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Publications (128)
Introduction
Obesity, a complex chronic disease, is on the rise, leading to increased mortality, morbidity and societal challenges. This study explores intersectoral interventions focusing on the needs of people living with obesity (PLO).
Methods and analysis
An environmental scan of the published and unpublished literature will be conducted using...
Background Previous studies on the impact of the coronavirus disease 2019 (COVID-19) pandemic on persons living with dementia (PLWD) were mostly conducted in a single jurisdiction or focused on a limited number of outcomes. Our study estimates the impact of the first two pandemic waves on emergency department (ED) visits (all-cause/ambulatory care...
INTRODUCTION
Inequities associated with socioeconomic status (SES) manifest across dementia outcomes; however, research investigating service use across SES in people with dementia is scarce.
METHODS
We conducted a repeated yearly cohort study of community‐dwelling people in Quebec with incident dementia (2000–2017), using health administrative da...
Background and Objectives: Geriatric Emergency Management (GEM) nurses aim to reduce adverse outcomes by addressing unique needs of older adults seen in emergency departments (EDs), but evidence to demonstrate their impact on ED care transitions is mixed. We evaluated the impact of implementing a GEM nurse model in a local ED on thirty-day revisits...
Background
End-of-life periods are often characterised by suboptimal healthcare use (HCU) patterns in persons aged 65 years and older, with negative effects on health and quality of life. Understanding care trajectories (CTs) and transitions in this period can highlight potential areas of improvement, a subject yet only little studied.
Objective
T...
Objective
Improving care transitions for older adults can reduce emergency department (ED) revisits, and the strain placed upon caregivers. We analyzed whether caregivers felt a change in burden following a care transition, and what may be improved to reduce it.
Methods
This mixed-methods observational study nested within LEARNING WISDOM included...
Background
Most older adults wish to remain in their homes and communities as they age. Despite this widespread preference, disparities in health outcomes and access to healthcare and social support may create inequities in the ability to age in place. Our objectives were to synthesise evidence of social inequity in ageing in place among older adul...
Background and Objectives
People aged 65 and over, deemed most “vulnerable” by public health, were targeted by the COVID-19 protection measures which sought to minimize physical contact and social activities. Older adults living alone were particularly impacted by these measures. However, such measures meant to protect the older population may not...
Objective: Improving care transitions for older adults can reduce emergency department (ED) revisits, and the strain placed upon caregivers. We analyzed whether caregivers felt a change in burden following a care transition, and what may be improved to reduce it.
Methods: This mixed-methods observational study nested within LEARNING WISDOM included...
Aim
Persons living with dementia are a heterogeneous population with complex needs whose healthcare use varies widely. This study aimed to identify the healthcare use profiles in a cohort of persons with incident dementia, and to describe their characteristics.
Methods
This is a retrospective cohort study of health administrative data in Quebec (C...
Introduction
Intersectoral collaboration is a collaborative approach between the health sectors and other sectors to address the interdependent nature of the social determinants of health associated with chronic diseases such as diabetes. This scoping review aims to identify intersectoral health interventions implemented in primary care and communi...
Objectives: Describe sex differences in healthcare utilization and mortality in persons with new dementia in Quebec, Canada. Methods: We conducted a repeated cohort study from 2000 to 2017 using health administrative databases. Community-dwelling persons aged 65+ with a new diagnosis of dementia were included. We measured 23 indicators of healthcar...
Objectives
This study aimed to support the implementation of the 11th Revision of the International Classification of Diseases (ICD-11). We used common comorbidity indices as a case study for proactively assessing the impact of transitioning to ICD-11 for mortality and morbidity statistics (ICD-11-MMS) on real-world data analyses.
Materials and Me...
Randomized controlled trials (RCTs) have traditionally been considered the gold standard for medical evidence. However, in light of emerging methodologies in data science, many experts question the role of RCTs. Within this context, experts in the USA and Canada came together to debate whether the primacy of RCTs as the gold standard for medical ev...
Objective
Improving care transitions for older adults can reduce emergency department (ED) visits, adverse events, and empower community autonomy. We conducted an inductive qualitative content analysis to identify themes emerging from comments to better understand ED care transitions.
Methods
The LEARNING WISDOM prospective longitudinal observatio...
Introduction
Rapid population ageing and associated health issues such as frailty are a growing public health concern. While early identification and management of frailty may limit adverse health outcomes, the complex presentations of frailty pose challenges for clinicians. Artificial intelligence (AI) has emerged as a potential solution to suppor...
Introduction:
Measuring the performance of interprofessional primary care is needed to examine whether this model of care is achieving its desired outcomes on patient care and health system effectiveness as well as to guide quality improvement initiatives. The aim of this scoping review is to map the literature on primary care performance measurem...
Although frailty is an important, well-characterized concept in the provision of medical care to older adults, it has not been linked to the concept of vulnerability developed in the humanities and social sciences. Here, we distinguish between the two main dimensions of vulnerability: a fundamental, anthropological dimension in which people are exp...
Objective:
To identify different profiles of socially isolated older adults during the first wave of COVID-19 in Quebec, Canada.
Study design:
Cross-sectional data were obtained through a telehealth socio-geriatric risk assessment tool, ESOGER, administered to adults aged 70 years or more between April and July 2020 in Montreal, Canada.
Measure...
Context: Virtual pre-consultation screening of patient needs may offer opportunities to improve the care and health outcomes of older patients in primary care, especially those with multiple care needs. Objective: We sought to implement and evaluate the effectiveness of a multidimensional virtual pre-consultation tool in the primary care setting to...
Purpose:
Interprofessional primary care has the potential to optimize hospital use for acute care among people with dementia. We compared 1-year emergency department (ED) visits and hospitalizations among people with dementia enrolled in a practice having an interprofessional primary care team with those enrolled in a physician-only group practice...
Aim
The objective of the present study was to measure the impact of the intervention of combining a medication review with an integrated care approach on potentially inappropriate medications (PIMs) and hospital readmissions in frail older adults.
Methods
A cohort of hospitalized older adults enrolled in the French PAERPA integrated care pathway (...
BACKGROUND
The latest global figures show that 55 million persons lived with major neurocognitive disorders (MNCDs) worldwide in 2021. In Quebec, Canada, most of these seniors are cared for by family physicians in interdisciplinary primary care clinics such as family medicine groups (FMG). When a person suffers from a MNCD, taking potentially inapp...
Background:
The latest global figures show that 55 million persons lived with major neurocognitive disorders (MNCDs) worldwide in 2021. In Quebec, Canada, most of these seniors are cared for by family physicians in interdisciplinary primary care clinics such as family medicine groups (FMG). When a person suffers from a MNCD, taking potentially ina...
Objective:
To develop a framework of population-based primary care quality indicators adapted to patients with dementia and to identify a subset of stakeholder-driven priority indicators.
Design:
Framework development was carried out through the selection of an initial framework based on a rapid review and identification of relevant indicators a...
During the COVID-19 pandemic, policymakers had to quickly offer telehealth services to address older adults’ needs. This study aimed to understand the experiences of providers who implemented a telephone-based telehealth tool named Socio-Geriatric Evaluation (ESOGER), which assessed health and social isolation risks in community-dwelling older adul...
Background:
Community-dwelling people with dementia have been affected by COVID-19 pandemic health risks and control measures that resulted in worsened access to health care and service cancellation. One critical access point in health systems is the emergency department. We aimed to determine the change in weekly rates of visits to the emergency...
Background
COVID-19 catalyzed a rapid and substantial reorganization of primary care, accelerating the spread of existing strategies and fostering a proliferation of innovations. Access to primary care is an essential component of a healthcare system, particularly during a pandemic. We describe organizational innovations aiming to improve access to...
Background
Organizational and clinician characteristics are important considerations for the implementation of evidence-based recommendations into primary care practice. The introduction of Canadian dementia practice guidelines and Alzheimer strategies offers a unique context to study which of the organizational and clinician characteristics align...
There is growing consensus that interprofessional primary care is key to delivering timely, coordinated, and comprehensive care, especially in the older patient population who often live with complex and chronic needs. Despite significant investments in reforming health systems toward interprofessional primary care, there is a paucity of evidence d...
Introduction
Institutional support, encompassing financial and training support, as well as interdisciplinary teams, may be important for the quality of dementia primary care for persons living with dementia. The aim of this study was to measure the association between the level of institutional support provided to primary care practices and the qu...
Importance:
Persons with dementia and Parkinson disease (PD) are vulnerable to disruptions in health care and services.
Objective:
To examine changes in health service use among community-dwelling persons with dementia, persons with PD, and older adults without neurodegenerative disease during the first wave of the COVID-19 pandemic.
Design set...
Objective: Our hypothesis was that the intervention would decrease (or at least not increase) the number of potentially inappropriate medications (PIMs) and the number of hospital readmissions within 30 days of discharge per hospital stay. Methods: A cohort of hospitalized older adults enrolled in the PAERPA integrated care pathway (the exposed coh...
Antiretroviral therapy effectively prevents sexual and vertical transmission of HIV. Yet, some women living with HIV report having unmet needs for reproductive health care. This study measured the prevalence of women discussing reproductive goals with any current healthcare provider and assessed the effect of the current HIV care provider’s gender...
Background
Little has been quantified, at a population‐level, about the magnitude of heath service disruption to persons living with dementia in community settings during the COVID‐19 pandemic. Sustained access to health care services is particularly important for persons with dementia and other neurodegenerative diseases as they are vulnerable to...
Background
COVID-19 catalyzed a rapid and substantial reorganization of primary care, accelerating the spread of existing strategies and fostering a proliferation of innovations. Access to primary care is an essential component of a health care system, particularly during a pandemic. We describe organizational innovations aiming to improve access t...
Background:
Whether avoidable hospitalizations in community-dwelling persons with dementia have decreased during primary care reforms is unknown.
Methods:
We described the prevalence and trends in avoidable hospitalizations in population-based repeated yearly cohorts of 192,144 community-dwelling persons with incident dementia (Quebec, 2000-2015...
Introduction: The implications of the COVID-19 pandemic are far reaching for persons living with dementia (PLWD) in the community and in long-term care (LTC), as they are among the most vulnerable. PLWD are at risk for severe COVID-19 and a disruption in accessing supportive and health care due to the confinement measures.
Objectives: 1) To measur...
Background and Objectives: Older adults are among the populations most vulnerable to the physical, psychological and social consequences of the COVID-19 pandemic. Some telehealth tools have been developed to assess their health condition and social isolation, but little is known about how they have been implemented during the pandemic. This study a...
Background and Objectives: The confinement measures of COVID-19 may have changed the landscape of socially isolated older persons, either by worsening or creating new situations of social isolation. It is important to understand the variety of health, mental and cognitive characteristics of this group of persons to adapt practices aimed at reducing...
Background
Older adults are more vulnerable to severe infection and mortality due to COVID-19. They often have atypical presentations of the disease without respiratory symptoms, which makes early diagnosis clinically challenging. We aimed to compare the baseline characteristics, presentation, and disease course of older and younger patients hospit...
Background/objective:
To measure the association between high primary care continuity and potentially avoidable hospitalization in community-dwelling persons with dementia. Our hypothesis was that high primary care continuity is associated with fewer potentially avoidable hospitalizations.
Design:
Population-based retrospective cohort (2012-2016...
Background
As the Canadian population ages, challenges have emerged with the quality and healthcare utilization of services for persons living with dementia (PWD). These challenges may be exacerbated when we consider the sex inequalities. A disconcerting trend in sex differences has arisen among older adult women, where they are more disadvantaged...
Many countries have answered the call from the World Health Organization, and developed or implemented Alzheimer Plans. Some plans anchored the majority of the care for persons living with dementia in specialized care settings, while others anchored it in primary care. In this article we present the Quebec Alzheimer Plan, which is being implemented...
Background:
The influence of sex and gender on the risk of dementia, its clinical presentation and progression is increasingly being recognized. However, current dementia strategies have not explicitly considered sex and gender differences in the management of dementia to ensure equitable care. The objective of this study was to examine the modera...
Our study objective was to develop and validate a questionnaire assessing the knowledge, attitude, and practice (KAP) of family physicians regarding dementia care and dementia strategies in Canada. Using a multistage process with a panel of experts, we developed and distributed an 83-item questionnaire to 542 eligible family physicians in 42 interd...
Introduction
Dementia is on the rise in Canada and globally. Ensuring accessibility to diagnosis, treatment and management throughout the course of the disease is a very significant problem worldwide. In order to provide comprehensive care to patients and their caregivers, enhancing primary care-based dementia care is seen as the way forward. In ma...
Transitional care interventions, often led by hospital specialists, have mixed impact on reducing readmissions. Interventions led by family physicians may be more promising. The objective of this study was to evaluate the impact of a family-medicine-based intervention in reducing the incidence of emergency department (ED) visits, hospital readmissi...
Objectives:
Growing evidence points to underlying sex differences in the risk factors and clinical presentation of dementia. It is unclear, however, whether sex differences also exist in the management and healthcare utilization of persons with dementia. We compared primary care performance and health service use indicators for newly identified me...
Background:
The Quebec Alzheimer Plan aims to improve care provided to patients with neurocognitive disorders in Family Medicine Groups (FMGs) (multidisciplinary team-based primary care practices). The objective of this study was to determine changes in the detection and management of neurocognitive disorders following implementation of the plan,...
Context: Many provinces are implementing initiatives to better prepare primary care to tackle dementia care. In Quebec, a provincial plan was implemented in 2014. In Ontario, many local initiatives have been put in place since 1999 and similar initiatives are under consideration in New Brunswick. Knowledge, attitudes, and practices of the family ph...
Context: In 2014, the Quebec Alzheimer Plan (AP) was launched in 38 family medicine groups (FMGs) to improve the ability of primary care professionals to detect and care for patients with Alzheimer’s disease and their caregivers. Objective: Describe the fidelity of implementation of the AP in participating FMGs Method: 42-item questionnaire measuri...
Background
Passive dissemination of information in healthcare refers to the publication or mailing of newly established guidelines or recommendations. It is one of the least costly knowledge translation activities. This approach is generally considered to be ineffective or to result in only small changes in practice. Recent research, however, sugge...
Background
The objective of this study is to explore the association between frailty and surgical recovery over a 6-month period, in elderly patients undergoing elective abdominal surgery.
Methods
A total of 144 patients were categorized as frail, pre-frail, and non-frail based on five criteria: weight loss, exhaustion, weakness, slowness, and low...
In 2013, the Quebec Ministry of Health implemented a reform called the ‘Alzheimer Plan’ in 42 family medicine groups (FMG) to better manage dementia patients in primary care. We created and validated two questionnaires to measure the clinicians’ knowledge, attitudes, and practices regarding dementia care in each FMG.
Based on the literature and con...
In 2013, the Quebec government implemented an Alzheimer Plan (AP) to improve dementia patients’ management in primary care. We aimed to evaluate the impact of this intervention on the clinicians’ knowledge, attitudes, and practices (KAP) and their association with the quality of dementia care. To this end, clinicians’ questionnaires were distribute...
Nonrandomized studies are increasingly used to evaluate interventions where randomization is not feasible or desired such as with policy reforms or practice change. A common practice is to statistically compare baseline characteristics between the control and intervention group to determine imbalances and confounders for model adjustment. This prac...
Healthcare systems are facing an increasing number of vulnerable older patients with chronic diseases (CD). Transitions in care from hospital to primary care for this population are complex and lead to increased mortality and service use. In response to these challenges, transitional care (TC) interventions are being widely implemented to increase...
The Alzheimer Plan, focusing on primary health care as the hub of networked care for patients with dementia, is being implemented in 40 selected Family Medicine Groups in Quebec, Canada. Our objectives were to: 1) assess the impact of the plan on detection, diagnosis, treatment and quality of dementia care management, 2) describe the implementation...
The Quebec government has started implementing an Alzheimer Plan (AP) in 42 family medicine groups (FMGs) to improve the management of patients with dementia. We aimed to evaluate the change in the quality of dementia care management and the rate of cognitive testing and diagnosis after the implementation of this reform. Two independent sets of cha...
http://www.premiereligne.org/4142
Transitions in care from hospital to primary care for older patients with chronic diseases (CD) are complex and lead to increased mortality and service use. In response to these challenges, transitional care (TC) interventions are being widely implemented. They encompass education on self-management, discharge planning, structured follow-up and coo...
Background:
Malnutrition among elderly surgical patients has been associated with poor postoperative outcomes and reduced functional status. Although previous studies have shown that nutrition contributes to patient outcomes, its long-term impact on functional status requires better characterization. This study examines the effect of nutrition on...
While the negative impact of postoperative complications on hospital costs, survival, and cancer recurrence is well known, few studies have quantified the impact of postoperative complications on patient-centered outcomes such as functional status. The objective of this study was to estimate the impact of postoperative complications on recovery of...
The purpose of this study was to determine the proportion of symptomatic recurrence following initial non-operative management of gallstone disease in the elderly and to test possible predictors.
This is a single institution retrospective chart review of patients 65 years and older with an initial hospital visit (V1) for symptomatic gallstone disea...
The effect of an educational program on antipsychotic prescribing was assessed in two Canadian long-term care centers (LTCC). In each center (Center A residents, n = 258 and Center B residents, n = 191, with dementia at program inception), the rate of change in the odds of using antipsychotics in residents was estimated using mixed-effects logistic...
Objectives
To determine the association between self-rated health (SRH) and functional status, comorbidity, toxicity of treatment and mortality in older patients with newly-diagnosed cancer.
Materials and Methods
Patients aged 65 and over, newly diagnosed were recruited at the Jewish General Hospital, Montreal, Canada. SRH and functional status [i...
The ability to measure surgical quality of care is important and can lead to improvements in patient safety. As such, processes should be carried out in an identical fashion for all patients, regardless of how vulnerable or complex they are. Our objectives were to assess quality of surgical care delivered to elderly patients and to determine the as...
Background:
Little is known about the contribution of frailty in improving patient-level prediction beyond readily available clinical information. The objective of this study is to compare the predictive ability of 129 combinations of seven frailty markers (cognition, energy, mobility, mood, nutrition, physical activity, and strength) and quantify...
Background
Measuring quality of surgical care is essential to identifying areas of weakness in the delivery of effective surgical care and to improving patient outcomes. Our objectives were 1) to assess the quality of surgical care delivered to adult patients and 2) to determine the association between quality of surgical care and post-operative co...
