1
|
Arsenault-Lapierre G, Lemay-Compagnat A, Guillette M, Couturier Y, Massamba V, Dufour I, Maubert E, Fournier C, Denis J, Morin C, Vedel I. Dashboards to Support Implementation of the Quebec Alzheimer Plan: Evaluation Study With Regional and Professional Considerations. JMIR Form Res 2024; 8:e55064. [PMID: 38717803 PMCID: PMC11112472 DOI: 10.2196/55064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/27/2024] [Accepted: 04/04/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Health organizations face the critical task of executing and overseeing comprehensive health care. To address the challenges associated with this task, evidence-based dashboards have emerged as valuable tools. Since 2016, the regional health organizations of Quebec, Canada, have been responsible for ensuring implementation of the Quebec Alzheimer Plan (QAP), a provincial plan that aims to reinforce the capacity of primary care services to detect, diagnose, and treat persons with dementia. Despite the provincial scope of the QAP, the diverse material and human resources across regions introduce variability in the interest, utility, and specific needs associated with these dashboards. OBJECTIVE The aim of this study was to assess the interest and utility of dashboards to support the QAP implementation, as well as to determine the needs for improving these aspects according to the perspectives of various types of professionals involved across regions. METHODS An evaluative study using qualitative methods was conducted within a collaborative research approach involving different stakeholders, including the ministerial advisor and the four project managers responsible for supporting the implementation of the QAP, as well as researchers/scientific advisors. To support these organizations, we developed tailored, 2-page paper dashboards, detailing quantitative data on the prevalence of dementia, the use of health services by persons with dementia, and achievements and challenges of the QAP implementation in each organization's jurisdiction. We then conducted 23 focus groups with the managers and leading clinicians involved in the implementation of the QAP of each regional health organization. Real-time notes were taken using a structured observation grid. Content analysis was conducted according to different regions (organizations with university mandates or nearby organizations, labeled "university/peripheral"; organizations for which only part of the territory is in rural areas, labeled "mixed"; and organizations in remote or isolated areas, labeled "remote/isolated") and according to different types of participants (managers, leading clinicians, and other participants). RESULTS Participants from organizations in all regions expressed interest in these dashboards and found them useful in several ways. However, they highlighted the need for indicators on orphan patients and other health care providers. Differences between regions were observed, particularly in the interest in continuity of care in university/peripheral regions and the need for diagnostic tools adapted to the culture in remote/isolated regions. CONCLUSIONS These dashboards support the implementation of an Alzheimer Plan and contribute to the emergence of a learning health care system culture. This project allows each region to increase its monitoring capacity for the implementation of the QAP and facilitates reflection among individuals locally carrying out the implementation. The perspectives expressed will guide the preparation of the next iteration of the dashboards.
Collapse
Affiliation(s)
- Genevieve Arsenault-Lapierre
- Center for Research and Expertise in Social Gerontology, Centre intégré universitaire de santé et de services sociaux du Centre-Ouest de l'Ile de Montréal, Côte Saint-Luc, QC, Canada
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Alexandra Lemay-Compagnat
- Lady Davis Institute for Medical Research, Centre intégré universitaire de santé et de services sociaux du Centre-Ouest de l'Ile de Montréal, Montreal, QC, Canada
| | - Maxime Guillette
- Department of Social Work, Sherbrooke University, Sherbrooke, QC, Canada
| | - Yves Couturier
- Department of Social Work, Sherbrooke University, Sherbrooke, QC, Canada
| | | | - Isabelle Dufour
- School of Nursing, Sherbrooke University, Sherbrooke, QC, Canada
- Center on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Eric Maubert
- Integrated University Health and Social Services Network of McGill University, Montreal, QC, Canada
| | - Christine Fournier
- Integrated University Health and Social Services Network of Université de Montréal, Montreal, QC, Canada
| | - Julie Denis
- Integrated University Health and Social Services Network of Université Laval, Quebec, QC, Canada
| | - Caroline Morin
- Integrated University Health and Social Services Network of Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Centre intégré universitaire de santé et de services sociaux du Centre-Ouest de l'Ile de Montréal, Montreal, QC, Canada
| |
Collapse
|
2
|
Poitras ME, Couturier Y, Beaupré P, Girard A, Aubry F, Vaillancourt VT, Carrier JD, Fortin L, Racine J, Morneau J, Boudreault A, Cormier C, Morin A, McGraw M. Collaborative practice competencies needed for telehealth delivery by health and social care professionals: a scoping review. J Interprof Care 2024; 38:331-345. [PMID: 37226329 DOI: 10.1080/13561820.2023.2213712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 04/06/2023] [Indexed: 05/26/2023]
Abstract
In the context of the COVID-19 pandemic, many healthcare and social services professionals have had to provide services through virtual care. In the workplace, such professionals often need to be sufficiently resourced to collaborate and address collaborative care barriers in telehealth. We performed a scoping review to identify the competencies required to support interprofessional collaboration among clinicians in telehealth. We followed Arksey and O'Malley's and the Joanna Briggs Institute's methodological guidelines, including quantitative and qualitative peer-reviewed articles published between 2010 and 2021. We expanded our data sources by searching for any organization or experts in the field via Google. The analysis of the resulting thirty-one studies and sixteen documents highlighted that health and social services professionals are generally unaware of the competencies they need to develop or maintain interprofessional collaboration in telehealth. In an era of digital innovations, we believe this gap may jeopardize the quality of the services offered to patients and needs to be addressed. Of the six competency domains in the National Interprofessional Competency Framework, it was observed that interprofessional conflict resolution was the competency that emerged least as an essential competency to be developed, while interprofessional communication and patient/client/family/community-centered care were identified as the two most reported essential competencies.
Collapse
Affiliation(s)
- Marie-Eve Poitras
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Saguenay, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Canada
| | - Yves Couturier
- School of Social Work, Université de Sherbrooke, Sherbrooke, Canada
| | - Priscilla Beaupré
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Saguenay, Canada
| | - Ariana Girard
- Centre de recherche en santé durable, Université Laval, Québec, Canada
| | - Francois Aubry
- Department of Social Work, Université du Québec en Outaouais, Gatineau, Canada
| | - Vanessa T Vaillancourt
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Saguenay, Canada
| | | | - Laurie Fortin
- Direction des soins infirmiers, Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Saguenay, Canada
| | - Julie Racine
- Centre de recherche appliquée en intervention psychosociale, Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Alma, Canada
| | - Jean Morneau
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Saguenay, Canada
| | - Amélie Boudreault
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Saguenay, Canada
| | - Caroline Cormier
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Saguenay, Canada
| | - Anaëlle Morin
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Saguenay, Canada
| | - Monica McGraw
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Saguenay, Canada
| |
Collapse
|
3
|
Couture V, Germain N, Côté É, Lavoie L, Robitaille J, Morin M, Chouinard J, Couturier Y, Légaré F, Hardy MS, Chartier LB, Brousseau AA, Sourial N, Mercier É, Dallaire C, Fleet R, Leblanc A, Melady D, Roy D, Sinha S, Sirois MJ, Witteman HO, Émond M, Rivard J, Pelletier I, Turcotte S, Samb R, Giguère R, Abrougui L, Smith PY, Archambault PM. Transitions of care for older adults discharged home from the emergency department: an inductive thematic content analysis of patient comments. BMC Geriatr 2024; 24:8. [PMID: 38172725 PMCID: PMC10763115 DOI: 10.1186/s12877-023-04482-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 11/13/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE Improving care transitions for older adults can reduce emergency department (ED) visits, adverse events, and empower community autonomy. We conducted an inductive qualitative content analysis to identify themes emerging from comments to better understand ED care transitions. METHODS The LEARNING WISDOM prospective longitudinal observational cohort includes older adults (≥ 65 years) who experienced a care transition after an ED visit from both before and during COVID-19. Their comments on this transition were collected via phone interview and transcribed. We conducted an inductive qualitative content analysis with randomly selected comments until saturation. Themes that arose from comments were coded and organized into frequencies and proportions. We followed the Standards for Reporting Qualitative Research (SRQR). RESULTS Comments from 690 patients (339 pre-COVID, 351 during COVID) composed of 351 women (50.9%) and 339 men (49.1%) were analyzed. Patients were satisfied with acute emergency care, and the proportion of patients with positive acute care experiences increased with the COVID-19 pandemic. Negative patient comments were most often related to communication between health providers across the care continuum and the professionalism of personnel in the ED. Comments concerning home care became more neutral with the COVID-19 pandemic. CONCLUSION Patients were satisfied overall with acute care but reported gaps in professionalism and follow-up communication between providers. Comments may have changed in tone from positive to neutral regarding home care over the COVID-19 pandemic due to service slowdowns. Addressing these concerns may improve the quality of care transitions and provide future pandemic mitigation strategies.
Collapse
Affiliation(s)
- Vanessa Couture
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Nathalie Germain
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Medicine, Université Laval, Québec, Québec Canada
| | - Émilie Côté
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Lise Lavoie
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Joanie Robitaille
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Michèle Morin
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Medicine, Université Laval, Québec, Québec Canada
| | - Josée Chouinard
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Yves Couturier
- Department of Social Work, Université de Sherbrooke, Sherbrooke, Québec Canada
| | - France Légaré
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- VITAM - Centre de recherche en santé durable, Québec, Québec Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Québec Canada
- Centre de recherche du CHU de Québec - Université Laval, Axe santé des populations et pratiques optimales en santé, Université Laval, Québec, Québec Canada
| | - Marie-Soleil Hardy
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Lucas B. Chartier
- Department of Emergency Medicine, University Health Network, Toronto, ON Canada
| | | | - Nadia Sourial
- Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montréal, Montréal, Québec Canada
| | - Éric Mercier
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- Centre de recherche du CHU de Québec - Université Laval, Axe santé des populations et pratiques optimales en santé, Université Laval, Québec, Québec Canada
| | - Clémence Dallaire
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Nursing Science, Université Laval, Québec, Québec Canada
| | - Richard Fleet
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- VITAM - Centre de recherche en santé durable, Québec, Québec Canada
| | - Annie Leblanc
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- VITAM - Centre de recherche en santé durable, Québec, Québec Canada
| | - Don Melady
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
- Schwartz-Reisman Emergency Medicine Institute, Mount Sinai Hospital, Toronto, ON Canada
| | - Denis Roy
- Commissaire à la santé et au bien-être (CSBE), Québec, Québec Canada
| | - Samir Sinha
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, Sinai Health System and University Health Network, Toronto, ON Canada
| | - Marie-Josée Sirois
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- Département de réadaptation, Faculté de médecine, Université Laval, Québec, Québec Canada
| | - Holly O. Witteman
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- VITAM - Centre de recherche en santé durable, Québec, Québec Canada
| | - Marcel Émond
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- VITAM - Centre de recherche en santé durable, Québec, Québec Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Québec Canada
| | - Josée Rivard
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Isabelle Pelletier
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Stéphane Turcotte
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Rawane Samb
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Raphaëlle Giguère
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Science and Engineering, Université Laval, Québec, Québec Canada
| | - Lyna Abrougui
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Science and Engineering, Université Laval, Québec, Québec Canada
| | - Pascal Y. Smith
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Patrick M. Archambault
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- VITAM - Centre de recherche en santé durable, Québec, Québec Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Québec Canada
| | | |
Collapse
|
4
|
Levasseur M, Naud D, Menec V, Dubois MF, Wolfson C, Griffith LE, Trottier L, McMillan J, Généreux M, Roy M, Couturier Y, Raina P. Effect of Age-Friendly Communities Action Plan on Trajectories of Older Canadians' Depressive Symptoms Between 2018 and 2020: Multilevel Results From the Canadian Longitudinal Study on Aging. Inquiry 2024; 61:469580231225918. [PMID: 38361415 PMCID: PMC10874163 DOI: 10.1177/00469580231225918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/28/2023] [Accepted: 12/17/2023] [Indexed: 02/17/2024]
Abstract
As the COVID-19 pandemic impacted mental health, this longitudinal study examined the effect of age-friendly communities (AFC) action plan on older adults' depressive symptoms. Using the CLSA, the CLSA COVID-19 Questionnaire study, survey of Canadian municipalities, and the census, the depressive symptoms trajectories were modeled with multilevel multinomial regressions. Most respondents (66.1%) had non-depressed trajectories, 28.1% experienced a moderate increase in depressive symptoms, and 5.8% had a depressed trajectory. AFC action plans did not have a protective effect on these trajectories. Being a female, greater loneliness, lower income, ≥2 chronic conditions, inferior social participation, weaker sense of belonging, COVID-19 infection, and pandemic stressors predicted a depressed trajectory. Neighborhood's deprivation had a weak protective effect on the declining trajectory. Although AFC action plans provided no benefits during the pandemic, volunteers facilitating resource access and social interactions could limit any increase in depressive symptoms.
Collapse
Affiliation(s)
- Mélanie Levasseur
- Eastern Townships Integrated University Health and Social Services Centre – Sherbrooke University Hospital Centre (CIUSSS de l’Estrie – CHUS), Sherbrooke, QC, Canada
- Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Daniel Naud
- Eastern Townships Integrated University Health and Social Services Centre – Sherbrooke University Hospital Centre (CIUSSS de l’Estrie – CHUS), Sherbrooke, QC, Canada
- Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Marie-France Dubois
- Eastern Townships Integrated University Health and Social Services Centre – Sherbrooke University Hospital Centre (CIUSSS de l’Estrie – CHUS), Sherbrooke, QC, Canada
- Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | | | - Lise Trottier
- Eastern Townships Integrated University Health and Social Services Centre – Sherbrooke University Hospital Centre (CIUSSS de l’Estrie – CHUS), Sherbrooke, QC, Canada
| | | | | | - Mathieu Roy
- Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | | |
Collapse
|
5
|
Prieur Chaintré A, Couturier Y, Nguyen TT, Levasseur M. Influence of Hearing Loss on Social Participation in Older Adults: Results From a Scoping Review. Res Aging 2024; 46:72-90. [PMID: 37157996 PMCID: PMC10666503 DOI: 10.1177/01640275231174561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
This study aimed to provide a comprehensive understanding of the influence of hearing loss on social participation in older adults and including its facilitators and barriers. Following the rigorous methodological framework of scoping studies, nine multidisciplinary databases were searched with 44 keywords. Published mainly in the last decade, 41 studies using primarily a quantitative cross-sectional design were selected. Older adults with hearing loss have been found to have difficulty maintaining relationships and social activities. While social support and engaged-coping strategies were major facilitators of social participation, barriers included greater hearing loss, communication difficulties, comorbidities and reduced mental health. To better promote the social participation of older adults, early detection of hearing loss, holistic assessment, and interprofessional collaboration must be considered. Future research is necessary to better address the stigma related to hearing loss in older adults and challenges of early detection, and to propose innovative solutions to develop interprofessional collaboration.
Collapse
Affiliation(s)
- Agathe Prieur Chaintré
- Faculty of Letters and Social Sciences, Université de Sherbrooke, Quebec, Canada
- Research Center on Aging, Health and Social Services Centre, University Institute of Geriatrics of Sherbrooke, Quebec, Canada
| | - Yves Couturier
- Faculty of Letters and Social Sciences, Université de Sherbrooke, Quebec, Canada
| | - T.H. Trang Nguyen
- Faculty of Letters and Social Sciences, Université de Sherbrooke, Quebec, Canada
- Research Center on Aging, Health and Social Services Centre, University Institute of Geriatrics of Sherbrooke, Quebec, Canada
| | - Mélanie Levasseur
- Research Center on Aging, Health and Social Services Centre, University Institute of Geriatrics of Sherbrooke, Quebec, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Quebec, Canada
| |
Collapse
|
6
|
Morin A, Couturier Y, Poirier MD, T Vaillancourt V, Massé S, D Tardif A, Poitras ME. The impact of patients as trainers on registered nurses' patient engagement in primary care clinics: a qualitative study. BMC Prim Care 2023; 24:265. [PMID: 38087266 PMCID: PMC10717897 DOI: 10.1186/s12875-023-02210-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND In Canada, primary care is usually the front door to health care for people with health issues. Among these primary care services are primary care clinics (PCC), where the competencies of registered nurses (RNs) are needed. However, nursing practice in PCCs is variable and sometimes suboptimal from one PCC to another. In 2019, the Quebec Ministry of Health and Social Services deployed a practical guide for RNs practicing in PCCs. This guide was intended to support best professional and interprofessional practices and enhance the quality of services offered according to a physical-social vision of care, interprofessional collaboration and partnership with the patient. The Formation de formateurs en première ligne (F2PL) project team developed a train-the-trainer educational intervention to support RNs in assimilating the content of this guide. This educational intervention is uncommon because it includes patients as trainers (PTs). PTs developed and provided andragogic content about patient's experience to enhance patient engagement. OBJECTIVE To describe the impacts of the educational intervention provided by the PTs in nurses' patient engagement practices in PCCs. METHODS A descriptive qualitative approach was used to describe in-depth changes in RNs' practices. Individual interviews were conducted with 10 RNs and 3 PTs to explore the changes in RNs' practice and the barriers and facilitators to adopting this new practice. An inductive and deductive thematic analysis was carried out according to a conceptual model of patient engagement (the Montreal Model), and emerging themes were condensed into propositions. To ensure credibility, a peer review was conducted with the F2PL team, which includes a patient co-leader. RESULTS The educational intervention provided by PTs has impacted RNs' practice in 3 ways: awareness or reminding of general principles, updating commitment to already known principles and enhancing the development of new professional skills. CONCLUSIONS PTs could effectively support the RNs' motivation to use patient engagement practices in primary care.
Collapse
Affiliation(s)
- A Morin
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Saguenay, Canada
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Saguenay, Canada
- CRMUS Research Chair On Optimal Professional Practices in Primary Care, Saguenay, Canada
| | - Y Couturier
- Department of Social Work, Université de Sherbrooke, Sherbrooke, Canada
| | - M-D Poirier
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Saguenay, Canada
- CRMUS Research Chair On Optimal Professional Practices in Primary Care, Saguenay, Canada
| | - V T Vaillancourt
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Saguenay, Canada
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Saguenay, Canada
- CRMUS Research Chair On Optimal Professional Practices in Primary Care, Saguenay, Canada
| | - S Massé
- School of Nursing, Université du Québec À Chicoutimi, Chicoutimi, Canada
| | - A D Tardif
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Saguenay, Canada
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Saguenay, Canada
- CRMUS Research Chair On Optimal Professional Practices in Primary Care, Saguenay, Canada
| | - M-E Poitras
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Saguenay, Canada.
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Saguenay, Canada.
- CRMUS Research Chair On Optimal Professional Practices in Primary Care, Saguenay, Canada.
| |
Collapse
|
7
|
Dufour I, Arsenault-Lapierre G, Guillette M, Dame N, Poitras ME, Lussier MT, Fortier A, Brunet J, Martin J, Laverdure M, Brousseau G, Bergman H, Couturier Y, Quesnel-Vallée A, Vedel I. Research protocol of the Laval-ROSA Transilab: a living lab on transitions for people living with dementia. BMC Health Serv Res 2023; 23:1255. [PMID: 37964248 PMCID: PMC10647081 DOI: 10.1186/s12913-023-10248-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/30/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND The Laval-ROSA Transilab is a living lab that aims to support the Laval Integrated Health and Social Services Centres (Quebec, Canada) in consolidating the Quebec Alzheimer Plan. It aims to improve care transitions between different settings (Family Medicine Groups, home care, and community services) and as such improve the care of people living with dementia and their care partners. Four transition-oriented innovations are targeted. Two are already underway and will be co-evaluated: A) training of primary care professionals on dementia and interprofessional collaboration; B) early referral process to community services. Two will be co-developed and co-evaluated: C) developing a structured communication strategy around the dementia diagnosis disclosure; D) designation of a care navigator from the time of dementia diagnosis. The objectives are to: 1) co-develop a dashboard for monitoring transitions; 2) co-develop and 3) co-evaluate the four targeted innovations on transitions. In addition, we will 4) co-evaluate the impact and implementation process of the entire Laval-ROSA Transilab transformation, 5) support its sustainability, and 6) transfer it to other health organizations. METHODS Multi-methods living lab approach based on the principles of a learning health system. Living labs are open innovation systems that integrate research co-creation and knowledge exchange in real-life settings. Learning health systems centers care improvement on developing the organization's capacity to learn from their practices. We will conduct two learning cycles (data to knowledge, knowledge to practice, and practice to data) and involve various partners. We will use multiple data sources, including health administrative databases, electronic health records data, surveys, semi-structured interviews, focus groups, and observations. DISCUSSION Through its structuring actions, the Laval-ROSA Transilab will benefit people living with dementia, their care partners, and healthcare professionals. Its strategies will support sustainability and will thus allow for improvements throughout the care continuum so that people can receive the right services, at the right time, in the right place, and from the right staff.
Collapse
Affiliation(s)
- Isabelle Dufour
- School of Nursing, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12E Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada.
| | | | - Maxime Guillette
- School of Social Work, Faculty of Letters and Humanities, Université de Sherbrooke, Sherbrooke, Canada
| | - Nathalie Dame
- School of Social Work, Faculty of Letters and Humanities, Université de Sherbrooke, Sherbrooke, Canada
| | - Marie-Eve Poitras
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Marie-Thérèse Lussier
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Annie Fortier
- Integrated Health and Social Services Centre of Laval, Laval, Canada
| | - Julie Brunet
- Integrated Health and Social Services Centre of Laval, Laval, Canada
| | - Julie Martin
- School of Social Work, Faculty of Letters and Humanities, Université de Sherbrooke, Sherbrooke, Canada
| | | | - Ginette Brousseau
- Integrated Health and Social Services Centre of Laval, Laval, Canada
| | - Howard Bergman
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Yves Couturier
- School of Social Work, Faculty of Letters and Humanities, Université de Sherbrooke, Sherbrooke, Canada
| | | | - Isabelle Vedel
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| |
Collapse
|
8
|
Stewart T, Dionne É, Urquhart R, Oelke ND, Couturier Y, Scott CM, Haggerty J. Integrating Health and Social Care for Community-Dwelling Older Adults: A Description of 16 Canadian Programs. Healthc Policy 2023; 19:78-87. [PMID: 37850707 PMCID: PMC10594941 DOI: 10.12927/hcpol.2023.27177] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
This paper describes 16 Canadian programs designed to provide integrated primary care for older adults. Publicly available data were used to identify the "what" and the "how" of integration for each program. Most programs integrated with other healthcare or medical services (vs. social services). Mechanisms of integration varied; the most common mechanism was interprofessional teams. Only 25% of the programs formally engaged with autonomous physician-led primary care practices (where most Canadians receive their primary care). Findings suggest that integrated care is a priority across Canada but also highlight how far we have to go to achieve both vertical integration within the healthcare sector (primary, secondary and tertiary services) and horizontal integration across sectors (health and social).
Collapse
Affiliation(s)
- Tara Stewart
- Assistant Professor, Department of Community Health Sciences, University of Manitoba, Researcher/Evaluator, George & Fay Yee Centre for Healthcare Innovation, Manitoba SPOR SUPPORT Unit, Winnipeg, MB
| | - Émilie Dionne
- Researcher and Adjunct Professor, Vitam - Centre de recherche en santé durable, Department of Sociology, Faculty of Social Sciences, Laval University, Quebec City, QC
| | - Robin Urquhart
- Endowed Chair in Population Cancer Research, Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS
| | - Nelly D Oelke
- Associate Professor, School of Nursing, Faculty of Health and Social Development, University of British Columbia-Okanagan, Kelowna, BC
| | - Yves Couturier
- Scientific Director and, Réseau-1 Quebec Professor, École de travail social, Faculté des lettres et des sciences humaines, Université de Sherbrooke, Sherbrooke, QC
| | - Catherine M Scott
- Adjunct Professor, University of Calgary and University of British Columbia-Okanagan, Executive Coach and Knowledge Mobilisation Consultant, K2A Consulting, Calgary, AB
| | - Jeannie Haggerty
- McGill Research Chair in Family and Community Medicine, McGill University and St. Mary's Hospital Research Centre, Montréal, QC
| |
Collapse
|
9
|
Scott CM, Haggerty J, Couturier Y, Quesnel-Vallée A, Stewart T, Dionne É. Inconsistent Governance Structures for Health and Social Services Limit Service Integration for Patients with Complex Care Needs. Healthc Policy 2023; 19:39-52. [PMID: 37850704 PMCID: PMC10594950 DOI: 10.12927/hcpol.2023.27180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
This paper describes how health and social services are governed and organized across Canada for two patient groups. Governance configurations and governance proximity between primary care and priority health and social services varied markedly between provinces. While the need for integrated service delivery has been made a clear priority during the COVID-19 pandemic, the potential of Canada's healthcare systems has not yet translated into coordinated and integrated care for health services, much less for health and social services. It is time to act on the policy recommendations from commissioned reports over the past two decades that focus on comprehensive, community-based care.
Collapse
Affiliation(s)
- Catherine M Scott
- Adjunct Professor, University of Calgary and University of British Columbia-Okanagan, Executive Coach and Knowledge Mobilisation Consultant, K2A Consulting, Calgary, AB
| | - Jeannie Haggerty
- McGill Research Chair in Family and Community Medicine, McGill University and St. Mary's Hospital Research Centre, Montréal, QC
| | - Yves Couturier
- Scientific Director and, Réseau-1 Quebec Professor, École de travail social, Faculté des lettres et des sciences humaines, Université de Sherbrooke, Sherbrooke, QC
| | - Amélie Quesnel-Vallée
- Canada Research Chair in Policies and Health Inequalities, Professor, Department of Epidemiology, Biostatistics and Occupational Health, Department of Sociology, McGill University, Montréal, QC
| | - Tara Stewart
- Assistant Professor, Department of Community Health Sciences, University of Manitoba, Researcher/Evaluator, George & Fay Yee Centre for Healthcare Innovation, Manitoba SPOR SUPPORT Unit, Winnipeg, MB
| | - Émilie Dionne
- Researcher and Adjunct Professor, VITAM- Centre de recherche en santé durable, Department of Sociology, Faculty of Social Sciences, Laval University, Quebec City, QC
| |
Collapse
|
10
|
Levasseur M, Dubois MF, Généreux M, Naud D, Trottier L, Menec V, Roy M, Gabaude C, Couturier Y, Raina P. Key Age-Friendly Components of Municipalities that Foster Social Participation of Aging Canadians: Results from the Canadian Longitudinal Study on Aging. J Urban Health 2023; 100:1032-1042. [PMID: 37594674 PMCID: PMC10618123 DOI: 10.1007/s11524-023-00762-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 08/19/2023]
Abstract
Municipalities can foster the social participation of aging adults. Although making municipalities age-friendly is recognized as a promising way to help aging adults stay involved in their communities, little is known about the key components (e.g., services and structures) that foster social participation. This study thus aimed to identify key age-friendly components (AFC) best associated with the social participation of older Canadians. Secondary analyses were carried out using baseline data from the Canadian Longitudinal Study on Aging (n = 25,411) in selected municipalities (m = 110 with ≥ 30 respondents), the Age-friendly Survey, and census data. Social participation was estimated based on the number of community activities outside the home per month. AFC included housing, transportation, outdoor spaces and buildings, safety, recreation, workforce participation, information, respect, health, and community services. Multilevel models were used to examine the association between individual social participation, key AFC, and environmental characteristics, while controlling for individual characteristics. Aged between 45 and 89, half of the participants were women who were engaged in 20.2±12.5 activities per month. About 2.5% of the variance in social participation was attributable to municipalities. Better outdoor spaces and buildings (p < 0.001), worse communication and information (p < 0.01), and lower material deprivation (p < 0.001) were associated with higher social participation. Age was the only individual-level variable to have a significant random effect, indicating that municipal contexts may mediate its impact with social participation. This study provides insights to help facilitate social participation and promote age-friendliness, by maintaining safe indoor and outdoor mobility, and informing older adults of available activities.
Collapse
Affiliation(s)
- Mélanie Levasseur
- CIUSSS de L'Estrie CHUS: Centre Integre Universitaire de Sante Et de Services Sociaux de L'Estrie Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada.
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada.
| | - Marie-France Dubois
- CIUSSS de L'Estrie CHUS: Centre Integre Universitaire de Sante Et de Services Sociaux de L'Estrie Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Mélissa Généreux
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Daniel Naud
- CIUSSS de L'Estrie CHUS: Centre Integre Universitaire de Sante Et de Services Sociaux de L'Estrie Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Lise Trottier
- CIUSSS de L'Estrie CHUS: Centre Integre Universitaire de Sante Et de Services Sociaux de L'Estrie Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
| | - Verena Menec
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Mathieu Roy
- CIUSSS de L'Estrie CHUS: Centre Integre Universitaire de Sante Et de Services Sociaux de L'Estrie Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
| | | | - Yves Couturier
- Department of Social Work, Université de Sherbrooke, Sherbrooke, Canada
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Labarge Centre for Mobility in Aging, McMaster University, Hamilton, Canada
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Canada
| |
Collapse
|
11
|
Dionne É, Haggerty J, Scott CM, Doucet S, Stewart T, Quesnel-Vallée A, Montelpare W, Urquhart R, Sutherland JM, Couturier Y. Toward Comprehensive Care Integration in Canada: Delphi Process Findings from Researchers, Clinicians, Patients and Decision Makers. Healthc Policy 2023; 19:24-38. [PMID: 37850703 PMCID: PMC10594939 DOI: 10.12927/hcpol.2023.27181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
Introduction From a larger study examining policy and program information on how Canadian provinces integrate care services, this study aimed to create "priority lists" of 10-15 services that are "absolutely needed" for care integration. Methodology A diverse group of over 50 Canadian stakeholders participated in virtual consensus-building using the nominal group technique and a modified e-Delphi method to identify services that focused on two different groups: children and youth with high functional health needs and older adults in functional decline. Results Three lists - containing services, processes and infrastructure elements - emerged: one per tracer condition group and a consolidated list. The latter identified the following five services as top priority for primary care integration: mental health and addictions services; home care; transition between urgent-emergency-acute care; medication reconciliation in community pharmacies; and respite care. No single social service was a clear priority, but those that mitigate material deprivation emerged within the top 10. Discussion This humble pan-Canadian study shows that priority services in health and social services are neither well integrated nor connected to primary care. It also suggests that effective policy strategizing for primary care integration for those with complex care needs may require thinking beyond the logic of services - given their siloed organization.
Collapse
Affiliation(s)
- Émilie Dionne
- Researcher and Adjunct Professor, VITAM - Centre de recherche en santé durable, Department of Sociology, Faculty of Social Sciences, Laval University, Quebec City, QC
| | - Jeannie Haggerty
- McGill Research Chair in Family and Community Medicine, McGill University and St. Mary's Hospital Research Centre, Montréal, QC
| | - Catherine M Scott
- Adjunct Professor, University of Calgary and University of British Columbia-Okanagan, Executive Coach and Knowledge Mobilisation Consultant, K2A Consulting, Calgary, AB
| | - Shelley Doucet
- Jarislowsky Chair in Interprofessional Patient-Centred Care, Associate Professor, Department of Nursing and Health Sciences, University of New Brunswick, Saint John, NB
| | - Tara Stewart
- Assistant Professor, Department of Community Health Sciences, University of Manitoba, Researcher/Evaluator, George & Fay Yee Centre for Healthcare Innovation, Manitoba SPOR SUPPORT Unit, Winnipeg, MB
| | - Amélie Quesnel-Vallée
- Canada Research Chair in Policies and Health Inequalities, Professor, Department of Epidemiology, Biostatistics and Occupational Health, Department of Sociology, McGill University, Montréal, QC
| | - William Montelpare
- Margaret and Wallace McCain Chair in Human Development and Health, Professor, Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, PEI
| | - Robin Urquhart
- Endowed Chair in Population Cancer Research, Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS
| | - Jason M Sutherland
- Professor, Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC
| | - Yves Couturier
- Scientific Director and Réseau-1 Quebec Professor, École de travail social, Faculté des lettres et des sciences humaines, Université de Sherbrooke, Sherbrooke, QC
| |
Collapse
|
12
|
Haggerty J, Scott CM, Couturier Y, Quesnel-Vallée A, Dionne ÉM, Stewart T, Urquhart R, Montelpare W, Doucet S, Oelke ND. Connecting Health and Social Services for Patients with Complex Care Needs: A Pan-Canadian Comparative Policy Research Program. Healthc Policy 2023; 19:10-23. [PMID: 37850702 PMCID: PMC10594949 DOI: 10.12927/hcpol.2023.27182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
Comprehensive primary healthcare for patients with complex care needs requires connections to other health services, social services and community supports. This descriptive comparative policy research program used publicly available documents and informant interviews to examine progress toward integrated comprehensive care through the lens of services needed by children and youth (0-25 years) and community-dwelling older adults (≥ 65 years) with high functional health needs. This article describes five projects. The following three findings emerged across all the projects: Canada indeed has multiple health systems; numerous integrated service delivery solutions are being trialled and most focus on medical services; and it is an ongoing challenge for ministries of health to engage physicians and physician associations in integration.
Collapse
Affiliation(s)
- Jeannie Haggerty
- McGill Research Chair in Family and Community Medicine, McGill University and St. Mary's Hospital Research Centre, Montréal, QC
| | - Catherine M Scott
- Adjunct Professor, University of Calgary and University of British Columbia-Okanagan, Executive Coach and Knowledge Mobilisation Consultant, K2A Consulting, Calgary, AB
| | - Yves Couturier
- Scientific Director and Réseau-1 Quebec Professor École de travail social, Faculté des lettres et des sciences humaines, Université de Sherbrooke, Sherbrooke, QC
| | - AméLie Quesnel-Vallée
- Canada Research Chair in Policies and Health Inequalities, Professor, Department of Epidemiology, Biostatistics and Occupational Health, Department of Sociology, McGill University, Montréal, Qc
| | - ÉMilie Dionne
- Researcher and Adjunct Professor, VITAM - Centre de recherche en santé durable, Department of Sociology, Faculty of Social Sciences, Laval University, Québec, QC
| | - Tara Stewart
- Assistant Professor, Department of Community Health Sciences, University of Manitoba, Researcher/Evaluator, George & Fay Yee Centre for Healthcare Innovation, Manitoba SPOR SUPPORT Unit, Winnipeg, MB
| | - Robin Urquhart
- Endowed Chair in Population Cancer Research, Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS
| | - William Montelpare
- Margaret and Wallace McCain Chair in Human Development and Health, Professor, Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, Pei
| | - Shelley Doucet
- Jarislowsky Chair in Interprofessional Patient-Centred Care, Associate Professor, Department of Nursing and Health Sciences, University of New Brunswick, Saint John, NB
| | - Nelly D Oelke
- Associate Professor, School of Nursing, Faculty of Health and Social Development, University of British Columbia, Okanagan, BC
| |
Collapse
|
13
|
Haggerty J, Scott CM, Quesnel-Vallée A, Stewart T, Dionne É, Farmanara N, Couturier Y. Have Primary Care Renewal Initiatives in Canada Increased Comprehensive Care for Patients with Complex Care Needs? Yes and No. Healthc Policy 2023; 19:53-64. [PMID: 37850705 PMCID: PMC10594942 DOI: 10.12927/hcpol.2023.27179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
The First Ministers Health Accords of 2001 through 2003 (Health Canada 2006) launched the renewal of primary care toward more comprehensive care delivery models. We scanned government websites in the 10 Canadian provinces to assess how comprehensive and integrated renewal models were for health and social services in 2018. More comprehensive primary care delivery models were the norm in five out of 10 provinces. The policy approaches were: (1) expanding traditional family practice; (2) creating primary care networks; and (3) increasing the number of community health centres, which provide the broadest range of health and social care. Integration initiatives were limited to medical services. Additional financial and policy investments will be required to meet the comprehensive needs of patients with complex health and social needs at a system level.
Collapse
Affiliation(s)
- Jeannie Haggerty
- McGill Research Chair in Family and Community Medicine, McGill University and St. Mary's Hospital Research Centre, Montréal, QC
| | - Catherine M Scott
- Adjunct Professor, University of Calgary and University of British Columbia-Okanagan, Executive Coach and Knowledge Mobilisation Consultant, K2A Consulting, Calgary, AB
| | - Amélie Quesnel-Vallée
- Canada Research Chair in Policies and Health Inequalities, Professor, Department of Epidemiology, Biostatistics and Occupational Health, Department of Sociology, McGill University, Montréal, QC
| | - Tara Stewart
- Assistant Professor, Department of Community Health Sciences, University of Manitoba, Researcher/Evaluator, George & Fay Yee Centre for Healthcare Innovation, Manitoba Spor Support Unit, Winnipeg, MB
| | - Émilie Dionne
- Researcher and Adjunct Professor, VITAM - Centre de recherche en santé durable, Department of Sociology, Faculty of Social Sciences, Laval University, Quebec City, QC
| | | | - Yves Couturier
- Scientific Director and Réseau-1 Quebec Professor, École de travail social, Faculté des lettres et des sciences humaines, Université de Sherbrooke, Sherbrooke, QC
| |
Collapse
|
14
|
Menear M, Duhoux A, Bédard M, Paquette JS, Baron M, Breton M, Courtemanche S, Dubé S, Dufour S, Fortin M, Girard A, Larouche-Côté É, L'Espérance A, LeBlanc A, Poitras ME, Rivet S, Sasseville M, Achim A, Archambault P, Bajurny V, Brown JB, Carrier JD, Côté N, Couturier Y, Dogba MJ, Gagnon MP, Ghio SC, Marshall EG, Kothari A, Lussier MT, Mair FS, Smith S, Vachon B, Wong S. Understanding the impacts of the COVID-19 pandemic on the care experiences of people with mental-physical multimorbidity: protocol for a mixed methods study. BMC Prim Care 2023; 24:154. [PMID: 37488515 PMCID: PMC10364355 DOI: 10.1186/s12875-023-02106-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/06/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Primary care and other health services have been disrupted during the COVID-19 pandemic, yet the consequences of these service disruptions on patients' care experiences remain largely unstudied. People with mental-physical multimorbidity are vulnerable to the effects of the pandemic, and to sudden service disruptions. It is thus essential to better understand how their care experiences have been impacted by the current pandemic. This study aims to improve understanding of the care experiences of people with mental-physical multimorbidity during the pandemic and identify strategies to enhance these experiences. METHODS We will conduct a mixed-methods study with multi-phase approach involving four distinct phases. Phase 1 will be a qualitative descriptive study in which we interview individuals with mental-physical multimorbidity and health professionals in order to explore the impacts of the pandemic on care experiences, as well as their perspectives on how care can be improved. The results of this phase will inform the design of study phases 2 and 3. Phase 2 will involve journey mapping exercises with a sub-group of participants with mental-physical multimorbidity to visually map out their care interactions and experiences over time and the critical moments that shaped their experiences. Phase 3 will involve an online, cross-sectional survey of care experiences administered to a larger group of people with mental disorders and/or chronic physical conditions. In phase 4, deliberative dialogues will be held with key partners to discuss and plan strategies for improving the delivery of care to people with mental-physical multimorbidity. Pre-dialogue workshops will enable us to synthesize an prepare the results from the previous three study phases. DISCUSSION Our study results will generate much needed evidence of the positive and negative impacts of the COVID-19 pandemic on the care experiences of people with mental-physical multimorbidity and shed light on strategies that could improve care quality and experiences.
Collapse
Affiliation(s)
- Matthew Menear
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada.
- VITAM Centre de recherche en santé durable, Quebec City, Canada.
| | - Arnaud Duhoux
- Faculty of Nursing, Université de Montréal, Montreal, Canada
- Centre de Recherche Charles-Le Moyne, Montreal, Canada
| | - Myreille Bédard
- Person With Lived Experience (Patient Partner), Montreal, Canada
| | - Jean-Sébastien Paquette
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Marie Baron
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Mylaine Breton
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | | | - Savannah Dubé
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Stefany Dufour
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Martin Fortin
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Ariane Girard
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | | | | | - Annie LeBlanc
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Marie-Eve Poitras
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Sophie Rivet
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Maxime Sasseville
- VITAM Centre de recherche en santé durable, Quebec City, Canada
- Faculty of Nursing, Université Laval, Quebec, Canada
| | - Amélie Achim
- VITAM Centre de recherche en santé durable, Quebec City, Canada
- Department of Psychiatry, Université Laval, Quebec, Canada
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Virtue Bajurny
- Person with Lived Experience (Patient Partner), Toronto, Canada
| | | | - Jean-Daniel Carrier
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Nancy Côté
- VITAM Centre de recherche en santé durable, Quebec City, Canada
- Faculty of Social Sciences, Université Laval, Quebec, Canada
| | - Yves Couturier
- School of Social Work, Université de Sherbrooke, Sherbrooke, Canada
| | - Maman Joyce Dogba
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Marie-Pierre Gagnon
- VITAM Centre de recherche en santé durable, Quebec City, Canada
- Faculty of Nursing, Université Laval, Quebec, Canada
| | | | | | - Anita Kothari
- Department of Health Studies, Western University, London, Canada
| | - Marie-Thérèse Lussier
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, Canada
| | - Frances S Mair
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Susan Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, UK
| | - Brigitte Vachon
- School of Rehabilitation, Université de Montréal, Montreal, Canada
| | - Sabrina Wong
- Faculty of Applied Science, University of British Colombia, Vancouver, Canada
| |
Collapse
|
15
|
Viscogliosi C, Dame N, Mino-Roy J, Rahimaly S, Breton V, Déry J, Chassé B, Couturier Y, Giroux D, Renaud C, Provencher V. [Trouble neurocognitif majeur et méthodes optimisant l'apprentissage]. Can J Aging 2023; 42:189-198. [PMID: 35971842 DOI: 10.1017/s0714980822000216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Les difficultés cognitives consécutives aux troubles neurocognitifs majeurs (TNCM) engendrent des enjeux dans la réalisation d'activités de la vie quotidienne. Ce projet visait à identifier auprès des proches aidants et des intervenants des situations nécessitant des méthodes optimisant l'apprentissage pour faciliter l'engagement de personnes vivant avec un TNCM dans leurs activités de la vie quotidienne. Des entrevues individuelles semi-dirigées, d'une durée de 60 à 90 minutes, ont été menées auprès de proches aidants et d'intervenants. Les résultats montrent que les activités quotidiennes et domestiques sont notamment affectées par les difficultés à repérer ou à utiliser les objets, à garder en tête la tâche en cours, à mettre en séquences des étapes, à ne pas se laisser distraire par autre chose et à constater ses difficultés pour s'y adapter. Les proches aidants souhaitent du soutien dans l'application des méthodes optimisant l'apprentissage pour contribuer au maintien de l'autonomie des personnes vivant avec un TNCM.
Collapse
Affiliation(s)
- Chantal Viscogliosi
- Université de Sherbrooke et Centre de recherche sur le vieillissement du CIUSSS de l'Estrie-CHUS, Sherbrooke, Québec, Canada
| | - Nathalie Dame
- Université de Sherbrooke et Centre de recherche sur le vieillissement du CIUSSS de l'Estrie-CHUS, Sherbrooke, Québec, Canada
| | - Jordan Mino-Roy
- Université de Sherbrooke et Centre de recherche sur le vieillissement du CIUSSS de l'Estrie-CHUS, Sherbrooke, Québec, Canada
| | - Sarah Rahimaly
- Université de Sherbrooke et Centre de recherche sur le vieillissement du CIUSSS de l'Estrie-CHUS, Sherbrooke, Québec, Canada
| | | | - Jessica Déry
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Mauricie et du Centre-du-Québec (CIUSSS MCQ), Bécancour, Québec, Canada
| | - Bernard Chassé
- Société Alzheimer des Maskoutains - Vallée des Patriotes, St-Hilaire, Québec, Canada
| | - Yves Couturier
- Université de Sherbrooke et Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Dominique Giroux
- Université Laval et Centre de recherche en santé durable VITAM, Québec, Québec, Canada
| | | | - Véronique Provencher
- Université de Sherbrooke et Centre de recherche sur le vieillissement du CIUSSS de l'Estrie-CHUS, Sherbrooke, Québec, Canada
| |
Collapse
|
16
|
Yapi SM, Poitras ME, Donnelly C, Ashcroft R, Greiver M, Couturier Y, Nikiema JN, Breton M, Layani G, Kaczorowski J, Bergman H, Lussier MT, Aggarwal M, Fernainy P, McGraw M, Milius D, Mehta K, Samson K, Sourial N. Identify and classify interprofessional primary care performance indicators: a scoping review protocol. BMJ Open 2023; 13:e072186. [PMID: 37253498 DOI: 10.1136/bmjopen-2023-072186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION Measuring the performance of interprofessional primary care is needed to examine whether this model of care is achieving its desired outcomes on patient care and health system effectiveness as well as to guide quality improvement initiatives. The aim of this scoping review is to map the literature on primary care performance measurement indicators to determine the extent to which current indicators capture or could be adapted to capture processes, outputs and outcomes that reflect interprofessional primary care. METHODS AND ANALYSIS The review will be guided by the six-stage framework by Arksey and O'Malley (2005). MEDLINE, Embase, CINAHL, grey literature and the reference list of key studies will be searched to identify any study, published in English or French between 2000 and 2022, related to the concepts of performance indicators, frameworks, interprofessional teams and primary care. Two reviewers will independently screen all abstracts and full-text studies for inclusion. Eligible indicators will be classified according to process, output and outcome domains proposed by two validated frameworks. This study started in November 2022 and is expected to be completed by July 2023. ETHICS AND DISSEMINATION This review does not require ethical approval. The results will be disseminated through a peer-reviewed publication, conference presentations and presentations to stakeholders.
Collapse
Affiliation(s)
- Sopie Marielle Yapi
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
| | - Marie-Eve Poitras
- Département des sciences de la santé, Université du Québec à Chicoutimi, Chicoutimi, Québec, Canada
| | - Catherine Donnelly
- Health Services and Policy Research Institute, Queen's University Faculty of Health Sciences, Kingston, Ontario, Canada
| | - Rachelle Ashcroft
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Greiver
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Yves Couturier
- School of Social Work, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Jean Noël Nikiema
- Department of Health Management, Evaluation & Policy, University of Montreal, Montreal, Québec, Canada
| | - Mylaine Breton
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Quebec, Canada
| | - Géraldine Layani
- Department of Family and Emergency Medicine, University of Montreal, Montreal, Québec, Canada
| | - Janusz Kaczorowski
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
- Department of Family and Emergency Medicine, University of Montreal, Montreal, Québec, Canada
| | - Howard Bergman
- Department of Family Medicine, McGill University, Montreal, Québec, Canada
| | | | - Monica Aggarwal
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Pamela Fernainy
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
- Department of Health Management, Evaluation & Policy, University of Montreal, Montreal, Québec, Canada
| | - Monica McGraw
- Département des sciences de la santé, Université du Québec à Chicoutimi, Chicoutimi, Québec, Canada
| | - Djims Milius
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
| | - Kavita Mehta
- Association of Family Health Teams of Ontario, Toronto, Ontario, Canada
| | - Kevin Samson
- Association of Family Health Teams of Ontario, Toronto, Ontario, Canada
| | - Nadia Sourial
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
- Department of Health Management, Evaluation & Policy, University of Montreal, Montreal, Québec, Canada
| |
Collapse
|
17
|
Hudon C, Chouinard MC, Dumont-Samson O, Gobeil-Lavoie AP, Morneau J, Paradis M, Couturier Y, Poitras ME, Poder T, Sabourin V, Lambert M. Integrated case management between primary care clinics and hospitals for people with complex needs who frequently use healthcare services: A multiple-case embedded study. Health Policy 2023; 132:104804. [PMID: 37028261 DOI: 10.1016/j.healthpol.2023.104804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/29/2023] [Accepted: 04/02/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION Case management (CM) is recognized to improve care integration and outcomes of people with complex needs who frequently use healthcare services, but challenges remain regarding interaction between primary care clinics and hospitals. This study aimed to implement and evaluate an integrated CM program for this population where nurses in primary care clinics worked with a hospital case manager. METHODS A multiple embedded case study was conducted in the Saguenay-Lac-Saint-Jean region (Québec, Canada), in four dyads including a clinic and a hospital. Mixed data collection included, at baseline and 6 months, interviews and focus groups with stakeholders, patient questionnaires (patient experience of integrated care and self-management), and emergency department (ED) visits in the previous 6 months. RESULTS Integrated CM implementation was optimal when all stakeholders provided collective leadership, and were supportive of the program, particularly the physicians. The 6-month program enabled the observation of positive qualitative outcomes in most clinic-hospital dyads where implementation occurred. Full implementation was associated with improved care integration. DISCUSSION AND CONCLUSION Integrated CM between primary care clinics and hospitals is a promising innovation to improve care integration for people with complex needs who frequently use healthcare services. Collective leadership and physicians' buy-in to integrated CM are important to foster the implementation.
Collapse
|
18
|
Lane J, Manceau LM, Massuard M, Couturier Y, Cossette B, Ricard J, Viscogliosi C, Déry V, Gauthier P. [Déterminants du succès d'une démarche provinciale d'usage optimal des antipsychotiques chez les résidents en soins de longue durée selon les acteurs clés impliqués dans l'implantation]. Can J Aging 2023; 42:102-114. [PMID: 35968903 DOI: 10.1017/s0714980822000320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Le Québec présente le taux de prescriptions d'antipsychotiques le plus élevé chez les personnes âgées de 65 ans et plus au Canada. La démarche « Optimiser les pratiques, les usages, les soins et les services - antipsychotiques » (OPUS-AP) vise à pallier cet enjeu. Étant donné ses premiers résultats prometteurs, notre étude visait à identifier les déterminants de son succès. Elle repose sur un devis d'étude de cas regroupant une analyse documentaire et 21 entrevues auprès d'acteurs clés impliqués dans l'implantation. Les résultats mettent en lumière cinq déterminants centraux : 1) une démarche intégrée, collaborative et probante; 2) des communications et des réseaux au service de la démarche; 3) un climat d'implantation favorable aux changements; 4) un engagement et une implication des parties prenantes; et 5) une stratégie d'application des connaissances intégrée et appuyée. Des défis et recommandations pour assurer la pérennisation et la mise à l'échelle d'OPUS-AP et inspirer des démarches similaires sont identifiés.
Collapse
Affiliation(s)
- Julie Lane
- Faculté d'éducation, Université de Sherbrooke, 2500, boulevard de l'Université, Sherbrooke, Québec, J1K 2R1, Canada
| | - Luiza Maria Manceau
- Faculté d'éducation, Université de Sherbrooke, 2500, boulevard de l'Université, Sherbrooke, Québec, J1K 2R1, Canada
| | - Marie Massuard
- Faculté d'éducation, Université de Sherbrooke, 2500, boulevard de l'Université, Sherbrooke, Québec, J1K 2R1, Canada
| | - Yves Couturier
- Département de travail social, Université de Sherbrooke, 2500, boulevard de l'Université, Sherbrooke, Québec, J1K 2R1, Canada
| | - Benoit Cossette
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 2500, boulevard de l'Université, Sherbrooke, Québec, J1K 2R1, Canada
| | - Jacques Ricard
- Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke, 300 Rue King Est, Sherbrooke, Québec, J1G 1B1, Canada
| | - Chantal Viscogliosi
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 2500, boulevard de l'Université, Sherbrooke, Québec, J1K 2R1, Canada
| | - Véronique Déry
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 2500, boulevard de l'Université, Sherbrooke, Québec, J1K 2R1, Canada
| | - Patricia Gauthier
- Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke, 300 Rue King Est, Sherbrooke, Québec, J1G 1B1, Canada
| |
Collapse
|
19
|
Brodeur M, Roberge P, Cotton JC, Monson E, Morvannou A, Poitras ME, Lacasse A, Jutras-Aswad D, Couturier Y, Loignon C, Audette-Chapdelaine S, Auger AM, Bertrand K, Dorceus S, Simon O, Hudon C. Experience of LGBTQIA2S+ populations with gambling during the COVID-19 pandemic: protocol for a mixed-methods study. BMJ Open 2023; 13:e066231. [PMID: 36754562 PMCID: PMC9922879 DOI: 10.1136/bmjopen-2022-066231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION Research undertaken since the beginning of the COVID-19 pandemic has provided us information about the impact of the pandemic on the gambling habits of the general population. However, very little is known about certain subgroups at increased risk of developing gambling disorder, such as the LGBTQIA2S+ population. The purpose of this study is to describe the impact of the COVID-19 pandemic on gambling behaviours among LGBTQIA2S+ individuals. In addition, we want to understand the experiences of the LGBTQIA2S+ population with gambling disorder and identify interventions that LGBTQIA2S+ people have found to be effective in addressing problem gambling during the COVID-19 pandemic. METHODS AND ANALYSIS This study has a sequential explanatory mixed-method design in two phases over 2 years. The first phase is a correlational study. We will conduct a cross-sectional survey using a stratified random sampling among Canadian residents who are 18 years of age or older, self-identify as sexually and gender-diverse (ie, LGBTQIA2S+) and have gambled at least once in the previous 12 months. This survey will be administered online via a web panel (n=1500). The second phase is a qualitative study. Semistructured interviews will be conducted with LGBTQIA2S+ people with problematic gambling (n=30). ETHICS AND DISSEMINATION This research project has been ethically and scientifically approved by the Research Ethics Committee and by the CIUSSS de l'Estrie-CHUS scientific evaluation committee on 3 March 2022 (reference number: 2022-4633-LGBTQ-JHA). Electronic and/or written informed consent, depending on the data collection format (online survey and online or in-person interviews), will be obtained from each participant. A copy of the consent form and contact information will be delivered to each participant.
Collapse
Affiliation(s)
- Magaly Brodeur
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Pasquale Roberge
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Julie-Christine Cotton
- Department of Community Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Eva Monson
- Department of Community Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Adele Morvannou
- Department of Community Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marie-Eve Poitras
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Anaïs Lacasse
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Didier Jutras-Aswad
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, Quebec, Canada
| | - Yves Couturier
- School of Social Work, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Christine Loignon
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Sophie Audette-Chapdelaine
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Anne-Marie Auger
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Karine Bertrand
- Department of Community Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Sabruna Dorceus
- Department of Career Counseling, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Olivier Simon
- Department of Psychiatry, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Catherine Hudon
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| |
Collapse
|
20
|
Girard A, Dugas M, Lépine J, Carnovale V, Jalbert L, Turmel A, Stéfan T, Poirier AA, Mailhot B, Skidmore B, Couturier Y, Miller S, LeBlanc A. Strategies to engage family physicians in primary care research: A systematic review. J Eval Clin Pract 2023; 29:233-249. [PMID: 35796093 DOI: 10.1111/jep.13733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/14/2022] [Accepted: 06/22/2022] [Indexed: 01/18/2023]
Abstract
RATIONALE Moving towards high quality primary health care, involving family physicians in primary care research becomes an essential prerequisite to ensures a better adoption and routinization of patient-centred, evidence-based practices. AIM To assess the effectiveness of strategies to engage family physicians in primary care research. METHODS We systematically reviewed evidence for strategies used to engage family physicians in primary care research. We included any study design that reported at least one quantitative outcome. Searches were carried out on MEDLINE, Embase, PsycINFO and Web of Science. Pairs of reviewers independently screened for publications in two stages using standardized forms. We performed data analysis through a narrative synthesis approach, using the Reasoned-action approach as framework. RESULTS A total of 4859 deduped records were identified of which 41 studies met the eligibility criteria and were included for analysis. The majority of studies (n = 35) investigated family physician's participation in a research project. They aimed to influence family physicians' intention (n = 7) or their ability (n = 3) to participate in a research project. Three types of strategies (compensation/incentive, recruitment by a peer and support from a research network or an academic institution) demonstrated a significant increase in participation rate. Methodological quality of the studies evaluating these strategies was relatively low. Few studies (n = 6) targeted research capacity-building programmes with no significant impact noted. CONCLUSION Numerous strategies have been used to engage family physicians in primary care research, but few studies evaluated their effectiveness in a rigorous way. REGISTRATION The protocol of this review was registered with the SPOR Evidence Alliance and on the PROSPERO platform (registration number: CRD42020189322).
Collapse
Affiliation(s)
- Ariane Girard
- Faculté de Médecine, Université Laval, Quebec, Quebec, Canada.,VITAM Research Center on Sustainable Health, Québec, Québec, Canada
| | - Michèle Dugas
- VITAM Research Center on Sustainable Health, Québec, Québec, Canada
| | - Johanie Lépine
- VITAM Research Center on Sustainable Health, Québec, Québec, Canada
| | | | - Laura Jalbert
- VITAM Research Center on Sustainable Health, Québec, Québec, Canada
| | - Audrey Turmel
- VITAM Research Center on Sustainable Health, Québec, Québec, Canada
| | - Théo Stéfan
- VITAM Research Center on Sustainable Health, Québec, Québec, Canada
| | | | - Benoit Mailhot
- VITAM Research Center on Sustainable Health, Québec, Québec, Canada
| | | | - Yves Couturier
- Réseau-1 Québec, Réseau de connaissances sur les soins primaires, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Shandi Miller
- Réseau-1 Québec, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Annie LeBlanc
- Faculté de Médecine, Université Laval, Quebec, Quebec, Canada.,VITAM Research Center on Sustainable Health, Québec, Québec, Canada
| |
Collapse
|
21
|
Bruneau MA, Pépin MÉ, Bergman H, Couturier Y. [Improving the quality of care for people with behavioral and psychological symptoms of dementia in Quebec]. Sante Ment Que 2023; 48:229-255. [PMID: 38578191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Major neurocognitive disorders (MND) affect more than 100,000 Quebecers and this number is expected to increase by 66% by 2030. The World Health Organization (WHO) considers MND as a public health priority in its "Closing the Gaps in Mental Health" program (WHO, 2011). Behavioral and psychological symptoms related to dementia (BPSD) are highly prevalent and are associated with cognitive and functional deterioration, caregiver burnout, early admission to hospital and additional costs. As part of the ministerial initiative stemming from the Plan Alzheimer du Québec (PAQ) promoted by le ministère de la Santé et des Services sociaux (MSSS) du Québec, innovative clinical practices have been implemented for the optimal management of this clientele, particularly through the creation or enhancement of teams dedicated to BPSD. With a view to continuous quality improvement, the MSSS has mandated a team of clinicians, researchers and deciders to paint a picture of current practices in the context of BPSD and to issue recommendations. This study offers a unique and innovative look at the development of quality care for BPSD in Quebec. Objectives 1. Review organizational and clinical practices, as well as care pathways for BPSD; 2. Propose an interprofessional management process based on best practices; 3. Advise the MSSS on the implementation of measures necessary to ensure access to safe, quality clinical services. Method A review of recent international literature and practice guides was conducted. Semi-structured interviews with professionals from BPSD teams were also conducted in order to paint a picture of the situation in Quebec. An outline of a logic model was proposed based on this information. A group of experts was formed to review clinical and organizational BPSD practices in light of the results. Results The ministerial initiative resulting from the PAQ has had an important structuring effect on the development, consolidation and prioritization of services for people with BPSD. Facilitating elements as well as barriers to the implementation of these services were identified and recommendations were issued to advise the ministry on the actions to be taken. Conclusion The essential conditions and strategies to be adopted to consolidate the trajectory of care for BPSD were transmitted to the MSSS. The main impact is to improve the accessibility and quality of BPSD care for the benefit of users and their families.
Collapse
|
22
|
Poitras ME, Poirier MD, Couturier Y, T Vaillancourt V, Cormier C, Gauthier G, Massé S, Gendron A, Oswick ML, Morin A, Blanchette P, Bernier A. Chronic conditions patient's perception of post-COVID-19 pandemic teleconsulting continuation in primary care clinics: a qualitative descriptive study. BMJ Open 2022; 12:e066871. [PMID: 36521903 PMCID: PMC9755907 DOI: 10.1136/bmjopen-2022-066871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic has led to the prioritisation of teleconsultation instead of face-to-face encounters. However, teleconsultation revealed some shortcomings and undesirable effects that may counterbalance benefits. This study aims to explore the perspective of patients with chronic diseases on teleconsultation in primary care. This article also proposes recommendations to provide patient-oriented and appropriate teleconsultations. DESIGN We conducted a qualitative descriptive study that explored the patients' perception regarding teleconsultation services and the following themes: access, perceived benefits and disadvantages, interprofessional collaboration, patient-centred approach, specific competencies of professionals, and patient's global needs and preferences. SETTING Six primary care clinics in three regions of Quebec. PARTICIPANTS 39 patients were interviewed by telephone through semistructured qualitative interviews. RESULTS Patients want to maintain teleconsultation for the postpandemic period as long as their recommendations are followed: be able to choose to come to the clinic if they wish to, feel that their individual and environmental characteristics are considered, feel involved in the choice of the modality of each consultation, feel that interprofessional collaboration and patient-centred approach are promoted, and to maintain the professionalism, which must not be lessened despite the remote context. CONCLUSION Patients mainly expressed high satisfaction with teleconsultation. However, several issues must be addressed. Patients do and should contribute to the implementation of teleconsultation in primary care. They wish to be frequently consulted about their preferred consultation modality, which may change over time. The patient perspective must, therefore, be part of the balanced implementation of optimal teleconsultation that is currently taking place.
Collapse
Affiliation(s)
- Marie-Eve Poitras
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean du Québec, Chicoutimi, Québec, Canada
| | - Marie-Dominique Poirier
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean du Québec, Chicoutimi, Québec, Canada
| | - Yves Couturier
- School of social work, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Vanessa T Vaillancourt
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean du Québec, Chicoutimi, Québec, Canada
| | - Caroline Cormier
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean du Québec, Chicoutimi, Québec, Canada
| | - Gilles Gauthier
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean du Québec, Chicoutimi, Québec, Canada
| | - Sylvie Massé
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean du Québec, Chicoutimi, Québec, Canada
| | - Audrey Gendron
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Megan L Oswick
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Anaelle Morin
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Patricia Blanchette
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Andréanne Bernier
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Québec, Canada
| |
Collapse
|
23
|
Poitras ME, Couturier Y, Doucet E, T. Vaillancourt V, Poirier MD, Gauthier G, Hudon C, Delli-Colli N, Gagnon D, Careau E, Duhoux A, Gaboury I, Charif AB, Ashcroft R, Lukewich J, Ramond-Roquin A, Massé S. Co-design, implementation, and evaluation of an expanded train-the-trainer strategy to support the sustainability of evidence-based practice guides for registered nurses and social workers in primary care clinics: a developmental evaluation protocol. BMC Prim Care 2022; 23:84. [PMID: 35436845 PMCID: PMC9016936 DOI: 10.1186/s12875-022-01684-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 03/31/2022] [Indexed: 11/12/2022]
Abstract
Background The implementation of evidence-based innovations is incentivized as part of primary care reform in Canada. In the Province of Québec, it generated the creation of interprofessional care models involving registered nurses and social workers as members of primary care clinics. However, the scope of practice for these professionals remains variable and suboptimal. In 2019, expert committees co-designed and published two evidence-based practice guides, but no clear strategy has been identified to support their assimilation. This project’s goal is to support the implementation and deployment of practice guides for both social workers and registered nurses using a train-the-trainer educational intervention. Methods/design This three-phase project is a developmental evaluation using a multiple case study design across 17 primary care clinics. It will involve trainers in healthcare centers, patients, registered nurses and social workers. The development and implementation of an expanded train-the-trainer strategy will be informed by a patient-oriented research approach, the Kirkpatrick learning model, and evidence-based practice guides. For each case and phase, the qualitative and quantitative data will be analyzed using a convergent design method and will be integrated through assimilation. Discussion This educational intervention model will allow us to better understand the complex context of primary care clinics, involving different settings and services offered. This study protocol, based on reflective practice, patient-centered research and focused on the needs of the community in collaboration with partners and patients, may serve as an evidence based educational intervention model for further study in primary care.
Collapse
|
24
|
Guénette L, Kröger E, Bonnan D, Maheu A, Morin M, Bélanger L, Vedel I, Wilchesky M, Sirois C, Durand É, Couturier Y, Sourial N. Reorganizing pharmaceutical care in family medicine groups for seniors with or at risk of major neurocognitive disorders: a mixed-methods study protocol (Preprint). JMIR Res Protoc 2022; 11:e42577. [DOI: 10.2196/42577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/05/2022] [Accepted: 10/20/2022] [Indexed: 11/07/2022] Open
|
25
|
Couturier Y, Lanoue S, Karam M, Guillette M, Hudon C. Social workers coordination in primary healthcare for patients with complex needs: A scoping review. International Journal of Care Coordination 2022. [DOI: 10.1177/20534345221122952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Care coordination has been part of social work for some time. It has been recognized as contributing to care coordination for long-term care for the elderly and mental health but less is known about their contribution in primary care with patients with complex health and social needs. As social workers are increasingly present in primary healthcare, this scoping review aims to provide a synthesis of social workers’ coordination activities for patients with complex needs in primary healthcare. Methods CINAHL, Medline, Scopus, SocioIndex, Social Work Abstracts, and ProQuest databases were searched, from 2004 to 2020 for peer-reviewed literature. A thematic analysis using deductive and inductive approaches was used to conduct this scoping review. Results Eighteen studies on 11 different care coordination interventions were included. The care coordination activities have been classified into four categories: 1) activities that target the patient, family, and caregivers; 2) activities that target health and social care professionals and services; 3) activities that link the patient and family with health and social professionals and services; and 4) cross-cutting activities that support and enhance other activity. Discussion A variety of care coordination interventions conducted by social workers were identified, all of which included related but different activities. Still, the common aim is to reduce fragmentation of care. Social workers, because of their disciplinary skills characterized by linkages to nonmedical services, can make a significant contribution to the coordination of care in primary health care, in collaboration with nurses.
Collapse
Affiliation(s)
- Yves Couturier
- Department of Social Work, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Sèverine Lanoue
- Department of Education, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Marlène Karam
- Faculty of Nursing, University of Montréal, Montréal, Québec, Canada
| | - Maxime Guillette
- Department of Education, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Catherine Hudon
- Family Medicine and Emergency Medicine Department, Université de Sherbrooke, Sherbrooke, Québec, Canada
| |
Collapse
|
26
|
Levasseur M, Naud D, Presse N, Delli-Colli N, Boissy P, Cossette B, Couturier Y, Cadieux Genesse J. Aging all over the place: a multidisciplinary framework that considers place and life trajectories of older adults within their communities. QAOA 2022. [DOI: 10.1108/qaoa-07-2021-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This conceptual paper aims to describe aging all over the place (AAOP), a federative framework for action, research and policy that considers older adults’ diverse experiences of place and life trajectories, along with person-centered care.
Design/methodology/approach
The framework was developed through group discussions, followed by an appraisal of aging models and validation during workshops with experts, including older adults.
Findings
Every residential setting and location where older adults go should be considered a “place,” flexible and adaptable enough so that aging in place becomes aging all over the place. Health-care professionals, policymakers and researchers are encouraged to collaborate around four axes: biopsychosocial health and empowerment; welcoming, caring, mobilized and supportive community; spatiotemporal life and care trajectories; and out-of-home care and services. When consulted, a Seniors Committee showed appreciation for flexible person-centered care, recognition of life transitions and care trajectories and meaningfulness of the name.
Social implications
Population aging and the pandemic call for intersectoral actions and for stakeholders beyond health care to act as community leaders. AAOP provides opportunities to connect environmental determinants of health and person-centered care.
Originality/value
Building on the introduction of an ecological experience of aging, AAOP broadens the concept of care as well as the political and research agenda by greater integration of community and clinical actions. AAOP also endeavors to avoid patronizing older adults and to engage society in strengthening circles of benevolence surrounding older adults, regardless of their residential setting. AAOP’s applicability is evidenced by existing projects that share its approach.
Collapse
|
27
|
Cossette B, Bruneau MA, Morin M, Gilbert S, Boyer D, Donald TM, Rhéaume AA, Ben Gaied N, Tousignant M, Turcotte JP, Rodrigue C, Rouleau R, Couturier Y. Optimizing Practices, Use, Care, and Services–Antipsychotics (OPUS-AP) in Long-Term Care Centers in Quebec, Canada: A Successful Scale-Up. J Am Med Dir Assoc 2022; 23:1084-1089. [DOI: 10.1016/j.jamda.2021.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022]
|
28
|
Cossette B, Ricard G, Poirier R, Gosselin S, Langlois MF, Imbeault P, Breton M, Couturier Y, Sirois C, Lessard-Beaudoin M, Rodrigue C, Teasdale J, Turcotte JP, Mallet L. Pharmacist-led transitions of care between hospitals, primary care clinics, and community pharmacies. J Am Geriatr Soc 2021; 70:766-776. [PMID: 34817853 DOI: 10.1111/jgs.17575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 10/26/2021] [Accepted: 10/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pharmacist-led transitions of care (TOC) interventions have been described as some of the most promising interventions to reduce medication-related harm (MRH) in older adults. This study analyzed the feasibility of pharmacist-led TOC interventions between hospitals, multidisciplinary primary care clinics (PCC), and community pharmacies. METHODS Adults aged 65 years and older at risk of MRH in three regions of Quebec, Canada, with contrasting contexts of care based on university affiliation were recruited in this multicenter, single arm, and prospective intervention cohort. The hospital pharmacist developed the pharmaceutical care plan in collaboration with the hospital physician and transferred this plan with the hospitalization summary, at hospital discharge, to the PCC family physician and to the community and PCC pharmacists. A consultation with the community pharmacist was scheduled within seven days of hospital discharge and with the PCC pharmacist when appropriate. Feasibility outcomes included the time to complete the interventions and their location. RESULTS The 123 eligible patients had a mean age of 78.5 years, and 63.4% were females. The most frequent inclusion criterion was 10 medications or more, including one high-risk medication for 90 patients (73%). Recruitment in one region was stopped after three months due to unsuccessful recruitment of key PCC. The hospital pharmacist interventions took a median of 165 min. The first consultations of the PCC and community pharmacists took a median of 15 and 50 min. Among the 96 patients with a post-discharge pharmacist follow-up, 23 (24.0%) had a consultation with a PCC pharmacist, with 65.2% of the consultations conducted at the PCC. The community pharmacists conducted a consultation with 88 patients (93%), with more than 70% of consultations conducted by phone. CONCLUSION Our study showed the feasibility of pharmacist-led TOC interventions between hospitals, PCC, and community pharmacies and detailed the novel role that PCC pharmacists played in optimizing TOC interventions.
Collapse
Affiliation(s)
- Benoit Cossette
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Canada.,Research Centre on Aging, Integrated University Health and Social Services Centre of Estrie, Sherbrooke, Canada.,Department of Pharmacy, Integrated University Health and Social Services Centre of Estrie, Sherbrooke, Canada
| | - Geneviève Ricard
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Canada.,Department of Medicine, Integrated University Health and Social Services Centre of Estrie, Sherbrooke, Canada
| | - Rolande Poirier
- Department of Pharmacy, Integrated University Health and Social Services Centre of Estrie, Sherbrooke, Canada
| | - Suzanne Gosselin
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Canada.,Department of General Medicine, Integrated University Health and Social Services Centre of Estrie, Sherbrooke, Canada
| | - Marie-France Langlois
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Canada.,Department of Medicine, Integrated University Health and Social Services Centre of Estrie, Sherbrooke, Canada.,CHUS Research Centre, Integrated University Health and Social Services Centre of Estrie, Sherbrooke, Canada
| | - Philippe Imbeault
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Canada
| | - Mylaine Breton
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Canada
| | - Yves Couturier
- Faculty of Arts and Human Sciences, University of Sherbrooke, Sherbrooke, Canada
| | | | - Mélissa Lessard-Beaudoin
- Research Centre on Aging, Integrated University Health and Social Services Centre of Estrie, Sherbrooke, Canada
| | - Claudie Rodrigue
- Research Centre on Aging, Integrated University Health and Social Services Centre of Estrie, Sherbrooke, Canada
| | - Julie Teasdale
- Research Centre on Aging, Integrated University Health and Social Services Centre of Estrie, Sherbrooke, Canada
| | - Jean-Philippe Turcotte
- Research Centre on Aging, Integrated University Health and Social Services Centre of Estrie, Sherbrooke, Canada
| | - Louise Mallet
- Faculty of Pharmacy, University of Montreal, Montreal, Canada.,Department of Pharmacy, McGill University Health Centre, Montreal, Canada
| |
Collapse
|
29
|
Arsenault-Lapierre G, Henein M, Rojas-Rozo L, Bergman H, Couturier Y, Vedel I. Primary care clinicians' knowledge, attitudes, and practices concerning dementia: They are willing and need support. Can Fam Physician 2021; 67:731-735. [PMID: 34649895 DOI: 10.46747/cfp.6710731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Geneviève Arsenault-Lapierre
- Senior Research Associate for the Research on Organization of Healthcare Services for Alzheimers Team at the Lady Davis Institute for Medical Research affiliated with the Jewish General Hospital in Montreal, Que, and McGill University
| | - Mary Henein
- Research assistant for the Research on Organization of Healthcare Services for Alzheimers Team at the Lady Davis Institute for Medical Research
| | - Laura Rojas-Rozo
- Research assistant for the Research on Organization of Healthcare Services for Alzheimers Team at the Lady Davis Institute for Medical Research
| | - Howard Bergman
- Assistant Dean of Internal Affairs in the Faculty of Medicine at McGill University, and Professor of Family Medicine in the Department of Medicine and Oncology and the Institute for Health and Social Policy at McGill University
| | - Yves Couturier
- Tenured Professor at the University of Sherbrooke in Quebec and Scientific Director of the Réseau de connaissances en services et soins de santé intégrés de première ligne
| | - Isabelle Vedel
- Associate Professor and Graduate Program Director (MSc) at the University of McGill
| |
Collapse
|
30
|
Abbasgholizadeh Rahimi S, Légaré F, Sharma G, Archambault P, Zomahoun HTV, Chandavong S, Rheault N, T Wong S, Langlois L, Couturier Y, Salmeron JL, Gagnon MP, Légaré J. Application of Artificial Intelligence in Community-Based Primary Health Care: Systematic Scoping Review and Critical Appraisal. J Med Internet Res 2021; 23:e29839. [PMID: 34477556 PMCID: PMC8449300 DOI: 10.2196/29839] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Research on the integration of artificial intelligence (AI) into community-based primary health care (CBPHC) has highlighted several advantages and disadvantages in practice regarding, for example, facilitating diagnosis and disease management, as well as doubts concerning the unintended harmful effects of this integration. However, there is a lack of evidence about a comprehensive knowledge synthesis that could shed light on AI systems tested or implemented in CBPHC. OBJECTIVE We intended to identify and evaluate published studies that have tested or implemented AI in CBPHC settings. METHODS We conducted a systematic scoping review informed by an earlier study and the Joanna Briggs Institute (JBI) scoping review framework and reported the findings according to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Scoping Reviews) reporting guidelines. An information specialist performed a comprehensive search from the date of inception until February 2020, in seven bibliographic databases: Cochrane Library, MEDLINE, EMBASE, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), ScienceDirect, and IEEE Xplore. The selected studies considered all populations who provide and receive care in CBPHC settings, AI interventions that had been implemented, tested, or both, and assessed outcomes related to patients, health care providers, or CBPHC systems. Risk of bias was assessed using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Two authors independently screened the titles and abstracts of the identified records, read the selected full texts, and extracted data from the included studies using a validated extraction form. Disagreements were resolved by consensus, and if this was not possible, the opinion of a third reviewer was sought. A third reviewer also validated all the extracted data. RESULTS We retrieved 22,113 documents. After the removal of duplicates, 16,870 documents were screened, and 90 peer-reviewed publications met our inclusion criteria. Machine learning (ML) (41/90, 45%), natural language processing (NLP) (24/90, 27%), and expert systems (17/90, 19%) were the most commonly studied AI interventions. These were primarily implemented for diagnosis, detection, or surveillance purposes. Neural networks (ie, convolutional neural networks and abductive networks) demonstrated the highest accuracy, considering the given database for the given clinical task. The risk of bias in diagnosis or prognosis studies was the lowest in the participant category (4/49, 4%) and the highest in the outcome category (22/49, 45%). CONCLUSIONS We observed variabilities in reporting the participants, types of AI methods, analyses, and outcomes, and highlighted the large gap in the effective development and implementation of AI in CBPHC. Further studies are needed to efficiently guide the development and implementation of AI interventions in CBPHC settings.
Collapse
Affiliation(s)
- Samira Abbasgholizadeh Rahimi
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Mila-Quebec AI Institute, Montreal, QC, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada.,VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada
| | - Gauri Sharma
- Faculty of Engineering, Dayalbagh Educational Institute, Agra, India
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada.,VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada
| | - Herve Tchala Vignon Zomahoun
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada.,Quebec SPOR-Support Unit, Quebec City, QC, Canada
| | - Sam Chandavong
- Faculty of Science and Engineering, Université Laval, Quebec City, QC, Canada
| | - Nathalie Rheault
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada.,Quebec SPOR-Support Unit, Quebec City, QC, Canada
| | - Sabrina T Wong
- School of Nursing, University of British Columbia, Vancouver, BC, Canada.,Center for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Lyse Langlois
- Department of Industrial Relations, Université Laval, Quebec City, QC, Canada.,OBVIA - Quebec International Observatory on the social impacts of AI and digital technology, Quebec City, QC, Canada
| | - Yves Couturier
- School of Social Work, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Jose L Salmeron
- Department of Data Science, University Pablo de Olavide, Seville, Spain
| | | | - Jean Légaré
- Arthritis Alliance of Canada, Montreal, QC, Canada
| |
Collapse
|
31
|
Gaboury I, Breton M, Perreault K, Bordeleau F, Descôteaux S, Maillet L, Hudon C, Couturier Y, Duhoux A, Vachon B, Cossette B, Rodrigues I, Poitras ME, Loignon C, Vasiliadis HM. Interprofessional advanced access - a quality improvement protocol for expanding access to primary care services. BMC Health Serv Res 2021; 21:812. [PMID: 34388996 PMCID: PMC8361639 DOI: 10.1186/s12913-021-06839-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/30/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The Advanced Access (AA) Model has shown considerable success in improving timely access for patients in primary care settings. As a result, a majority of family physicians have implemented AA in their organizations over the last decade. However, despite its widespread use, few professionals other than physicians and nurse practitioners have implemented the model. Among those who have integrated it to their practice, a wide variation in the level of implementation is observed, suggesting a need to support primary care teams in continuous improvement with AA implementation. This quality improvement research project aims to document and measure the processes and effects of practice facilitation, to implement and improve AA within interprofessional teams. METHODS Five primary care teams at various levels of organizational AA implementation will take part in a quality improvement process. These teams will be followed independently over PDSA (Plan-Do-Study-Act) cycles for 18 months. Each team is responsible for setting their own objectives for improvement with respect to AA. The evaluation process consists of a mixed-methods plan, including semi-structured interviews with key members of the clinical and management teams, patient experience survey and AA-related metrics monitored from Electronic Medical Records over time. DISCUSSION Most theories on organizational change indicate that practice facilitation should enable involvement of stakeholders in the process of change and enable improved interprofessional collaboration through a team-based approach. Improving access to primary care services is one of the top priorities of the Quebec's ministry of health and social services. This study will identify key barriers to quality improvement initiatives within primary care and help to develop successful strategies to help teams improve and broaden implementation of AA to other primary care professionals.
Collapse
Affiliation(s)
- Isabelle Gaboury
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada.
| | - Mylaine Breton
- Department of community health sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Kathy Perreault
- GMF-U Saint-Jean-sur-Richelieu, Saint-Jean-sur-Richelieu, Canada
| | - François Bordeleau
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Sarah Descôteaux
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Lara Maillet
- École Nationale d'Administration Publique, Montreal, Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Yves Couturier
- School of social work, Faculty of letters and social sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Arnaud Duhoux
- Faculty of Nursing, Université de Montréal, Montreal, Canada
| | - Brigitte Vachon
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Benoit Cossette
- Department of community health sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Isabel Rodrigues
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Marie-Eve Poitras
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Christine Loignon
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Helen-Maria Vasiliadis
- Department of community health sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| |
Collapse
|
32
|
Couturier Y, Lanneville D, Lane J, Bruneau MA, Morin M, Gilbert S, Boyer D, MacDonald T, Ben Gaied N, Cosette B. Implementation conditions leading to the scale-up of an innovation involving the optimal use of antipsychotics in long-term care centers: The Optimizing Practices, use, Care and Services-Antipsychotics (OPUS-AP) program. Res Social Adm Pharm 2021; 18:2484-2488. [PMID: 33863639 DOI: 10.1016/j.sapharm.2021.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Antipsychotics are often used for the first-line management of behavioral and psychological symptoms of dementia despite their limited efficacy and the risk of serious adverse drug events, compounded with disregard for guidelines recommending prioritizing non-pharmacological interventions. Some innovative interventions promote the deprescription of antipsychotics in long term care (LTC) settings. OBJECTIVE The objective of this article is to present the conditions leading to the scale-up of an innovative program on the appropriate use of antipsychotics in LTC centers. METHODS The Optimizing Practices, Use, Care and Services-Antipsychotics (OPUS-AP) program is a mixed-method project that aims to improve LTC residents' care through increased knowledge and competency among staff, resident-centered approaches, nonpharmacologic interventions, and by deprescribing antipsychotics when appropriate. This article consists of a qualitative study focused on exploring the implementation conditions of the OPUS-AP program. This study was carried out in an integrated health area of Québec. It consisted of 46 semi-structured interviews with staff members and managers involved in the implementation of OPUS-AP. The qualitative data analysis was inspired by a realistic evaluation approach, which shed light on the causal chain between context, mechanisms, and perceived effects. RESULTS This study identified certain conditions conducive to scaling up the OPUS-AP program: an integrated, collaborative and evidence-based approach; communications in support of the process; stakeholder engagement at the strategic, tactical and operational levels; an implementation climate conducive to change; and an integrated knowledge translation strategy. CONCLUSION Despite evidence of clinical efficacy, deprescribing programs require great deal of scaling up efforts. Hence, this study underscores the need to further examine conditions for scaling up medication usage programs in real life contexts.
Collapse
Affiliation(s)
| | | | - Julie Lane
- University of Sherbrooke, Canada; RBC Centre of Academic Expertise in Mental Health, Canada.
| | | | - Michèle Morin
- Laval University, Canada; CISSS Chaudière-Appalaches, Canada.
| | | | - Diane Boyer
- Centre Intégré Universitaire de Santé et de Services Sociaux de L'Estrie - Centre Hospitalier Universitaire de Sherbrooke (the French Official Name of the Institution), Canada.
| | | | | | - Benoît Cosette
- University of Sherbrooke, Canada; Research Center on Aging of CIUSSS de L'Estrie-CHUS, Canada.
| |
Collapse
|
33
|
Arsenault-Lapierre G, Godard-Sebillotte C, Sourial N, Couturier Y, Bouchard P, Rozo LR, Pilon C, Bergman H, Vedel I. Le Plan Alzheimer québécois, un plan basé sur les soins primaires. Sante Publique 2021; 32:375-380. [PMID: 33512104 DOI: 10.3917/spub.204.0375] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Many countries have answered the call from the World Health Organization, and developed or implemented Alzheimer Plans. Some plans anchored the majority of the care for persons living with dementia in specialized care settings, while others anchored it in primary care. In this article we present the Quebec Alzheimer Plan, which is being implemented in Family Medicine Groups, primary care interdisciplinary clinics, across the Canadian province. The Quebec Alzheimer Plan aims to enable primary healthcare teams of physicians, nurses and/or social workers to provide access to personalized, coordinated assessment and treatment services for people living with dementia and their caregivers. The Quebec Alzheimer Plan enables and empowers primary care clinicians to detect, diagnose, treat and follow-up the vast majority of patients/caregivers. A major strength of the Quebec Alzheimer Plan strategy is the embedded evaluation to inform implementation and its flexibility to allow local adaptations. We are discussing that it is feasible and advantageous to anchor dementia care in an interprofessional primary care setting.
Collapse
|
34
|
Corriveau G, Couturier Y, Camden C. Developing Competencies of Nurses in Wound Care: The Impact of a New Service Delivery Model Including Teleassistance. J Contin Educ Nurs 2020; 51:547-555. [PMID: 33232502 DOI: 10.3928/00220124-20201113-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 06/08/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The implementation of a new wound care model of service delivery, including training and teleassistance, provided us with the opportunity to study nursing competencies in a primary health care context. METHOD A mixed-methods study was chosen to address the complexity related to the development of competencies from two complementary perspectives. RESULTS Nurses' self-perceived knowledge and skills improved immediately after training. Factors identified as influencing the development process were grouped into three themes: Acquired Skills and Knowledge, Personal Factors, and Work Organization Factors. CONCLUSION Our study demonstrates that the skills and knowledge can be enhanced through integrated continuing education efforts, and brings a deeper understanding of factors that influence the competency development. Finally, the research team highlighted the potential of telehealth technologies. [J Contin Educ Nurs. 2020;51(12):547-555.].
Collapse
|
35
|
Bruneau M, Couturier Y, Gilbert S, Boyer D, Ricard J, MacDonald T, Arcand M, Morin M, Tousignant M, Rhéaume A, Turcotte J, Cossette B. Optimizing Practices, Use, Care and Services‐Antipsychotics (OPUS‐AP): A phase 2 scale‐up to 129 long‐term care (LTC) centers in Quebec, Canada. Alzheimers Dement 2020. [DOI: 10.1002/alz.037171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Marie‐Andrée Bruneau
- University of Montreal Montreal QC Canada
- Institut Universitaire de Gériatrie de Montréal Research Center Montréal QC Canada
| | | | - Suzanne Gilbert
- Institut Universitaire de Gériatrie de Montréal Montréal QC Canada
| | | | - Jacques Ricard
- Ministère de la Santé et des Services Sociaux du Québec Québec QC Canada
| | - Tanya MacDonald
- Canadian Foundation for Healthcare Improvement Montreal QC Canada
| | | | | | | | | | | | | |
Collapse
|
36
|
Viscogliosi C, Asselin H, Basile S, Borwick K, Couturier Y, Drolet MJ, Gagnon D, Obradovic N, Torrie J, Zhou D, Levasseur M. Importance of Indigenous elders' contributions to individual and community wellness: results from a scoping review on social participation and intergenerational solidarity. Can J Public Health 2020; 111:667-681. [PMID: 32109314 PMCID: PMC7501322 DOI: 10.17269/s41997-019-00292-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 12/23/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Wellness is a challenge for Indigenous peoples, partly because Western services do not adopt a holistic approach. By devaluing traditional knowledge, Indigenous values and beliefs, these services lower Indigenous power and affect cultural identities. Indigenous elders participate in intergenerational solidarity by transmitting knowledge, values, and culture in a holistic approach. Despite widespread acceptance of the importance of Indigenous elders' contributions to wellness, a rigorous synthesis of knowledge has never been done. This study aimed to provide a comprehensive understanding of how Indigenous elders' social participation contributes to individual and community wellness. METHOD A scoping review was conducted with Indigenous elders and stakeholders in Québec (Canada). Sixteen databases were searched with 57 keywords. Data from the documents retrieved were analyzed, organized, and synthesized based on the International Classification of Functioning, Disability and Health. SYNTHESIS A total of 144 documents were examined, comprising 74 scientific papers and 70 sources from the gray literature. Indigenous elders contributed to wellness mainly through relationships and interactions with other community members and non-Indigenous people (72.2%); intergenerational oral and written communications (70.1%); community, social and civic life (45.8%); volunteering and jobs (35.4%); and family life (29.9%). Elders transmit traditional knowledge, strengthen social cohesion, and help to develop positive attitudes such as reciprocity. Their actions favour disease prevention and health promotion, as including traditional approaches increases the acceptability of health and social services. CONCLUSION This scoping review highlights the need for longitudinal studies with mixed-method designs involving Indigenous communities at all stages of the research to deepen understanding of the contributions of Indigenous elders to individual and community wellness.
Collapse
Affiliation(s)
- Chantal Viscogliosi
- School of Rehabilitation, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Canada.
- Research Centre on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie-Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Canada.
| | - Hugo Asselin
- School of Indigenous Studies, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Canada
| | - Suzy Basile
- School of Indigenous Studies, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Canada
| | - Kimberly Borwick
- School of Rehabilitation, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Canada
| | - Yves Couturier
- Research Centre on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie-Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Canada
- School of Social Work, Université de Sherbrooke, Sherbrooke, Canada
| | - Marie-Josée Drolet
- Occupational Therapy Department, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Dominique Gagnon
- Unité d'enseignement et de recherche en sciences du développement humain et social, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Canada
| | - Natasa Obradovic
- School of Rehabilitation, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Canada
| | - Jill Torrie
- Department of Public Health, Cree Board of Health and Social Services of James Bay, Montréal, Canada
| | - Diana Zhou
- School of Rehabilitation, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Canada
| | - Mélanie Levasseur
- School of Rehabilitation, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Canada
- Research Centre on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie-Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Canada
| |
Collapse
|
37
|
Roy M, Lavoie-Trudeau E, Benkhalti M, Couturier Y, Lane J, Clapperton I, Roy MA, Bibeau L, Ouellette M, Camden C. Community outreach workers: Perceived practices and impacts on families and young children. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Community outreach workers support individuals accessing healthcare and other services that could be useful to respond to their needs. Even though community outreach workers have been working in the province of Quebec (Canada) for the past 40 years, their practice is poorly documented and evaluated, especially with respect to young children aged 0 to 5 years. This study aimed to document the practice of community outreach workers and its perceived impacts among children and families.
Methods
A qualitative methodology with a descriptive research design was used. We performed a content analysis on 55 scientific and grey literature documents, 24 individual interviews, and 3 focus groups with stakeholders including parents, community outreach workers, healthcare employees, and inter-sectoral partners.
Results
Our analysis reveals three main themes: 1) characteristics of the population served, 2) concrete actions performed by community outreach workers, and 3) perceived impacts of community outreach on families and children. Community outreach workers were perceived as essential to reach families with vulnerable circumstances and children with special needs. With respect to concrete actions, community outreach workers were reported to tailor their interventions to respond in different but complementary ways to the healthcare system. Perceived impacts included increased access for children and families to appropriate services, decreased social isolation, increased empowerment (especially with respect to parental abilities), increased social capital of families, and confidence towards the healthcare system. Results showed that community outreach workers helped to reduce inequalities in health
Conclusions
Community outreach work help the healthcare system to fulfill its legal mandate to protect citizen and increase health and well-being. It is crucial that such type of proximity approaches be not only encouraged but also sustained.
Key messages
Community outreach workers adapt their practices to act in a complementary way to the healthcare system. Community outreach workers help to reduce inequalities in health.
Collapse
Affiliation(s)
- M Roy
- Health Technology and Social Services Assessment Unit, CIUSSS de l'Estrie - CHUS, Sherbrooke, Canada
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Sherbrooke, Canada
| | - E Lavoie-Trudeau
- School of Rehabilitation, University of Sherbrooke, Sherbrooke, Canada
| | - M Benkhalti
- Health Technology and Social Services Assessment Unit, CIUSSS de l'Estrie - CHUS, Sherbrooke, Canada
| | - Y Couturier
- School of Social Work, University of Sherbrooke, Sherbrooke, Canada
| | - J Lane
- School of Education, University of Sherbrooke, Sherbrooke, Canada
| | - I Clapperton
- Eastern Townships Public Health Department, CIUSSS de l'Estrie-CHUS, Sherbrooke, Canada
- Department of Community Health Sciences, University of Sherbrooke, Sherbrooke, Canada
| | - M A Roy
- Eastern Townships Public Health Department, CIUSSS de l'Estrie-CHUS, Sherbrooke, Canada
| | - L Bibeau
- Avenir d’enfants, Boucherville, Canada
| | - M Ouellette
- Eastern Townships Public Health Department, CIUSSS de l'Estrie-CHUS, Sherbrooke, Canada
| | - C Camden
- School of Rehabilitation, University of Sherbrooke, Sherbrooke, Canada
| |
Collapse
|
38
|
Archambault PM, Rivard J, Smith PY, Sinha S, Morin M, LeBlanc A, Couturier Y, Pelletier I, Ghandour EK, Légaré F, Denis JL, Melady D, Paré D, Chouinard J, Kroon C, Huot-Lavoie M, Bert L, Witteman HO, Brousseau AA, Dallaire C, Sirois MJ, Émond M, Fleet R, Chandavong S. Learning Integrated Health System to Mobilize Context-Adapted Knowledge With a Wiki Platform to Improve the Transitions of Frail Seniors From Hospitals and Emergency Departments to the Community (LEARNING WISDOM): Protocol for a Mixed-Methods Implementation Study. JMIR Res Protoc 2020; 9:e17363. [PMID: 32755891 PMCID: PMC7439141 DOI: 10.2196/17363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/17/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Elderly patients discharged from hospital experience fragmented care, repeated and lengthy emergency department (ED) visits, relapse into their earlier condition, and rapid cognitive and functional decline. The Acute Care for Elders (ACE) program at Mount Sinai Hospital in Toronto, Canada uses innovative strategies, such as transition coaches, to improve the care transition experiences of frail elderly patients. The ACE program reduced the lengths of hospital stay and readmission for elderly patients, increased patient satisfaction, and saved the health care system over Can $4.2 million (US $2.6 million) in 2014. In 2016, a context-adapted ACE program was implemented at one hospital in the Centre intégré de santé et de services sociaux de Chaudière-Appalaches (CISSS-CA) with a focus on improving transitions between hospitals and the community. The quality improvement project used an intervention strategy based on iterative user-centered design prototyping and a "Wiki-suite" (free web-based database containing evidence-based knowledge tools) to engage multiple stakeholders. OBJECTIVE The objectives of this study are to (1) implement a context-adapted CISSS-CA ACE program in four hospitals in the CISSS-CA and measure its impact on patient-, caregiver-, clinical-, and hospital-level outcomes; (2) identify underlying mechanisms by which our context-adapted CISSS-CA ACE program improves care transitions for the elderly; and (3) identify underlying mechanisms by which the Wiki-suite contributes to context-adaptation and local uptake of knowledge tools. METHODS Objective 1 will involve staggered implementation of the context-adapted CISSS-CA ACE program across the four CISSS-CA sites and interrupted time series to measure the impact on hospital-, patient-, and caregiver-level outcomes. Objectives 2 and 3 will involve a parallel mixed-methods process evaluation study to understand the mechanisms by which our context-adapted CISSS-CA ACE program improves care transitions for the elderly and by which our Wiki-suite contributes to adaptation, implementation, and scaling up of geriatric knowledge tools. RESULTS Data collection started in January 2019. As of January 2020, we enrolled 1635 patients and 529 caregivers from the four participating hospitals. Data collection is projected to be completed in January 2022. Data analysis has not yet begun. Results are expected to be published in 2022. Expected results will be presented to different key internal stakeholders to better support the effort and resources deployed in the transition of seniors. Through key interventions focused on seniors, we are expecting to increase patient satisfaction and quality of care and reduce readmission and ED revisit. CONCLUSIONS This study will provide evidence on effective knowledge translation strategies to adapt best practices to the local context in the transition of care for elderly people. The knowledge generated through this project will support future scale-up of the ACE program and our wiki methodology in other settings in Canada. TRIAL REGISTRATION ClinicalTrials.gov NCT04093245; https://clinicaltrials.gov/ct2/show/NCT04093245. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/17363.
Collapse
Affiliation(s)
- Patrick Michel Archambault
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Josée Rivard
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
| | - Pascal Y Smith
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Samir Sinha
- Department of Medicine, Sinai Health System, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, QC, Canada
- Department of Medicine, University of Toronto, Toronto, QC, Canada
| | - Michèle Morin
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Department of Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Annie LeBlanc
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
| | - Yves Couturier
- Department of Social Work, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Isabelle Pelletier
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - El Kebir Ghandour
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Institut national d'excellence en sante et en services sociaux, Québec, QC, Canada
| | - France Légaré
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Québec, QC, Canada
| | - Jean-Louis Denis
- Département de gestion, d'évaluation et de politique de santé, École de santé publique, Université de Montréal, Montreal, QC, Canada
| | - Don Melady
- Schwartz-Reisman Emergency Medicine Institute, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel Paré
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
| | - Josée Chouinard
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
| | - Chantal Kroon
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
| | - Maxime Huot-Lavoie
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Laetitia Bert
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Faculty of Nursing, Université Laval, Québec, QC, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Office of Education and Professional Development, Faculty of Medicine, Université Laval, Québec, QC, Canada
- CHU de Québec-Université Laval, Québec, QC, Canada
| | - Audrey-Anne Brousseau
- Centre intégré universitaire de santé et de services sociaux de l'Estrie - CHUS, Sherbrooke, QC, Canada
| | - Clémence Dallaire
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Faculty of Nursing, Université Laval, Québec, QC, Canada
| | - Marie-Josée Sirois
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Centre d'excellence sur le vieillissement du Québec, Hôpital du Saint-Sacrement, Québec, QC, Canada
- Département de réadaptation, Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Marcel Émond
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- CHU de Québec-Université Laval, Québec, QC, Canada
| | - Richard Fleet
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Sam Chandavong
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| |
Collapse
|
39
|
Wankah P, Guillette M, Lemaitre T, Belzile L, Couturier Y. Challenges in measuring integrated care models: International knowledge and the case of Québec. International Journal of Care Coordination 2020. [DOI: 10.1177/2053434520945087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction The implementation of integrated care models requires significant efforts, especially due to institutional and organisational inertial forces that characterize health and social care systems of developed countries. It is therefore crucial to deploy strategies that promote continuous adjustment to these barriers so as to improve the benefits of integrating care. Measuring the implementation and effects of integrated care models are key component of these strategies. However, measuring integrated care also faces major challenges. This study aims to identify and characterise integrated care measurement challenges. Methods A review of reviews on the measurement of integrated care identified 12 papers. A thematic analysis was conducted to identify and categorize measurement challenges. Document analysis was done on the measurement of an integrated care model for older adults in Québec. Results Eight categories of measurement challenges were identified. These challenges include difficulties in measuring structures, processes, and effects of models; conceptual ambiguity and heterogeneity of organisational forms; involving multiple actors in the measurement strategy; and including multiple data sources, amongst others. These challenges revealed and explained potential gaps in the measurement of integrated care for older adults in Québec. For instance, the Québec measurement strategy did not include effects indicators. Conclusion Although the measurement of integrated care is a complex endeavour, there is a need for adequate measurement strategies that allow to appreciate important elements of integrate care. The findings of this study could be used as a reflexive tool in advancing research and practice of measuring integrated care.
Collapse
|
40
|
Shrivastava R, Couturier Y, Girard F, Papineau L, Emami E. Two-eyed seeing of the integration of oral health in primary health care in Indigenous populations: a scoping review. Int J Equity Health 2020; 19:107. [PMID: 32605562 PMCID: PMC7329486 DOI: 10.1186/s12939-020-01195-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Indigenous people experience significant poor oral health outcomes and poorer access to oral health care in comparison to the general population. The integration of oral health care with primary health care has been highlighted to be effective in addressing these oral health disparities. Scoping studies are an increasingly popular approach to reviewing health research evidence. Two-eyed seeing is an approach for both Western and Indigenous knowledge to come together to aid understanding and solve problems. Thus, the two-eyed seeing theoretical framework advocates viewing the world with one eye focused on Indigenous knowledge and the other eye on Western knowledge. This scoping review was conducted to systematically map the available integrated primary oral health care programs and their outcomes in these communities using the two-eyed seeing concept. METHODS This scoping review followed Arksey and O'Malley's five-stage framework and its methodological advancement by Levac et al. A literature search with defined eligibility criteria was performed via several electronic databases, non-indexed Indigenous journals, Indigenous health organizational websites, and grey literature. The charted data was classified, analyzed, and reported using numeral summary and qualitative content analysis. The two-eyed seeing concept guided the interpretation and synthesis of the evidence on approaches and outcomes. RESULTS A total of 29 publications describing 30 programs conducted in Australia and North America from 1972 to 2019 were included in the final analysis. The following four program categories emerged from the analysis: oral health promotion and prevention programs (n = 13), comprehensive dental services (n = 13), fly in, fly out dental services (n = 3), and teledentistry (n = 1). Biomedical approaches for integrated primary oral health care were leadership and governance, administration and funding, capacity building, infrastructure and technology, team work, and evidence-based practice. Indigenous approaches included the vision for holistic health, culturally appropriate services, community engagement, shared responsibility, and cultural safety. The program outcomes were identified for biological, mental, and emotional dimensions of oral health; however, measurement of the spiritual dimension was missing. CONCLUSION Our results suggest that a multiple integrated primary oral health care approach with a particular focus on Indigenous culture seems to be efficient and relevant in improving Indigenous oral health.
Collapse
Affiliation(s)
- Richa Shrivastava
- Faculty of Dentistry, Université de Montréal, Montréal, Québec, H3C 3J7, Canada
| | - Yves Couturier
- School of Social Work, Université de Sherbrooke, Sherbrooke, J1H 4C4, Québec, Canada
| | - Felix Girard
- Faculty of Dentistry, Université de Montréal, Montréal, Québec, H3C 3J7, Canada
| | - Lucie Papineau
- Cree Board of Health and Social Services of James Bay, Oujé-Bougoumou Healing Centre, Oujé-Bougoumou, Québec, G0W 3C0, Canada
| | - Elham Emami
- Faculty of Dentistry, Université de Montréal, Montréal, Québec, H3C 3J7, Canada. .,Faculty of Dentistry, McGill University, Montreal, Québec, H3A 1G1, Canada.
| |
Collapse
|
41
|
Shrivastava R, Couturier Y, Girard F, Bedos C, Macdonald ME, Torrie J, Emami E. Appreciative inquiry in evaluating integrated primary oral health services in Quebec Cree communities: a qualitative multiple case study. BMJ Open 2020; 10:e038164. [PMID: 32595166 PMCID: PMC7322273 DOI: 10.1136/bmjopen-2020-038164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The Strategic Regional Plan of the Cree Board of Health and Social Services of James Bay (CBHSSJB), serving the Quebec Cree communities, mandates the objective of integrating oral health within primary healthcare. Emerging evidence suggests that the integration of oral health into primary healthcare can decrease oral health disparities. This research study aimed to answer the following research question: how and to what extent does the integration of oral health into primary healthcare address the oral health needs of the Cree communities? DESIGN We used a multiple-case study design within a qualitative approach and developmental evaluation methodology. The Discovery, Dream, Design and Destiny model of appreciative inquiry was selected as a study framework among existing frameworks of the developmental evaluation. SETTING Four purposefully selected Cree communities. PARTICIPANTS Healthcare providers, administrators and patients at the community wellness centres and hospital. OUTCOME MEASURES Integration of oral health into primary healthcare. RESULTS A total of 36 interviews and 6 focus group discussions were conducted. We identified ten themes in discovery and dream phases. The Discovery phase identified the strengths of the organisation in facilitating enablers of integration including strategic planning, organisational structure, cultural integration, coordinated networks and colocation. In the Dream phase, participants' oral healthcare stories expressed various dimensions of integration and their wish for strengthening integration via extending public oral healthcare programmes, increasing resources and improving organisational management. In the Design phase, recommendations were formulated for a future action plan within the CBHSSJB. CONCLUSION This study results suggested that the CBHSSJB has been successful in implementing oral health integration into primary care following its strategic planning. At present, the organisation could extend the level of integration into full integration by following study recommendations derived from the perspective of local stakeholders.
Collapse
Affiliation(s)
- Richa Shrivastava
- Faculty of Dentistry, Université de Montréal, Montréal, Québec, Canada
| | - Yves Couturier
- School of Social Work, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Felix Girard
- Faculty of Dentistry, Université de Montréal, Montréal, Québec, Canada
| | - Christophe Bedos
- Faculty of Dentistry, McGill University, Montréal, Québec, Canada
| | | | - Jill Torrie
- Public-Health Department, Cree Board of Health and Social Services of James Bay, Mistissini, Québec, Canada
| | - Elham Emami
- Faculty of Dentistry, McGill University, Montréal, Québec, Canada
| |
Collapse
|
42
|
Harnagea H, Couturier Y, Lamothe L, Emami E. [Integrating oral health care services into primary care in Quebec]. Sante Publique 2020; 31:809-816. [PMID: 32550663 DOI: 10.3917/spub.196.0809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Although integrated care is drawing considerable attention from health care policy makers, little is known about integration of oral health care services into primary care in Quebec. Therefore, the objective of this study was to compile information and compare the aspects of primary oral health care in two public health care organizations. METHOD An environmental scan was carried out in one rural and one urban primary health care organizations in Quebec. Data were collected from organizations' websites, operational documents, observational notes on facility visits, primary care meeting minutes, online pages of professional orders and face to face interviews (N = 74) and focus groups (N = 5), between November 2016 and October 2018. Thematic and Prior's documentation analyses were used to analyse the data. RESULTS Three themes were identified: normative aspects of integrated care delivery, integration trajectories, and integration initiatives. In both organizations, the integration of oral health into primary care rooted in public health sectors and dental teams were the key players. While urban center showed informal linkages between dental and non-dental primary care providers, the rural organization succeeded in coordination processes, even though these were also informal. CONCLUSION The majority of primary oral health care services are delivered in the public health sectors and the sustainability of integration initiatives in other primary health care sectors remains to be demonstrated. A better management of resources, as well as partnerships between public health care organizations and universities, could contribute to this integration.
Collapse
|
43
|
Vedel I, McAiney C, Couturier Y, Pakzad S, Arsenault-Lapierre G, Godard-Sebillotte C, Sourial N, Simmons R, Bergman H. Assessing care models implemented in primary healthcare for persons with dementia: a mixed-methods study protocol. BMJ Open 2020; 10:e035916. [PMID: 32414829 PMCID: PMC7232631 DOI: 10.1136/bmjopen-2019-035916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Dementia is on the rise in Canada and globally. Ensuring accessibility to diagnosis, treatment and management throughout the course of the disease is a very significant problem worldwide. In order to provide comprehensive care to patients and their caregivers, enhancing primary care-based dementia care is seen as the way forward. In many Canadian provinces various collaborative care models (collCMs) anchored in primary care to improve dementia care have been developed and implemented. The overall objective of our research programme is to identify key factors for the successful implementation of collCMs, and to facilitate dissemination and scale-up of dementia best practices. METHODS AND ANALYSIS We will use a convergent mixed-methods design. An observational study using chart review (2014-2016) and questionnaires (2014-2018; repeated in 2020) will measure application of guidelines and implementation of collCMs. This study will be complemented with a qualitative descriptive study using interviews (2017-2020) conducted in parallel. Quantitative and qualitative results will be further integrated using a matrix representing sites and findings. An integrated knowledge exchange strategy will ensure uptake by principal stakeholders throughout the research. ETHICS AND DISSEMINATION Our study has been approved by all relevant ethics committees. Our dissemination plan follows an integrated knowledge transfer strategy using provincial, national and international councils. We will present the results individually to the clinical sites and then to these councils. Our research will be the first provincial and cross jurisdictional evaluation of primary care models for patients living with dementia, providing evidence on the ongoing debate on the respective role of clinicians in primary care and specialists in caring for patients with dementia.
Collapse
Affiliation(s)
- Isabelle Vedel
- Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Carrie McAiney
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada
| | - Yves Couturier
- Social Work, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Sarah Pakzad
- School of Psychology, University of Moncton, Moncton, New Brunswick, Canada
| | | | | | - Nadia Sourial
- Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Rachel Simmons
- Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Howard Bergman
- Family Medicine, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
44
|
Shrivastava R, Campeau R, Couturier Y, Torrie J, Girard F, Marie-Pierre B, Emami E. Anthropological perspectives on Miyupimaatisiiun and the integration of oral health in primary care in the Cree communities of Northern Quebec. PLoS One 2020; 15:e0231406. [PMID: 32271846 PMCID: PMC7144986 DOI: 10.1371/journal.pone.0231406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/22/2020] [Indexed: 12/23/2022] Open
Abstract
The integration of primary oral health care has a pivotal role in improving oral health outcomes and providing accessible and affordable health care. This article contributes to the deep understanding of the cultural aspects of the integration of oral health into primary health care at an Indigenous health organization. Proceeding from a collaborative and interdisciplinary research project evaluating the integration of oral health care within primary care in Eeyou Istchee, this research is based on group discussions (6) and individual interviews (36) with 74 participants (care providers, administrators, and patients) held in four Eastern James Bay Cree communities. This study anthropologically explored participants’ perceptions about primary health care conceptualizations, culturally based approaches, and experiences of oral care services at this organization using a “two-eyed seeing” Indigenous framework. The study identified three key factors related to the integration of primary oral health care: Cree perception of primary health and oral health care, cultural safety, and health provider–patient communication and the role of silence. Study findings reflected a dichotomy of perception of primary health care and the relevant units of care between the Cree structural and cultural perspective and the non-Cree professional perspective. The Cree people perceived “household” as a unit of care in comparison to non-Cree who viewed “health care services” as units of care. Our results also underline the role of cultural safety agents to address the needs for cultural competence and the role of silence as implicit cultural protocol. Our anthropological analysis illustrates the potential for increasing the level of appreciation for both users and workers in oral care in the future by ameliorating communication skills and intercultural knowledge.
Collapse
Affiliation(s)
- Richa Shrivastava
- Faculty of Dentistry, Université de Montréal, Montreal, Quebec, Canada
| | - Roxane Campeau
- Faculty of Music, Université de Montréal, Montreal, Quebec, Canada
| | - Yves Couturier
- School of Social Work, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Jill Torrie
- Specialised Services Department, Cree Board of Health and Social Services of James Bay, Mistissini, Quebec, Canada
| | - Felix Girard
- Faculty of Dentistry, Université de Montréal, Montreal, Quebec, Canada
| | | | - Elham Emami
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
- * E-mail:
| |
Collapse
|
45
|
Shrivastava R, Couturier Y, Simard-Lebel S, Girard F, Aguirre NVB, Torrie J, Emami E. Relational continuity of oral health care in Indigenous communities: a qualitative study. BMC Oral Health 2019; 19:287. [PMID: 31865901 PMCID: PMC6927186 DOI: 10.1186/s12903-019-0986-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 12/11/2019] [Indexed: 11/23/2022] Open
Abstract
Background The relational continuity of care is an essential function of primary health care. This study reports on the perspectives of Cree communities and their primary health care providers regarding the barriers and enablers of relational continuity of oral health care integrated at a primary health care organization. Methods A multiple case study design within a qualitative approach and developmental evaluation methodology were used to conduct this research study in Cree communities of Northern Québec. Maximum variation sampling and snowball techniques were used to recruit the participants. Data collection consisted of individual interviews and focus group discussions. Thematic analysis was conducted which included transcription, debriefing, codification, data display, and interpretation. The consolidated criteria for reporting qualitative studies (COREQ) were used to guide the reporting of study findings. Results A total of six focus group discussions and 36 individual interviews were conducted. Five major themes emerged from the thematic analyses for barriers (two) and enablers (three). Themes for barriers included impermanence and lack of effective communication, whereas themes for enablers included culturally competent professionals, working across professional boundaries, and proactive organizational engagement. Conclusions Based on these findings, relational continuity can be empowered by effective strategies for overcoming barriers and encouraging enablers, such as recruitment of permanent professionals, organizing cultural competency training, development of a Cree language dental glossary, encouraging inter-professional collaboration, and promoting the organization’s efforts.
Collapse
Affiliation(s)
- Richa Shrivastava
- Faculty of Dentistry, Université de Montréal, Montréal, Québec, H3C 3J7, Canada
| | - Yves Couturier
- School of Social Work, Université de Sherbrooke, Sherbrooke, J1H 4C4, Québec, Canada
| | | | - Felix Girard
- Faculty of Dentistry, Université de Montréal, Montréal, Québec, H3C 3J7, Canada
| | | | - Jill Torrie
- Director of Specialised Services, Cree Board of Health and Social Services of James Bay, Mistissini, Québec, G0W 1C0, Canada
| | - Elham Emami
- Faculty of Dentistry, McGill University, Montréal, Québec, H3A 1G1, Canada.
| |
Collapse
|
46
|
Smits P, Denis JL, Couturier Y, Touati N, Roy D, Boucher G, Rochon J. Implementing public policy in a non-directive manner: capacities from an intermediary organization. Can J Public Health 2019; 111:72-79. [PMID: 31667779 DOI: 10.17269/s41997-019-00257-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 08/22/2019] [Indexed: 11/17/2022]
Abstract
SETTING We investigate the capacities of an organization responsible for bridging top-down instructions emanating from a law on public health with the bottom-up realities of health service providers working on population-based health. This article traces the implementation of this law, which requires service-provider organizations to base their actions (planning, prevention, and curative activities) upon the expressed and non-expressed needs of the local population. We investigate a case in the province of Québec that took place over more than 10 years. INTERVENTION The state strategy involved a key structure: an intermediary organization named IPCDC/KSCDI. We first describe how the organization emerged; the expertise involved from the academic, service, and policy domains; the support provided to service-provider organizations; and the achievements. We then highlight the critical capacities the intermediary organization had to nurture. OUTCOMES We identify five critical capacities of the intermediary organization: the business intelligence to read and adjust to the given environment of certain organizations, a dedication to collective means, a win-win mentality, scientific connectivity, and the animation of safe havens. IMPLICATIONS It may be important to focus attention on a capacity approach to intermediary organizations. These capacities can potentially enable governmental organizations to compile a stock of resources that can be mobilized and transferred to support future implementations of other reforms. They could also benefit public health partners in the community who collaborate with service providers and actors who aspire to become intermediary organizations. Finally, the performance measurement of implementing reforms in a non-directive manner could be based on indicators related to these five critical capacities.
Collapse
Affiliation(s)
- Pernelle Smits
- Université Laval, Pavillon Palasis-Prince, 2325 Rue de la Terrasse, Ville de Québec, QC, G1V 0A6, Canada.
| | - Jean-Louis Denis
- School of Public Health, Centre de Recherche du CHUM, Université de Montréal, 900, rue Saint-Denis, Pavillon R, Montréal, QC, H2X 0A9, Canada
| | - Yves Couturier
- Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Nord-de-l'Île-de-Montréal, Montréal, Canada.,Centre de recherche et de partage des savoirs InterActions, Université de Sherbrooke, Sherbrooke, Canada
| | - Nassera Touati
- École nationale d'administration publique, Québec, Canada
| | - Denis Roy
- Science et gouvernance clinique, et en services sociaux, Institut national d'excellence en santé et services sociaux (INESSS), Québec, Canada
| | - Gylaine Boucher
- Institut national de santé publique du Québec, Montréal, Canada
| | - Jean Rochon
- Institut national de santé publique du Québec, Montréal, Canada
| |
Collapse
|
47
|
Cossette B, Bruneau MA, Couturier Y, Gilbert S, Boyer D, Ricard J, McDonald T, Labarre K, Déry V, Arcand M, Rodrigue C, Rhéaume AA, Moreault S, Allard C, Pépin MÉ, Beauchet O. Optimizing Practices, Use, Care and Services-Antipsychotics (OPUS-AP) in Long-term Care Centers in Québec, Canada: A Strategy for Best Practices. J Am Med Dir Assoc 2019; 21:212-219. [PMID: 31669289 DOI: 10.1016/j.jamda.2019.08.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/26/2019] [Accepted: 08/30/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Antipsychotic medications are often used for the first-line management of behavioral and psychological symptoms of dementia (BPSD) contrary to guideline recommendations. The Optimizing Practices, Use, Care and Services-Antipsychotics (OPUS-AP) strategy aims to improve the well-being of long-term care (LTC) residents with major neurocognitive disorder (MNCD) by implementing a resident-centered approach, nonpharmacologic interventions, and antipsychotic deprescribing in inappropriate indications. DESIGN Prospective, closed cohort supplemented by a developmental evaluation. SETTING AND PARTICIPANTS Residents of designated wards in 24 LTC centers in Québec, Canada. METHODS Provincial guidelines were disseminated, followed by the implementation of an integrated knowledge translation and mobilization strategy, including training, coaching, clinical tools, evaluation of clinical practices, and a change management strategy. Antipsychotic, benzodiazepine, and antidepressant prescriptions; BPSD; and falls were evaluated every 3 months, for 9 months, from January to October 2018. Semistructured interviews (n = 20) were conducted with LTC teams to evaluate the implementation of OPUS-AP. RESULTS Of 1054 residents, 78.3% had an MNCD diagnosis and 51.7% an antipsychotic prescription. The cohort included 464 residents with both MNCD and antipsychotic prescription. Antipsychotic deprescribing (cessation or dose decrease) was attempted in 220 of the 344 residents still admitted at 9 months. Complete cessation was observed in 116 of these residents (52.7%) and dose reduction in 72 (32.7%), for a total of 188 residents (85.5%; 95% confidence interval: 80.1%, 89.8%). A decrease in benzodiazepine prescriptions and improvements in Cohen-Mansfield Agitation Inventory scores were observed among residents who had their antipsychotics deprescribed. Caregivers and clinicians expressed satisfaction as a result of observing an improved quality of life among residents. CONCLUSIONS AND IMPLICATIONS Antipsychotic deprescribing was successful in a vast majority of LTC residents with MNCD without worsening of BPSD. Based on this success, phase 2 of OPUS-AP is now under way in 129 LTC centers in Québec.
Collapse
Affiliation(s)
- Benoit Cossette
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada; Research Centre on Aging, Integrated University Health and Social Services Centre of Estrie-Sherbrooke University Hospital Centre, Sherbrooke, Quebec, Canada.
| | - Marie-Andrée Bruneau
- Faculty of Medicine, Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada; Institut universitaire de gériatrie de Montréal research centre, Integrated University Health and Social Services Centre of the Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Yves Couturier
- Department of Social Work, University of Sherbrooke, Sherbrooke, Quebec, Canada; Québec Knowledge Network in Integrated Primary Health Care, Longueuil, Quebec, Canada
| | - Suzanne Gilbert
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
| | - Diane Boyer
- Integrated University Health and Social Services Centre of Estrie, Sherbrooke University Hospital Centre, Sherbrooke, Canada
| | - Jacques Ricard
- Integrated University Health and Social Services Centre of Estrie, Sherbrooke University Hospital Centre, Sherbrooke, Canada; Ministry of Health and Social Services, Quebec, Quebec, Canada
| | - Tanya McDonald
- Canadian Foundation for Healthcare Improvement, Ottawa, Ontario, Canada
| | | | - Véronique Déry
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marcel Arcand
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada; Research Centre on Aging, Integrated University Health and Social Services Centre of Estrie-Sherbrooke University Hospital Centre, Sherbrooke, Quebec, Canada
| | - Claudie Rodrigue
- Research Centre on Aging, Integrated University Health and Social Services Centre of Estrie-Sherbrooke University Hospital Centre, Sherbrooke, Quebec, Canada
| | - Andrée-Anne Rhéaume
- Centre of Excellence on Aging of Quebec, Integrated University Health and Social Services Centre of the National Capital, Quebec, Quebec, Canada
| | - Sylvie Moreault
- Integrated University Health and Social Services Centre of Estrie, Sherbrooke University Hospital Centre, Sherbrooke, Canada
| | - Catherine Allard
- Centre Hospitalier Universitaire de Sherbrooke Research centre, Sherbrooke, Québec, Canada
| | - Maude-Émilie Pépin
- Research Centre on Aging, Integrated University Health and Social Services Centre of Estrie-Sherbrooke University Hospital Centre, Sherbrooke, Quebec, Canada; School of Social Work, Faculty of Letters and Human Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Olivier Beauchet
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis, Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada; Dr. Joseph Kaufmann Chair in Geriatric Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| |
Collapse
|
48
|
Levasseur M, Filiatrault J, Larivière N, Trépanier J, Lévesque MH, Beaudry M, Parisien M, Provencher V, Couturier Y, Champoux N, Corriveau H, Carbonneau H, Sirois F. Influence of Lifestyle Redesign ® on Health, Social Participation, Leisure, and Mobility of Older French-Canadians. Am J Occup Ther 2019; 73:7305205030p1-7305205030p18. [PMID: 31484027 DOI: 10.5014/ajot.2019.031732] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
IMPORTANCE Developed in California to enable community-dwelling older adults to maintain healthy and meaningful activities, Lifestyle Redesign® is a well-known cost-effective preventive occupational therapy intervention. The impact of a newly adapted French version on older French-Canadians was, however, unknown. OBJECTIVE To explore the influence of Lifestyle Redesign on older French-Canadians' health, social participation, leisure, and mobility. DESIGN A mixed-methods design included a preexperimental component (questionnaires administered before and after the intervention and 3 and 6 mo postintervention) and an exploratory descriptive qualitative clinical study. Individual semidirected interviews were digitally audiotaped and transcribed, then underwent thematic content analysis using mix extraction grids. SETTING Community. PARTICIPANTS Sixteen volunteers (10 women) aged 65-90 yr (mean = 76.4, standard deviation = 7.6), 10 without and 6 with disabilities. Inclusion criteria were age ≥65 yr, normal cognitive functions, residence in a conventional or senior home, and French speaking. INTERVENTION French-Canadian 6-mo version of Lifestyle Redesign. OUTCOMES AND MEASURES Health, social participation, leisure, and mobility were measured using the 36-item Short Form Health Survey, Social Participation Scale, Leisure Profile, and Life-Space Assessment, as well as a semistructured interview guide. RESULTS The French-Canadian Lifestyle Redesign had a beneficial effect on participants' mental health (p = .02) and interest in leisure (p = .02) and, in those with disabilities, social participation (p = .03) and attitudes toward leisure (p = .04). Participants reported positive effects on their mental health, leisure, mobility, and social participation, including frequency and quality of social interactions, and indicated that having an occupational routine fostered better health. None of the participants reported no effect. CONCLUSION AND RELEVANCE The translated and culturally adapted Lifestyle Redesign is a promising occupational therapy intervention for community-dwelling older French-Canadians. WHAT THIS ARTICLE ADDS This study sheds light on the influence of the French-Canadian version of the intervention not only on older adults' health and social participation but also on their leisure activities and life-space mobility, two important outcomes not addressed in previous Lifestyle Redesign studies. Moreover, this study provides an in-depth understanding of the Lifestyle Redesign experience of French-Canadian older adults with and without disabilities, including participants with significant communication and mobility disabilities.
Collapse
Affiliation(s)
- Mélanie Levasseur
- Mélanie Levasseur, PhD, OT, is Full Professor, School of Rehabilitation, Université de Sherbrooke, and Researcher, Research Centre on Aging, Eastern Townships Integrated University Centre for Health and Social Services-Sherbrooke Hospital University Centre (CIUSSSE-CHUS), Sherbrooke, Quebec, Canada;
| | - Johanne Filiatrault
- Johanne Filiatrault, PhD, OT, is Associate Professor, School of Rehabilitation, Université de Montréal, and Researcher, Research Center, Montreal University Geriatric Institute, Montreal, Quebec, Canada
| | - Nadine Larivière
- Nadine Larivière, PhD, OT, is Full Professor, School of Rehabilitation, Université de Sherbrooke, and Researcher, University Institute for Primary Health Care and Social Services (IUPLSSS), CIUSSSE-CHUS, Sherbrooke, Quebec, Canada
| | - Jordane Trépanier
- Jordane Trépanier, MOT, OT, is Student, Université du Québec à Trois-Rivières, Quebec, Canada. At the time of this study, she was Student, School of Rehabilitation, Université de Sherbrooke, and Student, Research Centre on Aging, CIUSSSE-CHUS, Sherbrooke, Quebec, Canada
| | - Marie-Hélène Lévesque
- Marie-Hélène Lévesque, MOT, OT, is Student, School of Rehabilitation, Université de Sherbrooke, and Student, Research Centre on Aging, CIUSSSE-CHUS, Sherbrooke, Quebec, Canada
| | - Maryke Beaudry
- Maryke Beaudry, MSW, is Research Assistant, Research Centre on Aging, CIUSSSE-CHUS, Sherbrooke, Quebec, Canada
| | - Manon Parisien
- Manon Parisien, MSc, OT, is Reader, School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Quebec, Canada, and Research Coordinator, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Véronique Provencher
- Véronique Provencher, PhD, OT, is Assistant Professor, School of Rehabilitation, Université de Sherbrooke, and Researcher, Research Centre on Aging, CIUSSSE-CHUS, Sherbrooke, Quebec, Canada
| | - Yves Couturier
- Yves Couturier, PhD, is Full Professor, School of Rehabilitation, Université de Sherbrooke, and Researcher, IUPLSSS, CIUSSSE-CHUS, Sherbrooke, Quebec, Canada
| | - Nathalie Champoux
- Nathalie Champoux, MD, is Clinical Adjunct Professor, Department of Family Medicine, Université de Montréal, and Researcher, Research Center, Montreal University Geriatric Institute, Montreal, Quebec, Canada
| | - Hélène Corriveau
- Hélène Corriveau, PhD, PT, is Full Professor, School of Rehabilitation, Université de Sherbrooke, and Researcher, Research Centre on Aging, CIUSSSE-CHUS, Sherbrooke, Quebec, Canada
| | - Hélène Carbonneau
- Hélène Carbonneau, PhD, Rec, is Full Professor, Department of Leisure, Culture and Tourism Studies, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Fuschia Sirois
- Fuschia Sirois, PhD, Psy, is Reader, Department of Psychology, University of Sheffield, Sheffield, England
| |
Collapse
|
49
|
Shrivastava R, Couturier Y, Kadoch N, Girard F, Bedos C, Macdonald ME, Torrie J, Emami E. Patients' perspectives on integrated oral healthcare in a northern Quebec Indigenous primary health care organisation: a qualitative study. BMJ Open 2019; 9:e030005. [PMID: 31366663 PMCID: PMC6677955 DOI: 10.1136/bmjopen-2019-030005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Patient-centred care is considered to be an important element in the evaluation of integrated healthcare and has been effective in addressing oral health disparities. This study explored the patients' perspectives of patient-centred integrated care in oral health services integrated into a primary healthcare organisation serving a northern Quebec Cree population. DESIGN This study used a multiple case study design within a qualitative approach and developmental evaluation methodology. Two theoretical models, Picker's Principles of Patient-Centred Care and Valentijn's Rainbow Model of Integrated Care, guided data collection and data analysis. The thematic analysis included transcription, debriefing, codification, data display and interpretation. SETTING This study was conducted in purposefully selected four Cree communities of Northern Quebec. PARTICIPANTS Adult patients in need of oral healthcare and who attended the local dental clinic were identified and recruited by maximum variation sampling and snowball techniques. OUTCOME MEASURES Patients' perspectives of patient-centred integrated oral healthcare. RESULTS Data analysis generated six major themes: enhanced accessibility, creating supportive environment, building trust through shared decision making, appreciation of public health programmes, raising oral health awareness and growing cultural humility among healthcare providers. Patients identified the integration of dental care into primary healthcare with respect to co-location, provision of free oral healthcare services, care coordination and continuity of care, referral services, developing supportive environment, shared decision making, oral health promotion and culturally competent care. CONCLUSION These results confirmed that patient-centred care is an important element of integrated care. Patients valued the use of this concept in all domains and levels of integration. They recommended to further strengthen the clinical integration by involving parents in oral health promotion as well as optimising care coordination and empowering a supportive environment in organisational integration.
Collapse
Affiliation(s)
- Richa Shrivastava
- Faculty of Dentistry, Université de Montréal, Montréal, Québec, Canada
| | - Yves Couturier
- School of Social Work, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Naomi Kadoch
- Faculty of Dentistry, Université de Montréal, Montréal, Québec, Canada
| | - Felix Girard
- Faculty of Dentistry, Université de Montréal, Montréal, Québec, Canada
| | - Christophe Bedos
- Faculty of Dentistry, McGill University, Montréal, Québec, Canada
| | | | - Jill Torrie
- Public Health Department, Cree Board of Health and Social Services of James Bay, Mistissini, Québec, Canada
| | - Elham Emami
- Faculty of Dentistry, McGill University, Montréal, Québec, Canada
| |
Collapse
|
50
|
Morin É, Michaud-Létourneau I, Couturier Y, Roy M. A whole-food, plant-based nutrition program: Evaluation of cardiovascular outcomes and exploration of food choices determinants. Nutrition 2019; 66:54-61. [PMID: 31207440 DOI: 10.1016/j.nut.2019.03.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES An ideal diet to prevent cardiovascular diseases contains an unlimited intake of various plant foods and a reduced intake of animal and highly processed foods. Researchers have reported that nutrition education programs that prioritize whole-plant foods effectively contribute to the prevention of unhealthy cardiovascular outcomes. We examined whether a 12-wk nutrition education program in adults from Montreal (Quebec, Canada) with at least one risk factor of cardiovascular disease was effective in modifying their eating patterns toward including more whole-plant foods. We further evaluated the effects of this program on participants' cardiovascular outcomes and explored determinants influencing food choices toward whole-food, plant-based diets. METHODS A sequential, explanatory, mixed-methods, research design was used. A quantitative step (i.e., single-arm, quasi-experimental trial) preceded participant recruitment for a qualitative phase (i.e., phenomenological study; semistructured interview; thematic analysis). The examined outcomes were changes in cardiovascular risk factors (paired t tests) and determinants of food choice (thematic analysis). RESULTS Weight (-10.5 lbs; 95% confidence interval [CI]: -9.0 to -12.0), waist circumference (-7.4 cm; 95% CI: -6.5 to -8.4), total cholesterol (-0.87 mmol/L; 95% CI: -0.57 to -1.17), and low-density lipoprotein cholesterol (-29.7% or -0.84 mmol/L; 95% CI: -0.55 to -1.13) all improved significantly (P ˂ 0.001). Encouraging ad libitum intake of various whole-food plant-based items appealed more to participants than traditional strategies. Altruistic and societal motives, in addition to health, were identified as key determinants of an increased adoption of whole-food plant-based diets. CONCLUSIONS The whole-food, plant-based nutrition program improves cardiovascular health in adults and features characteristics that may inform future nutrition programs and public health interventions.
Collapse
Affiliation(s)
- Étienne Morin
- Research Centre on Aging, University of Sherbrooke, Sherbrooke, Quebec, Canada; School of Social Work, Faculty of Arts and Humanities, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Isabelle Michaud-Létourneau
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | - Yves Couturier
- Research Centre on Aging, University of Sherbrooke, Sherbrooke, Quebec, Canada; School of Social Work, Faculty of Arts and Humanities, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mathieu Roy
- Health Technology and Social Services Assessment Unit, Eastern Townships Integrated University Health and Social Services Centre, Sherbrooke, Quebec, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine & Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada.
| |
Collapse
|