ABSTRACT
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.
Subject(s)
Delivery of Health Care, Integrated , General Practitioners , Aged , Humans , Frail Elderly , Referral and Consultation , France , Attitude of Health Personnel , Qualitative ResearchABSTRACT
Worldwide surface waters suffer from the presence of nitrogen (N) compounds causing eutrophication and deterioration of the water quality. Despite many Europe-wide legislation's, we still observe high N levels across many water bodies in Europe. Information on long-term annual soil N surplus is needed to better understand these N levels and inform future management strategies. Here, we reconstructed and analysed the annual long-term N surplus for both agricultural and non-agricultural soils across Europe at a 5 arcmin (≈10 km at the equator) spatial resolution for more than a century (1850-2019). The dataset consists of 16 N surplus estimates that account for the uncertainties resulting from input data sources and methodological choices in major components of the N surplus. We documented the consistency and plausibility of our estimates by comparing them with previous studies and discussed about possible avenues for further improvements. Importantly, our dataset offers the flexibility of aggregating the N surplus at any spatial scale of relevance to support water and land management strategies.
ABSTRACT
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.
ABSTRACT
Global Sensitivity Analysis (GSA) is a set of statistical techniques to investigate the effects of the uncertainty in the input factors of a mathematical model on the model's outputs. The value of GSA for the construction, evaluation, and improvement of earth system models is reviewed in a companion paper by Wagener and Pianosi (2019). The present paper focuses on the implementation of GSA and provides a set of workflow scripts to assess the critical choices that GSA users need to make before and while executing GSA. The workflows proposed here can be adopted by GSA users and easily adjusted to a range of GSA methods. We demonstrate how to interpret the outcomes resulting from these different choices and how to revise the choices to improve GSA quality, using a simple rainfall-runoff model as an example. We implement the workflows in the SAFE toolbox, a widely used open source software for GSA available in MATLAB and R. â¢The workflows aim to contribute to the dissemination of good practice in GSA applications.â¢The workflows are well-documented and reusable, as a way to ensure robust and reproducible computational science.
