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Purpose: The purpose of the study was to understand better the clinical collaboration process among primary care physicians (PCPs), case managers (CMs), and geriatricians in integrated models of care. Methods: We conducted a qualitative study with semistructured interviews. A purposive sample of 35 PCPs, 7 CMs, and 4 geriatricians was selected in 2 integrated models of care for frail elderly patients in Canada and France: System of Integrated Care for Older Patients of Montreal and Coordination of Care for Older Patients of Paris. Data were analyzed using a grounded theory approach. Findings: The dynamics of the collaboration process develop in three phases: (1) initiating relationships, (2) developing real two-way collaboration, and (3) developing interdisciplinary teamwork. The findings suggest that CMs and geriatricians collaborated well from the start and throughout the care management process. Real collaboration between the CMs and the PCPs occurred only later and was mostly fostered by the interventions of the geriatricians. PCPs and geriatricians collaborated only occasionally. Implications: The findings provide information about PCPs' commitment to the integrated models of care, the legitimization of the CM's role among PCPs, and the appropriate positioning of geriatricians in such models.

Purpose: Potentially inappropriate medications (PIMs) have become a major issue in improving prescribing practices and reducing the risk of adverse drug events in older people. However, very few studies have compared exposition to PIMs controlling for differences in demographic and health between nursing home residents (NHRs) and community‐dwelling older adults (CDOAs). This study aimed to assess the prescribing pattern of PIMs between NHRs and CDOAs. Methods: We conducted a cross‐sectional study over three months in 2019 using the French Health Insurance databases. The study population included 274 971 NHRs and 4 893 721 CDOAs aged 75 years or over. The prevalence ratio (PR) between NHRs and CDOAs of 17 PIM indicators, based on the Beers and STOPP criteria lists, was assessed using multivariable robust Poisson regression adjusted for age, sex, diseases, and polypharmacy. Results: During the study period, 54% of NHRs and 29% of CDOAs received at least one PIM. After adjustment, the prevalence of PIMs was 33% higher among NHRs compared to CDOAs (aPR = 1.33; 95% CI [1.33–1.34]). NHRs received PIMs related to benzodiazepines (aPR = 1.43; 95% CI [1.42–1.43]), anticholinergic drugs (aPR = 1.29; 95% CI [1.27–1.31]), and at least three central nervous system‐active drugs (aPR = 1.94; 95% CI [1.92–1.96]) more frequently. Prevalence of PIMs related to non‐steroidal anti‐inflammatory drugs (aPR = 0.50; 95% CI [0.48–0.52]) and long‐acting benzodiazepines (aPR = 0.84; 95% CI [0.82–0.85]) was lower among NHRs. Conclusion: The NHRs were at greater risk for PIM than CDOAs, although differences exist according to the category of PIMs. As the population is aging, it is essential to promote and evaluate interventions in NHs and the community to enhance medication optimization. [ABSTRACT FROM AUTHOR]

This research on a sample of 133 persons older than 60 years and suffering from chronic diseases, concerns their practices towards medicines. Various practices displayed can be grouped in three different ways according to the regularity and the order of medicine taking, forgetting, self-medication, etc.; they seem to be linked neither to sex or age of subjects nor to variables directly or indirectly affected by the disease (number and type of medicines, gravity of the disease, subjective health). The understanding of these differential practices is improved if we consider the self-concept of subjects, that is to say their different positions in an organized whole of personality traits; this position reflects traits that they recognize as being more or less constitutive of their identity, that which motivates and gives sense to the totality of their life conduct. Key words - medicines, elderly, behavior, self concept

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.

Abstract Background In order to increase the chances of success in new interventions in healthcare, it is generally recommended to tailor the intervention to the target setting and the target professionals. Nonetheless, pre-intervention studies are rarely conducted or are very limited in scope. Moreover, little is known about how to integrate the results of a pre-intervention study into an intervention. As part of a project to develop an intervention aimed at improving care for the elderly in France, a pre-intervention study was conducted to systematically gather data on the current practices, issues, and expectations of healthcare professionals and managers in order to determine the defining features of a successful intervention. Methods A qualitative study was carried out from 2004 to 2006 using a grounded theory approach and involving a purposeful sample of 56 healthcare professionals and managers in Paris, France. Four sources of evidence were used: interviews, focus groups, observation, and documentation. Results The stepwise approach comprised three phases, and each provided specific results. In the first step of the pre-intervention study, we gathered data on practices, perceived issues, and expectations of healthcare professionals and managers. The second step involved holding focus groups in order to define the characteristics of a tailor-made intervention. The third step allowed validation of the findings. Using this approach, we were able to design and develop an intervention in elderly care that met the professionals' and managers' expectations. Conclusion This article reports on an in-depth pre-intervention study that led to the design and development of an intervention in partnership with local healthcare professionals and managers. The stepwise approach represents an innovative strategy for developing tailored interventions, particularly in complex domains such as chronic care. It highlights the usefulness of seeking out the insight of healthcare professionalnd managers and emphasizes the need to intervene at different levels. Further research will be needed in order to develop a more thorough understanding of the impacts of such strategies on the final outcomes of intervention implementations.

Abstract Background The objective of this study was to assess the responsiveness of the Minimum Data Set Activities of Daily Living (MDS-ADL) Scale to change over time by examining the change in physical function in adults with moderate to severe dementia with no comorbid illness who had been resident in a nursing home for over 90 days. Methods Longitudinal data were collected on nursing home residents with moderate (n = 7001) or severe (n = 4616) dementia in one US state from the US national Minimum Data Set (MDS). Severity of dementia was determined by the MDS Cognitive Performance Scale (CPS). Physical function was assessed by summing the seven items (bed mobility, transfer, locomotion, dressing, eating, toilet use, personal hygiene) on the MDS activities of daily living (ADL) Long Form scale. Mean change over time of MDS-ADL scores were estimated at three and six months for residents with moderate (CPS score of 3) and severe (CPS score of 4 or 5) dementia. Results Physical function in residents with moderate cognitive impairment deteriorated over six months by an average of 1.78 points on the MDS-ADL Long Form scale, while those with severe cognitive impairment declined by an average of 1.70 points. Approximately one quarter of residents in both groups showed some improvement in physical function over the six month period. Residents with moderate cognitive impairment experienced the greatest deterioration in early-loss and mid-loss ADL items (personal hygiene, dressing, toilet use) and residents with severe cognitive impairment showed the greatest deterioration in activities related to eating, a late loss ADL. Conclusion The MDS-ADL Long Form scale detected clinically meaningful change in physical function in a large cohort of long-stay nursing home residents with moderate to severe dementia, supporting its use as a research tool in future studies.

Background: Case management has focused on care coordination reinforcement for the very frail community-dwelling older people in order to allow them to stay at home as long as possible. However the definition of the target population eligible to have a case manager is not clear. The purpose of this study was to identify predictive factors leading to not living at home over one year in a very frail community dwelling older population. Methods: A secondary analysis from a prospective cohort of 428 very frail older people, aged 65 years and over, living at home in Paris were set up. Patients were assessed using RAI-HC 2.0 (Resident Assessment Instrument -- Home care) tool. Not living at home at one year was identified in relation with admission characteristics using logistic regressions. Results: At baseline, a large majority of the patients lived alone with cognitive impairments and functional limitations. In one year, 48.6% (n = 208) did not live at home anymore. Among them 40.5% were dead, 36% were institutionalized and 23.5% were hospitalized and moved away. Functional disabilities formeal preparation (p = 0.04) and eating (p = 0.08), bladder incontinence (p = 0.07) and prior hospitalization (p = 0.08) increased the risk of not living at home over one year. Cognitive impairment, socio-demographic characteristics and number of home-based services were not related with the primary outcome. Conclusion: Functional limitations and prior hospitalizationswere predictive factors leading to not living at home in a very frail community dwelling older population. Results could help for identifying the population eligible to have a case manager. [ABSTRACT FROM AUTHOR]

Studies the link between psychotropic drug use and personologic identity. Side effects of psychotropic drugs; Subjective factors that refer to the patient and his/her subjectivity; Difference in sociodemographic characteristics between psychotropic consumers and non-consumers.