Hélène Trouvé

Analysis of case management programs for patients with dementia: A systematic review

People suffering from dementia are particularly vulnerable to the gaps between the health and social service systems. Case management is a professional field that seeks to fill in these gaps and remedy this fragmentation.

Multidisciplinary teams of case managers in the implementation of an innovative integrated services delivery for the elderly in France.

BackgroundThe case management process is now well defined, and teams of case managers have been implemented in integrated services delivery. However, little is known about the role played by the team of case managers and the value in having multidisciplinary case management teams. The objectives were to develop a fuller understanding of the role played by the case manager team and identify the value of inter-professional collaboration in multidisciplinary teams during the implementation of an innovative integrated service in France.MethodsWe conducted a qualitative study with focus groups comprising 14 multidisciplinary teams for a total of 59 case managers, six months after their recruitment to the MAIA program (Maison Autonomie Integration Alzheimer).ResultsMost of the case managers saw themselves as being part of a team of case managers (91.5%). Case management teams help case managers develop a comprehensive understanding of the integration concept, meet the complex needs of elderly people and change their professional practices. Multidisciplinary case management teams add value by helping case managers move from theory to practice, by encouraging them develop a comprehensive clinical vision, and by initiating the interdisciplinary approach.ConclusionsThe multidisciplinary team of case managers is central to the implementation of case management and helps case managers develop their new role and a core inter-professional competency.

Niveau de preuve de la gestion de cas dans la maladie d’Alzheimer : revue de littérature

Les personnes atteintes de la maladie d’Alzheimer ou de pathologies apparentees sont particulierement vulnerables aux fragmentations du systeme de soins et d’aide francais. Les pouvoirs publics ont decide de mettre en œuvre un plan national dont deux des mesures cles sont la mise en œuvre de l’integration et de la gestion de cas. Nous rapportons les resultats d’une revue de litterature portant a la fois sur la definition de ces concepts et sur leurs impacts tels que rapportes dans des etudes randomisees controlees. Il est note d’importantes differences dans les etudes concernant l’etendue de l’integration (soins aigus et chroniques, secteurs sanitaires et sociaux, secteurs institutionnel ou liberal et mode de financement notamment). De meme, le terme de gestion de cas n’est pas univoque et il convient d’en preciser l’intensite et le contexte d’intervention. Selon les donnees probantes disponibles, la gestion de cas est de nature a ameliorer, pour la personne atteinte de maladie d’Alzheimer, la qualite des soins, sa qualite de vie et celle des aidants. Les conditions permettant a un programme d’avoir les effets escomptes sont un ciblage adequat de la population cible, un niveau suffisant d’integration et une intensite suffisante de la gestion de cas. Les programmes les plus aboutis et les plus intensifs rapportent un effet sur la prevention de la perte d’autonomie, voire sur la mortalite, et sans surcout evident. Les effets sur l’hospitalisation ou l’entree en institution sont actuellement hypothetiques et meritent d’etre plus amplement etudies.Alzheimers disease or related diseases patients are particularly vulnerable to fragmentation of the French system of care and support. The government has decided to implement a national plan from which two key steps are the implementation of integration and case management. We report results of a review of the literature on both the definition of these concepts and their impacts as reported in randomized controlled studies. Important differences are noticeable between studies concerning the spectrum of integration (acute and long-term care, social and health sectors, institutional and liberal sectors and financing mode notably). Case-management has multiple sense, and it must be paid attention to intensity and context of the intervention. According to available evidence, case management is likely to improve, for the person with Alzheimers, quality of care, quality of life and quality of life of caregivers at least. Conditions for a program to be successful are adequate targeting of the target population, sufficient level of integration and adequate intensity of case management. The programs most successful and most intensive relate an effect on prevention of loss of autonomy, even death, and no extra cost. The effects on hospitalization or entry into the institution are currently hypothetical and should be further studied.

Institutional integration, health and social care policy and social welfare: an application of the ‘path dependence’ theory in France

Introduction The PRISMA integration model is a promising method to implement integration in health and social services for elderly people. The PRISMA France study aims to investigate the implementation of this model, which relies on the establishment of advisory boards at institutional, organisational and professional levels of decision-making, in France. These boards are guided by whole systems thinking and function in a joined-up, co-ordinated manner. Method A qualitative approach was adopted to study the models implementation. Analyses were based on semi-structured interviews with actors of all levels of decision-making, observations of advisory board meetings and administrative documentations. Validity was insured by triangulation methods and content saturation. Results Our analyses revealed the complexity, instability and fragmentation of the institutional governance of publics policies for elderly people. The ‘path dependence’ to the Bismarckian system and the incomplete reforms of gerontological policies generate a cohabitation of three concurrent policies (national, regional and local) and a juxtaposition of two institutional systems (health and social care policy and social welfare). In such a context, no institution possesses sufficient authority to determine gerontological policy. Conclusion In the light of these analyse, the particularly complex and time-consuming implementation of the PRISMA model in France can be better understood.

Is there a way to measure implementation of integration in different countries? The case of the PRISMA implementation qualitative methodology

Introduction The PRISMA implementation research has used an innovative tool: the penetration rate of integrated model in the system. The experimentation in France of the PRISMA adopts and adapts this methodology. Aims and objective This measurement relates to the functions of the 6 tools and mechanisms of the model: coordination boards, single entry point, case-management, single assessment instrument, individualised services plan and information system. In contrast with Quebec, no public policy in France incites to move towards this model of integration. In addition, in the French system the construction of coordination boards is complex because there is as much as ten supervision authorities and about fifteen organisation managers involved in each experimental site. Methods of adaptation of the tool in France The measurement was not only the absence, partial existence or existence of the 6 components but takes into account the appropriation process for each one, the administrative time and the new definition of thresholds to reach as compared to the model. Results This research tool presents two advantages. The measurement scale enables also the partners to appropriate the function of each model component and more precisely the global model of the integration. Actors do not feel evaluated but accompanied.