Les indicateurs de santé et d’expérience rapportés par les patients et les patientes. Conduire le changement pour l’amélioration des soins.

Demander aux personnes atteintes de maladies chroniques d’évaluer l’impact de leurs soins sur leur santé et leur expérience de soins primaires est l’étape la plus importante pour en rehausser la qualité. Le système de santé québécois collecte massivement des données médico-administratives qui peuvent fournir de l’information pertinente à l’orientation des politiques et à la mise en place de soins primaires pour répondre à leurs besoins. Cependant, peu d’information est disponible en ce qui a trait à la perception de ce public quant à leurs expériences de soins et leur santé. De plus, aucune collecte systématisée de données au niveau provincial ou canadien en santé primaire n’a été réalisée. La perspective du patient ou de la patiente est souvent absente des indicateurs collectés pour moduler les soins primaires et les politiques ministérielles. Pourtant, ces données sont essentielles à considérer pour : 1) la mise en place de plans d’intervention centrés sur leurs besoins réels; 2) l’établissement de politiques en santé en soins primaires, permettant une meilleure prise en charge de cette clientèle atteinte de maladies chroniques et; 3) pour l’amélioration (continue) des soins et services de santé. Notre équipe a été mandatée pour réaliser la portion québécoise de l’enquête internationale PaRIS (Patientreported Indicator Surveys) de l’Organisation de coopération et de développement économiques (OCDE), qui vise à dresser un portrait comparatif de l’expérience de soins et des résultats de santé de la patientèle atteinte de maladies chroniques bénéficiant de soins primaires. Afin de développer une méthodologie efficace et optimale, nous avons réalisé un colloque dans le cadre du 88e congrès de l’ACFAS, ayant eu lieu le 7 mai 2021. Celuici avait pour titre : Enjeux, priorités et leçons apprises pour les enquêtes sur la qualité des soins primaires selon la perspective des patients et des patientes. Nous avons réuni un groupe de personnes provenant de différents secteurs clés (patients et patientes partenaires, personnel de recherche et clinique, entreprises privées, experte en éthique, etc.) afin d’identifier les barrières et facilitants de l’implantation d’études de grande envergure et de s’inspirer des leçons apprises de celles-ci. Ce livre blanc vise à regrouper les constats tirés de cette journée ainsi que des recommandations formulées par l’équipe de co-responsables de la portion québécoise du PaRIS-OCDE.

Dual-tasking and gait in people with Mild Cognitive Impairment. The effect of working memory

<p>Abstract</p> <p>Background</p> <p>Cognition and mobility in older adults are closely associated and they decline together with aging. Studies evaluating associations between cognitive factors and gait performance in people with Mild Cognitive Impairment (MCI) are scarce. In this study, our aim was to determine whether specific cognitive factors have a more identifiable effect on gait velocity during dual-tasking in people with MCI.</p> <p>Methods</p> <p>Fifty-five participants, mean age 77.7 (SD = 5.9), 45% women, with MCI were evaluated for global cognition, working memory, executive function, and attention. Gait Velocity (GV) was measured under a single-task condition (single GV) and under two dual-task conditions: 1) while counting backwards (counting GV), 2) while naming animals (verbal GV). Multivariable linear regression analysis was used to examine associations with an alpha-level of 0.05.</p> <p>Results</p> <p>Participants experienced a reduction in GV while engaging in dual-task challenges (p < 0.005). Low executive function and working memory performances were associated with slow single GV (p = 0.038), slow counting GV (p = 0.017), and slow verbal GV (p = 0.031). After adjustments, working memory was the only cognitive factor which remained significantly associated with a slow GV.</p> <p>Conclusion</p> <p>In older adults with MCI, low working memory performance was associated with slow GV. Dual-task conditions showed the strongest associations with gait slowing. Our findings suggest that cortical control of gait is associated with decline in working memory in people with MCI.</p

Impact of uncertainty in the onset time of disease on the estimation of the survival function

The analysis of interval censored and truncated survival data is reviewed with the addition of many details omitted in the literature. Careful attention is paid to the derivation of the likelihood in the nonparametric setting and to the assumptions under which the likelihood is valid. In addition, we explore the details of a self-consistency algorithm used to numerically obtain survival estimates. We demonstrate how these methods can be adapted when there is uncertainty in the onset time by application to data from the Canadian Study of Health and Aging. The results are compared with those previously obtained using an analysis where the reported dates of onset of dementia were used without accounting for their inherent uncertainty

Shedding light on conditions for the successful passive dissemination of recommendations in primary care: a mixed methods study

Abstract Background Passive dissemination of information in healthcare refers to the publication or mailing of newly established guidelines or recommendations. It is one of the least costly knowledge translation activities. This approach is generally considered to be ineffective or to result in only small changes in practice. Recent research, however, suggests that passive dissemination could, under certain conditions, result in modifications of practice, similar to more active dissemination approaches. The objective of our study was to uncover the conditions associated with the change in primary care practice, namely Family Medicine Groups (FMGs) in Quebec (Canada), following the passive dissemination of recommendations for the diagnosis and management of Alzheimer’s disease and related dementia (AD). Methods We used a three-step, innovative, convergent mixed methods design based on a multiple case study in eight FMGs. Two studies were conducted in parallel: (1) a before and after retrospective chart review and a cluster analysis of FMGs performed on two clinical performance indicators—the rate of AD diagnosis and the quality of follow-up care; (2) a qualitative descriptive study using interviews and focus groups with FMG clinicians and healthcare managers. The results were integrated using joint displays. Results After the passive dissemination of the recommendations, some FMGs started to implement the recommendations while other FMGs did not change their practice with respect to the AD diagnosis rate and quality of follow-up care. Three interrelated conditions were identified for the successful passive dissemination of clinical recommendations: (1) FMG clinicians with a moderate to high baseline expertise and confidence, which was linked to their existing collaboration with hospital-based specialists in dementia and their motivation; (2) the presence of a self-identified champion (individual champion or collective championship) in the FMGs taking the lead, motivating the clinical staff or organizing training; (3) the availability of sufficient clinical staff enabled these two conditions to have an impact on the implementation of recommendations through passive dissemination. Conclusions Passive dissemination of clinical recommendations, a low-cost knowledge translation approach, may lead to practice change under some specific conditions. More active dissemination efforts may only be needed in sites where these conditions are absent

Additional file 1 of Rethinking the pros and cons of randomized controlled trials and observational studies in the era of big data and advanced methods: a panel discussion

Additional file 1

The association between the level of institutional support for dementia care in primary care practices and the quality of dementia primary care: A retrospective chart review

Abstract Introduction Institutional support, encompassing financial and training support, as well as interdisciplinary teams, may be important for the quality of dementia primary care for persons living with dementia. The aim of this study was to measure the association between the level of institutional support provided to primary care practices and the quality of dementia care. Methods This was a cross‐sectional chart review in 33 Canadian primary care practices to measure the quality of dementia primary care using a quality of follow‐up score. The score was based on the assessment of 10 indicators. Practices were chosen using a purposeful sampling method with varying levels of institutional support for dementia primary care (e.g., financial support, training, interdisciplinary team). A linear mixed‐effect model was used to measure the association between the level of institutional support and the quality of dementia care. Results There was a significant association between the level of institutional support and the quality of dementia care (mean difference = 23.5, 95% confidence interval: 16.4, 30.6). Discussion Providing more institutional support for primary care practices could be a promising avenue to improve the care of persons living with dementia

Reorganizing Pharmaceutical Care in Family Medicine Groups for Older Adults With or at Risk of Major Neurocognitive Disorders: Protocol for a Mixed Methods Study

BackgroundThe latest global figures show that 55 million persons lived with major neurocognitive disorders (MNCDs) worldwide in 2021. In Quebec, Canada, most of these older adults are cared for by family physicians in interdisciplinary primary care clinics such as family medicine groups (FMG). When a person has a MNCD, taking potentially inappropriate medications or polypharmacy (5 different medications or more) increases their vulnerability to serious adverse events. With the recent arrival of pharmacists working in FMGs and their expanded scope of practice and autonomy, new possibilities for optimizing older adults’ pharmacotherapy are opening. ObjectiveThis project aims to evaluate the impact of involving these pharmacists in the care trajectory of older adults living with MNCD, in an interdisciplinary collaboration with the FMG team, as well as home care nurses and physicians. Pharmacists will provide medication reviews, interventions, and recommendations to improve the pharmacotherapy and support offered to these patients and their caregivers. MethodsThis 2-step mixed methods study will include a quasi-experimental controlled trial (step 1) and semistructured interviews (step 2). Older adults undergoing cognitive assessment, recently diagnosed with MNCD, or receiving care for this at home will be identified and recruited in FMGs in 2 Quebec regions. FMGs implementing the intervention will involve pharmacists in these patients’ care trajectory. Training and regular mentoring will be offered to these FMGs, especially to pharmacists. In control FMGs, no FMG pharmacist will be involved with these patients, and usual care will be provided. ResultsMedication use (including appropriateness) and burden, satisfaction of care received, and quality of life will be assessed at study beginning and after 6 months of follow-up and compared between groups. At the end of the intervention study, we will conduct semistructured interviews with FMG care team members (pharmacists, nurses, and physicians) who have experienced the intervention. We will ask about the feasibility of integrating the intervention into practice and their satisfaction with and their perception of the intervention’s impacts for older adults and their families. We will assess the effect of improved pharmaceutical care for older adults with or at risk of MNCDs through the involvement of FMG pharmacists and a reorganization of pharmaceutical care. ConclusionsThe inclusion of pharmacists in interdisciplinary care teams is recent and rising, strengthened by more substantial pharmacist practice roles. Results will inform the processes required to successfully involve pharmacists and implement developed tools and procedures transposable to other care settings to improve patient care. Trial RegistrationClinicalTrials.gov NCT04889794; https://clinicaltrials.gov/ct2/show/NCT04889794 International Registered Report Identifier (IRRID)DERR1-10.2196/4257

Profiles of socially isolated community-dwelling older adults during the COVID-19 pandemic: A latent class analysis

Sourial N, Beauchet O, Kruglova K, et al. Profiles of socially isolated community-dwelling older adults during the COVID-19 pandemic: A latent class analysis. Maturitas. 2023;171:1-6