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While most patients receive anticancer injection in a conventional hospital, some are treated in hospital at home. Given the lack of data, we seek to determine the clinical characteristics and care pathways of patients benefiting from hospital at home (HAH) for anticancer injection. A longitudinal scheme was conducted about patients with multiple myeloma (MM) starting bortezomib-based regimens in HAH in 2015 with a follow-up to September 2019. 154 patients received bortezomib at home with a mean age of 70.6 years, 72.7% over 65y-old and, a median Karnofsky Performans Status of 70. One-third of the elderly lived alone, 16.1% required domestic help. After a 24-month follow-up, 77.9% of patients were alive. The median overall survival was not reached at 4 years. Between 42.1% and 48.1% of patients returned to HAH for a new line of treatment. Patients were mainly independent and "fit." The involvement of HAH was achieved without safety issues nor compromise long-term outcomes. However, the real-world patterns highlighted that only a small proportion of patients returned to HAH for a new treatment line. [ABSTRACT FROM AUTHOR]

Background: Although collaborative team models (CTM) improve care processes and health outcomes, their diffusion poses challenges related to difficulties in securing their adoption by primary care clinicians (PCPs). The objectives of this study are to understand: (1) how the perceived characteristics of a CTM influenced clinicians' decision to adopt -or not- the model; and (2) the model's diffusion process. Methods: We conducted a longitudinal case study based on the Diffusion of Innovations Theory. First, diffusion curves were developed for all 175 PCPs and 59 nurses practicing in one borough of Paris. Second, semi-structured interviews were conducted with a representative sample of 40 PCPs and 15 nurses to better understand the implementation dynamics. Results: Diffusion curves showed that 3.5 years after the start of the implementation, 100% of nurses and over 80% of PCPs had adopted the CTM. The dynamics of the CTM's diffusion were different between the PCPs and the nurses. The slopes of the two curves are also distinctly different. Among the nurses, the critical mass of adopters was attained faster, since they adopted the CTM earlier and more quickly than the PCPs. Results of the semi-structured interviews showed that these differences in diffusion dynamics were mostly founded in differences between the PCPs' and the nurses' perceptions of the CTM's compatibility with norms, values and practices and its relative advantage (impact on patient management and work practices). Opinion leaders played a key role in the diffusion of the CTM among PCPs. Conclusion: CTM diffusion is a social phenomenon that requires a major commitment by clinicians and a willingness to take risks; the role of opinion leaders is key. Paying attention to the notion of a critical mass of adopters is essential to developing implementation strategies that will accelerate the adoption process by clinicians. Keywords: Primary care, Primary care physician, Nurses, Chronic disease, Collaboration, Health service research, Diffusion of innovation [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses the relationship between the prescription of anxiolytic and hypnotic drugs and mortality in older people.

Abstract: Very frail elderly patients living in the community, present complex needs and have a higher rate of hospital admissions with emergency department (ED) visits. Here, we evaluated the impact on hospital admissions of the COPA model (CO-ordination Personnes Agées), which provides integrated primary care with intensive case management for community-dwelling, very frail elderly patients. We used a quasi-experimental study in an urban district of Paris with four hundred twenty-eight very frail patients (105 in the intervention group and 323 in the control group) with one-year follow-up. The primary outcome measures were the presence of any unplanned hospitalization (via the ED), any planned hospitalizations (direct admission, no ED visit) and any hospitalization overall. Secondary outcome measures included health parameters assessed with the RAI-HC (Resident Assessment Instrument-Home Care). Comparing the intervention group with the control group, the risk of having at least one unplanned hospital admission decreased at one year and the planned hospital admissions rate increased, without a significant change in total hospital admissions. Among patients in the intervention group, there was less risk of depression and dyspnea. The COPA model improves the quality of care provided to very frail elderly patients by reducing unplanned hospitalizations and improving some health parameters. [Copyright &y& Elsevier]