Améliorer la santé globale des jeunes atteints d'une pathologie chronique nécessite la mise en œuvre de stratégies médicales et managériales innovantes s'appuyant sur la coordination des soins, l'intégration des services et le case management. Ce travail étudie les apports d’une nouvelle forme d’organisation hybride développée par Prepsy, au service des usagers en situation complexe, souffrants de schizophrénie, sous la forme d’un accompagnement personnalisé collaboratif intensif dans l’environnement naturel, visant à limiter l’impact bio-psycho-social et le risque de handicap psychique par le maintien dans le parcours de vie. Il met en évidence les conditions de réussite organisationnelles et stratégiques de ce type d'organisation dans le but d’en affiner le modèle pour mieux l’adapter aux besoins des populations concernées et de leur entourage. / Improving Global Health of young people with chronic disease requires the implementation of innovative medical and managerial strategies based on the coordination of care, integration of services and case management. This work studies the contributions of a new form of hybrid organization developed by Prepsy, serving users in complex situations, with schizophrenia suffering in the form of an intensive collaborative personalized support in the natural environment, to limit the bio-psycho-social impact and the risk of mental disability by maintaining the life course. It highlights the organizational and strategic conditions for success of this type of organization in order to refine the model to better suit the needs of the people concerned and their families.

The lack of resources a young person brings with them to their experience of being homeless dramatically impacts on their ability to get out of homelessness. Young people who become homeless come with limited experience of successful independent living and at a life stage in which they are still developing physically, intellectually and psychologically. Johnson (2006) found that the younger a person was when they first became homeless the more likely they would remain homeless for a longer period of time. Evidence also shows that the longer someone remains homeless the more likely it is that they will develop substance use and/or mental health issues, further reducing their opportunities to ‘get out’ of homelessness. Youth homelessness disrupts schooling and limits future opportunities for economic participation, placing these young people well and truly at the bottom of the labour market. This paper asks ‘“Given that young people follow a unique pathway to homelessness, what supports and services are needed to effectively respond to this group?” This paper is divided into three sections – a critique of the characteristics of young people who become homeless, a review of current theories of intervention and government responses, and finally a proposal for an improved response to young people who are at risk of becoming or who are already homeless.

Introduktion: Under de senaste decennierna har olika omvårdnadsinsatser för individer med psykisk funktionsnedsättning växt sig allt större. En av dessa insatser är case management där den psykiskt funktionsnedsatta tillsammans med en case manager får hjälp att utföra aktiviteter på viktiga livsområden. Syfte: Är att beskriva nyttan av case management för personer med psykisk funktionsnedsättning. Metod: Studien genomfördes som en systematisk litteraturstudie där flertalet artiklar granskats. Resultat: En huvudkategori med fokus på case management som omvårdnadsinsats för den psykiskt funktionsnedsatta uppkom med sju tillhörande underkategorier. Dessa underkategorier var; självständigt liv, minskade symtom, tillgänglighet, ökad livskvalitet, relationsarbete, kommunikation och stöd av personal. Case management som omvårdnadsinsats visade sig ha ett stort inflytande i livet för människor med psykisk funktionsnedsättning. Diskussion: Ju mer kvalitetstid den psykiskt funktionsnedsatta får från en engagerad case manager, desto bättre relation och därmed bättre resultat. Intensive case management och Assertive Community Treatment är de modeller som bäst hjälper den psykiskt funktionsnedsatta till bättre livskvalitet, minskade psykiatriska symtom, ökad social förmåga och ett mer självständigt liv. Dessa modeller leder också till färre återinläggningar på sjukhus vilket är mer kostnadseffektivt för samhället. Slutsats: En bra relation mellan den psykiskt funktionsnedsatta och case managern gör att den psykiskt funktionsnedsatta får en bättre livskvalitet, mindre psykiatriska symtom och färre återinläggningar på sjukhus. Case management är framtidens vård för psykiskt funktionsnedsatta.

This thesis describes the evaluation of a program to employ bilingual staff in case management positions in community mental health services in Melbourne, Australia. A literature review showed that no previous research in Australia had investigated the impact of bilingual staff on clients of mental health services. While research conducted in the USA shows that ethnic matching (matching clients and clinicians on the basis of language or ethnic background) increases service use, its impact on outcome domains such as social functioning remains uncertain. (For complete abstract open document)

Universiẗat, Diss., 2006--Kassel.

This study evaluated the effect of community-based case management (CM) intervention on patient outcomes in Medicare beneficiaries with chronic illness in a rural Midwest region from 2002 to 2004. The relationships between 252 patients' access and clinical outcomes (the number of hospitalizations, length of stay (LOS), and emergency department (ED) visits) and CM were investigated. CM services were provided as four types: high home, high clinic, high telephone, and mixed-care services by nurse case managers. A descriptive, repeated-measurement design was used, and a secondary analysis of a data set containing longitudinal community-based CM data was conducted. The transitional care model and transition theory served as the theoretical background for the study. Descriptive statistics and frequency analysis, t-test, and a repeated-measure ANOVA analysis were used to analyze the data. Characteristic profiles of the patients were analyzed with their self-care Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scores. The patients in this study were relatively healthy on their self-care functional status at the beginning of the study. The four types of CM services were compared with patient-reported clinical outcomes (the self-care ADL, IADL, symptom control, quality-of-life, and personal well-being scores) in each year. Analyses showed that patients' clinical outcomes were similar regardless of the type of CM services in each year. Two years of longitudinal CM intervention greatly affected patient's clinical outcomes and access outcomes. The study found that CM significantly reduced the number of hospital days and influenced patients' quality of life and symptom control. The impact of CM on LOS and ED visits was indeterminate. Further research is needed-including the effect of type and dosage of CM services and outcomes and the development of a comprehensive CM model-to guarantee CM as a core intervention in health care reconfiguration.

No description available.

Schizophrenia has been a public mental health barometer for many decades, and health professionals and government agencies continue to look for treatment options that produce the best outcomes. The purpose of this study was to determine the effectiveness of assertive community treatment (ACT) and supportive case management (SCM) outpatient treatment interventions as an alternative to inpatient psychiatric hospital care. Social cognitive learning theory and choice theory provided the framework for the study. Archival data from inpatient psychiatric hospitalizations for 153 adult men and women with a primary diagnosis of schizophrenia who received ACT or SCM services were analyzed using regression analysis and a correlation. Predictor variables were gender, age cohort, and treatment model, and criterion variables were the number and duration of inpatient psychiatric hospitalizations for patients with schizophrenic diagnoses. Results showed some correlation between the number of admissions and length of stay for both ACT and SCM interventions. The first admission accounted for the longest length of stay, with a significant decline by the second admission, indicating that many participants received the appropriate and necessary treatment to address any changes or increase in symptoms during the first admission. Findings demonstrated the value of outpatient treatment interventions such as ACT and SCM for men and women in reducing the number and length of inpatient psychiatric hospitalizations. This translates into cost reductions for federal and state mental health care spending.

Syftet med denna pilotstudie var att beskriva hur sjuksköterskor som arbetar som Case Managers uppfattar effekterna av denna arbetsmodell avseende medicinsk vård, social situation, missbruk, vård- och omsorgskvalitet samt samordning för patienter med missbruk och samtidig psykisk störning. Metoden var kvantitativ och genomfördes med en webbenkät. Resultatet visade att respondenterna anser att Case Management haft en positiv påverkan på patienternas medicinska vård och sociala situation. Det ledde också till en bättre kontakt med patienten, och förbättrad bedömning av patientens sammansatta situation. Sammantaget framkom en övervägande positiv uppfattning även av vård- och omsorgskvaliteten, samordningen och de arbetsmetoder som använts. Vad gäller missbruket uppgav en del av respondenterna att det påverkades positivt och en del av respondenterna uppgav att det inte påverkades alls. Vid en fullskalig studie hade det varit intressant att göra enkäten mer nyanserad med fler svarsalternativ och även ha med bakgrundsvariabler för att se samband och göra jämförelser. Pilotstudien indikerar att Case Management är en arbetsmodell som kan underlätta omvårdnadsarbetet för patienter med komplex problematik och stort behov av vård och stöd, och även vara en metod för att lättare samordna insatser från olika vårdgivare. Sjuksköterskan kan genom Case Management arbeta hälsofrämjande för att stödja patienter med missbruk och samtidig psykisk störning i olika områden som påverkar hälsan. / The aim of this pilot study was to describe how nurses who work as Case Managers perceive the effect of this approach for medical treatment, social status, substance abuse, quality of health care and coordination for patients with substance abuse and concurrent psychiatric disorder. The method was quantitative and was conducted with a web survey. The results showed that the respondents believe that case management had a positive impact on patients' medical care and social situation. It also led to a better contact with the patient, and improved assessment of the patient's complex situation. Overall, the answers also revealed a generally positive perception of the care quality, the coordination and used methods. As for the abuse, some respondents answered that Case Management had affected the abuse in a positive way, and others that it had not been affected at all. In a full scale study it would have been interesting to make the questionnaire more nuanced with more response options, and also have the background variables to make comparisons. The pilot study indicate that case management is an approach that can facilitate nursing care for patients with complex problems and need of care and support, and also be a method to help to coordinate the efforts of various health care providers. The nurse can through Case Management support patients with substance abuse and mental disorders in different areas of health.

Les démences représentent un enjeu majeur de santé publique. Les carences organisationnelles de notre système de santé ne garantissent pas la qualité et la cohérence du parcours de soins des malades et de leurs familles. Le plan national Alzheimer 2008-2012 a introduit de nouveaux dispositifs ayant pour objectifs de mieux prendre en compte les besoins des malades et des familles et de mettre en place des offres adaptées. L’objectif général de cette thèse était d’étudier la prise en charge des démences en s'intéressant à la fois à une prise en charge pouvant être qualifiée d'optimale (le case management) et à la prise en charge effective en pratique courante. Dans une première partie, nous avons donc étudié l’efficacité du case management dans la démence et caractérisé les conditions d’optimisation de ce modèle de soins collaboratifs. Tout d’abord, nous nous sommes intéressés aux conditions d’efficacité dans un domaine où le niveau de preuve était élevé (le diabète) puis nous avons cherché à caractériser les points saillants pouvant conditionner l’efficacité du case management dans la démence. Quelques essais contrôlés randomisés de case management rapportent des résultats encourageants dans la démence sur des critères cliniques (troubles du comportement du malade, qualité de vie ou fardeau de l’aidant) ou sur l’institutionnalisation. L’efficacité est démontrée principalement auprès de patients inclus à des stades plutôt modérés. L’efficacité d’une intervention préventive dès le diagnostic est inconnue et mérite d’être testée. C’est pourquoi l’essai AIDALZ a été envisagé et est actuellement mené auprès de déments nouvellement diagnostiqués. Dans une deuxième partie, nous avons étudié la prise en charge telle qu'elle est actuellement réalisée en France. Nous avons d'abord décrit cette prise en charge et analysé les déterminants d’un recours aux soins dès le début de la maladie. Puis nous avons évalué les bénéfices de ce recours aux soins sur la survie des déments. Les différentes analyses de survie menées n’ont pas démontré de bénéfice d’un recours aux soins dès le début de la maladie chez des déments incidents des cohortes populationnelles des 3 Cités et de PAQUID. Ce travail témoigne de la difficulté de prendre en compte tous les facteurs pouvant influer sur l’accès aux soins et/ou sur la survie dans des études observationnelles. De nouvelles recherches doivent être menées pour étudier les bénéfices d’un diagnostic dès le début de la maladie sur des indicateurs variés du pronostic. Des essais d’intervention seraient nécessaires pour évaluer plus précisément l’intérêt du diagnostic et de la prise en charge dans la démence. / Dementia represents a major public health issue. The organisational carencies of our health system do not guarantee the quality of the care channels for patients and families. The national Alzheimer plan 2008-2012 has introduced new health facilities whose objectives are to better take into account patients and families needs and to implement tailored care. The main aim of this thesis was to evaluate care of demented patients, both optimal care (the case management) and usual care. In the first part we studied case management effectiveness and delineated conditions to optimize the effectiveness of this collaborative model of care. Firstly, we concentrated our attention on effectiveness conditions in diabetes and we studied case management in dementia. Some randomized controlled trials of case management reported promising impacts on clinical criteria (patient’s behavioural troubles, caregiver burden or quality of life) or patient’s institutionalization. Case management effectiveness is reported mainly for patients at moderate stages. The effectiveness of a preventive intervention early in the disease process is unknown, but it deserves further investigation; that is why, the AIDALZ trial has been planned and is currently under way. In a second part, we studied the real care of demented patients in France. We firstly described the care and analysed the determinants of an early recourse to care for incident dementia patients. Then, we evaluated the benefits of recourse to care at the onset of dementia on survival. The different survival analyses performed did not report any benefit of an early recourse to care on incident dementia patients from the PAQUID or the 3 City population-based cohorts. These findings underlie the difficulties to take into account factors interfering with recourse to care and/or survival in observational studies. Further studies should be planned to investigate the benefits of early dementia diagnosis on various prognostic indicators. Intervention trials would be necessary to conclude on the relevance of early diagnosis in dementia.