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We aimed to explore stroke rehabilitation professionals' understanding and representations of peer support; the benefits they anticipated for patients; and the levers and barriers they perceived to implement the intervention in their practice. This qualitative study comprised four focus groups with 21 rehabilitation professionals and four semi-structured interviews. It was held in a French hospital. Interpretation was guided by the Consolidated Framework for Implementation Research. Although professionals had poor knowledge on peer support, they identified many unmet needs of stroke survivors that peer support could meet such as social, emotional and informational support. Main barriers were the lack of human and financial resources, and of linkage between hospital and community professionals, and the fear that peer support would give false hope to survivors if not delivered properly. They showed ambivalence towards patient engagement, acknowledging its importance, but demonstrating top-down attitudes. They also identified potential avenues for the implementation of peer support for stroke survivors. Our study supports the necessity to involve professionals in the construction of peer-support interventions and to sensitise them to provide patient-centred care. It delivers insights on effective implementation strategies to develop peer support interventions for stroke survivors reintegrating the community. Stroke survivors experience many difficulties especially when transitioning from hospital to home, in which peer-support could be helpful. Success of peer-support interventions rely on the collaboration of healthcare professionals with peer supporters. Individual peer-support might be useful for stroke survivors in the following key dimensions: healthcare pathway orientation, social/administrative procedures, emotional support, informational support, informal caregivers support. Rehabilitation departments planning to implement individual peer-support, should consider supporting and training both the team and the peer-supporters to work together and adopt partnership postures. [ABSTRACT FROM AUTHOR]

Background: Emergency Departments (ED) have seen an increasing number of older patients who are mostly referred following a call to the Emergency Medical Services (EMS). Long waiting times in settings, which are not designed to meet older patients' needs, may increase the risk of hospital‐acquired complications. Unnecessary visits should therefore be avoided as much as possible. The objective of the study was to evaluate whether a program to provide geriatric knowledge and tools to the dispatching physicians of the EMS could decrease ED referrals of older patients. Methods: Design: Before‐and‐after study with two 6‐month periods before and after intervention. Participants: All calls received by a dispatching physician of the Rhône EMS from 8 am to 6 pm concerning patients aged 75 years or above during the study period. Intervention: A program consisting of training dispatching physicians in the specific care of older patients and the developing, with a multidisciplinary team, of specific tools for dispatching physicians. Outcome: Proportion of ED referrals of patients aged 75 years or above after a call to the EMS. Results: A total of 2671 calls to the Rhône EMS were included corresponding to 1307 and 1364 patients in the pre‐and post‐intervention phases, respectively. There was no significant difference in the proportion of referrals to the ED between the pre‐intervention (61.7%) and the post‐intervention (62.8%) phases (p = 0.57). Contact of the patients with their General Practitioner (GP) in the month preceding the call was associated with a 22% reduced probability of being referred to an ED. Conclusions: No beneficial effect of the intervention was demonstrated. This strategy of intervention is probably not effective enough in such time‐constraint environment. Other strategies with a specific parallel dispatching of geriatric calls by geriatricians should be tested to avoid these unnecessary ED referrals. Trial registration: ClinicalTrials NCT02712450. [ABSTRACT FROM AUTHOR]

Résumé: L'unité mobile extrahospitalière de gériatrie de Lyon-Sud propose une expertise gériatrique pluridisciplinaire au domicile des patients. Elle émet des recommandations pour rationaliser le parcours du sujet âgé en fonction de ses problématiques. L'objectif principal était de déterminer le taux de suivi à 2 mois des recommandations, et l'objectif secondaire de décrire le profil des patients suivis. Cette étude a inclus 500 patients sur 2 ans et a analysé 1 677 recommandations. Le taux de suivi global était de 65,1 %. Les patients avaient un âge médian de 83,5 ans, 61 % étaient des femmes et 88 % avaient un GIR ≤ 4. L'application des recommandations permet une diminution des hospitalisations non programmées. L'implication de l'équipe à l'issue de la visite optimise la mi%se en œuvre de ces recommandations. Le grand effectif de cette étude permet de mieux décrire les patients vus à domicile : une population vulnérable présentant une polypathologie, dépendance, associés à un contexte socio-familial instable. Ce travail montre que les recommandations doivent être appliquées pour limiter les hospitalisations et que l'implication de l'équipe permet d'améliorer le suivi des préconisations. Mobile geriatric team making home visit (MGT) were created to reinforce the link between home and hospital. Frail elderly patients can benefit from a comprehensive geriatric assessment (CGA) by a geriatric mobile team during a home visit. MGT at the hospital center of Lyon Sud presents recommendations after a CGA to better adjust healthcare to patients' needs. There are few studies that have analysed the MGT who treat patients at home. Objectives: The goal of the study was to determine adherence rate at 2 months and examines the socio-demographic profile of patients assessed by the MGT. We conducted a descriptive and retrospective study in single center, with 500 patients during 2 years (2016-2017). Results: The mean adherence rate was 65,1%. The highest rate concerned recommendations on the future orientation. The lower rate concerned recommendations on lifestyle and environment. Mean age of the 500 patients was 83.5 years, 61% were women. The patients included in this study take an average of seven prescription medications (whitout psychotropic medications). The majority of the patients was GIR 3 and achieved an average score of 3 on ADL scale and 2 of IADL scale. Ninety-six per cent of the patients had a caregiver. It has been proven statistically that, adherence rate of recommendations (more than 65%), reduce unplanned hospitalizations. Conclusion: This study with a large sample of patients allows to better describe patients seen at home. It is a vulnerable population presenting a polypathology, dependence, associated with an unstable socio-family context. This work shows that the recommendations must be applied to limit hospitalizations and that the involvement of the team makes it possible to improve the follow-up of the recommendations. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Adherence to post‐stroke secondary prevention medications mitigates recurrence risk. This study aimed to measure adherence to secondary prevention medications during 3 years post‐ischemic stroke/transient ischemic attack, using prescription and dispensing data, and identify factors associated with suboptimal adherence.This multicenter, prospective, cohort study involved patients from the STROKE 69 cohort, which included all consecutive patients with suspected acute stroke admitted between November 2015 and December 2016 to any emergency department or stroke center in the Rhône area in France. Prescription data for antihypertensive agents, antidiabetic agents, lipid‐lowering drugs, and antithrombotics were collected. Dispensing data were provided by the French regional reimbursement database. Adherence was calculated using the continuous medication acquisition index. Associations between suboptimal adherence and potential influencing factors across the World Health Organization's five dimensions were explored through univariate and multivariate analyses.From 1512 eligible patients, 365 were included. Optimal adherence to overall treatment (≥90%) was observed in 61%, 62%, and 65% of patients in the first, second, and third years, respectively. Education level (high school diploma or higher: OR = 3.24, 95% CI [1.49; 7.36]) and depression (Hospital Anxiety and Depression Scale–Depression scores 8–10: OR = 1.90, 95% CI [1.05; 3.44]) were significantly associated with suboptimal adherence.Overall adherence to secondary prevention medications was fairly good. Having an initial diagnosis of transient ischemic attack, a high level of education, or depression was associated with increased odds of suboptimal adherence, while having a history of heart rhythm disorder was associated with lower odds. [ABSTRACT FROM AUTHOR]

Mobile geriatric team making home visit (MGT) were created to reinforce the link between home and hospital. Frail elderly patients can benefit from a comprehensive geriatric assessment (CGA) by a geriatric mobile team during a home visit. MGT at the hospital center of Lyon Sud presents recommendations after a CGA to better adjust healthcare to patients’ needs. There are few studies that have analysed the MGT who treat patients at home., Objectives: The goal of the study was to determine adherence rate at 2 months and examines the socio-demographic profile of patients assessed by the MGT. We conducted a descriptive and retrospective study in single center, with 500 patients during 2 years (2016-2017)., Results: The mean adherence rate was 65,1%. The highest rate concerned recommendations on the future orientation. The lower rate concerned recommendations on lifestyle and environment. Mean age of the 500 patients was 83.5 years, 61% were women. The patients included in this study take an average of seven prescription medications (whitout psychotropic medications). The majority of the patients was GIR 3 and achieved an average score of 3 on ADL scale and 2 of IADL scale. Ninety-six per cent of the patients had a caregiver. It has been proven statistically that, adherence rate of recommendations (more than 65%), reduce unplanned hospitalizations., Conclusion: This study with a large sample of patients allows to better describe patients seen at home. It is a vulnerable population presenting a polypathology, dependence, associated with an unstable socio-family context. This work shows that the recommendations must be applied to limit hospitalizations and that the involvement of the team makes it possible to improve the follow-up of the recommendations.