Réjean Hébert, Anne Veil, Michel Raîche, Marie‐France Dubois, Nicole Dubuc and Michel Tousignant
PRISMA is the only example of a co‐ordinated‐type model to be developed and fully implemented with a process and outcome evaluation. The PRISMA model was implemented in three…
Abstract
PRISMA is the only example of a co‐ordinated‐type model to be developed and fully implemented with a process and outcome evaluation. The PRISMA model was implemented in three areas (urban, rural with or without a local hospital) in Quebec, Canada and an implementation evaluation was carried out using mixed (qualitative and quantitative) methods. Over four years, the implementation rates went from 22% to 79%. The perception of integration by managers and clinicians working in the various organisations of the network shows that most interactions are perceived as at the co‐operation level, some getting the highest collaboration level. The perception of the efficacy of case managers was very high. Implementing such a model is feasible, and the decision to generalise it was made in Quebec. This model might be more appropriate for a universal publicly funded health care system like those in Canada, the UK and the Scandinavian countries.
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Gina Bravo, Michel Raîche, Marie‐France Dubois and Réjean Hébert
Interest has grown in integrated care models as means of responding better to the needs of frail older adults. In order to provide appropriate input for health policy reforms, the…
Abstract
Interest has grown in integrated care models as means of responding better to the needs of frail older adults. In order to provide appropriate input for health policy reforms, the effects of integrated care must be assessed with sound methodologies. Based on three experiments conducted in the province of Quebec, Canada, this article provides practical advice on key issues involved in evaluating integrated care models.
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Helen Frost, Sally Haw and John Frank
The population of older people in the UK is expected to rise rapidly over the next 20 years and therefore identification of effective interventions that prevent functional decline…
Abstract
Purpose
The population of older people in the UK is expected to rise rapidly over the next 20 years and therefore identification of effective interventions that prevent functional decline and disablement is a public health priority. This review summarises the evidence for interventions in community settings that aim to prevent or delay disablement in later life.
Design/methodology/approach
A search of review‐level literature was conducted for the period September 1999 and 2009 of Ovid MEDLINE, EMBASE and CINAHL databases. It included interventions that aimed to prevent disablement of community dwelling older people (50+ years old). It excluded interventions carried out in institutional care and those focused on specific disease. The reviews were screened using the AMSTAR assessment tool.
Findings
The search identified 62 reviews of complex interventions (preventative home visits (n=9), integrated service delivery/case management and comprehensive geriatric assessment (n=6), falls prevention (n=17), exercise (n=15), nutritional needs (n=3), medication review (n=2), telecare/telehealth (n=5), social integration interventions (n=3) and vision screening (n=2).
Originality/value to Conclusion
The review identified many areas of unknown effectiveness, partly due to unstandardised use of outcomes and poor experimental design. The most promising complex interventions include: assessment of risk factors; and direct referral to an easily accessible, comprehensive range of interventions that are tailored to need and include long‐term follow up. There is consistent evidence that exercise can be beneficial, particularly in preventing falls, but overall, the evidence‐base for other specific interventions is limited.