navigation: The Caregiver's Guide is a caregiving resource for making home hospice understandable
- Jody Luttrell, MSN, RN, CCM, is a past director of Care Management and currently director of business development at Kennedy Krieger Institute. She also serves on the National CMSA Board of Directors and the CMSA Chesapeake Board of Directors. Her tips are based upon decades of experience in rehabilitation case management
- Melanie Prince, MSS, MSN, BSN, RN, NE-BC, CCM, FAAN, FCM, is immediate past president of CMSA and copresenter of the 2023 CMSA Case Management Boot Camp. She offers the following guidance from a military case management career spanning more than 30 years
- Mindy Owen, RN, CRRN, CCM, FCM, has been a case management leader for nearly 40 years and more recently has provided extensive consulting in hospital case management for large integrated and academic systems. In 2021, she was awarded the Lifetime Achievement Award by CMSA for her significant impact in the field of case management
| | - Anne Llewellyn
- Kathleen Moreo, BSN, BHSA, RN, CMGT-BC, CCM, CDMS, is the founder of PRIME Education, LLC, with a 30-year career in educating and mentoring case managers and other members of the health care team. She has been conducting and publishing the results of research-informed quality improvement projects involving case managers in health systems, payer organizations, and community clinics for the past 10 years
- Anne Llewellyn, MS, BHSA, RN, CCM, CRRN, CMGT-BC, BCPA, FCM, is a past president of CMSA with more than 40 years of experience in critical care, risk management, case management, patient advocacy, health care publications, and training and development. Since 2010, she has been a leader in patient advocacy and writes a weekly blog, Nurse Advocate, to empower and educate others
- Judith Sands, RN, MSL, BSN, CPHRM, CPHQ, CCM, ARM, has more than 30 years of experience in hospitals, managed care, specialty networks, academia, and health IT organizations, as well as hospice care. Her book, Home Hospice Navigation: The Caregiver's Guide is a caregiving resource for making home hospice understandable
- Jody Luttrell, MSN, RN, CCM, is a past director of Care Management and currently director of business development at Kennedy Krieger Institute. She also serves on the National CMSA Board of Directors and the CMSA Chesapeake Board of Directors. Her tips are based upon decades of experience in rehabilitation case management
- Melanie Prince, MSS, MSN, BSN, RN, NE-BC, CCM, FAAN, FCM, is immediate past president of CMSA and copresenter of the 2023 CMSA Case Management Boot Camp. She offers the following guidance from a military case management career spanning more than 30 years
- Mindy Owen, RN, CRRN, CCM, FCM, has been a case management leader for nearly 40 years and more recently has provided extensive consulting in hospital case management for large integrated and academic systems. In 2021, she was awarded the Lifetime Achievement Award by CMSA for her significant impact in the field of case management
| | - Judith Sands
- Kathleen Moreo, BSN, BHSA, RN, CMGT-BC, CCM, CDMS, is the founder of PRIME Education, LLC, with a 30-year career in educating and mentoring case managers and other members of the health care team. She has been conducting and publishing the results of research-informed quality improvement projects involving case managers in health systems, payer organizations, and community clinics for the past 10 years
- Anne Llewellyn, MS, BHSA, RN, CCM, CRRN, CMGT-BC, BCPA, FCM, is a past president of CMSA with more than 40 years of experience in critical care, risk management, case management, patient advocacy, health care publications, and training and development. Since 2010, she has been a leader in patient advocacy and writes a weekly blog, Nurse Advocate, to empower and educate others
- Judith Sands, RN, MSL, BSN, CPHRM, CPHQ, CCM, ARM, has more than 30 years of experience in hospitals, managed care, specialty networks, academia, and health IT organizations, as well as hospice care. Her book, Home Hospice Navigation: The Caregiver's Guide is a caregiving resource for making home hospice understandable
- Jody Luttrell, MSN, RN, CCM, is a past director of Care Management and currently director of business development at Kennedy Krieger Institute. She also serves on the National CMSA Board of Directors and the CMSA Chesapeake Board of Directors. Her tips are based upon decades of experience in rehabilitation case management
- Melanie Prince, MSS, MSN, BSN, RN, NE-BC, CCM, FAAN, FCM, is immediate past president of CMSA and copresenter of the 2023 CMSA Case Management Boot Camp. She offers the following guidance from a military case management career spanning more than 30 years
- Mindy Owen, RN, CRRN, CCM, FCM, has been a case management leader for nearly 40 years and more recently has provided extensive consulting in hospital case management for large integrated and academic systems. In 2021, she was awarded the Lifetime Achievement Award by CMSA for her significant impact in the field of case management
| | - Jody Luttrell
- Kathleen Moreo, BSN, BHSA, RN, CMGT-BC, CCM, CDMS, is the founder of PRIME Education, LLC, with a 30-year career in educating and mentoring case managers and other members of the health care team. She has been conducting and publishing the results of research-informed quality improvement projects involving case managers in health systems, payer organizations, and community clinics for the past 10 years
- Anne Llewellyn, MS, BHSA, RN, CCM, CRRN, CMGT-BC, BCPA, FCM, is a past president of CMSA with more than 40 years of experience in critical care, risk management, case management, patient advocacy, health care publications, and training and development. Since 2010, she has been a leader in patient advocacy and writes a weekly blog, Nurse Advocate, to empower and educate others
- Judith Sands, RN, MSL, BSN, CPHRM, CPHQ, CCM, ARM, has more than 30 years of experience in hospitals, managed care, specialty networks, academia, and health IT organizations, as well as hospice care. Her book, Home Hospice Navigation: The Caregiver's Guide is a caregiving resource for making home hospice understandable
- Jody Luttrell, MSN, RN, CCM, is a past director of Care Management and currently director of business development at Kennedy Krieger Institute. She also serves on the National CMSA Board of Directors and the CMSA Chesapeake Board of Directors. Her tips are based upon decades of experience in rehabilitation case management
- Melanie Prince, MSS, MSN, BSN, RN, NE-BC, CCM, FAAN, FCM, is immediate past president of CMSA and copresenter of the 2023 CMSA Case Management Boot Camp. She offers the following guidance from a military case management career spanning more than 30 years
- Mindy Owen, RN, CRRN, CCM, FCM, has been a case management leader for nearly 40 years and more recently has provided extensive consulting in hospital case management for large integrated and academic systems. In 2021, she was awarded the Lifetime Achievement Award by CMSA for her significant impact in the field of case management
| | - Melanie Prince
- Kathleen Moreo, BSN, BHSA, RN, CMGT-BC, CCM, CDMS, is the founder of PRIME Education, LLC, with a 30-year career in educating and mentoring case managers and other members of the health care team. She has been conducting and publishing the results of research-informed quality improvement projects involving case managers in health systems, payer organizations, and community clinics for the past 10 years
- Anne Llewellyn, MS, BHSA, RN, CCM, CRRN, CMGT-BC, BCPA, FCM, is a past president of CMSA with more than 40 years of experience in critical care, risk management, case management, patient advocacy, health care publications, and training and development. Since 2010, she has been a leader in patient advocacy and writes a weekly blog, Nurse Advocate, to empower and educate others
- Judith Sands, RN, MSL, BSN, CPHRM, CPHQ, CCM, ARM, has more than 30 years of experience in hospitals, managed care, specialty networks, academia, and health IT organizations, as well as hospice care. Her book, Home Hospice Navigation: The Caregiver's Guide is a caregiving resource for making home hospice understandable
- Jody Luttrell, MSN, RN, CCM, is a past director of Care Management and currently director of business development at Kennedy Krieger Institute. She also serves on the National CMSA Board of Directors and the CMSA Chesapeake Board of Directors. Her tips are based upon decades of experience in rehabilitation case management
- Melanie Prince, MSS, MSN, BSN, RN, NE-BC, CCM, FAAN, FCM, is immediate past president of CMSA and copresenter of the 2023 CMSA Case Management Boot Camp. She offers the following guidance from a military case management career spanning more than 30 years
- Mindy Owen, RN, CRRN, CCM, FCM, has been a case management leader for nearly 40 years and more recently has provided extensive consulting in hospital case management for large integrated and academic systems. In 2021, she was awarded the Lifetime Achievement Award by CMSA for her significant impact in the field of case management
| | - Mindy Owen
- Kathleen Moreo, BSN, BHSA, RN, CMGT-BC, CCM, CDMS, is the founder of PRIME Education, LLC, with a 30-year career in educating and mentoring case managers and other members of the health care team. She has been conducting and publishing the results of research-informed quality improvement projects involving case managers in health systems, payer organizations, and community clinics for the past 10 years
- Anne Llewellyn, MS, BHSA, RN, CCM, CRRN, CMGT-BC, BCPA, FCM, is a past president of CMSA with more than 40 years of experience in critical care, risk management, case management, patient advocacy, health care publications, and training and development. Since 2010, she has been a leader in patient advocacy and writes a weekly blog, Nurse Advocate, to empower and educate others
- Judith Sands, RN, MSL, BSN, CPHRM, CPHQ, CCM, ARM, has more than 30 years of experience in hospitals, managed care, specialty networks, academia, and health IT organizations, as well as hospice care. Her book, Home Hospice Navigation: The Caregiver's Guide is a caregiving resource for making home hospice understandable
- Jody Luttrell, MSN, RN, CCM, is a past director of Care Management and currently director of business development at Kennedy Krieger Institute. She also serves on the National CMSA Board of Directors and the CMSA Chesapeake Board of Directors. Her tips are based upon decades of experience in rehabilitation case management
- Melanie Prince, MSS, MSN, BSN, RN, NE-BC, CCM, FAAN, FCM, is immediate past president of CMSA and copresenter of the 2023 CMSA Case Management Boot Camp. She offers the following guidance from a military case management career spanning more than 30 years
- Mindy Owen, RN, CRRN, CCM, FCM, has been a case management leader for nearly 40 years and more recently has provided extensive consulting in hospital case management for large integrated and academic systems. In 2021, she was awarded the Lifetime Achievement Award by CMSA for her significant impact in the field of case management
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Hudon C, Bisson M, Chouinard MC, Delahunty-Pike A, Lambert M, Howse D, Schwarz C, Dumont-Samson O, Aubrey-Bassler K, Burge F, Doucet S, Ramsden VR, Luke A, Macdonald M, Gaudreau A, Porter J, Rubenstein D, Scott C, Warren M, Wilhelm L. Implementation analysis of a case management intervention for people with complex care needs in primary care: a multiple case study across Canada. BMC Health Serv Res 2023; 23:377. [PMID: 37076851 PMCID: PMC10116737 DOI: 10.1186/s12913-023-09379-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 04/08/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Case management is one of the most frequently performed interventions to mitigate the negative effects of high healthcare use on patients, primary care providers and the healthcare system. Reviews have addressed factors influencing case management interventions (CMI) implementation and reported common themes related to the case manager role and activities, collaboration with other primary care providers, CMI training and relationships with the patients. However, the heterogeneity of the settings in which CMI have been implemented may impair the transferability of the findings. Moreover, the underlying factors influencing the first steps of CMI implementation need to be further assessed. This study aimed to evaluate facilitators and barriers of the first implementation steps of a CMI by primary care nurses for people with complex care needs who frequently use healthcare services. METHODS A qualitative multiple case study was conducted including six primary care clinics across four provinces in Canada. In-depth interviews and focus groups with nurse case managers, health services managers, and other primary care providers were conducted. Field notes also formed part of the data. A mixed thematic analysis, deductive and inductive, was carried out. RESULTS Leadership of the primary care providers and managers facilitated the first steps of the of CMI implementation, as did the experience and skills of the nurse case managers and capacity development within the teams. The time required to establish CMI was a barrier at the beginning of the CMI implementation. Most nurse case managers expressed apprehension about developing an "individualized services plan" with multiple health professionals and the patient. Clinic team meetings and a nurse case managers community of practice created opportunities to address primary care providers' concerns. Participants generally perceived the CMI as a comprehensive, adaptable, and organized approach to care, providing more resources and support for patients and better coordination in primary care. CONCLUSION Results of this study will be useful for decision makers, care providers, patients and researchers who are considering the implementation of CMI in primary care. Providing knowledge about first steps of CMI implementation will also help inform policies and best practices.
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Affiliation(s)
- Catherine Hudon
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Pavillon Z7-Room 3007, 3001, 12E Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada.
- Centre Hospitalier Universitaire de Sherbrooke Research Centre, Sherbrooke, QC, Canada.
| | - Mathieu Bisson
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Pavillon Z7-Room 3007, 3001, 12E Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | | | | | - Mireille Lambert
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Pavillon Z7-Room 3007, 3001, 12E Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Dana Howse
- Primary Healthcare Research Unit, Memorial University, St-John's, NL, Canada
| | - Charlotte Schwarz
- Department of Nursing and Health Sciences, University of New Brunswick, Fredericton, NB, Canada
| | - Olivier Dumont-Samson
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Pavillon Z7-Room 3007, 3001, 12E Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University, St-John's, NL, Canada
| | - Fred Burge
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, Fredericton, NB, Canada
| | - Vivian R Ramsden
- Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Alison Luke
- Department of Nursing and Health Sciences, University of New Brunswick, Fredericton, NB, Canada
| | - Marilyn Macdonald
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | | | - Judy Porter
- Nova Scotia Health Authority, Halifax, NS, Canada
| | | | - Cathy Scott
- Canadian Cancer Society, Toronto, ON, Canada
| | - Mike Warren
- Patient Advisory Council, Newfoundland and Labrador SPOR SUPPORT Unit, St. John's, NL, Canada
| | - Linda Wilhelm
- Canadian Arthritis Patient Alliance, Ottawa, ON, Canada
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Österholm J, Nedlund AC, Larsson Ranada Å. Collaboration and coordination of health and care services for older people with dementia by multidisciplinary health and care providers: a scoping review protocol. BMJ Open 2022; 12:e066578. [PMID: 36585145 PMCID: PMC9809266 DOI: 10.1136/bmjopen-2022-066578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Collaboration and coordination of health and care services are key to catering for the diverse needs of a growing population of older people with dementia. When multidisciplinary health and care providers work together, they have the possibility to use resources in a fair, accurate and effective way and thereby do the right thing, at the right time, for the right individual. The aim of this scoping review is to map how different care-providing agencies collaborate and coordinate health and care services for older people with dementia. METHODS AND ANALYSIS A scoping review will be carried out following the proposed methodology by Joanna Briggs Institute and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review Extension guidelines. Systematic searches will be carried out in scientific databases. Studies published within the last 10 years will be included based on certain eligibility criteria. All included studies will be critically appraised using the Research Pyramid. Data from included studies will be charted and subjected to content analysis. ETHICS AND DISSEMINATION Ethics approval is not required for scoping reviews. The dissemination of findings will be conducted through conference presentations and publication in international scientific journals.
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Affiliation(s)
- Johannes Österholm
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Linköping University Faculty of Medicine, Linköping, Sweden
| | - Ann-Charlotte Nedlund
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Unit of Health Care Analysis, Linköping University, Linköping, Sweden
| | - Åsa Larsson Ranada
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Linköping University Faculty of Medicine, Linköping, Sweden
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Bujold M, Pluye P, Légaré F. Decision-making and related outcomes of patients with complex care needs in primary care settings: a systematic literature review with a case-based qualitative synthesis. BMC PRIMARY CARE 2022; 23:279. [PMID: 36352376 PMCID: PMC9644584 DOI: 10.1186/s12875-022-01879-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND In primary care, patients increasingly face difficult decisions related to complex care needs (multimorbidity, polypharmacy, mental health issues, social vulnerability and structural barriers). There is a need for a pragmatic conceptual model to understand decisional needs among patients with complex care needs and outcomes related to decision. We aimed to identify types of decisional needs among patients with complex care needs, and decision-making configurations of conditions associated with decision outcomes. METHODS We conducted a systematic mixed studies review. Two specialized librarians searched five bibliographic databases (Medline, Embase, PsycINFO, CINAHL and SSCI). The search strategy was conducted from inception to December 2017. A team of twenty crowd-reviewers selected empirical studies on: (1) patients with complex care needs; (2) decisional needs; (3) primary care. Two reviewers appraised the quality of included studies using the Mixed Methods Appraisal Tool. We conducted a 2-phase case-based qualitative synthesis framed by the Ottawa Decision Support Framework and Gregor's explicative-predictive theory type. A decisional need case involved: (a) a decision (what), (b) concerning a patient with complex care needs with bio-psycho-social characteristics (who), (c) made independently or in partnership (how), (d) in a specific place and time (where/when), (e) with communication and coordination barriers or facilitators (why), and that (f) influenced actions taken, health or well-being, or decision quality (outcomes). RESULTS We included 47 studies. Data sufficiency qualitative criterion was reached. We identified 69 cases (2997 participants across 13 countries) grouped into five types of decisional needs: 'prioritization' (n = 26), 'use of services' (n = 22), 'prescription' (n = 12), 'behavior change' (n = 4) and 'institutionalization' (n = 5). Many decisions were made between clinical encounters in situations of social vulnerability. Patterns of conditions associated with decision outcomes revealed four decision-making configurations: 'well-managed' (n = 13), 'asymmetric encounters' (n = 21), 'self-management by default' (n = 8), and 'chaotic' (n = 27). Shared decision-making was associated with positive outcomes. Negative outcomes were associated with independent decision-making. CONCLUSION Our results could extend decision-making models in primary care settings and inform subsequent user-centered design of decision support tools for heterogenous patients with complex care needs.
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Affiliation(s)
- Mathieu Bujold
- Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montreal, Canada.
- Department of Family Medicine, McGill University, Montreal, Canada.
| | - Pierre Pluye
- Department of Family Medicine, McGill University, Montreal, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
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Schiller C, Grünzig M, Heinrich S, Meyer G, Bieber A. Case management for people with dementia living at home and their informal caregivers: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1233-1253. [PMID: 34783085 DOI: 10.1111/hsc.13647] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 06/13/2023]
Abstract
Case management is a complex intervention aimed at addressing a variety of health needs of people in their social environment. Case management for people with dementia is often poorly defined and insufficiently described. The crucial process steps are often not well understood. We aim to map and compare the key components, processes and contextual factors of case management programmes for dementia and to explore aspects of the interventions' generalisability. Our search covered the databases PubMed, CINAHL, Cochrane and GeroLit, as well as policy papers from international organisations. We included qualitative, quantitative and mixed-methods studies in the English or German language that was published between 1999 and 2020. The programmes were analysed according to programme characteristics, case management intervention and the structural and processing conditions. We identified 67 studies dealing with 25 programmes. Approximately half of the programmes were investigated in randomised controlled trials, two programmes used a mixed-methods design and the remaining were the subject of pre-post cohort studies. Participants in the studies were predominantly dyads of people with dementia and their informal caregivers. About half of the programmes reported a theoretical framework. All the programmes were derived from case management approaches or referred to such approaches. Despite huge differences in implementation, all the programmes covered the case management steps. In 14 out of 25 programmes, case management was carried out without additional intervention, the other programmes provided mainly education and training for informal caregivers. Costs of the case management interventions were stated in more than half of the programmes.The effectiveness and generalisability of dementia-specific case management interventions could be enhanced if the framework introduced in the review was used in the future by policy, practice and research.
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Affiliation(s)
- Christine Schiller
- Medical Faculty, Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Manuela Grünzig
- Medical Faculty, Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Stephanie Heinrich
- Medical Faculty, Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Gabriele Meyer
- Medical Faculty, Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Anja Bieber
- Medical Faculty, Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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The Care Coordinator’s Tasks During the Implementation of an Integrated Care Pathway for Older Patients: A Qualitative Study Based on the French National “Health Pathway of Seniors for Preserved Autonomy” Pilot Program. Int J Integr Care 2022; 22:2. [PMID: 35431705 PMCID: PMC8973761 DOI: 10.5334/ijic.5977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 03/15/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Although integrated care and care coordination are known to be beneficial for older adults’ population, the specific tasks of a Care Coordinator (CC) for integrated care pathways for this population have not been studied in detail. Setting & Subjects: The French national pilot program PAERPA provided an integrated care pathway for older adults. In North France, a CC was recruited to support patients and professionals. Objectives: (i) To analyse the CC’s tasks in an integrated care pathway for older patients, and (ii) to record perceptions on the CC’s tasks among the participating general practitioners (GP) and community pharmacists. Design & Methods Qualitative, two-phase study: (i) Task analysis of the CC’s tasks, to compare the planned and actual tasks; (ii) semi-structured interviews among GPs and community pharmacists involved in the pathway. Results: (i) The task analysis showed that the CC’s actual tasks differed from planned tasks. The CC was only meant to be involved in the early stages of the process; actually, the CC undertook more or even unforeseen tasks in coordination, communication, and administrative support throughout the care pathways. (ii) The 28 interviewed healthcare professionals considered the CC’s tasks to be essential to the success of pathways. They appreciated the CC’s administrative support. However, CC’s tasks related to interprofessional communication, and patient and family information, were controversially perceived among GPs and pharmacists. Conclusions: The CC’s tasks in an integrated care pathway for older adults showed that the CC’s overall workload was greater than expected and appreciated by healthcare professionals.
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Hudon C, Chouinard MC, Bisson M, Brousselle A, Lambert M, Danish A, Rodriguez C, Sabourin V. Case Management Programs for Improving Integrated Care for Frequent Users of Healthcare Services: An Implementation Analysis. Int J Integr Care 2022; 22:11. [PMID: 35221827 PMCID: PMC8833259 DOI: 10.5334/ijic.5652] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/28/2022] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Case management programs (CMP) for frequent users of healthcare services presenting complex healthcare needs constitute an effective strategy to improve patient experience of integrated care and to decrease healthcare overuse and cost. This study sought to identify characteristics of these programs, and their implementation contexts, that help to improve patient self-management, experience of integrated care, and healthcare services use. METHODS A mixed methods multiple embedded case study design was conducted, with six CMP implemented in six hospitals of a region of Quebec (Canada). RESULTS Within-case analysis describes the structural, environmental, organizational, practitioner, patient, and innovation level characteristics of each CMP and their services integration outcomes based on patient experience, self-management and healthcare services use. Cross-case analysis suggests that the skills, leadership and experience of the case manager, providers' access to the individualized services plan, consideration of the needs of the patient and family members, their participation in decision-making, and the self-management approach, impact integrated care and healthcare services use. CONCLUSION AND DISCUSSION This study underscores the necessity of an experienced, knowledgeable and well-trained case manager with interpersonal skills to optimize CMP implementation such that patients are more proactive in their care and their outcomes improve.
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Affiliation(s)
- Catherine Hudon
- Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC, Canada
- Centre de recherche du CHUS, 12e Avenue Nord Porte 6, Sherbrooke, QC, Canada
| | - Maud-Christine Chouinard
- Faculté des sciences infirmières, Université de Montréal, Pavillon Marguerite-d’Youville, 2375 Chemin de la Côte-Sainte-Catherine, Montreal, QC, Canada
| | - Mathieu Bisson
- Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC, Canada
| | - Astrid Brousselle
- School of Public Administration, University of Victoria, Public Administration, HSD building, Room A302, Victoria, BC, Canada
| | - Mireille Lambert
- Centre intégré universitaire de santé et services sociaux du Saguenay–Lac-Saint-Jean, 930 rue Jacques-Cartier E, Chicoutimi, QC, Canada
| | - Alya Danish
- Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC, Canada
| | - Charo Rodriguez
- Department of Family Medicine, McGill University, 5858, Chemin de la Côte-des-Neiges, Montreal, QC, Canada
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11
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Khan N, Garcia N, Mehdipanah R, Briceño EM, Heeringa SG, Levine DA, Gonzales XF, Langa KM, Longoria R, Morgenstern LB. Lack of Any Caregiving for Those with Dementia. J Alzheimers Dis 2022; 86:531-535. [PMID: 35068465 PMCID: PMC8960337 DOI: 10.3233/jad-215418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Older adults with significant cognitive impairment require help with activities of daily living. The BASIC-Cognitive Project, set in Nueces County, Texas, is a community-based study examining trends in cognition among Mexican Americans and non-Hispanic Whites. Using cross-sectional data from a cohort study, we found that at least 7% of individuals aged 65 and older with a Montreal Cognitive Assessment (MoCA) score of < 20 (or < 15 for telephone MoCA), did not receive any caregiving help. This conservative estimate highlights an important community need for those with significant cognitive impairment and has implications regarding safety and care for older adults.
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Affiliation(s)
- Noreen Khan
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Nelda Garcia
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Roshanak Mehdipanah
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Emily M Briceño
- Department of Physical Medicine & Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Steven G Heeringa
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Deborah A Levine
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Xavier F Gonzales
- Department of Life Sciences, Texas A&M University, Corpus Christi, TX, USA
| | - Kenneth M Langa
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Ruth Longoria
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Lewis B Morgenstern
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA.,Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, Ann Arbor, MI, USA
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12
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Yang XQ, Vedel I, Khanassov V. The Cultural Diversity of Dementia Patients and Caregivers in Primary Care Case Management: a Pilot Mixed Methods Study. Can Geriatr J 2021; 24:184-194. [PMID: 34484501 PMCID: PMC8390323 DOI: 10.5770/cgj.24.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
CONTEXT The Canadian reality of dementia care may be complicated by the cultural diversity of patients and their informal caregivers. OBJECTIVES To what extent do needs differ between Canadian- and foreign-born patients and caregivers? What are their experiences with the illness in primary care case management? METHODS Mixed methods, sequential explanatory design (a cross-sectional study, followed by a qualitative descriptive study), involving 15 pairs of patients and caregivers. RESULTS Foreign-born patients had more needs compared to their Canadian-born counterparts. Foreign-born caregivers reported more stress, more problems, and increased need for services. However, the reported experiences of Canadian- vs. foreign-born individuals were similar. CONCLUSION The results remain hypothesis-generating. The present pilot illustrated the suitability of mixed methods to this area of study, which deserves further investigation to better serve all members of a population already vulnerable by age and disease.
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Affiliation(s)
- Xin Qiang Yang
- Faculty of Medicine, McGill University, Montreal, USA, QC
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montreal, USA, QC
| | - Vladimir Khanassov
- Department of Family Medicine, McGill University, Montreal, USA, QC
- Herzl Family Practice Centre, Jewish General Hospital, Montreal, QC
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13
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Fernandes B, Goodarzi Z, Holroyd-Leduc J. Optimizing the diagnosis and management of dementia within primary care: a systematic review of systematic reviews. BMC FAMILY PRACTICE 2021; 22:166. [PMID: 34380424 PMCID: PMC8359121 DOI: 10.1186/s12875-021-01461-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 05/13/2021] [Indexed: 01/08/2023]
Abstract
Background To understand how best to approach dementia care within primary care and its challenges, we examined the evidence related to diagnosing and managing dementia within primary care. Methods Databases searched include: MEDLINE, Embase, PsycINFO and The Cochrane Database of Systematic Reviews from inception to 11 May 2020. English-language systematic reviews, either quantitative or qualitative, were included if they described interventions involving the diagnosis, treatment and/or management of dementia within primary care/family medicine and outcome data was available. The risk of bias was assessed using AMSTAR 2. The review followed PRISMA guidelines and is registered with Open Science Framework. Results Twenty-one articles are included. The Mini-Cog and the MMSE were the most widely studied cognitive screening tools. The Abbreviated Mental Test Score (AMTS) achieved high sensitivity (100 %, 95 % CI: 70-100 %) and specificity (82 %, 95 % CI: 72-90 %) within the shortest amount of time (3.16 to 5 min) within primary care. Five of six studies found that family physicians had an increased likelihood of suspecting dementia after attending an educational seminar. Case management improved behavioural symptoms, while decreasing hospitalization and emergency visits. The primary care educational intervention, Enhancing Alzheimer’s Caregiver Health (Department of Veterans Affairs), was successful at increasing carer ability to manage problem behaviours and improving outcomes for caregivers. Conclusions There are clear tools to help identify cognitive impairment in primary care, but strategies for management require further research. The findings from this systematic review will inform family physicians on how to improve dementia diagnosis and management within their primary care practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01461-5.
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Affiliation(s)
| | - Zahra Goodarzi
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, Foothills Medical Centre, University of Calgary, North Tower (Rm 930), 1403 29 St NW, Calgary, AB, T2N 2T9, Canada
| | - Jayna Holroyd-Leduc
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, Foothills Medical Centre, University of Calgary, North Tower (Rm 930), 1403 29 St NW, Calgary, AB, T2N 2T9, Canada
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14
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Barriers and Facilitators in the Uptake of Integrated Care Pathways for Older Patients by Healthcare Professionals: A Qualitative Analysis of the French National "Health Pathway of Seniors for Preserved Autonomy" Pilot Program: Barriers and Facilitators for Adhesion of Healthcare Professionals in Integrated Care for Older Patients: A Qualitative Assessment Based on the French National Experiment: 'Health Pathway of Seniors for Preserved Autonomy' (PAERPA). Int J Integr Care 2021; 21:7. [PMID: 33976596 PMCID: PMC8064286 DOI: 10.5334/ijic.5483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: Integrated care is a particularly promising approach in geriatrics – a field in which the medical, psychological and social issues are often complex. The uptake of integrated care by healthcare professionals (HCPs) is essential but varies markedly. The objective of the present study of healthcare professionals was to identify barriers to and facilitators of commitment to integrated care for seniors. Methods: We performed a two-step, qualitative study, comprising (i) six qualitative, semi-directive series of interviews with HCPs (hospital practitioners, family physicians, nurses and pharmacists) who agreed or disagreed to take part in the French national “Health Pathway of Seniors for Preserved Autonomy” (PAERPA) pilot program; and (ii) an analysis of the pooled results, in order to identify common concerns among the healthcare professionals. Results: We identified four key “barrier” and “facilitator” topics shared by HCPs who had committed to the pilot program and those who had not: (i) awareness of and/or interest in geriatric medicine and team working, (ii) the presence of a care coordinator; (iii) the provision of information about the program and about the patient, and communication between HCPs, and (iv) personal benefits for the HCPs and the patients. Key conclusions: The four key topics identified in this large qualitative study of several healthcare professions should be considered during the design and dissemination of integrated care pathways for older patients.
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15
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Feyereisen S, Puro N, Thomas C, McConnell W. A new kind of gatekeeper: The increasing prevalence of Advanced Practice Nurses as case managers in US hospitals. Health (London) 2020; 25:596-612. [PMID: 33322938 DOI: 10.1177/1363459320976758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Case management is a representation of managed care, cost-containment organizational practices in healthcare, where managed care and its constitutive parts are situated against physician autonomy and decision-making. As a professional field, case management has evolved considerably, with the role recently taken up increasingly by Advanced Practice Nurses in various health care settings. We look at this evolution of a relatively new work task for Advanced Practice Nurses using a countervailing powers perspective, which allows us to move beyond discussions of case management effectiveness and best practices, and draw connections to trends in the social organization of healthcare, especially hospitals. We evaluated organizational (hospital-level) and environmental (county and state-level) characteristics associated with hospitals' use of Advanced Practice Nurses as case managers, using data from U.S. community acute care hospitals for 2016-2018, collected from three data sources: American Hospital Association annual survey (AHA), Centers for Medicare and Medicaid Services (CMS), and Area Resource File. Among organizational characteristics, we found that hospitals that are a part of established Accountable Care Organizations (OR = 2.55, p = 0.009; 95% CI = 1.26-5.14) and those that serve higher acuity patients, as indicated by possessing a higher Case Mix Index (OR = 1.32, p = 0.001; 95% CI = 1.13-1.55), were more likely to use Advanced Practice Nurses as case managers. Among environmental characteristics, having higher local Advanced Practice Nurses concentrations (OR = 1.24, p < 0.001; 95% CI = 1.11-1.39) was associated with hospital Advanced Practice Nurses case management service provision. Beyond the health impacts of Covid-19, its associated recession is placing families, governments and insurers under unprecedented financial stress. Governments and insurers alike are looking to reduce costs anywhere possible. This will inevitably result in increasing amounts of managed care, and decreasing reimbursements to hospitals, likely resulting in higher demand for APRN patient navigators.
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16
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Nothelle S, Wolff J, Nkodo A, Litman J, Dunbar L, Boyd C. "It's Tricky": Care Managers' Perspectives on Interacting with Primary Care Clinicians. Popul Health Manag 2020; 24:338-344. [PMID: 32758066 DOI: 10.1089/pop.2020.0082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Care management programs that facilitate collaboration between care managers and primary care clinicians are more likely to be successful in improving chronic disease metrics than programs that do not facilitate such collaboration. The authors sought to understand care managers' perspectives on interacting with primary care clinicians. Semi-structured qualitative interviews were conducted with care managers (n = 29) from 3 health systems in and around a large, urban academic center. Interviews were audio recorded, transcribed verbatim, and iteratively analyzed using a grounded theory approach. Care managers worked for health plans (14%), outpatient specialty clinics (31%), hospitals and emergency departments (24%), and primary care offices (14%). Care managers identified the primary care clinician as leading patients' care and as essential to avoiding unnecessary utilization. Care managers described variability in and barriers to interacting with primary care clinicians. When possible, care managers use the electronic medical record to facilitate interaction rather than communicating directly (eg, phone call) with primary care clinicians. The role of the care manager varied across programs, contributing to primary care clinicians' poor understanding of what the care manager could provide. Consequently, primary care clinicians asked the care manager for help with tasks beyond his/her role. Care managers felt inferior to primary care clinicians, a potential result of the traditional medical hierarchy, which also hindered interactions. Although care managers view interactions with the primary care clinician as essential to the health of the patient, communication challenges, variability of the care manager's role, and medical hierarchy limit collaboration.
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Affiliation(s)
- Stephanie Nothelle
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Amelie Nkodo
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jessica Litman
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Linda Dunbar
- Johns Hopkins HealthCare, Baltimore, Maryland, USA
| | - Cynthia Boyd
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Monaco A, Palmer K, Marengoni A, Maggi S, Hassan TA, Donde S. Integrated care for the management of ageing-related non-communicable diseases: current gaps and future directions. Aging Clin Exp Res 2020; 32:1353-1358. [PMID: 32277438 PMCID: PMC7316682 DOI: 10.1007/s40520-020-01533-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/10/2020] [Indexed: 11/04/2022]
Abstract
Due to the increase in the older population in Europe and associated rise in the absolute number of persons with Non-Communicable Diseases (NCDs), it is becoming increasingly important to find ways to promote healthy ageing, which is defined as the process of developing and maintaining the functional ability that enables well-being in older age. Older persons with NCDs can have complex care needs due to the increased risk of frailty, multimorbidity, and polypharmacy. However, current health systems in Europe often provide fragmented care for older people with NCDs; many receive disjointed care from numerous specialists or via different levels of care. In the current article, we discuss barriers and challenges in implementing integrated care models in European settings for older NCD patients. Specifically, we discuss the need for greater use of case managers in the care and treatment persons with complex care needs as well as the lack of training and education in healthcare professionals on topics related to multimorbidity, frailty, and polypharmacy. We discuss the limitations that arise from the current focus on disease-specific guidelines and care models that do not take comorbid conditions into account, and the lack of good quality evidence that evaluates the effectiveness of integrated care interventions, especially in European health settings. We highlight the importance of evaluating and monitoring mental health in conjunction with somatic symptoms in NCD patients and discuss the integral role of information and communication technology in healthcare to streamline integrated care processes and help to achieve better outcomes for patients.
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Affiliation(s)
| | - Katie Palmer
- Oliba, Via Federico Cesi 30, 00193, Rome, Italy.
| | - Alessandra Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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18
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Hudon C, Chouinard MC, Pluye P, El Sherif R, Bush PL, Rihoux B, Poitras ME, Lambert M, Zomahoun HTV, Légaré F. Characteristics of Case Management in Primary Care Associated With Positive Outcomes for Frequent Users of Health Care: A Systematic Review. Ann Fam Med 2019; 17:448-458. [PMID: 31501208 PMCID: PMC7032902 DOI: 10.1370/afm.2419] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/28/2019] [Accepted: 03/29/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Case management (CM) interventions are effective for frequent users of health care services, but little is known about which intervention characteristics lead to positive outcomes. We sought to identify characteristics of CM that yield positive outcomes among frequent users with chronic disease in primary care. METHODS For this systematic review of both quantitative and qualitative studies, we searched MEDLINE, CINAHL, Embase, and PsycINFO (1996 to September 2017) and included articles meeting the following criteria: (1)population: adult frequent users with chronic disease, (2)intervention: CM in a primary care setting with a postintervention evaluation, and (3)primary outcomes: integration of services, health care system use, cost, and patient outcome measures. Independent reviewers screened abstracts, read full texts, appraised methodologic quality (Mixed Methods Appraisal Tool), and extracted data from the included studies. Sufficient and necessary CM intervention characteristics were identified using configurational comparative methods. RESULTS Of the 10,687 records retrieved, 20 studies were included; 17 quantitative, 2 qualitative, and 1 mixed methods study. Analyses revealed that it is necessary to identify patients most likely to benefit from a CM intervention for CM to produce positive outcomes. High-intensity intervention or the presence of a multidisciplinary/interorganizational care plan was also associated with positive outcomes. CONCLUSIONS Policy makers and clinicians should focus on their case-finding processes because this is the essential characteristic of CM effectiveness. In addition, value should be placed on high-intensity CM interventions and developing care plans with multiple types of care providers to help improve patient outcomes.
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Affiliation(s)
- Catherine Hudon
- Département de Médecine de Famille et de Médecine d'Urgence, Université de Sherbrooke, Québec, Canada
| | | | - Pierre Pluye
- Département de Médecine de Famille, Université McGill, Québec, Canada
| | - Reem El Sherif
- Département de Médecine de Famille, Université McGill, Québec, Canada
| | - Paula Louise Bush
- Département de Médecine de Famille, Université McGill, Québec, Canada
| | - Benoît Rihoux
- Institut de Sciences Politiques Louvain-Europe (ISPOLE), Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Marie-Eve Poitras
- Département des Sciences de la Santé, Université du Québec à Chicoutimi, Québec, Canada
| | - Mireille Lambert
- Centre Intégré Universitaire de Santé et Services Sociaux du Saguenay-Lac-Saint-Jean, Québec, Canada
| | | | - France Légaré
- Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Canada
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Impact of health service interventions on acute hospital use in community-dwelling persons with dementia: A systematic literature review and meta-analysis. PLoS One 2019; 14:e0218426. [PMID: 31226138 PMCID: PMC6588225 DOI: 10.1371/journal.pone.0218426] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/03/2019] [Indexed: 11/19/2022] Open
Abstract
Background Persons with dementia have twice the acute hospital use as older persons without dementia. In addition to straining overburdened healthcare systems, acute hospital use impacts patient and caregiver quality of life and is associated with increased risk of adverse outcomes including death. Reducing avoidable acute hospital use in persons with dementia is thus a global healthcare priority. However, evidence regarding the impact of health service interventions as defined by the Effective Practice and Organization of Care Cochrane Group on acute hospital use is scant and inconclusive. The aim of this systematic review and meta-analysis was to synthesize available evidence on the impact of health service interventions on acute hospital use in community-dwelling persons with dementia compared to usual care. Methods Data Sources: MEDLINE, EMBASE, CINAHL and Cochrane CENTRAL (from 01/1995 to 08/2017). Study eligibility criteria: Randomised controlled trials measuring the impact of health service interventions on acute hospital use (proportion and mean number of emergency department visits and hospitalisations, mean number of hospital days, measured at 12 months, and at longest follow-up) in community-dwelling persons with dementia, compared to usual care. Study selection, appraisal and synthesis methods: Reviewers independently identified studies, extracted data, and assessed the risk of bias, with the Cochrane risk of bias tool. Authors of relevant trials were queried about unpublished data. Random effects model was used for meta-analyses. Effect heterogeneity was assessed through prediction intervals, and explored using sub-group analyses. Findings Seventeen trials provided data on 4,549 persons. Unpublished data were obtained for 13 trials, representing 65% of synthesized data. Most interventions included a case management or a self-management component. None of the outcome comparisons provided conclusive evidence supporting the hypothesis that these interventions would lead to a decrease in acute hospital use. Furthermore, prediction intervals indicated possible and important increased service use associated with these interventions, such as emergency department visits, hospital admissions, and hospital days. Subgroup analyses did not favour any type of intervention. A limitation of this study is the inclusion of any type of health service intervention, which may have increased the observed heterogeneity. Conclusion Despite a comprehensive systematic review and meta-analysis, including predominantly unpublished data, no health service intervention beyond usual care was found to reduce acute hospital use in community-dwelling persons with dementia. An important increase in service use may be associated with these interventions. Further research is urgently needed to identify effective interventions for this vulnerable population to limit rising acute hospital use, associated costs and adverse outcomes. Systematic review registration PROSPERO CRD42016046444.
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Vedel I, Kaur N, Hong QN, El Sherif R, Khanassov V, Godard-Sebillotte C, Sourial N, Yang XQ, Pluye P. Why and how to use mixed methods in primary health care research. Fam Pract 2019; 36:365-368. [PMID: 31120129 PMCID: PMC6544942 DOI: 10.1093/fampra/cmy127] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Isabelle Vedel
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Navdeep Kaur
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Quan Nha Hong
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Reem El Sherif
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Vladimir Khanassov
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | | | - Nadia Sourial
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Xin Qiang Yang
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Pierre Pluye
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
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Abstract
The importance of better care integration is emphasized in many national dementia plans. The inherent complexity of organizing care for people with dementia provides both the justification for improving care integration and the challenges to achieving it. The prevention, detection, and early diagnosis of cognitive disorders mainly resides in primary care, but how this is best integrated within the range of disorders that primary care clinicians are expected to screen is unclear. Models of integrated community dementia assessment and management have varying degrees of involvement of primary and specialist care, but share an emphasis on improving care coordination, interdisciplinary teamwork, and personalized care. Integrated care strategies in acute care are still in early development, but have been a focus of investigation in the past decade. Integrated care outreach strategies to reduce transfers from long-term residential care to acute care have been consistently effective. Integrated long-term residential care includes considerations of end-of-life care. Future directions should include strategies for training and education, early detection in anticipation of disease modifying treatments, integration of technological developments into dementia care, integration of dementia care into general health and social care, and the encouragement of a dementia-friendly society.
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Affiliation(s)
- Brian Draper
- a School of Psychiatry , University of NSW , Sydney , NSW , Australia
| | - Lee-Fay Low
- b Faculty of Health Sciences , University of Sydney , Sydney , NSW , Australia
| | - Henry Brodaty
- c Centre for Healthy Brain Ageing , University of NSW Sydney , Sydney , NSW , Australia
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Moschetti K, Iglesias K, Baggio S, Velonaki V, Hugli O, Burnand B, Daeppen JB, Wasserfallen JB, Bodenmann P. Health care costs of case management for frequent users of the emergency department: Hospital and insurance perspectives. PLoS One 2018; 13:e0199691. [PMID: 30248102 PMCID: PMC6152853 DOI: 10.1371/journal.pone.0199691] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 06/08/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In most emergency departments (EDs), few patients account for a relatively high number of ED visits. To improve the management of these patients, the university hospital of Lausanne, Switzerland, implemented an interdisciplinary case management (CM) intervention. This study examined whether the CM intervention-compared with standard care (SC) in the ED-reduced costs generated by frequent ED users, not only from the hospital perspective, but also from the third-party payer perspective, that is, from a broader perspective that takes into account the costs of health care services used outside the hospital offering the intervention. METHODS In this randomized controlled trial, 250 frequent ED users (>5 visits during the previous 12 months) were allocated to either the CM or the SC group and followed up for 12 months. Cost data were obtained from the hospital's analytical accounting system for the entire sample and from health insurance companies for a subgroup (n = 140). Descriptive statistics and multivariate regressions were used to make comparisons between groups and assess the contribution of patient characteristics to the main cost components. RESULTS At the end of the 12-month follow-up, 115 patients were in the CM group and 115 in the SC group (20 had died). Despite differences in economic costs between patients in the CM intervention and the SC groups, our results do not show any statistically significant reduction in costs associated with the intervention, either for the hospital that housed the intervention or for the third-party payer. Frequent ED users were big users of health services provided by both the hospital and community-based services, with 40% of costs generated outside the hospital that housed the intervention. Higher age, Swiss citizenship, and having social difficulty increased costs significantly. CONCLUSIONS As the role of the CM team is to guide patients through the entire care process, the intervention location is not limited to the hospital but often extends into the community.
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Affiliation(s)
- Karine Moschetti
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
- Technology Assessment Unit, Lausanne University Hospital, Lausanne, Switzerland
- IEMS Plateforme interfacultaire en économie et management de la santé, University of Lausanne, Lausanne Switzerland
| | - Katia Iglesias
- School of Health Sciences (HEdS-FR), University of Applied Sciences Western Switzerland (HES-SO), Fribourg, Switzerland
| | - Stéphanie Baggio
- Life Course and Social Inequality Research Center, University of Lausanne, Lausanne, Switzerland
| | - Venetia Velonaki
- Department of Community Medicine and Public Health, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Hugli
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Bernard Burnand
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | | | | | - Patrick Bodenmann
- Vulnerable Population Center, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
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23
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Discriminating between empirical studies and nonempirical works using automated text classification. Res Synth Methods 2018; 9:587-601. [DOI: 10.1002/jrsm.1317] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/28/2018] [Accepted: 07/22/2018] [Indexed: 11/07/2022]
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24
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Hartzler AL, Tuzzio L, Hsu C, Wagner EH. Roles and Functions of Community Health Workers in Primary Care. Ann Fam Med 2018; 16:240-245. [PMID: 29760028 PMCID: PMC5951253 DOI: 10.1370/afm.2208] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 12/13/2017] [Accepted: 01/11/2017] [Indexed: 11/09/2022] Open
Abstract
Community health workers have potential to enhance primary care access and quality, but remain underutilized. To provide guidance on their integration, we characterized roles and functions of community health workers in primary care through a literature review and synthesis. Analysis of 30 studies identified 12 functions (ie, care coordination, health coaching, social support, health assessment, resource linking, case management, medication management, remote care, follow-up, administration, health education, and literacy support) and 3 prominent roles representing clusters of functions: clinical services, community resource connections, and health education and coaching. We discuss implications for community health worker training and clinical support in primary care.
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Affiliation(s)
- Andrea L Hartzler
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington
| | - Leah Tuzzio
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Clarissa Hsu
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Edward H Wagner
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
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25
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Threapleton DE, Chung RY, Wong SYS, Wong E, Chau P, Woo J, Chung VCH, Yeoh EK. Integrated care for older populations and its implementation facilitators and barriers: A rapid scoping review. Int J Qual Health Care 2018; 29:327-334. [PMID: 28430963 DOI: 10.1093/intqhc/mzx041] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 03/20/2017] [Indexed: 12/14/2022] Open
Abstract
Purpose Inform health system improvements by summarizing components of integrated care in older populations. Identify key implementation barriers and facilitators. Data sources A scoping review was undertaken for evidence from MEDLINE, the Cochrane Library, organizational websites and internet searches. Eligible publications included reviews, reports, individual studies and policy documents published from 2005 to February 2017. Study selection Initial eligible documents were reviews or reports concerning integrated care approaches in older/frail populations. Other documents were later sourced to identify and contextualize implementation issues. Data extraction Study findings and implementation barriers and facilitators were charted and thematically synthesized. Results of data synthesis Thematic synthesis using 30 publications identified 8 important components for integrated care in elderly and frail populations: (i) care continuity/transitions; (ii) enabling policies/governance; (iii) shared values/goals; (iv) person-centred care; (v) multi-/inter-disciplinary services; (vi) effective communication; (vii) case management; (viii) needs assessments for care and discharge planning. Intervention outcomes and implementation issues (barriers or facilitators) tend to depend heavily on the context and programme objectives. Implementation issues in four main areas were observed: (i) Macro-level contextual factors; (ii) Miso-level system organization (funding, leadership, service structure and culture); (iii) Miso-level intervention organization (characteristics, resources and credibility) and (iv) Micro-level factors (shared values, engagement and communication). Conclusion Improving integration in care requires many components. However, local barriers and facilitators need to be considered. Changes are expected to occur slowly and are more likely to be successful where elements of integrated care are well incorporated into local settings.
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Affiliation(s)
- Diane E Threapleton
- The School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China SAR
| | - Roger Y Chung
- The School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China SAR
| | - Samuel Y S Wong
- The School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China SAR
| | - Eliza Wong
- The School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China SAR
| | - Patsy Chau
- The School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China SAR
| | - Jean Woo
- Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China SAR
| | - Vincent C H Chung
- The School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China SAR
| | - Eng-Kiong Yeoh
- The School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China SAR
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26
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Joo J, Liu M. Experiences of case management with chronic illnesses: a qualitative systematic review. Int Nurs Rev 2018; 65:102-113. [DOI: 10.1111/inr.12429] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J.Y. Joo
- College of Nursing Gachon University Incheon Korea
| | - M.F. Liu
- College of Nursing School of Gerontology Health Management Taipei Medical University Taipei Taiwan
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Backhouse A, Richards DA, McCabe R, Watkins R, Dickens C. Stakeholders perspectives on the key components of community-based interventions coordinating care in dementia: a qualitative systematic review. BMC Health Serv Res 2017; 17:767. [PMID: 29166898 PMCID: PMC5700484 DOI: 10.1186/s12913-017-2725-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 11/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interventions aiming to coordinate services for the community-based dementia population vary in components, organisation and implementation. In this review we aimed to investigate the views of stakeholders on the key components of community-based interventions coordinating care in dementia. METHODS We searched four databases from inception to June 2015; Medline, The Cochrane Library, EMBASE and PsycINFO, this was aided by a search of four grey literature databases, and backward and forward citation tracking of included papers. Title and abstract screening was followed by a full text screen by two independent reviewers, and quality was assessed using the CASP appraisal tool. We then conducted thematic synthesis on extracted data. RESULTS A total of seven papers from five independent studies were included in the review, and encompassed the views of over 100 participants from three countries. Through thematic synthesis we identified 32 initial codes that were grouped into 5 second-order themes: (1) case manager had four associated codes and described preferences for the case manager personal and professional attributes, including a sound knowledge in dementia and availability of local services; (2) communication had five associated codes and emphasized the importance stakeholders placed on multichannel communication with service users, as well as between multidisciplinary teams and across organisations; (3) intervention had 11 associated codes which focused primarily on the practicalities of implementation such as the contact type and frequency between case managers and service users, and the importance of case manager training and service evaluation; (4) resources had five associated codes which outlined stakeholder views on the required resources for coordinating interventions and potential overlap with existing resources, as well as arising issues when available resources do not meet those required for successful implementation; and (5) support had seven associated codes that reflect the importance that was placed on the support network around the case manager and the investment of professionals involved directly in care as well as the wider professional network. CONCLUSION The synthesis of relevant qualitative studies has shown how various stakeholder groups considered dementia care coordination interventions to be acceptable, useful and appropriate for dementia care, and have clear preferences for components, implementation methods and settings of these interventions. By incorporating stakeholders' perspectives and preferences when planning and developing coordinating interventions we may increase the likelihood of successful implementation and patient benefits.
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Affiliation(s)
- Amy Backhouse
- University of Exeter Medical School, College House, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU UK
- National Institute for Health Research (NIHR) South West Peninsula Collaboration for Leadership in Applied Health Research and Care (CLAHRC), Exeter, UK
| | - David A. Richards
- University of Exeter Medical School, College House, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU UK
- National Institute for Health Research (NIHR) South West Peninsula Collaboration for Leadership in Applied Health Research and Care (CLAHRC), Exeter, UK
| | - Rose McCabe
- University of Exeter Medical School, College House, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Ross Watkins
- University of Exeter Medical School, College House, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU UK
- National Institute for Health Research (NIHR) South West Peninsula Collaboration for Leadership in Applied Health Research and Care (CLAHRC), Exeter, UK
| | - Chris Dickens
- University of Exeter Medical School, College House, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU UK
- National Institute for Health Research (NIHR) South West Peninsula Collaboration for Leadership in Applied Health Research and Care (CLAHRC), Exeter, UK
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Swanson J, Weissert WG. Case Managers for High-Risk, High-Cost Patients as Agents and Street-Level Bureaucrats. Med Care Res Rev 2017; 75:527-561. [PMID: 29148354 DOI: 10.1177/1077558717727116] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Case management programs often designate a nurse or social worker to take responsibility for guiding care when patients are expected to be expensive or risk a major decline. We hypothesized that though an intuitively appealing idea, careful program design and faithful implementation are essential if case management programs are to succeed. We employed two theory perspectives, principal-agent framework and street-level bureaucratic theory to describe the relationship between program designers (principals) and case managers (agents/street-level bureaucrats) to review 65 case management studies. Most programs were successful in limited program-specific process and outcome goals. But there was much less success in cost-saving or cost-effectiveness-the original and overarching goal of case management. Cost results might be improved if additional ideas of agency and street-level theory were adopted, specifically, incentives, as well as "green tape," clear rules, guidelines, and algorithms relating to resource allocation among patients.
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Affiliation(s)
| | - William G Weissert
- 1 Florida State University, Tallahassee, FL, USA.,2 University of Michigan, Ann Arbor, MI, USA
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29
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Renehan E, Goeman D, Koch S. Development of an optimised key worker framework for people with dementia, their family and caring unit living in the community. BMC Health Serv Res 2017; 17:501. [PMID: 28728578 PMCID: PMC5520382 DOI: 10.1186/s12913-017-2448-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 07/13/2017] [Indexed: 11/17/2022] Open
Abstract
Background In Australia, dementia is a national health priority. With the rising number of people living with dementia and shortage of formal and informal carers predicted in the near future, developing approaches to coordinating services in quality-focused ways is considered an urgent priority. Key worker support models are one approach that have been used to assist people living with dementia and their caring unit coordinate services and navigate service systems; however, there is limited literature outlining comprehensive frameworks for the implementation of community dementia key worker roles in practice. In this paper an optimised key worker framework for people with dementia, their family and caring unit living in the community is developed and presented. Methods A number of processes were undertaken to inform the development of a co-designed optimised key worker framework: an expert working and reference group; a systematic review of the literature; and a qualitative evaluation of 14 dementia key worker models operating in Australia involving 14 interviews with organisation managers, 19 with key workers and 15 with people living with dementia and/or their caring unit. Data from the systematic review and evaluation of dementia key worker models were analysed by the researchers and the expert working and reference group using a constant comparative approach to define the essential components of the optimised framework. Results The developed framework consisted of four main components: overarching philosophies; organisational context; role definition; and key worker competencies. A number of more clearly defined sub-themes sat under each component. Reflected in the framework is the complexity of the dementia journey and the difficulty in trying to develop a ‘one size fits all’ approach. Conclusions This co-designed study led to the development of an evidence based framework which outlines a comprehensive synthesis of components viewed as being essential to the implementation of a dementia key worker model of care in the community. The framework was informed and endorsed by people living with dementia and their caring unit, key workers, managers, Australian industry experts, policy makers and researchers. An evaluation of its effectiveness and relevance for practice within the dementia care space is required. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2448-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emma Renehan
- RDNS Institute, Royal District Nursing Service Ltd, 31 Alma Rd, St Kilda, Vic, 3182, Australia.
| | - Dianne Goeman
- RDNS Institute, Royal District Nursing Service Ltd, 31 Alma Rd, St Kilda, Vic, 3182, Australia.,Central Clinical School, Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia.,School of Medicine & Public Health, The University of Newcastle, Callaghan, Australia
| | - Susan Koch
- RDNS Institute, Royal District Nursing Service Ltd, 31 Alma Rd, St Kilda, Vic, 3182, Australia.,School of Medicine & Public Health, The University of Newcastle, Callaghan, Australia
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Iliffe S, Wilcock J, Synek M, Carboch R, Hradcová D, Holmerová I. Case Management for People with Dementia and its Translations: A Discussion Paper. DEMENTIA 2017; 18:951-969. [DOI: 10.1177/1471301217697802] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Steve Iliffe
- Research Department of Primary Care & Population Health, University College London, UK
| | - Jane Wilcock
- Research Department of Primary Care & Population Health, University College London, UK
| | - Michal Synek
- Centre of Expertise in Longevity and Long-term Care, Faculty of Humanities, Charles University in Prague, Czech Republic; Department of Sociology, Faculty of Social Studies, Masaryk University, Czech Republic
| | - Radek Carboch
- Centre of Expertise in Longevity and Long-term Care, Faculty of Humanities, Charles University in Prague, Czech Republic; Department of Sociology, Faculty of Social Studies, Masaryk University, Czech Republic
| | - Dana Hradcová
- Centre of Expertise in Longevity and Long-term Care, Faculty of Humanities, Charles University in Prague, Czech Republic
| | - Iva Holmerová
- Centre of Expertise in Longevity and Long-term Care, Faculty of Humanities, Charles University in Prague, Czech Republic
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Khanassov V, Pluye P, Descoteaux S, Haggerty JL, Russell G, Gunn J, Levesque JF. Organizational interventions improving access to community-based primary health care for vulnerable populations: a scoping review. Int J Equity Health 2016; 15:168. [PMID: 27724952 PMCID: PMC5057425 DOI: 10.1186/s12939-016-0459-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 10/03/2016] [Indexed: 12/24/2022] Open
Abstract
Access to community-based primary health care (hereafter, 'primary care') is a priority in many countries. Health care systems have emphasized policies that help the community 'get the right service in the right place at the right time'. However, little is known about organizational interventions in primary care that are aimed to improve access for populations in situations of vulnerability (e.g., socioeconomically disadvantaged) and how successful they are. The purpose of this scoping review was to map the existing evidence on organizational interventions that improve access to primary care services for vulnerable populations. Scoping review followed an iterative process. Eligibility criteria: organizational interventions in Organisation for Economic Cooperation and Development (OECD) countries; aiming to improve access to primary care for vulnerable populations; all study designs; published from 2000 in English or French; reporting at least one outcome (avoidable hospitalization, emergency department admission, or unmet health care needs). SOURCES Main bibliographic databases (Medline, Embase, CINAHL) and team members' personal files. STUDY SELECTION One researcher selected relevant abstracts and full text papers. Theory-driven synthesis: The researcher classified included studies using (i) the 'Patient Centered Access to Healthcare' conceptual framework (dimensions and outcomes of access to primary care), and (ii) the classification of interventions of the Cochrane Effective Practice and Organization of Care. Using pattern analysis, interventions were mapped in accordance with the presence/absence of 'dimension-outcome' patterns. Out of 8,694 records (title/abstract), 39 studies with varying designs were included. The analysis revealed the following pattern. Results of 10 studies on interventions classified as 'Formal integration of services' suggested that these interventions were associated with three dimensions of access (approachability, availability and affordability) and reduction of hospitalizations (four/four studies), emergency department admissions (six/six studies), and unmet healthcare needs (five/six studies). These 10 studies included seven non-randomized studies, one randomized controlled trial, one quantitative descriptive study, and one mixed methods study. Our results suggest the limited breadth of research in this area, and that it will be feasible to conduct a full systematic review of studies on the effectiveness of the formal integration of services to improve access to primary care services for vulnerable populations.
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Affiliation(s)
- Vladimir Khanassov
- Department of Family Medicine, McGill University, 5858 Côte-des-neiges, 3rd Floor, Suite 300, Montreal, QC H3S 1Z1 Canada
| | - Pierre Pluye
- Department of Family Medicine, McGill University, 5858 Côte-des-neiges, 3rd Floor, Suite 300, Montreal, QC H3S 1Z1 Canada
| | - Sarah Descoteaux
- St. Mary’s Hospital Research Centre, 3830 Lacombe Ave, Montréal, QC H3T1M5 Canada
| | - Jeannie L. Haggerty
- Department of Family Medicine, McGill University, St. Mary’s Hospital Research Centre, 3830 Lacombe Ave, Montréal, QC H3T1M5 Canada
| | - Grant Russell
- Southern Academic Primary Care Research Unit, Department of General Practice, School of Primary Health Care, Monash University, Building 1, 270 Ferntree Gully Rd, Notting Hill, VIC 3168 Australia
| | - Jane Gunn
- University of Melbourne, 200 Berkeley Street, Melbourne, VIC 3053 Australia
| | - Jean-Frederic Levesque
- Centre for Primary Health Care and Equity, University of New South Wales, Bureau of Health Information, 67 Albert Avenue, Chatswood, Sydney, NSW 2067 Australia
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Opening-up the definition of systematic literature review: the plurality of worldviews, methodologies and methods for reviews and syntheses. J Clin Epidemiol 2016; 73:2-5. [DOI: 10.1016/j.jclinepi.2015.08.033] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 08/13/2015] [Indexed: 11/21/2022]
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Khanassov V, Vedel I. Family Physician-Case Manager Collaboration and Needs of Patients With Dementia and Their Caregivers: A Systematic Mixed Studies Review. Ann Fam Med 2016; 14:166-77. [PMID: 26951593 PMCID: PMC4781521 DOI: 10.1370/afm.1898] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 10/15/2015] [Accepted: 11/08/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Dementia case management (CM) in primary care is a complex intervention aimed at identifying the various needs of patients with dementia and their caregivers, as well as the organization and coordination of care. A key element of CM is the collaboration of family physicians with case managers. We conducted a systematic mixed-studies review to identify the needs of the patient-caregiver dyad and the effects of CM. METHODS We searched MEDLINE, PsycINFO, and EMBASE up to October 2014, regardless of the study design. Our main outcomes were needs of patients and their caregivers and the effects of CM on these needs. We used narrative syntheses to develop a taxonomy of needs and to describe the effects of CM on those needs. We used meta-analysis to calculate the prevalence of needs and the standardized mean differences to evaluate the effects of CM on the needs identified. RESULTS Fifty-four studies were included. We identified needs of the patient-caregiver dyad and needs of the patient and caregiver individually. CM addressed the majority of the identified needs. Still, some very common needs (eg, early diagnosis) are overlooked while other needs (eg, education on the disease) are well addressed. Fully establishing the value of CM is difficult given the small number of studies of CM in primary care. CONCLUSIONS There is good evidence that case managers, in collaboration with family physicians, have a pivotal role in addressing the needs of the patient-caregiver dyad.
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Affiliation(s)
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montreal, Canada
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de Lange J, Deusing E, van Asch IFM, Peeters J, Zwaanswijk M, Pot AM, Francke AL. Factors facilitating dementia case management: Results of online focus groups. DEMENTIA 2016; 17:110-125. [DOI: 10.1177/1471301216634959] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
To obtain insight into facilitating factors for case management in dementia care, we conducted a qualitative study with 13 online focus groups (OFGs). Participants were professionals involved in dementia case management ( N = 99). We used mind-maps and the method of constant comparison for analysis. Participants perceived OFGs as a useful tool to explore their perspectives. The perceived advantage of OFGs was the flexibility and convenience of logging in at any time or place preferred. Five facilitating factors for case management were identified in the OFGs: 1. Good cooperation between partners; 2. Organisational embedding with an independent position of case managers; 3. Structural funding; 4. Competent case managers; 5. Familiarity with case management in the region. Good cooperation was essential for successful dementia case management and should thus be a primary concern for care providers.
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Affiliation(s)
- Jacomine de Lange
- Program on Aging, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands; Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Eline Deusing
- Program on Aging, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Iris FM van Asch
- Program on Aging, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - José Peeters
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Marieke Zwaanswijk
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Anne Margriet Pot
- Program on Aging, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands; Department of Clinical Psychology, EMGO+, VU University Amsterdam, the Netherlands
| | - Anneke L Francke
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands; Department of Public and Occupational Health, EMGO+, VU University Medical Center Amsterdam, the Netherlands
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Bunn F, Burn AM, Goodman C, Robinson L, Rait G, Norton S, Bennett H, Poole M, Schoeman J, Brayne C. Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem). HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04080] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundAmong people living with dementia (PLWD) there is a high prevalence of comorbid medical conditions but little is known about the effects of comorbidity on processes and quality of care and patient needs or how services are adapting to address the particular needs of this population.ObjectivesTo explore the impact of dementia on access to non-dementia services and identify ways of improving the integration of services for this population.DesignWe undertook a scoping review, cross-sectional analysis of a population cohort database, interviews with PLWD and comorbidity and their family carers and focus groups or interviews with health-care professionals (HCPs). We focused specifically on three conditions: diabetes, stroke and vision impairment (VI). The analysis was informed by theories of continuity of care and access to care.ParticipantsThe study included 28 community-dwelling PLWD with one of our target comorbidities, 33 family carers and 56 HCPs specialising in diabetes, stroke, VI or primary care.ResultsThe scoping review (n = 76 studies or reports) found a lack of continuity in health-care systems for PLWD and comorbidity, with little integration or communication between different teams and specialities. PLWD had poorer access to services than those without dementia. Analysis of a population cohort database found that 17% of PLWD had diabetes, 18% had had a stroke and 17% had some form of VI. There has been an increase in the use of unpaid care for PLWD and comorbidity over the last decade. Our qualitative data supported the findings of the scoping review: communication was often poor, with an absence of a standardised approach to sharing information about a person’s dementia and how it might affect the management of other conditions. Although HCPs acknowledged the vital role that family carers play in managing health-care conditions of PLWD and facilitating continuity and access to care, this recognition did not translate into their routine involvement in appointments or decision-making about their family member. Although we found examples of good practice, these tended to be about the behaviour of individual practitioners rather than system-based approaches; current systems may unintentionally block access to care for PLWD. Pathways and guidelines for our three target conditions do not address the possibility of a dementia diagnosis or provide decision-making support for practitioners trying to weigh up the risks and benefits of treatment for PLWD.ConclusionsSignificant numbers of PLWD have comorbid conditions such as stroke, diabetes and VI. The presence of dementia complicates the delivery of health and social care and magnifies the difficulties that people with long-term conditions experience. Key elements of good care for PLWD and comorbidity include having the PLWD and family carer at the centre, flexibility around processes and good communication which ensures that all services are aware when someone has a diagnosis of dementia. The impact of a diagnosis of dementia on pre-existing conditions should be incorporated into guidelines and care planning. Future work needs to focus on the development and evaluation of interventions to improve continuity of care and access to services for PLWD with comorbidity.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Anne-Marie Burn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Louise Robinson
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Greta Rait
- PRIMENT Clinical Trials Unit, Research Department of Primary Care and Population Health, University College London Medical School, London, UK
| | - Sam Norton
- Department of Psychology, Institute of Psychiatry, King’s College London, London, UK
| | - Holly Bennett
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Marie Poole
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Carol Brayne
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Backhouse A, Dickens C, Richards D, McCabe R. Key components in models of community-based interventions coordinating care in dementia: a mixed studies systematic review protocol. Syst Rev 2015; 4:156. [PMID: 26546134 PMCID: PMC4636819 DOI: 10.1186/s13643-015-0143-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/23/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Current health and social care systems are providing suboptimal and fragmented care to the growing dementia population. Interventions aiming to coordinate care services for individuals with dementia and their families are already widely used; however, the structure and implementation of these interventions vary. This mixed studies review aims to investigate the key components of effective community-based interventions that focus on coordinating care in dementia. METHODS We will search MEDLINE, Cochrane Library, Embase and PsycINFO databases for studies of any design that look at community-based interventions that aim to coordinate dementia care through the allocation of a specified professional responsible for provision of care. Health Management Information Consortium (HMIC), Social Policy and Practice (SPP), ProQuest and International Clinical Trials Registry Platform (ICTRP) databases will be searched for grey literature. Outcomes of interest are health outcome measures that relate to the individual with dementia and/or informal caregiver, measures of resource use or process measures. Two independent reviewers will screen identified papers and extract data from eligible studies. Evidence synthesis will take place in three stages, and methods will be largely dependent on the data available. A sequential review design will be used where the qualitative evidence will be synthesised first, focusing on stakeholder's subjective views of key components. This will drive forward the quantitative stage which will identify key components of effective interventions. The final stage of the review will merge the two strands of evidence through a narrative synthesis. DISCUSSION The results from this review will be used to develop a model for a community-based intervention coordinating care in dementia. Furthermore, the findings will help guide future work on intervention development of health and social care services for dementia. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015024618.
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Affiliation(s)
- Amy Backhouse
- University of Exeter Medical School, College House, St Luke's Campus, Exeter, EX1 2LU, UK. .,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - Chris Dickens
- University of Exeter Medical School, College House, St Luke's Campus, Exeter, EX1 2LU, UK. .,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - David Richards
- University of Exeter Medical School, College House, St Luke's Campus, Exeter, EX1 2LU, UK. .,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - Rose McCabe
- University of Exeter Medical School, College House, St Luke's Campus, Exeter, EX1 2LU, UK. .,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK.
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Modifiable factors and cognitive dysfunction in breast cancer survivors: a mixed-method systematic review. Support Care Cancer 2015; 24:481-497. [DOI: 10.1007/s00520-015-2927-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 08/31/2015] [Indexed: 02/01/2023]
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Stephan A, Möhler R, Renom-Guiteras A, Meyer G. Successful collaboration in dementia care from the perspectives of healthcare professionals and informal carers in Germany: results from a focus group study. BMC Health Serv Res 2015; 15:208. [PMID: 26017697 PMCID: PMC4446073 DOI: 10.1186/s12913-015-0875-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 05/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Informal carers of persons with dementia are in contact with numerous healthcare professionals (HCP) in a complex healthcare system. Successful collaboration between the parties involved appears to be essential for good dementia care. Thus, we investigated the perceptions of both HCP and informal carers regarding successful collaboration and sought to describe obstacles and facilitators. METHODS As part of the 7(th) framework EU project RightTimePlaceCare, five focus groups were conducted with HCP and informal carers of persons with dementia in Germany (n = 30 participants/ time: Oct/Nov 2011). A supplementary secondary data analysis was performed, applying qualitative content analysis with open coding. RESULTS The derived categories were sorted into three overarching themes: collaboration between HCP and informal carers, collaboration among HCP and the impact of resources and healthcare system. HCP and informal carers largely agree on what facilitates or impedes successful collaboration between them. Making the initial contact appears to be a major challenge. While HCP expect to be contacted, informal carers hesitate to seek assistance, primarily due to inner barriers. Permanent contact person/institution, well-trained, empathetic HCP who can establish a trustful relationship are regarded as facilitating collaboration. The relational perspective is more clearly emphasised by HCP than by informal carers. This may be attributed to the absence of a permanent contact person in Germany. Sufficient information relay, clear responsibilities, motivation and defined aims, and a personal relationship between professionals are mentioned as facilitators. External factors, such as rapid staff turnover, insufficient time resources and conditions specified by the health and long-term care system causing financial competition between providers, are described as general barriers to successful collaboration. CONCLUSIONS HCP and informal carers had comparable perceptions of successful collaboration among them. The initial contact seems to be particularly challenging. Better strategies are urgently needed to facilitate the access to professional support. A permanent contact person (e.g., a case manager) might improve collaboration among all the parties involved, but this is not available regularly. Constraints created by the healthcare system may considerably hinder successful collaboration.
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Affiliation(s)
- Astrid Stephan
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Stockumer Straße 12, 58453, Witten, Germany. .,Medical Faculty, Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany.
| | - Ralph Möhler
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Stockumer Straße 12, 58453, Witten, Germany. .,Medical Faculty, Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany.
| | - Anna Renom-Guiteras
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Stockumer Straße 12, 58453, Witten, Germany. .,Faculty of Health, Institute of General Practice and Family Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany.
| | - Gabriele Meyer
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Stockumer Straße 12, 58453, Witten, Germany. .,Medical Faculty, Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany.
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Affiliation(s)
- Sascha Köpke
- University of LübeckNursing Research Group, Institute of Social Medicine and EpidemiologyGermany
- Cochrane Dementia and Cognitive Impairment Group
| | - Jenny McCleery
- Cochrane Dementia and Cognitive Impairment Group
- Oxford Health NHS Foundation TrustBanburyUK
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Stange KC. In this issue: raise the gaze. Ann Fam Med 2014; 12:398-9. [PMID: 25354413 PMCID: PMC4157973 DOI: 10.1370/afm.1695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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