Assessment of a Suicide Prevention Gatekeeper Training Program for Nursing Home Staff.

INTRODUCTION: Older adults have one of the highest age-specific suicide rates in France, and the risk of suicide is higher for those living in nursing homes. The aim of our study was to assess the effectiveness of gatekeeper training for nursing home staff on the knowledge and stigmas towards suicidal crisis and the impact on suicidal behaviour rates. METHOD: A total of 427 nursing or administrative staff from 110 nursing homes received gatekeeper training in the Hauts-de-France French region between September 2016 and June 2018. First, knowledge and stigmas on suicidal crisis were assessed through a pretest and posttest survey. Second, a retrospective survey was conducted to determine suicide behaviour rates before and after training in nursing homes. Then, changes between pre- and posttraining scores and suicide rates were evaluated with a paired samples T test and rate difference calculation (P value of <0.05 was considered statistically significant). RESULTS: A total of 315 trainees completed the questionnaires on knowledge and stigmas related to suicidal crisis, and we found a significant difference in the total scores (P < 0.01). Moreover, we found a significant decrease in the incidence of suicide attempts (SAs) after training (P = 0.002), but the incidence of deaths by suicide was not significantly different prior to and after the training course (P = 0.46). CONCLUSION: We highlighted an improvement in knowledge and stigmas after training and a reduction in the rates of SAs with our gatekeeper suicide prevention program. Future research is needed to improve suicide prevention for nursing home residents.

GPs' interest in integrated care for frail older adults and corresponding consulting and prescribing data: qualitative and quantitative analyses of the PAERPA integrated care project.

BACKGROUND: Integrated care pathways can help to avoid unnecessary admissions to hospital and improve the overall quality of care for frail older patients. Although these integrated care pathways should be coordinated by GPs their level of commitment may vary. AIM: To profile GPs who had participated or had declined to participate in the Personnes Agées En Risque de Perte d'Autonomie (PAERPA) integrated care project (ICP) in the Valenciennois-Quercitain area of France between 2014 and 2019. DESIGN AND SETTING: A combined qualitative and quantitative analysis of GPs who were participating in or had declined to participate in the PAERPA ICP. METHOD: Both GPs participating in the ICP and GPs who chose not to participate in the ICP were interviewed, and then consultation and prescription profiles for these two groups were compared. RESULTS: Some GPs were interested in the PAERPA ICP, whereas others were opposed. The 48 qualitative interviews revealed four issues that influenced participation in the PAERPA ICP: 1) awareness of issues in care of older adults and the value of collaborative work; 2) time saving; 3) task delegation; and 4) advantages of coordination. The level of interest in the ICP for frail older adults was indirectly reflected by the data on consulting and prescribing. In GPs who participated in the PAERPA ICP there was a greater proportion of older (aged ≥70 years) patients (P<0.05), a larger number of consultations per year (P<0.05), and a larger number of home visits (P<0.01), relative to GPs who declined to participate. CONCLUSION: The level of interest in the PAERPA ICP for frail older adults varied widely among GPs. These findings suggest that commitment to an integrated care pathway could be increased by customising the recruitment strategy as a function of the GP's profile.

Barriers and Facilitators in the Uptake of Integrated Care Pathways for Older Patients by Healthcare Professionals: A Qualitative Analysis of the French National "Health Pathway of Seniors for Preserved Autonomy" Pilot Program: Barriers and Facilitators for Adhesion of Healthcare Professionals in Integrated Care for Older Patients: A Qualitative Assessment Based on the French National Experiment: 'Health Pathway of Seniors for Preserved Autonomy' (PAERPA).

INTRODUCTION: Integrated care is a particularly promising approach in geriatrics - a field in which the medical, psychological and social issues are often complex. The uptake of integrated care by healthcare professionals (HCPs) is essential but varies markedly. The objective of the present study of healthcare professionals was to identify barriers to and facilitators of commitment to integrated care for seniors. METHODS: We performed a two-step, qualitative study, comprising (i) six qualitative, semi-directive series of interviews with HCPs (hospital practitioners, family physicians, nurses and pharmacists) who agreed or disagreed to take part in the French national "Health Pathway of Seniors for Preserved Autonomy" (PAERPA) pilot program; and (ii) an analysis of the pooled results, in order to identify common concerns among the healthcare professionals. RESULTS: We identified four key "barrier" and "facilitator" topics shared by HCPs who had committed to the pilot program and those who had not: (i) awareness of and/or interest in geriatric medicine and team working, (ii) the presence of a care coordinator; (iii) the provision of information about the program and about the patient, and communication between HCPs, and (iv) personal benefits for the HCPs and the patients. KEY CONCLUSIONS: The four key topics identified in this large qualitative study of several healthcare professions should be considered during the design and dissemination of integrated care pathways for older patients.

Importance of previous hospital stays on the risk of hospital re-admission in older adults: a real-life analysis of the PAERPA study population.

BACKGROUND: consideration of the first hospital re-admission only and failure to take account of previous hospital stays, which are the two significant limitations when studying risk factors for hospital re-admission. The objective of the study was to use appropriate statistical models to analyse the impact of previous hospital stays on the risk of hospital re-admission among older patients. METHODS: an exhaustive analysis of hospital discharge and health insurance data for a cohort of patients participating in the PAERPA ('Care Pathways for Elderly People at Risk of Loss of Personal Independence') project in the Hauts de France region of France. All patients aged 75 or over were included. All data on hospital re-admissions via the emergency department were extracted. The risk of unplanned hospital re-admission was estimated by applying a semiparametric frailty model, the risk of death by applying a time-dependent semiparametric Cox regression model. RESULTS: a total of 24,500 patients (median [interquartile range] age: 81 [77-85]) were included between 1 January 2015 and 31 December 2017. In a multivariate analysis, the relative risk (95% confidence interval [CI]) of hospital re-admission rose progressively from 1.8 (1.7-1.9) after one previous hospital stay to 3.0 (2.6-3.5) after five previous hospital stays. The relative risk [95%CI] of death rose slowly from 1.1 (1.07-1.11) after one previous hospital stay to 1.3 (1.1-1.5) after five previous hospital stays. CONCLUSION: analyses of the risk of hospital re-admission in older adults must take account of the number of previous hospital stays. The risk of death should also be analysed.

Transforming French Electronic Health Records into the Observational Medical Outcome Partnership's Common Data Model: A Feasibility Study.

BACKGROUND: Common data models (CDMs) enable data to be standardized, and facilitate data exchange, sharing, and storage, particularly when the data have been collected via distinct, heterogeneous systems. Moreover, CDMs provide tools for data quality assessment, integration into models, visualization, and analysis. The observational medical outcome partnership (OMOP) provides a CDM for organizing and standardizing databases. Common data models not only facilitate data integration but also (and especially for the OMOP model) extends the range of available statistical analyses. OBJECTIVE: This study aimed to evaluate the feasibility of implementing French national electronic health records in the OMOP CDM. METHODS: The OMOP's specifications were used to audit the source data, specify the transformation into the OMOP CDM, implement an extract-transform-load process to feed data from the French health care system into the OMOP CDM, and evaluate the final database. RESULTS: Seventeen vocabularies corresponding to the French context were added to the OMOP CDM's concepts. Three French terminologies were automatically mapped to standardized vocabularies. We loaded nine tables from the OMOP CDM's "standardized clinical data" section, and three tables from the "standardized health system data" section. Outpatient and inpatient data from 38,730 individuals were integrated. The median (interquartile range) number of outpatient and inpatient stays per patient was 160 (19-364). CONCLUSION: Our results demonstrated that data from the French national health care system can be integrated into the OMOP CDM. One of the main challenges was the use of international OMOP concepts to annotate data recorded in a French context. The use of local terminologies was an obstacle to conceptual mapping; with the exception of an adaptation of the International Classification of Diseases 10th Revision, the French health care system does not use international terminologies. It would be interesting to extend our present findings to the 65 million people registered in the French health care system.

Potentially inappropriate medication prescribing is associated with socioeconomic factors: a spatial analysis in the French Nord-Pas-de-Calais Region.

Background: potentially inappropriate medication (PIM) prescribing is common in older people and leads to adverse events and hospital admissions. Objective: to determine whether prevalence of PIM prescribing varies according to healthcare supply and socioeconomic status. Methods: all prescriptions dispensed at community pharmacies for patients aged 75 and older between 1 January  and 31 March 2012 were retrieved from French Health Insurance Information System of the Nord-Pas-de-Calais Region for patients affiliated to the Social Security scheme. PIM was defined according to the French list of Laroche. The geographic distribution of PIM prescribing in this area was analysed using spatial scan statistics. Results: overall, 65.6% (n = 207,979) of people aged 75 years and over living in the Nord-Pas-de-Calais Region were included. Among them, 32.6% (n = 67,863) received at least one PIM. The spatial analysis identified 16 and 10 clusters of municipalities with a high and a low prevalence of PIM prescribing, respectively. Municipalities with a low prevalence of PIM were characterised by a high socioeconomic status whereas those with a high prevalence of PIM were mainly characterised by a low socioeconomic status, such as a high unemployment rate and low household incomes. Markers of healthcare supply were weakly associated with high or low prevalence clusters. Conclusion: significant geographic variation in PIM prescribing was observed in the study territory and was mainly associated with socioeconomic factors.

[Evaluation of health education trainings developped between 2005 and 2007 in the North]. / Evaluation de formations continues en education pour la santé développées entre 2005 et 2007 dans les territoires de santé du Nord-Pas-de-Calais.

The regional health education plan (SREPS) in Nord Pas-de-Calais opened a window for the Regional Directorate of Health and Social Affairs (DRASS) to initiate and engage in a process to reflect on the development of health education training. The Regional Committee of Health Education (CRES) has developed and led a regional project on health education training since 2005, financed by the National Institute of Prevention and Health Education (Inpes). At the request of the Inpes, the 3 year duration of the project was evaluated in 2008. The results provide on opportunity for conducting analyses and drawing some interesting conclusions such as: to construct the profile of the 572 people trained, to evaluate the impact of such training on the locally programmed health actions and on actors' skills, and to analyse the educational process developed through the sessions. This work initiates a new regional questioning and exploration of continuing education in the field of health education and promotion.

[An experimental approach in territorialization by re-grouping geriatric care in Nord Pas de Calais]. / Une démarche expérimentale de territorialisation par la labellisation des filières gériatriques en Nord-Pas-de-Calais.

The ageing population is an important public health issue for our health system which is poorly adapted for this group because it is conceived primarily for managing acute issues and not as prepared for dealing with chronic disease. Elderly people require continuous care, including attention to geographic proximity of services and a holistic approach to care. Appropriate geriatric care necessitates the active contribution of all health actors including prevention and re-adaptation. This kind of organisation of work must incorporate an adequate delineation of the health territory and a corresponding plan in which all responses are readily available and accessible. We propose the application of geriatric managed care through the implementation of the third generation of the national health plan to respond to this issue. This experience at the regional level is described and outlined, as well as the relevant reflections and learning outcomes that can be extracted.

[Evaluation of health education training in a French region]. / Evaluation de l'offre de formation en education pour la santé (EPS) dans le Nord/Pas-de-Calais.

In the context of the National Health Education Plan launched in 2001, the Nord/ Pas-de-Calais Region engaged itself in reflection and debate on how to improve health education practices. The teaching curricula of health education programmes from the regional paramedical, social and teacher training schools were studied. They were then compared with a set of official texts on the subject (including the national report by Sandrin Berthon) which provide regulations and guidance for this type of teacher training. Teachers and trainers from these institutions were interviewed and questioned about their difficulties and needs. Health education is an optional module in these schools, creating heterogeneity in teaching methods. A shared basis for core teaching materials on subjects in health education does not exist, and specifically, evaluation as a practice is under-developed. These difficulties are therefore exposed, and the article demonstrates the need to provide teachers with a common culture to be shared across these different frameworks and models if one aims to teach health education according to the methods advocated by WHO and Sandrin Berthon's report.

[Prenatal diagnosis in the Nord-Pas-de-Calais in 2004: organisational issues and challenges]. / Diagnostic prénatal dans le Nord-Pas-de-Calais en 2004: difficultés d'organisation et enjeux.

The development of the Regional Plan for Health Organisation (SROS III) in the Nord-Pas-de-Calais has provided an opportunity for further reflection on the operation and organisation of professionals and structures in the field of prenatal diagnoses. The alleged claims resulting from this reflection process are not only integrated in the perinatal stream of the SROS but also in the objectives of the regional public health plan. The study which was carried out takes into account the regional data available, complemented by interviews with professionals working on the ground, which are then compared with national data. All of these elements contributed to the construction of proposals for an improved organisation of this regional management system, on the one hand curative and on the other preventive.

[A study on the management of short term care for elderly patients aged 75 and over in the Nord-Pas de Calais region]. / Enquête sur la prise en charge des personnes âgées de 75 ans et plus dans les services de court séjour "Médecine" de la région Nord-Pas-de-Calais.

The development of the geriatrics portion of the third national health plan in the Nord-Pas de Calais presented an interesting opportunity to analyse the management of health care for an ageing population in one of France's youngest regions. This work served as a means to establish recommendations for the improvement of the organisation and planning of health care services for this particular population group in the region. In this article reporting on the study's outcomes, the authors present the results on the management of health care for elderly people in hospitals and other short term medical care facilities.