Sébastien Carrier

The interdisciplinary condition of work in relational professions of the health and social care field: a theoretical standpoint.

The best-known theories on interdisciplinarity in the health and social care field seek to identify personal characteristics and organizational predispositions favourable to interprofessionnal collaboration. This paper proposes a reversal of this positioning through the theorization of interdisciplinarity in the health and social care field as a condition of the work of its professionals rather than one of their peculiar attributes. To achieve this reversal, we set out the epistemological foundations of the current debate on interdisciplinarity.

Les pratiques de coordination en gestion de cas dans le secteur du soutien à domicile pour les personnes en perte d'autonomie liée au vieillissement, une analyse conventionnaliste

The objective of this article is to understand coordination as it unfolds in case management practices in the context of integrated care networks devoted to frail elderly individuals. More specifically, we describe practical coordination processes. We conducted a qualitative exploratory study using an embedded case study design. Our study covers three health and social service centers in Québec. We noted that coordination produces convention in case management practices through a process of bringing together different types of compromise in home care situations where multidimensionality appears to be more or less important. We constructed four different types of compromise-producing convention with regard to coordination in case management practices: compromise at the interface, scheduling compromise, compromise of opportunity, and compromising change.

Service Coordination for Frail Elderly Individuals: An Analysis of Case Management Practices in Québec

The objective of this article is to understand coordination as it unfolds in case management practices in the context of integrated care networks devoted to frail elderly individuals. More specifically, my goal is to describe practical coordination processes. I conducted a qualitative exploratory study using an embedded case study design. My research covers three Health and Social Services Centres in Québec. I observed that case management is more frequently justified by a situation in which home care is precarious than by the intensity and multidimensionality present in a situation. In such instances, case management intervenes through a standby mode.

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.

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.