Authors: Ghadi, Veronique; Vedel, Isabelle; Routelous, Christelle; de Stampa, Mattieu; Ankri, Joel; Cassou, Bernard; Lapointe, Liette
Abstract: The increase in the number of elderly people requires a reorganization of patient care based on integrated networks of healthcare and community services. These services enable patients to remain at home, thus avoiding the significant costs incurred as a result of long hospital stays and numerous visits to emergency departments. Despite the interest of policy-makers in integrated services, the real impact of gerontological networks remains unknown. This study aims to investigate healthcare professionals' perceptions of the links between the various actors involved in older patient care (professionals, health services and community services) and to examine the perceived impact of a gerontological network among a range of different actors. The qualitative study conducted as part of this research examined the Parisian gerontological network Ancrage and its partners based on three main data sources: Ancrage documentation; interviews with 40 healthcare professionals; and observations (inter-service meetings and case management meetings). The data were analyzed using qualitative research methods. Data analysis highlighted three characteristics: the central role of the general practitioner, who remains responsible for the trajectory of care; the relevance of the geriatrician's interventions in the case of severely dependent patients and the assessment of older patients' needs; and the interface between hospitals, general practitioners and homecare professionals. Healthcare professionals highlighted improvements in patients' transition between home and hospital. Two particular areas for improvement emerged from the data. The relationship between the case manager and general practitioners was found to be akin to a delegation of homecare responsibilities and has little impact on practices and relationships between actors. In addition, although geriatricians are gaining in legitimacy, collaboration with general practitioners remains limited.
Santé Publique, July/August 2011