Intro -- Introduction -- La situation de Benoît -- Les bienfaits de la collaboration interprofessionnelle -- CHAPITRE 1 -- Les concepts -- L'inter, une affaire de rapports -- La jurisprudence clinique -- Des réponses mono, pluri, multi, inter et circumà des situations complexes -- L'exemple de la dysphagie -- Une synthèse des rapports entre acteurs et objets -- L'inter, révélateur d'un changement de paradigme -- L'inter et ses principes fondamentaux -- La famille épistémologique interdisciplinaire -- La famille pragmatiste de la collaboration interprofessionnelle -- La famille de l'intervention politique -- Les principes fondamentaux -- La prise en compte de la complexité des objets -- La prise en compte de la nature de l'objet -- La prise en compte du caractère situé de l'intervention -- L'explicitation de l'intention de l'action -- La prise en compte de l'intrication des besoins et de l'interdépendance des solutions -- L'établissement concerté d'un foyer de convergence -- Une certaine tolérance au risque -- CHAPITRE 2 -- La mise en oeuvre -- Une formation à la collaboration interprofessionnelle -- Une opérationnalisation efficace du projet interprofessionnel -- Un leadership managérial collaboratif -- La reconnaissance des enjeux stratégiques disciplinaires -- Une politique organisationnelle pour développer une culture apprenante -- Le monitorage de la performance collaborative -- L'implantation de dispositifs durables de médiation -- La constitution d'agoras pérennes et adaptées -- La création d'interfaces entre l'organisation et son environnement -- Des systèmes d'accueil sensibles à la diversité culturelledes organisations partenaires -- Des agents de liaison interorganisationnelle -- Des agents d'information -- Des coordonnateurs de services -- Des agents de développement communautaire -- Des lieux permanents de concertation.
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Pour les situations cliniques complexes, comme c'est le cas pour les personnes âgées en perte d'autonomie, le principe général d'une meilleure coordination des services est actuellement promu par de nombreuses organisations internationales dans le domaine de la santé et des services sociaux. Sa mise en œuvre progressive sollicite les proches aidants des personnes âgées en perte d'autonomie de façon nouvelle. Le présent article expose les fondements de ce principe et explore les effets de sa mise en œuvre sur la contribution-même des proches aidants à l'organisation des services. Les proches aidants sont au centre de cette organisation, mais selon quatre statuts fort différents : celui d'aidant-ressource, celui de co-usager, celui d'aidant inadéquat et celui d'aidant-revendicateur.
L'article porte sur la représentation des premiers diplômés et doctorants d'un programme de formation doctorale en gérontologie sur la place de la composante interdisciplinaire dans leur cursus. Celle-ci est représentée comme une source d'enrichissement personnel et professionnel pour les étudiants, essentielle à la compréhension en profondeur des phénomènes complexes qui émergent du vieillissement et à la constitution d'une perspective gérontologique. La condition fondamentale favorable à cet effet semble être la constitution dans le cadre des séminaires d'un espace inter-épistémologique de formation qui a su se prolonger dans l'ensemble des activités du lieu de formation.
Il est possible d'affirmer que la façon d'organiser les services pour les clientèles présentant des situations sociales et sanitaires complexes, dont les personnes âgées en perte d'autonomie, se transforme de telle sorte que nous sommes devant une bascule paradigmatique. Le présent article exposera quelques-uns des principes fondamentaux qui pèsent dans cette bascule, puis explorera leur mise en forme concrète à travers le déploiement de dispositifs intégrateurs favorisant les processus de transversalisation des actions professionnelles et organisationnelles.
La situation du Québec et celle des pays de l'Afrique francophone se différencient à nombre d'égards, tant sur les plans démographique qu'économique. Malgré ces différences, tous ces pays partagent un même défi fondamental, soit la nécessité d'ajuster l'offre de services de santé et sociaux à la transition démographique découlant du vieillissement global de leur population. Si la démographie québécoise présente une transition quasiment accomplie, l'ajustement des services de santé et sociaux aux besoins actuels de la population demeure néanmoins en cours. L'article introduira la situation démographique québécoise puis exposera les choix qui président à la transition conceptuelle puis fonctionnelle de l'organisation des services de santé et sociaux au Québec. En conclusion, il esquissera quelques leçons importantes que le lecteur africain pourra éventuellement transférer vers son contexte.
Alzheimer's disease (AD) and other major neuro-cognitive disorders (NCDs) pose significant challenges as the number of people living with Alzheimer's disease is rapidly increasing. Alzheimer's disease is incurable and has biopsychosocial implications for those affected. This obviously raises a multitude of issues for persons with AD and their families, but from a societal point of view, these issues require developing collective solutions by transforming communities, developing better organizational practices and adopting renewed public policies. It is in this spirit that since the early 2000s some governments have adopted action plans for these diseases. We conducted a literature review with the objective of understanding the social dynamics that led to the adoption of public policies, identifying their main areas of action, and exploring how these measures are actually implemented. This report presents the results in four main sections: Section 1. The literature review strategy. We used three types of documentary data: 1) 57 scientific articles that focused on the process of recognizing the social problem of AD and NCDs, the political agenda, content, implementation and effects; 2) two reports published by international organizations; and 3) action plans for these diseases which have been adopted by eight of the ten Canadian provinces. We analyzed these documents using a grid based on a public policy analysis model, and the main areas of public policy as identified by the World Health Organization (WHO). Section 2. How ad and NCD's came to appear on the political agenda, their emergence as a social problem and the adoption of dedicated public policies. From 1900 to 1970, AD and NCDs were mainly perceived as a state of madness associated with old age. The boom in medical research in this area in the following decades changed the social representations and contributed to the recognition of the pathological nature. The dissociation of normal aging from cognitive disorders has contributed to the development of associative movements along with increased media attention. Although AD and NCDs emerged as a social problem in the second half of the 20th century, the importance of the psychosocial needs of those living with their impact was diminished in public policy and in the care provided. However, recognition of these needs has grown since the early 2000s, and many governments have adopted action plans. Several scientific articles propose that the participation of people with Alzheimer's disease, their families and the organizations that make their voices heard in the policy making process, is a particularly favourable condition for the recognition of their needs and their expertise. Governments must, however, develop mechanisms that effectively support the ability of these actors to act, rather than simply delegating responsibilities to them. Section 3. Actions plans – comparison and identification of predominant trends. In a report by the WHO, seven main areas were identified : 1)dementia as a public health priority; 2) dementia awareness and friendliness; 3)dementia risk reduction; 4) dementia diagnosis, treatment, care and support; 5) support for dementia carers; 6) information systems for dementia; and 7) dementia research and innovation (World Health Organization, 2017). These areas transcend action plans for AD and other major NCDs, and are thus broadly convergent, although WHO recommends that governments operationalize them in concrete measures adapted to their political, sociosanitary, population and territorial realities. We observed that measures to improve early phases of the care and service trajectory, such as improved diagnosis, are the focus of the action plans. Improved diagnosis is usually put in place too late, constituting a major obstacle to the implementation of follow-up adapted for people living with the repercussions of these diseases. This explains why diagnostic measures are almost universally promoted in public policies, under various conceptual arrangements. However, several action plans have not given the same importance to the development of care and services, following diagnosis, and this can generate feelings of helplessness. A holistic approach to the needs of people living with AD and NCDs, requires public policies to reflect the same intensity in all of the main areas. This can be achieved using the concepts of dementia capable, dementia friendly and dementia positive. These shared concepts are useful in functional components, in transforming the physical and social environment, and in recognizing that people with Alzheimer's disease deserve to live a fulfilling life. This approach is key for people living with these diseases, and their loved ones, to fully exercise their remaining abilities and live with dignity. Section 4. Policy implementation process. The first characteristic of effective implementation of an action plan is the adequate investment of financial resources. The second determinant is the development of a national steering committee, which serves to coordinate numerous departments and partners in various levels of government involved in the implementation of change. The committee helps plan activities implemented, address issues encountered, and monitor and follow up on changes made. The third determinant is the development of a strategy to support change. Several governments have developed projects that experiment with change in practices. Projects that stand out are identified and the conditions of change and implementation are understood, with a view to scaling up. Based on learnings from the literature review, governments need to consider four major aspects when engaging in this type of strategy: 1) mobilizing local actors is crucial to rooting change in local realities; 2) change needs to be flagged and actors must be supported to fully achieve the fundamental objectives of public policy; 3)experimental projects must be rigorously evaluated to draw meaningful learning from them; and 4) large-scale dissemination of innovative practices must mobilize the same type of implementation strategy and maintain the importance of the conceptual foundations on which the experimental projects were based. The policy implementation process must be a priority for governments since the real action to effectively improve the quality of life of people living with the repercussions of AD and NCDs can be realized only by the effective implementation of the measures proposed in the action plans.
The term "social licence" has been used to describe which uses and users of health data the public supports - and under what conditions. From November 2022 to January 2023, Health Data Research Network Canada was funded by the Public Health Agency of Canada to explore whether there was consensus among experienced public and patient advisors on: (i) uses of health data that all members supported or opposed and (ii) what constitutes an essential requirement for a health data use or user to be within social licence. The project was conducted in English and French in collaboration with the Interdisciplinary Research Group in Health Informatics (GRIIS) at the University of Sherbrooke. It involved 20 public/patient advisor "participants" and an additional 13 public/patient advisors who served as peer-reviewers, all of whom had prior experience working in a health-related field and/or with health data. The process followed inclusive design principles in that it captured views held by the majority and minority of participants, including views expressed by only one or two participants. After two 2-hour facilitated sessions, participants agreed that it is within social licence for health data to be used (i) by healthcare practitioners to improve patient care, (ii) by governments and administrators to improve the health system, and (iii) by university-based researchers to understand disease and well-being. There was consensus opposition to (i) an individual or organisation selling someone else's identified health data and (ii) health data being used for a purpose that has no public or societal benefit. There was no consensus about what constitutes an essential requirement for a use or users of health data to be with social licence. The results of the process have been published in a non-peer-reviewed report co-authored with participants. This paper has been co-authored with a subset of the participants and peer-reviewers to present a high-level summary of the findings, methodological details, and templates to enable other groups to adapt the process to their own settings. It also presents the results of an anonymous evaluation of the process using the Public and Patient Engagement Evaluation Tool (PPEET), which were mostly positive and identified some areas for improvement.
