Ten years of integrated care: backwards and forwards. The case of the province of Québec, Canada

<strong>Introduction: </strong>Québec's rapidly growing elderly and chronically ill population represents a major challenge to its healthcare delivery system, attributable in part to the system's focus on acute care and fragmented delivery. <strong></strong><p><strong>Description of policy practice: </strong>Over the past few years, reforms have been implemented at the provincial policy level to integrate hospital-based, nursing home, homecare and social services in 95 catchment areas. Recent organizational changes in primary care have also resulted in the implementation of family medicine groups and network clinics. Several localized initiatives were also developed to improve integration of care for older persons or persons with chronic diseases.<strong></strong></p><p><strong>Conclusion and discussion</strong>: Québec has a history of integration of health and social services at the structural level. Recent evaluations of the current reform show that the care provided by various institutions in the healthcare system is becoming better integrated. The Québec health care system nevertheless continues to face three important challenges in its management of chronic diseases: implementing the reorganization of primary care, successfully integrating primary and secondary care at the clinical level, and developing effective governance and change management.</p><p>Efforts should focus on strengthening primary care by implementing nurse practitioners, developing a shared information system, and achieving better collaboration between primary and secondary care.</p

Étude du concept de trajectoires de soins chez les personnes âgées vivant avec un trouble neurocognitif majeur, à l’aide du modèle multidimensionnel des trajectoires de soins « 6W » : un protocole de revue systématique mixte

Introduction: The use of healthcare services by older adults with major neurocognitive disorder (MNCD) varies significantly throughout the disease process. The evaluation of healthcare trajectories, defined as the pattern of care use over time, allows for a better understanding of how people move through the healthcare system and facilitates the identification of potentially modifiable risk factors for suboptimal care trajectories. Objectives: The objectives of the review are to: 1) critically appraise and synthesize evidence on how healthcare trajectories of older adults with MNCD are measured and defined, using the ‘6W’ multidimensional model of care trajectories, and 2) examine how socioeconomic factors are considered in studies reporting on healthcare trajectories. Inclusion criteria: This review will consider community-dwelling older adults diagnosed with MNCD. The quantitative component will include studies reporting on healthcare trajectories, including at least 2 different care services and at least 3 time-points. The qualitative component will include studies reporting on healthcare trajectories from the perspective of patients or their informal caregivers. Methods: This review will follow the Joanna Briggs Institute mixed methods review approach. We will search EMBASE, MEDLINE, CINAHL, PsycINFO, and the Web of Science Core Collection for English or French articles. Independent reviewers will identify articles for inclusion, extract data, and assess quality. A convergent integrated approach to synthesis and integration will be used. Discussion and conclusion: The results will help anticipate patients’ needs, improve patient care, service planning and coordination, and understand inequities in MNCD care.Introduction : L’utilisation des services de santé par les personnes vivant avec un trouble neurocognitif majeur (TNCM) varie tout au long de la maladie. S’intéresser aux trajectoires de soins, définies comme le schéma d’utilisation des soins sur une période donnée, permet de mieux comprendre l’évolution des individus dans le système de santé. Objectifs : 1) À l’aide du modèle multidimensionnel « 6W » sur les trajectoires de soins, évaluer comment les trajectoires de soins sont mesurées et définies chez les personnes âgées vivant avec un TNCM et, 2) Examiner comment les facteurs socio-économiques sont considérés dans les études portant sur les trajectoires de soins. Critères d’inclusion : Cette revue portera sur les personnes âgées vivant avec un TNCM, dans la communauté. Composante quantitative : études considérant les trajectoires de soins, portant sur un minimum de 2 services de santé différents et 3 temps de mesure. Composante qualitative : études portant sur les trajectoires de soins du point de vue des patients ou de proches aidants. Méthodes : Cette revue systématique utilise la méthode proposée par l’Institut Joanna Briggs. Nous rechercherons des articles (anglais ou français) dans 5 bases de données bibliographiques. Des évaluateurs indépendants procéderont aux choix des articles à inclure, à l’extraction des données et à l’évaluation de la qualité. Une approche intégrée convergente permettra l’intégration et la synthèse des données. Discussion et conclusion : Les résultats pourront alimenter les initiatives visant à améliorer l’adéquation des services et des besoins des personnes vivant avec un TNCM, ainsi que de comprendre les inégalités liées aux soins de cette population

The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers

INTRODUCTION: Appraising the quality of studies included in systematic reviews combining qualitative and quantitative evidence is challenging. To address this challenge, a critical appraisal tool was developed: the Mixed Methods Appraisal Tool (MMAT). The aim of this paper is to present the enhancements made to the MMAT. DEVELOPMENT: The MMAT was initially developed in 2006 based on a literature review on systematic reviews combining qualitative and quantitative evidence. It was subject to pilot and interrater reliability testing. A revised version of the MMAT was developed in 2018 based on the results from usefulness testing, a literature review on critical appraisal tools and a modified e-Delphi study with methodological experts to identify core criteria. TOOL DESCRIPTION: The MMAT assesses the quality of qualitative, quantitative, and mixed methods studies. It focuses on methodological criteria and includes five core quality criteria for each of the following five categories of study designs: (a) qualitative, (b) randomized controlled, (c) nonrandomized, (d) quantitative descriptive, and (e) mixed methods. CONCLUSION: The MMAT is a unique tool that can be used to appraise the quality of different study designs. Also, by limiting to core criteria, the MMAT can provide a more efficient appraisal

Diagnostic study, design and implementation of an integrated model of care in France: a bottom-up process with continuous leadership

<strong>Background: </strong>Sustaining integrated care is difficult, in large part because of problems encountered securing the participation of health care and social service professionals and, in particular, general practitioners (GPs). <p><br /><strong>Purpose: </strong>To present an innovative bottom-up and pragmatic strategy used to implement a new integrated care model in France for community-dwelling elderly people with complex needs.</p><p><br /><strong>Results: </strong>In the first step, a diagnostic study was conducted with face-to-face interviews to gather data on current practices from a sample of health and social stakeholders working with elderly people. In the second step, an integrated care model called Coordination Personnes Agées (COPA) was designed by the same major stakeholders in order to define its detailed characteristics based on the local context. In the third step, the model was implemented in two phases: adoption and maintenance. This strategy was carried out by a continuous and flexible leadership throughout the process, initially with a mixed leadership (clinician and researcher) followed by a double one (clinician and managers of services) in the implementation phase.</p><p><br /><strong>Conclusion: </strong>The implementation of this bottom-up and pragmatic strategy relied on establishing a collaborative dynamic among health and social stakeholders. This enhanced their involvement throughout the implementation phase, particularly among the GPs, and allowed them to support the change practices and services arrangements</p

How to implement person-centred care and support for dementia in outpatient and home/community settings: Scoping review

From Springer Nature via Jisc Publications RouterBackground: Little prior research focused on person-centred care and support (PCCS) for dementia in home, community or outpatient care. We aimed to describe what constitutes PCCS, how to implement it, and considerations for women who comprise the majority of affected persons (with dementia, carers). Methods: We conducted a scoping review by searching multiple databases from 2000 inclusive to June 7, 2020. We extracted data on study characteristics and PCCS approaches, evaluation, determinants or the impact of strategies to implement PCCS. We used summary statistics to report data and interpreted findings with an existing person-centred care framework. Results: We included 22 studies with qualitative (55%) or quantitative/multiple methods design (45%) involving affected persons (50%), or healthcare workers (50%). Studies varied in how PCCS was conceptualized; 59% cited a PCC definition or framework. Affected persons and healthcare workers largely agreed on what constitutes PCCS (e.g. foster partnership, promote autonomy, support carers). In 4 studies that evaluated care, barriers of PCCS were reported at the affected person (e.g. family conflict), healthcare worker (e.g. lack of knowledge) and organizational (e.g. resource constraints) levels. Studies that evaluated strategies to implement PCCS approaches were largely targeted to healthcare workers, and showed that in-person inter-professional educational meetings yielded both perceived (e.g. improved engagement of affected persons) and observed (e.g. use of PCCS approaches) beneficial outcomes. Few studies reported results by gender or other intersectional factors, and none revealed if or how to tailor PCCS for women. This synthesis confirmed and elaborated the PCC framework, resulting in a Framework of PCCS for Dementia. Conclusion: Despite the paucity of research on PCCS for dementia, synthesis of knowledge from diverse studies into a Framework provides interim guidance for those planning or evaluating dementia services in outpatient, home or community settings. Further research is needed to elaborate the Framework, evaluate PCCS for dementia, explore determinants, and develop strategies to implement and scale-up PCCS approaches. Such studies should explore how to tailor PCCS needs and preferences based on input from persons with dementia, and by sex/gender and other intersectional factors such as ethnicity or culture.22pubpu

Experiences of people with dementia and informal caregivers with post-diagnostic support: Data from the international COGNISANCE study

OBJECTIVES: The study aims to describe people with dementia and informal caregivers' respective experiences of support after diagnosis and compares these experiences. Additionally, we determine how people with dementia and informal caregivers who are satisfied with support differ from those dissatisfied. METHODS: A cross-sectional survey study in Australia, Canada, the Netherlands, Poland, and United Kingdom was carried out to examine people with dementia and informal caregivers experience with support (satisfaction with information, access to care, health literacy, and confidence in ability to live well with dementia). The separate surveys contained closed questions. Analysis consisted of descriptive statistics and Chi-square tests. RESULTS: Ninety people with dementia and 300 informal caregivers participated, and 69% of people with dementia and 67% of informal caregivers said support after diagnosis helped them deal more efficiently with their concerns. Up to one-third of people with dementia and informal caregivers were dissatisfied with information about management, prognosis, and strategies for living positively. Few people with dementia (22%) and informal caregivers (35%) received a care plan. People with dementia were more often satisfied with information, had more often confidence in their ability to live well with dementia, and were less often satisfied with access to care compared to informal caregivers. Informal caregivers who were satisfied with support were more satisfied with information and access to care compared to informal caregivers not satisfied with support. CONCLUSIONS: Experience of dementia support can be improved and people with dementia and informal caregiver differ in their experiences of support

TRY plant trait database – enhanced coverage and open access

Plant traits - the morphological, anatomical, physiological, biochemical and phenological characteristics of plants - determine how plants respond to environmental factors, affect other trophic levels, and influence ecosystem properties and their benefits and detriments to people. Plant trait data thus represent the basis for a vast area of research spanning from evolutionary biology, community and functional ecology, to biodiversity conservation, ecosystem and landscape management, restoration, biogeography and earth system modelling. Since its foundation in 2007, the TRY database of plant traits has grown continuously. It now provides unprecedented data coverage under an open access data policy and is the main plant trait database used by the research community worldwide. Increasingly, the TRY database also supports new frontiers of trait‐based plant research, including the identification of data gaps and the subsequent mobilization or measurement of new data. To support this development, in this article we evaluate the extent of the trait data compiled in TRY and analyse emerging patterns of data coverage and representativeness. Best species coverage is achieved for categorical traits - almost complete coverage for ‘plant growth form’. However, most traits relevant for ecology and vegetation modelling are characterized by continuous intraspecific variation and trait–environmental relationships. These traits have to be measured on individual plants in their respective environment. Despite unprecedented data coverage, we observe a humbling lack of completeness and representativeness of these continuous traits in many aspects. We, therefore, conclude that reducing data gaps and biases in the TRY database remains a key challenge and requires a coordinated approach to data mobilization and trait measurements. This can only be achieved in collaboration with other initiatives