Enhanced train-the-trainer program for registered nurses and social workers to apply the founding principles of primary care in their practice: a pre-post study.

BACKGROUND: A train-the-trainer approach can effectively support the integration of new practice standards for health and social services professionals. This study describes the effects of an enhanced train-the-trainer program to support registered nurses and social workers working in primary care clinics in their understanding of the fundamental principles of primary care. METHODS: We implemented an enhanced train-the-trainer program for registered nurses and social workers in six primary care clinics. We conducted a pre-post study using quantitative and qualitative data to assess trainers' and trainees' intention, commitment, and confidence in applying acquired knowledge. RESULTS: We trained 11 trainers and 33 trainees. All the trainers and trainees were satisfied with the program. Trainers were less confident in their abilities as trainers following the training, especially regarding tailored coaching (p = 0.03). Trainees' commitment to becoming familiar with the functioning of their clinic (p = 0.05) and becoming part of the team increased significantly (p = 0.01); however, their intention to use their knowledge decreased (p = 0.02). Trainers and trainees identified organizational and professional barriers that may explain the observed decrease. CONCLUSION: An enhanced train-the-trainer program positively impacted registered nurses' and social workers' assimilation of the fundamental principles of primary care. Further research is needed to understand the long-term effects of train-the-trainer programs on primary care trainees and how these effects translate into patient care.

Personalized Citizen Assistance for Social Participation (APIC) adapted for older adults with visual impairment: results from a mixed study.

PURPOSE: To explore the effects of the Personalized Citizen Assistance for Social Participation (APIC), an intervention adapted here for visual impairment, involving weekly stimulation sessions over six to twelve months, provided by trained and supervised attendants, on seven outcomes (social participation, leisure, independence, mobility, quality of life, health-related quality of life, and empowerment) in older adults with visual impairment, and to document its facilitators and barriers. METHODS: A mixed-method design, which included a pre-experimental and an exploratory qualitative clinical research component, was used on 8 older adults (7 women) with visual impairment aged 70-86, and 8 attendants (5 women) aged 20-74. Before the intervention, directly after, and four months later, older adults completed questionnaires on the 7 outcomes. During the intervention, attendants completed diaries and participated in monthly meetings. Semi-structured interviews were administered to all participants after the intervention. RESULTS: Social participation, leisure, mobility, quality of life and empowerment had increased immediately after the APIC. These improvements were still generally observed four months later. Participants reported that the APIC improved older adults' capabilities, social participation, and social environment. CONCLUSIONS: The APIC is a promising intervention which helps older adults with visual impairment to deal with social restrictions.

In older adults, visual impairment has important consequences on active and healthy aging.Personalized citizen assistance for social participation (APIC) is an intervention that aims to foster the social participation.This study shows that APIC adapted to visual impairment influences social participation, leisure, mobility, quality of life and empowerment of older adults with visual impairment.Participants also reported improvements in their capabilities, social participation, and social environment.

Dashboards to Support Implementation of the Quebec Alzheimer Plan: Evaluation Study With Regional and Professional Considerations.

BACKGROUND: Health organizations face the critical task of executing and overseeing comprehensive health care. To address the challenges associated with this task, evidence-based dashboards have emerged as valuable tools. Since 2016, the regional health organizations of Quebec, Canada, have been responsible for ensuring implementation of the Quebec Alzheimer Plan (QAP), a provincial plan that aims to reinforce the capacity of primary care services to detect, diagnose, and treat persons with dementia. Despite the provincial scope of the QAP, the diverse material and human resources across regions introduce variability in the interest, utility, and specific needs associated with these dashboards. OBJECTIVE: The aim of this study was to assess the interest and utility of dashboards to support the QAP implementation, as well as to determine the needs for improving these aspects according to the perspectives of various types of professionals involved across regions. METHODS: An evaluative study using qualitative methods was conducted within a collaborative research approach involving different stakeholders, including the ministerial advisor and the four project managers responsible for supporting the implementation of the QAP, as well as researchers/scientific advisors. To support these organizations, we developed tailored, 2-page paper dashboards, detailing quantitative data on the prevalence of dementia, the use of health services by persons with dementia, and achievements and challenges of the QAP implementation in each organization's jurisdiction. We then conducted 23 focus groups with the managers and leading clinicians involved in the implementation of the QAP of each regional health organization. Real-time notes were taken using a structured observation grid. Content analysis was conducted according to different regions (organizations with university mandates or nearby organizations, labeled "university/peripheral"; organizations for which only part of the territory is in rural areas, labeled "mixed"; and organizations in remote or isolated areas, labeled "remote/isolated") and according to different types of participants (managers, leading clinicians, and other participants). RESULTS: Participants from organizations in all regions expressed interest in these dashboards and found them useful in several ways. However, they highlighted the need for indicators on orphan patients and other health care providers. Differences between regions were observed, particularly in the interest in continuity of care in university/peripheral regions and the need for diagnostic tools adapted to the culture in remote/isolated regions. CONCLUSIONS: These dashboards support the implementation of an Alzheimer Plan and contribute to the emergence of a learning health care system culture. This project allows each region to increase its monitoring capacity for the implementation of the QAP and facilitates reflection among individuals locally carrying out the implementation. The perspectives expressed will guide the preparation of the next iteration of the dashboards.

Effect of Age-Friendly Communities Action Plan on Trajectories of Older Canadians' Depressive Symptoms Between 2018 and 2020: Multilevel Results From the Canadian Longitudinal Study on Aging.

As the COVID-19 pandemic impacted mental health, this longitudinal study examined the effect of age-friendly communities (AFC) action plan on older adults' depressive symptoms. Using the CLSA, the CLSA COVID-19 Questionnaire study, survey of Canadian municipalities, and the census, the depressive symptoms trajectories were modeled with multilevel multinomial regressions. Most respondents (66.1%) had non-depressed trajectories, 28.1% experienced a moderate increase in depressive symptoms, and 5.8% had a depressed trajectory. AFC action plans did not have a protective effect on these trajectories. Being a female, greater loneliness, lower income, ≥2 chronic conditions, inferior social participation, weaker sense of belonging, COVID-19 infection, and pandemic stressors predicted a depressed trajectory. Neighborhood's deprivation had a weak protective effect on the declining trajectory. Although AFC action plans provided no benefits during the pandemic, volunteers facilitating resource access and social interactions could limit any increase in depressive symptoms.

Transitions of care for older adults discharged home from the emergency department: an inductive thematic content analysis of patient comments.

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 observational cohort includes older adults (≥ 65 years) who experienced a care transition after an ED visit from both before and during COVID-19. Their comments on this transition were collected via phone interview and transcribed. We conducted an inductive qualitative content analysis with randomly selected comments until saturation. Themes that arose from comments were coded and organized into frequencies and proportions. We followed the Standards for Reporting Qualitative Research (SRQR). RESULTS: Comments from 690 patients (339 pre-COVID, 351 during COVID) composed of 351 women (50.9%) and 339 men (49.1%) were analyzed. Patients were satisfied with acute emergency care, and the proportion of patients with positive acute care experiences increased with the COVID-19 pandemic. Negative patient comments were most often related to communication between health providers across the care continuum and the professionalism of personnel in the ED. Comments concerning home care became more neutral with the COVID-19 pandemic. CONCLUSION: Patients were satisfied overall with acute care but reported gaps in professionalism and follow-up communication between providers. Comments may have changed in tone from positive to neutral regarding home care over the COVID-19 pandemic due to service slowdowns. Addressing these concerns may improve the quality of care transitions and provide future pandemic mitigation strategies.

Collaborative practice competencies needed for telehealth delivery by health and social care professionals: a scoping review.

In the context of the COVID-19 pandemic, many healthcare and social services professionals have had to provide services through virtual care. In the workplace, such professionals often need to be sufficiently resourced to collaborate and address collaborative care barriers in telehealth. We performed a scoping review to identify the competencies required to support interprofessional collaboration among clinicians in telehealth. We followed Arksey and O'Malley's and the Joanna Briggs Institute's methodological guidelines, including quantitative and qualitative peer-reviewed articles published between 2010 and 2021. We expanded our data sources by searching for any organization or experts in the field via Google. The analysis of the resulting thirty-one studies and sixteen documents highlighted that health and social services professionals are generally unaware of the competencies they need to develop or maintain interprofessional collaboration in telehealth. In an era of digital innovations, we believe this gap may jeopardize the quality of the services offered to patients and needs to be addressed. Of the six competency domains in the National Interprofessional Competency Framework, it was observed that interprofessional conflict resolution was the competency that emerged least as an essential competency to be developed, while interprofessional communication and patient/client/family/community-centered care were identified as the two most reported essential competencies.

Research protocol of the Laval-ROSA Transilab: a living lab on transitions for people living with dementia.

BACKGROUND: The Laval-ROSA Transilab is a living lab that aims to support the Laval Integrated Health and Social Services Centres (Quebec, Canada) in consolidating the Quebec Alzheimer Plan. It aims to improve care transitions between different settings (Family Medicine Groups, home care, and community services) and as such improve the care of people living with dementia and their care partners. Four transition-oriented innovations are targeted. Two are already underway and will be co-evaluated: A) training of primary care professionals on dementia and interprofessional collaboration; B) early referral process to community services. Two will be co-developed and co-evaluated: C) developing a structured communication strategy around the dementia diagnosis disclosure; D) designation of a care navigator from the time of dementia diagnosis. The objectives are to: 1) co-develop a dashboard for monitoring transitions; 2) co-develop and 3) co-evaluate the four targeted innovations on transitions. In addition, we will 4) co-evaluate the impact and implementation process of the entire Laval-ROSA Transilab transformation, 5) support its sustainability, and 6) transfer it to other health organizations. METHODS: Multi-methods living lab approach based on the principles of a learning health system. Living labs are open innovation systems that integrate research co-creation and knowledge exchange in real-life settings. Learning health systems centers care improvement on developing the organization's capacity to learn from their practices. We will conduct two learning cycles (data to knowledge, knowledge to practice, and practice to data) and involve various partners. We will use multiple data sources, including health administrative databases, electronic health records data, surveys, semi-structured interviews, focus groups, and observations. DISCUSSION: Through its structuring actions, the Laval-ROSA Transilab will benefit people living with dementia, their care partners, and healthcare professionals. Its strategies will support sustainability and will thus allow for improvements throughout the care continuum so that people can receive the right services, at the right time, in the right place, and from the right staff.

Connecting Health and Social Services for Patients with Complex Care Needs: A Pan-Canadian Comparative Policy Research Program.

Comprehensive primary healthcare for patients with complex care needs requires connections to other health services, social services and community supports. This descriptive comparative policy research program used publicly available documents and informant interviews to examine progress toward integrated comprehensive care through the lens of services needed by children and youth (0-25 years) and community-dwelling older adults (≥ 65 years) with high functional health needs. This article describes five projects. The following three findings emerged across all the projects: Canada indeed has multiple health systems; numerous integrated service delivery solutions are being trialled and most focus on medical services; and it is an ongoing challenge for ministries of health to engage physicians and physician associations in integration.

Inconsistent Governance Structures for Health and Social Services Limit Service Integration for Patients with Complex Care Needs.

This paper describes how health and social services are governed and organized across Canada for two patient groups. Governance configurations and governance proximity between primary care and priority health and social services varied markedly between provinces. While the need for integrated service delivery has been made a clear priority during the COVID-19 pandemic, the potential of Canada's healthcare systems has not yet translated into coordinated and integrated care for health services, much less for health and social services. It is time to act on the policy recommendations from commissioned reports over the past two decades that focus on comprehensive, community-based care.

Toward Comprehensive Care Integration in Canada: Delphi Process Findings from Researchers, Clinicians, Patients and Decision Makers.

Introduction: From a larger study examining policy and program information on how Canadian provinces integrate care services, this study aimed to create "priority lists" of 10-15 services that are "absolutely needed" for care integration. Methodology: A diverse group of over 50 Canadian stakeholders participated in virtual consensus-building using the nominal group technique and a modified e-Delphi method to identify services that focused on two different groups: children and youth with high functional health needs and older adults in functional decline. Results: Three lists - containing services, processes and infrastructure elements - emerged: one per tracer condition group and a consolidated list. The latter identified the following five services as top priority for primary care integration: mental health and addictions services; home care; transition between urgent-emergency-acute care; medication reconciliation in community pharmacies; and respite care. No single social service was a clear priority, but those that mitigate material deprivation emerged within the top 10. Discussion: This humble pan-Canadian study shows that priority services in health and social services are neither well integrated nor connected to primary care. It also suggests that effective policy strategizing for primary care integration for those with complex care needs may require thinking beyond the logic of services - given their siloed organization.

Have Primary Care Renewal Initiatives in Canada Increased Comprehensive Care for Patients with Complex Care Needs? Yes and No.

The First Ministers Health Accords of 2001 through 2003 (Health Canada 2006) launched the renewal of primary care toward more comprehensive care delivery models. We scanned government websites in the 10 Canadian provinces to assess how comprehensive and integrated renewal models were for health and social services in 2018. More comprehensive primary care delivery models were the norm in five out of 10 provinces. The policy approaches were: (1) expanding traditional family practice; (2) creating primary care networks; and (3) increasing the number of community health centres, which provide the broadest range of health and social care. Integration initiatives were limited to medical services. Additional financial and policy investments will be required to meet the comprehensive needs of patients with complex health and social needs at a system level.

Integrating Health and Social Care for Community-Dwelling Older Adults: A Description of 16 Canadian Programs.

This paper describes 16 Canadian programs designed to provide integrated primary care for older adults. Publicly available data were used to identify the "what" and the "how" of integration for each program. Most programs integrated with other healthcare or medical services (vs. social services). Mechanisms of integration varied; the most common mechanism was interprofessional teams. Only 25% of the programs formally engaged with autonomous physician-led primary care practices (where most Canadians receive their primary care). Findings suggest that integrated care is a priority across Canada but also highlight how far we have to go to achieve both vertical integration within the healthcare sector (primary, secondary and tertiary services) and horizontal integration across sectors (health and social).

Key Age-Friendly Components of Municipalities that Foster Social Participation of Aging Canadians: Results from the Canadian Longitudinal Study on Aging.

Municipalities can foster the social participation of aging adults. Although making municipalities age-friendly is recognized as a promising way to help aging adults stay involved in their communities, little is known about the key components (e.g., services and structures) that foster social participation. This study thus aimed to identify key age-friendly components (AFC) best associated with the social participation of older Canadians. Secondary analyses were carried out using baseline data from the Canadian Longitudinal Study on Aging (n = 25,411) in selected municipalities (m = 110 with ≥ 30 respondents), the Age-friendly Survey, and census data. Social participation was estimated based on the number of community activities outside the home per month. AFC included housing, transportation, outdoor spaces and buildings, safety, recreation, workforce participation, information, respect, health, and community services. Multilevel models were used to examine the association between individual social participation, key AFC, and environmental characteristics, while controlling for individual characteristics. Aged between 45 and 89, half of the participants were women who were engaged in 20.2±12.5 activities per month. About 2.5% of the variance in social participation was attributable to municipalities. Better outdoor spaces and buildings (p < 0.001), worse communication and information (p < 0.01), and lower material deprivation (p < 0.001) were associated with higher social participation. Age was the only individual-level variable to have a significant random effect, indicating that municipal contexts may mediate its impact with social participation. This study provides insights to help facilitate social participation and promote age-friendliness, by maintaining safe indoor and outdoor mobility, and informing older adults of available activities.

Understanding the impacts of the COVID-19 pandemic on the care experiences of people with mental-physical multimorbidity: protocol for a mixed methods study.

BACKGROUND: Primary care and other health services have been disrupted during the COVID-19 pandemic, yet the consequences of these service disruptions on patients' care experiences remain largely unstudied. People with mental-physical multimorbidity are vulnerable to the effects of the pandemic, and to sudden service disruptions. It is thus essential to better understand how their care experiences have been impacted by the current pandemic. This study aims to improve understanding of the care experiences of people with mental-physical multimorbidity during the pandemic and identify strategies to enhance these experiences. METHODS: We will conduct a mixed-methods study with multi-phase approach involving four distinct phases. Phase 1 will be a qualitative descriptive study in which we interview individuals with mental-physical multimorbidity and health professionals in order to explore the impacts of the pandemic on care experiences, as well as their perspectives on how care can be improved. The results of this phase will inform the design of study phases 2 and 3. Phase 2 will involve journey mapping exercises with a sub-group of participants with mental-physical multimorbidity to visually map out their care interactions and experiences over time and the critical moments that shaped their experiences. Phase 3 will involve an online, cross-sectional survey of care experiences administered to a larger group of people with mental disorders and/or chronic physical conditions. In phase 4, deliberative dialogues will be held with key partners to discuss and plan strategies for improving the delivery of care to people with mental-physical multimorbidity. Pre-dialogue workshops will enable us to synthesize an prepare the results from the previous three study phases. DISCUSSION: Our study results will generate much needed evidence of the positive and negative impacts of the COVID-19 pandemic on the care experiences of people with mental-physical multimorbidity and shed light on strategies that could improve care quality and experiences.

Identify and classify interprofessional primary care performance indicators: a scoping review protocol.

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 measurement indicators to determine the extent to which current indicators capture or could be adapted to capture processes, outputs and outcomes that reflect interprofessional primary care. METHODS AND ANALYSIS: The review will be guided by the six-stage framework by Arksey and O'Malley (2005). MEDLINE, Embase, CINAHL, grey literature and the reference list of key studies will be searched to identify any study, published in English or French between 2000 and 2022, related to the concepts of performance indicators, frameworks, interprofessional teams and primary care. Two reviewers will independently screen all abstracts and full-text studies for inclusion. Eligible indicators will be classified according to process, output and outcome domains proposed by two validated frameworks. This study started in November 2022 and is expected to be completed by July 2023. ETHICS AND DISSEMINATION: This review does not require ethical approval. The results will be disseminated through a peer-reviewed publication, conference presentations and presentations to stakeholders.

Integrated case management between primary care clinics and hospitals for people with complex needs who frequently use healthcare services in Canada: A multiple-case embedded study.

INTRODUCTION: Case management (CM) is recognized to improve care integration and outcomes of people with complex needs who frequently use healthcare services, but challenges remain regarding interaction between primary care clinics and hospitals. This study aimed to implement and evaluate an integrated CM program for this population where nurses in primary care clinics worked with a hospital case manager. METHODS: A multiple embedded case study was conducted in the Saguenay-Lac-Saint-Jean region (Québec, Canada), in four dyads including a clinic and a hospital. Mixed data collection included, at baseline and 6 months, interviews and focus groups with stakeholders, patient questionnaires (patient experience of integrated care and self-management), and emergency department (ED) visits in the previous 6 months. RESULTS: Integrated CM implementation was optimal when all stakeholders provided collective leadership, and were supportive of the program, particularly the physicians. The 6-month program enabled the observation of positive qualitative outcomes in most clinic-hospital dyads where implementation occurred. Full implementation was associated with improved care integration. DISCUSSION AND CONCLUSION: Integrated CM between primary care clinics and hospitals is a promising innovation to improve care integration for people with complex needs who frequently use healthcare services. Collective leadership and physicians' buy-in to integrated CM are important to foster the implementation.

Nursing Care Coordination in Primary Healthcare for Patients with Complex Needs: A Comparative Case Study.

Introduction: Despite nurses' substantial role in care coordination, few education programs exist to better support them in this role. Identification of a set of core care coordination activities across heterogeneous care coordination programs would facilitate the development of a standard of practice. We sought to examine care coordination activities across two care coordination programs in Family Medicine Groups in Quebec, and their relationship to the program design. Methods: We performed a comparative case study of two care coordination programs in primary care targeting frequent users of healthcare services and people with Alzheimer's disease and related disorders. Data collection included documents and semi-structured interviews with key informants. Results: Several activities were common to both programs, such as patient identification; assessment, development of an individualized service plan; and linking patients and caregivers with professionals and services. However, their components were different due to the impact of the integrated care program design, policy environment, and the target patient populations' complex needs. Discussion: The homogeneity or heterogeneity of patients' complex needs shapes their care trajectory and the intensity of their care coordination needs. As the complexity of these needs grows, so does the necessity to build the care coordinators' capacity for integrated care.

Introduction: Malgré le rôle important des infirmières dans la coordination des soins et des services, peu de programmes de formation existent pour mieux les soutenir dans l'exercice de celui-ci. L'identification d'un tronc commun d'activités de coordination des soins et services effectuées par les infirmières à travers différents programmes de coordination faciliterait l'élaboration d'une norme de pratique en vue de rehausser leur formation à cet égard. Cette étude examine les activités de coordination des soins et services effectuées par les infirmières dans deux programmes de coordination hétérogènes déployés dans les groupes de médecine de famille au Québec, et la façon dont la conception du programme impacte celles-ci. Méthodes: Nous avons réalisé une étude de cas comparative de deux programmes de coordination des soins et services en première ligne ciblant les usagers fréquents des services de santé et les personnes atteintes de la maladie d'Alzheimer et des troubles apparentés. La collecte de données comprenait une analyse documentaire et des entretiens semi-dirigés avec des informateurs clés. Résultats: Plusieurs activités étaient communes aux deux programmes, telles que l'identification des patients ; évaluation, élaboration d'un plan de services individualisé ; et la mise en relation des patients et des soignants avec des professionnels et des services. Cependant, leurs composantes étaient différentes en raison de l'impact de la conception du programme de soins intégrés, de l'environnement politique et des besoins complexes des populations de patients cibles. Discussion: L'homogénéité ou l'hétérogénéité des besoins complexes des patients façonne leur trajectoire de soins et l'intensité de leurs besoins de coordination des soins. À mesure que la complexité de ces besoins augmente, la nécessité de renforcer la capacité des coordonnateurs de soins en matière de soins intégrés augmente également.

Experience of LGBTQIA2S+ populations with gambling during the COVID-19 pandemic: protocol for a mixed-methods study.

INTRODUCTION: Research undertaken since the beginning of the COVID-19 pandemic has provided us information about the impact of the pandemic on the gambling habits of the general population. However, very little is known about certain subgroups at increased risk of developing gambling disorder, such as the LGBTQIA2S+ population. The purpose of this study is to describe the impact of the COVID-19 pandemic on gambling behaviours among LGBTQIA2S+ individuals. In addition, we want to understand the experiences of the LGBTQIA2S+ population with gambling disorder and identify interventions that LGBTQIA2S+ people have found to be effective in addressing problem gambling during the COVID-19 pandemic. METHODS AND ANALYSIS: This study has a sequential explanatory mixed-method design in two phases over 2 years. The first phase is a correlational study. We will conduct a cross-sectional survey using a stratified random sampling among Canadian residents who are 18 years of age or older, self-identify as sexually and gender-diverse (ie, LGBTQIA2S+) and have gambled at least once in the previous 12 months. This survey will be administered online via a web panel (n=1500). The second phase is a qualitative study. Semistructured interviews will be conducted with LGBTQIA2S+ people with problematic gambling (n=30). ETHICS AND DISSEMINATION: This research project has been ethically and scientifically approved by the Research Ethics Committee and by the CIUSSS de l'Estrie-CHUS scientific evaluation committee on 3 March 2022 (reference number: 2022-4633-LGBTQ-JHA). Electronic and/or written informed consent, depending on the data collection format (online survey and online or in-person interviews), will be obtained from each participant. A copy of the consent form and contact information will be delivered to each participant.

Strategies to engage family physicians in primary care research: A systematic review.

RATIONALE: Moving towards high quality primary health care, involving family physicians in primary care research becomes an essential prerequisite to ensures a better adoption and routinization of patient-centred, evidence-based practices. AIM: To assess the effectiveness of strategies to engage family physicians in primary care research. METHODS: We systematically reviewed evidence for strategies used to engage family physicians in primary care research. We included any study design that reported at least one quantitative outcome. Searches were carried out on MEDLINE, Embase, PsycINFO and Web of Science. Pairs of reviewers independently screened for publications in two stages using standardized forms. We performed data analysis through a narrative synthesis approach, using the Reasoned-action approach as framework. RESULTS: A total of 4859 deduped records were identified of which 41 studies met the eligibility criteria and were included for analysis. The majority of studies (n = 35) investigated family physician's participation in a research project. They aimed to influence family physicians' intention (n = 7) or their ability (n = 3) to participate in a research project. Three types of strategies (compensation/incentive, recruitment by a peer and support from a research network or an academic institution) demonstrated a significant increase in participation rate. Methodological quality of the studies evaluating these strategies was relatively low. Few studies (n = 6) targeted research capacity-building programmes with no significant impact noted. CONCLUSION: Numerous strategies have been used to engage family physicians in primary care research, but few studies evaluated their effectiveness in a rigorous way. REGISTRATION: The protocol of this review was registered with the SPOR Evidence Alliance and on the PROSPERO platform (registration number: CRD42020189322).

[Déterminants du succès d'une démarche provinciale d'usage optimal des antipsychotiques chez les résidents en soins de longue durée selon les acteurs clés impliqués dans l'implantation].

Le Québec présente le taux de prescriptions d'antipsychotiques le plus élevé chez les personnes âgées de 65 ans et plus au Canada. La démarche « Optimiser les pratiques, les usages, les soins et les services - antipsychotiques ¼ (OPUS-AP) vise à pallier cet enjeu. Étant donné ses premiers résultats prometteurs, notre étude visait à identifier les déterminants de son succès. Elle repose sur un devis d'étude de cas regroupant une analyse documentaire et 21 entrevues auprès d'acteurs clés impliqués dans l'implantation. Les résultats mettent en lumière cinq déterminants centraux : 1) une démarche intégrée, collaborative et probante; 2) des communications et des réseaux au service de la démarche; 3) un climat d'implantation favorable aux changements; 4) un engagement et une implication des parties prenantes; et 5) une stratégie d'application des connaissances intégrée et appuyée. Des défis et recommandations pour assurer la pérennisation et la mise à l'échelle d'OPUS-AP et inspirer des démarches similaires sont identifiés.