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BackgroundNonprofit organizations have always played an important role in health promotion. Social media is widely used in health promotion efforts. However, there is a lack of evidence on how decisions regarding the use of social media are undertaken by nonprofit organizations that want to increase their impact in terms of health promotion. ObjectiveThe aim of this study was to understand why and how nonprofit health care organizations put forth social media strategies to achieve health promotion goals. MethodsA multiple case study design, using in-depth interviews and a content analysis of each social media strategy, was employed to analyze the use of social media tools by six North American nonprofit organizations dedicated to cancer prevention and management. ResultsThe resulting process model demonstrates how social media strategies are enacted by nonprofit organizations to achieve health promotion goals. They put forth three types of social media strategies relative to their use of existing information and communication technologies (ICT)—replicate, transform, or innovate—each affecting the content, format, and delivery of the message differently. Organizations make sense of the social media innovation in complementarity with existing ICT. ConclusionsFor nonprofit organizations, implementing a social media strategy can help achieve health promotion goals. The process of social media strategy implementation could benefit from understanding the rationale, the opportunities, the challenges, and the potentially complementary role of existing ICT strategies.

PURPOSE Interprofessional primary care has the potential to optimize hospital use for acute care among people with dementia. We compared 1-year emergency department (ED) visits and hospitalizations among people with dementia enrolled in a practice having an interprofessional primary care team with those enrolled in a physician-only group practice. METHODS A population-based, repeated cohort study design was used to extract yearly cohorts of 95,323 community-dwelling people in Ontario, Canada, newly identified in administrative data with dementia between April 1, 2005 and March 31, 2015. Patient enrollment in an interprofessional practice or a physician-only practice was determined at the time of dementia diagnosis. We used propensity score-based inverse probability weighting to compare study groups on overall and nonurgent ED visits as well as on overall and potentially avoidable hospitalizations in the 1 year following dementia diagnosis. RESULTS People with dementia enrolled in a practice having an interprofessional primary care team were more likely to have ED visits (relative risk = 1.03; 95% CI, 1.01-1.05) and nonurgent ED visits (relative risk = 1.22; 95% CI, 1.18-1.28) compared with those enrolled in a physician-only primary care practice. There was no evidence of an association between interprofessional primary care and hospitalization outcomes. CONCLUSIONS Interprofessional primary care was associated with increased ED use but not hospitalizations among people newly identified as having dementia. Although interprofessional primary care may be well suited to manage the growing and complex dementia population, a better understanding of the optimal characteristics of team-based care and the reasons leading to acute care hospital use by people with dementia is needed. https://doi.org/10.1370/afm.2881, INTRODUCTION Interprofessional primary care (IPC), a team-based primary care model whereby family physicians collaborate with nurses, nurse practitioners, social workers, pharmacists, and other health professionals, has been touted as an [...]

Introduction: Socialprotection programmes are considered HIV-sensitive when addressing risk, vulnerability or impact of HIV infection. Socio-economic interventions, like livelihood and employability programmes, address HIV vulnerabilities like poverty and gender inequality. We explored the HIV-sensitivity of socio-economic interventions for unemployed and out-of-school young women aged 15 to 30 years, in Fast and Southern Africa, a key population for HIV infection. Methods: We conducted a systematic review using a narrative synthesis method and the Mixed Methods AppraisalTool for quality appraisal. Interventions of interest were work skills training, microfinance, and employment support. Outcomes of interest were socio-economic outcomes (income, assets, savings, skills, (self-) employment) and HIV-related outcomes (behaviouraland biological). We searched published and grey literature (January 2005 to November 2019; English/French) in MFDLINF, Scopus, Web of Science and websites of relevant internationalorganizations. Results: We screened 3870 titles and abstracts and 188 full-text papers to retain 18 papers, representing 12 projects. Projects offered different combinations of HIV-sensitive socialprotection programmes, complemented with mentors, safe space and training (HIV, reproductive health and gender training). All 12 projects offered work skills training to improve life and business skills. Six offered formal(n = 2) or informal(n = 5) livelihood training. Fleven projects offered microfinance, including microgrants (n = 7), microcredit (n = 6) and savings (n = 4). One project offered employment support in the form of apprenticeships. In general, microgrants, savings, business and life skills contributed improved socio-economic and HIV-related outcomes. Most livelihood training contributed positive socio-economic outcomes, but only two projects showed improved HIV-related outcomes. Microcredit contributed little to either outcome. Programmes were effective when (i) sensitive to beneficiaries' age, needs, interests and economic vulnerability; (ii) adapted to local-implementation contexts; and (iii) included life skills. Programme delivery through mentorship and safe space increased social capital and may be critical to improve the HIV-sensitivity of socio-economic programmes. Conclusions: A wide variety of livelihood and employability programmes were leveraged to achieve improved socio-economic and HIV-related outcomes among unemployed and out-of-school young women. To be HIV-sensitive, programmes should be designed around their interests, needs and vulnerability, adapted to local implementation contexts, and include life skills. Fmployment support received little attention in this literature. Keywords: adolescent girls and young women; Africa region; HIV prevention; social support; structural drivers; structural interventions, 1 | INTRODUCTION In 2018, East and Southern Africa represented nearly one half of global human immunodeficiency virus (HIV) incident cases [1]. Adolescent girls and young women (AGYW) aged 15 [...]

Context. The type and level of healthcare services required to address the needs of older adults living with major neurocognitive disorders (MNCD) fluctuate over disease progression while being complexified by multimorbidity and inequality factors. Thus, their trajectories of care (TC--the pattern of healthcare use over time) may vary significantly. Objective. We aimed to 1) Propose a typology of TC of people living with MNCD; 2) Describe and compare their characteristics by TC type; 3) Evaluate the association between TC membership, socioeconomic factors, and self-perceived health. Study Design and Analysis. Retrospective cohort study. The TCs were developed using a multidimensional state sequence analysis approach based on the '6W' model of Care Trajectories, conceptualizing TCs according to 6 dimensions. Dataset. We used data from the Care Trajectories-Enriched Data (TorSaDE) cohort, a linkage between five waves of the Canadian Community Health Survey (CCHS) (2007-2016), and health administrative data from the Quebec provincial health-insurance board (1996-2016). Population Studied. Community-dwelling individuals who: 1) participated in at least one cycle of the CCHS (the date of the last CCHS completion is the index date); 2) were 65 years or older at the time of the index date; 3) had a diagnosis of MNCD at the index date. Outcome Measures. TCs were defined as sequences of healthcare use in the two years preceding the index date, using the following information: 1) Type of care units consulted (1. Hospitalization, 2. Emergency department, 3. Outpatient clinic, 4. Primary care clinic); 2) Type of healthcare care professionals consulted (1. Geriatrician/psychiatrist/neurologist, 2. Other specialists, 3. Family physician. We identified the MNCD before the index date using a validated algorithm. Results. The study cohort included 690 individuals living with MNCD, grouped into three distinct type of TC: 1) Low healthcare use (n=377; 54.6%); 2) High primary care use (n=159; 23.0%); 3) High overall healthcare use (n=154; 22.3%). TC type 3 membership was associated with younger age, being a male, living in urban areas, and a poorer perceived health status. Conclusions. Further understanding of how subgroups of patients use healthcare services over time could help highlight fragility areas in the allocation of geriatric care resources and implement best practices, especially in the context of resource shortage., Presenters Isabelle Dufour, PhD, RN, Josiane Courteau, Isabelle Vedel, MD, PhD, Amelie [...]

Context: The COVID-19 pandemic has substantially changed the delivery of primary care health services. Indeed, more clinic-based care has turned into virtual remote care. Thus, it is necessary to develop a comprehensive remote virtual care method. Telemedicine (TM) has the potential to improve the quality of primary health care and increase accessibility to the population. Some studies indicated that TM was an efficient way to deliver medical services, especially to older people. Nevertheless, its use may represent a challenge to older populations as they may have different needs from general population due to potential age-related changes in perceptual, motor and cognitive capacities. Objective: To explore older adults' and family physicians' experience with telemedicine (TM) use during the COVID-19 pandemic, and to identify potential facilitators and barriers of TM use. Design and Analysis: Multi-phase design. Phase 1: Systematic review; Phase 2: Qualitative descriptive study; Phase 3: Integration of the results from Phase 1 and 2 using deliberative dialogue. Individual semi- structured interviews and focus groups findings were analyzed using inductive thematic analysis, based on the Consolidated Framework for Implementation Research. Setting: Montreal. Population studied: Individual semi-structured interviews with twenty-nine older adults from four McGill family medicine sites--Herzl, CLSC-CDN, Parc-Extension and Metro. Preliminary interviews findings informed focus groups with family physicians. Findings: Participants indicated that telemedicine contributed to maintain continuity of care and was convenient to resolve minor health issues, triage/preliminary consultations, and follow-up with their family physicians. TM was also considered particularly beneficial for persons with limited mobility; and reduced the exposure of older adults to potential high-risk environments. Nevertheless, participants expressed some concerns about the lack of visual contact, negatively impacting the physician-patient relationship and causing important details to be overlooked. Similarly, miscommunication difficulties may emerge due to language or hearing barriers. Family physicians perceived that most patients did not consider phone consultations as a medical act. Conclusion: Older adults consider TM to be a good alternative for accessing health-care services, when provided in a hybrid approach combined with inperson consultations with their family physician., Presenters Vladimir Khanassov, MD, MSc, Laura Rojas-Rozo, MD, MSc, Ana Gabriela Saavedra Ruiz, MD, MSc, Marwa Ilali, MD, MSc, Melanie Le Berre, MSc, Isabelle Vedel, MD, [...]

Context: Providing context-specific information and fostering reflective practice is essential to support a learning health system. Regional health boards in Quebec, Canada, have the responsibility to ensure implementation of the Quebec Alzheimer's Plan (QAP) in primary, secondary, and tertiary care services but need support. As such, we have developed and disseminated regional portraits on dementia care. Objective: To describe the lesson learned and next steps on the development and presentations of regional portraits. Design: A multi-methods study with a participatory approach. Setting: Quebec, Canada. Population: Stakeholders (ministerial decision-maker and project managers, managers and clinicians from the 23 regional health board, and researchers/scientific advisors). Methods: We selected, with stakeholders, 9 indicators (prevalence, regular physician visits, emergency visits, and hospitalizations) and measured them in 2019-20. Also, we thematically analysed the last 3 years of ongoing QAP implementation evaluation reports and meetings. We combined these results to formulate, with stakeholders, key messages for each regional health board. Along with ministerial decision-maker and project managers, we presented these portraits to regional managers and clinicians. Real-time notes were taken using structured observation guide. A thematic analysis was performed. Results: The development of the portraits was facilitated by a strong and ongoing alliance between the stakeholders. Researchers and scientific advisors identified the most relevant data available; project managers ensured the formulated messages were meaningful to regional managers and clinicians; and policymakers ensured the collected data was useful to support the implementation of QAP. The regional managers and clinicians proposed ways to improve the portraits (i.e., adding indicators), and to regularly update and integrate these portraits into steering committees. Monitoring the indicators as precisely presents challenges, including regularly obtaining current data. Conclusion: This innovative project supports a learning health system for the care of persons with dementia. Specifically, it stimulates the emergence of regional and provincial innovations in dementia care to accomplish the implementation of the QAP, ensure its local appropriation and perpetuates sustainable transformed practices. Proposed solutions will guide the preparation of next iteration of regional portraits., Presenters Genevieve Arsenault-Lapierre, PhD, Maxime Guillette, Alexandra Lemay-Compagnat, Louis Rochette, MSc, Victoria Massamba, MPH, Yves Couturier, PhD, Eric Maubert, Christine Fournier, Caroline Morin, Caroline Boudreau, Isabelle Vedel, MD, [...]

This article explores the difficulties and potential solutions in recruiting older vulnerable adults (OVA) for research studies. OVA face various vulnerabilities that can hinder their participation, such as physical limitations and social challenges. The article suggests several strategies to improve recruitment, including creating age-friendly materials, involving trusted influencers, adapting the consent process, and providing support and education. Additionally, the article emphasizes the importance of promoting participant retention through study design and minimizing burdens. Overall, the article underscores the need for diverse recruitment methods to ensure inclusivity and meaningful research outcomes. [Extracted from the article]

PURPOSE Despite evidence on the benefits of case management for the care of patients with complex needs in primary care, implementing the program-necessary to achieve its benefits-has been challenging worldwide. Evidence on factors affecting implementation remains disparate. Accordingly, the objective of this systematic review was to identify barriers to and facilitators of case management, from the perspectives of health care professionals, in primary care settings around the world. METHODS We conducted a systematic review and thematic synthesis of qualitative findings. In collaboration with 2 librarians, we searched 3 electronic databases (MEDLINE, CINAHL, EMBASE) for studies related to factors affecting case management function in primary care. Two researchers screened titles, abstracts, and full texts for inclusion, then assessed included studies for quality. Results from included studies were synthesized by thematic synthesis, and a framework was developed. RESULTS Of 1,640 unique records identified, 22 studies, originating from 6 countries, met the inclusion criteria. We identified 9 barriers and facilitators: family context; policy and available resources; physician buy-in and understanding of the case manager role; relationship building; team communication practices; autonomy of case managers; training in technology; relationships with patients; and time pressure and workload. We describe these factors, then present a framework demonstrating the relationships among them. CONCLUSIONS Our study's findings show that multiple factors influence case management implementation. These findings have implications for researchers, clinicians, and policy makers who strive to implement or reform case management programs in local or larger primary care settings. Key words: case management; patients with complex needs; chronic disease; vulnerable populations; comorbidity; health plan implementation; health services misuse; delivery of health care, integrated https://doi.org/10.1370/afm.2555., INTRODUCTION In response to an aging global population and the corresponding increase in chronic illness, case management has emerged as a powerful innovation to better care for patients with complex [...]

Background Potentially avoidable emergency department transfers (PAEDTs) and hospitalizations (PAHs) from long-term care (LTC) homes are two key quality improvement metrics. We aimed to: 1) Measure proportions of PAEDTs and PAHs in a Quebec sample; and 2) Compare them with those reported for the rest of Canada. Methods We conducted a repeated cross-sectional study of residents who were received at one tertiary hospital between April 2017 and March 2019 from seven LTC homes in Quebec, Canada. The MedUrge emergency department database was used to extract transfers and resident characteristics. Using published definitions, PAEDTs and PAHs were identified from principal emergency department and hospitalization diagnoses, respectively. PAEDT and PAH proportions were compared to those reported by the Canadian Institute for Health Information. Results A total of 1,233 transfers by 692 residents were recorded, among which 36.3% were classified as being potentially avoidable: 22.8% 'PAEDT only', 11.6% 'both PAEDT & PAH', and 1.9% 'PAH only'. Shortness of breath was the most common reason for transfer. Pneumonia was the most common diagnosis from the 'both PAEDT & PAH' category. PAEDTs and PAHs accounted for 95% and 37% of potentially avoidable transfers, respectively. Among 533 hospitalizations, 31.3% were PAHs. These proportions were comparable to the rest of Canada, with some differences in proportions of transfers due to congestive heart failure, urinary tract infection, and implanted device management. Conclusions PAEDTs far outweigh PAHs in terms of frequency, and their monitoring is important for quality assurance as they may inform LTC-level interventions aimed at their reduction. [ABSTRACT FROM AUTHOR]