The Care Coordinator's Tasks During the Implementation of an Integrated Care Pathway for Older Patients: A Qualitative Study Based on the French National "Health Pathway of Seniors for Preserved Autonomy" Pilot Program.

Background: Although integrated care and care coordination are known to be beneficial for older adults' population, the specific tasks of a Care Coordinator (CC) for integrated care pathways for this population have not been studied in detail. Setting & Subjects: The French national pilot program PAERPA provided an integrated care pathway for older adults. In North France, a CC was recruited to support patients and professionals. Objectives: (i) To analyse the CC's tasks in an integrated care pathway for older patients, and (ii) to record perceptions on the CC's tasks among the participating general practitioners (GP) and community pharmacists. Design & Methods: Qualitative, two-phase study: (i) Task analysis of the CC's tasks, to compare the planned and actual tasks; (ii) semi-structured interviews among GPs and community pharmacists involved in the pathway. Results: (i) The task analysis showed that the CC's actual tasks differed from planned tasks. The CC was only meant to be involved in the early stages of the process; actually, the CC undertook more or even unforeseen tasks in coordination, communication, and administrative support throughout the care pathways. (ii) The 28 interviewed healthcare professionals considered the CC's tasks to be essential to the success of pathways. They appreciated the CC's administrative support. However, CC's tasks related to interprofessional communication, and patient and family information, were controversially perceived among GPs and pharmacists. Conclusions: The CC's tasks in an integrated care pathway for older adults showed that the CC's overall workload was greater than expected and appreciated by healthcare professionals.

Descriptive study of the parkinsonian population in the north of France: Epidemiological analysis and healthcare consumption.

BACKGROUND: The "neurodegenerative diseases plan" under elaboration for the Hauts-de-France region requires better knowledge of the patient population and care pathways. In France, the prevalence of Parkinson's disease (PD) has been estimated from cohorts to be about 1-3 per 1000 inhabitants, but exhaustive data are scarce for the general population. The purpose of this study was to evaluate the prevalence of PD in the Hauts-de-France region and to assess PD-related healthcare consumption. METHOD: A descriptive study was conducted to identify the parkinsonian population in the Hauts-de-France region (including the administrative districts of Pas-de-Calais and Picardie) for the year 2014. Parkinsonian patients were identified from health insurance fund reimbursement data using the following criteria: (i) reimbursement for a PD-specific medication; (ii) attribution of long-duration disease status coded as PD; (iii) hospital stay with PD diagnosis in the standard discharge report contained in the French medico-economic database on hospital activity (PMSI). RESULTS: The raw prevalence of PD in the region was 5.03 per 1000 inhabitants aged 20 years and older. The standardized prevalence by health territory ranged from 4.0 to 9.0 per 1000 inhabitants aged 20 years and older. During the 1-year study period, 33.5% of patients had a neurology consultation, 57.1% attended a physiotherapy session, and 7.7% received speech therapy. Most of patients (79.6%) were treated with levodopa, sometimes in combination with a catechol-O-methyl transferase inhibitor (14.4%). Dopaminergic agonists were prescribed in 33.5% of cases. A neuroleptic was prescribed for 6.9% of the population (clozapine for 25.9%). CONCLUSION: The prevalence of PD is high in the Hauts-de-France region with a heterogeneous distribution by health territory. Neurology consultations were attended by a minority of patients in 2014. This work provides perspectives for necessary improvement in specialized care for this disease, both in terms of follow-up consultations and home care.

[The state of affairs prior to the Regional Health Education Plan in the Nord/ Pas-de-Calais region: the present case, facts and expectations]. / Bilan préalable au Schéma Régional d'Education Pour la Santé en Nord/Pas-de-Calais: constat et attentes.

The work on the development of the regional health education plan (SREPS) in the Nord/Pas-de-Calais region has been analysed and viewed in the light of the specific regional context. A number of statements can now be made on this work, as it underlines the expectations of the different health education professionals. The article testifies to the fact that the implementation of the SREPS, through its dynamic approach, contributes to the creation and reinforcement of a common culture while uncovering the road which remains left to travel. The improved situation allows for a more effective comparison with other regional and national situations.

[Visually handicapped children and young adults in specialized schools in the French North department in 1995]. / Les enfants et jeunes adultes déficients visuels scolarisés en établissements spécialisés du département du Nord en 1995.

BACKGROUND: In 1988, the prevalence of blindness in France was 0.17/1000 and that of amblyopia 0.48/1000. Medical advances in the last 30 years have modified the population of children with visual impairment. PATIENTS AND METHODS: The populations in two specialized schools of the north (340 children and adolescents, 3-20-year-olds) were studied and compared with the literature. RESULTS: Cataracts (13%) and congenital nystagmus (11%) were the two most frequent causes. The children taken in charge had less severe diseases than in the past but needed all the same specialized education. However these schools provided more specialized help for children educated near home, in ordinary schools. The children who were educated in the two specialized schools had more severe diseases or more social problems in their families. CONCLUSION: The education and educative treatment of these children are discussed.

[The liberal ophthalmologists of the northern France and management of children with vision deficiencies]. / Les ophtalmologues libéraux du Nord de la France et la prise en charge des enfants déficients visuels.

PURPOSE: The purpose of this analysis was to appreciate the management of visually handicaped children outside specialized structures. We also assessed relays between primary physicians, hospitals and specialized structures. METHOD: A 12-question survey was sent to 144 liberal ophthalmologists of the North of France. The questionnary included 12 questions. We compared the results to litterature. RESULTS: The response-rate was 59.6%. This study indicated that the observed children by the liberal ophtalmologists had more simple diseases than in specialized structures. In hospitals, it seemed that the ophtalmologists diagnosed more severe diseases. These practitioners diagnosed some of these diseases. However some of diagnosis were to late. This study showed that specialized structures were not enough known by the practitioners who detected this handicap and that the families prefered the taking in charge near their home. CONCLUSION: We demonstrated the necessary organisation of precocious and systematic detection, and the necessary information to all practitioners on specialized structures.