Transition of care from post-acute services for the older adults in Quebec: a pilot impact evaluation.

BACKGROUND: Early discharge of frail older adults from post-acute care service may result in individuals' reduced functional ability to carry out activities of daily living, and social, emotional, and psychological distress. To address these shortcomings, the Montreal West Island Integrated University Health and Social Services Centre in Quebec, Canada piloted a post-acute home physiotherapy program (PAHP) to facilitate the transition of older adults from the hospital to their home. This study aimed to evaluate: (1) the implementation fidelity of the PAHP program; (2) its impact on the functional independence, physical and mental health outcomes and quality of life of older adults who underwent this program (3) its potential adverse events, and (4) to identify the physical, psychological, and mental health care needs of older adults following their discharge at home. METHODS: A quasi-experimental uncontrolled design with repeated measures was conducted between April 1st, 2021 and December 31st, 2021. Implementation fidelity was assessed using three process indicators: delay between referral to and receipt of the PAHP program, frequency of PAHP interventions per week and program duration in weeks. A battery of functional outcome measures, including the Functional Independence Measure (FIM) and the Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10 scale, as well as fall incidence, emergency visits, and hospitalizations were used to assess program impact and adverse events. The Patient's Global Impression of Change (PGICS) was used to determine changes in participants' perceptions of their level of improvement/deterioration. In addition, the Camberwell Assessment of Need for the Elderly (CANE) questionnaire was administered to determine the met and unmet needs of older adults. RESULTS: Twenty-four individuals (aged 60.8 to 94 years) participated in the PAHP program. Implementation fidelity was low in regards with delay between referral and receipt of the program, intensity of interventions, and total program duration. Repeated measures ANOVA revealed significant improvement in FIM scores between admission and discharge from the PAHP program and between admission and the 3-month follow-up. Participants also reported meaningful improvements in PGICS scores. However, no significant differences were observed on the physical or mental health T-scores of the PROMIS Global-10 scale, in adverse events related to the PAHP program, or in the overall unmet needs. CONCLUSION: Findings from an initial sample undergoing a PAHP program suggest that despite a low implementation fidelity of the program, functional independence outcomes and patients' global impression of change have improved. Results will help develop a stakeholder-driven action plan to improve this program. A future study with a larger sample size is currently being planned to evaluate the overall impact of this program. CLINICAL TRIAL REGISTRATION: Retrospectively registered NCT05915156 (22/06/2023).

Une formation complémentaire et appliquée : un besoin pour la relève en recherche interventionnelle en santé des populations.

Population Health Intervention Research (PHIR) is an emerging and distinct field that combines scientific research and public health practice. However, traditional academic training in research, which is founded on specific disciplinary orientations, does not sufficiently inform and prepare new PHIR researchers. In this commentary, we advance the idea that PHIR requires a broader range of competencies and knowledge that must be developed through a complementary and applied training program. Drawing on our experience as 4P Strategic Training Program fellows, we identified key elements of the program that have helped prepare us in our careers as future and new PHIR researchers. We believe that complementary and applied training programs such as the 4P Program are a promising strategy in training and supporting the next generation of PHIR researchers in their efforts to improve population health.

Représentation sociale de la santé d’immigrants allophones de Montréal,Canada / Social representation of health by allophones immigrants of Montreal, Canada

La province de Québec accueille 50 000 immigrants par an dont 35% sont allophones. Les immigrants ont une meilleure santé que les natifs à leur arrivée. Cet état de santé diminueavec le temps. Des liens ont été établis entre acculturation et prise de poids. L’analyse des représentations sociales de la santé révèle les obstacles et les opportunités de ces personnes àadopter de « saines habitudes de vie ». Une étude qualitative exploratoire a été menée à Montréal. L’analyse révèle des conceptions spécifiques de la santé, une évaluation positive de leur état de santé et les causes reliées à cet état. Un grand nombre de croyances, de normes etd'opinions sont exprimées en lien avec l’alimentation et l’activité physique. La représentation de la santé en contexte migratoire présente un conflit entre les valeurs du pays d’origine et du payshôte. Des mécanismes d’enchantement et de désenchantement sont opérés pour combler l’écart entre idéal espéré et réalité vécue. (AU)

The province of Quebec allowed 50,000 immigrants per year of which 35% areallophones. Immigrants have better health than natives and the health status decrease with the time. Links are done between acculturation and increase of bodyweight. The analysis of social representation (SR) of health shows obstacles and opportunities to adopt a “healthy lifestyles”. A qualitative exploratory study was done in Montreal. The analysis reveals specific conceptions of health, a positive health status assessment and origins of this status. Lots of beliefs, norms andopinions are connected with food and physical activity. The social representation of health in migration context shows a struggle between country of birth values and host country values. The Mechanisms of “enchanting” and “disenchanting” are working to fill the gap between the hoped ideal and the lived reality. (AU)

Représentation sociale de la santé d'immigrants allophones de Montréal, Canada / Social representation of health by allophones immigrants of Montreal, Canada

La province de Québec accueille 50 000 immigrants par an dont 35% sont allophones. Les immigrants ont une meilleure santé que les natifs à leur arrivée. Cet état de santé diminue avec le temps. Des liens ont été établis entre acculturation et prise de poids. L'analyse des représentations sociales de la santé révèle les obstacles et les opportunités de ces personnes à adopter de « saines habitudes de vie ¼. Une étude qualitative exploratoire a été menée à Montréal. L'analyse révèle des conceptions spécifiques de la santé, une évaluation positive de leur état de santé et les causes reliées à cet état. Un grand nombre de croyances, de normes et d'opinions sont exprimées en lien avec l'alimentation et l'activité physique. La représentation de la santé en contexte migratoire présente un conflit entre les valeurs du pays d'origine et du pays hôte. Des mécanismes d'enchantement et de désenchantement sont opérés pour combler l'écart entre idéal espéré et réalité vécue.

The province of Quebec allowed 50,000 immigrants per year of which 35% are allophones. Immigrants have better health than natives and the health status decrease with the time. Links are done between acculturation and increase of bodyweight. The analysis of social representation (SR) of health shows obstacles and opportunities to adopt a "healthy lifestyles". A qualitative exploratory study was done in Montreal. The analysis reveals specific conceptions of health, a positive health status assessment and origins of this status. Lots of beliefs, norms and opinions are connected with food and physical activity. The social representation of health in migration context shows a struggle between country of birth values and host country values. The Mechanisms of "enchanting" and "disenchanting" are working to fill the gap between the hoped ideal and the lived reality.