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1. Barriers and Facilitators in the Uptake of Integrated Care Pathways for Older Patients by Healthcare Professionals: A Qualitative Analysis of the French National 'Health Pathway of Seniors for Preserved Autonomy' Pilot Program

Author

Lorette Lorette, Mathieu Calafiore, François Puisieux, Claire Ramez, Fanny Sarrazin, Maxime Lotin, Romain Naessens, Apolline Delesalle, Gracia Adotey, Pascal Harduin, Nathalie Leveque, Delphine Dambre, Marguerite-Marie Defebvre, Carla Di Martino, and Jean-Baptiste Beuscart

Subjects
integrated care, care pathway, elderly, frailty, Medicine (General), R5-920
Abstract

Barriers and Facilitators for Adhesion of Healthcare Professionals in Integrated Care for Older Patients: A Qualitative Assessment Based on the French National Experiment: ‘Health Pathway of Seniors for Preserved Autonomy’ (PAERPA) Introduction: Integrated care is a particularly promising approach in geriatrics – a field in which the medical, psychological and social issues are often complex. The uptake of integrated care by healthcare professionals (HCPs) is essential but varies markedly. The objective of the present study of healthcare professionals was to identify barriers to and facilitators of commitment to integrated care for seniors. Methods: We performed a two-step, qualitative study, comprising (i) six qualitative, semi-directive series of interviews with HCPs (hospital practitioners, family physicians, nurses and pharmacists) who agreed or disagreed to take part in the French national “Health Pathway of Seniors for Preserved Autonomy” (PAERPA) pilot program; and (ii) an analysis of the pooled results, in order to identify common concerns among the healthcare professionals. Results: We identified four key “barrier” and “facilitator” topics shared by HCPs who had committed to the pilot program and those who had not: (i) awareness of and/or interest in geriatric medicine and team working, (ii) the presence of a care coordinator; (iii) the provision of information about the program and about the patient, and communication between HCPs, and (iv) personal benefits for the HCPs and the patients. Key conclusions: The four key topics identified in this large qualitative study of several healthcare professions should be considered during the design and dissemination of integrated care pathways for older patients.

Published
2021
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2. Relation between Vitamin D and COVID-19 in Aged People: A Systematic Review

Author

Moustapha Dramé, Eléonore Cantagrit, Maxime Lotin, Pecory Souleymane Coulibaly, Maxime Hentzien, Lukshe Kanagaratnam, Cécilia Cofais, David Demoustier-Tampere, Lidvine Godaert, Marc-Henri Destailleur, Agnès Cebille, Anne Desprez, Fanny Blondiau, and Emeline Proye

Subjects
Vitamin, Male, Pediatrics, medicine.medical_specialty, medicine.medical_treatment, 030209 endocrinology & metabolism, vitamin D, Disease, Review, Severity of Illness Index, vitamin D deficiency, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Risk Factors, Oxygen therapy, medicine, Vitamin D and neurology, Humans, TX341-641, 030212 general & internal medicine, Aged, Aged, 80 and over, Nutrition and Dietetics, Nutrition. Foods and food supply, business.industry, SARS-CoV-2, Mortality rate, Oxygen Inhalation Therapy, COVID-19, aged people, Vitamins, Middle Aged, medicine.disease, Vitamin D Deficiency, Respiration, Artificial, COVID-19 Drug Treatment, chemistry, Dietary Supplements, Population study, Observational study, Female, business, Food Science
Abstract

Background: Vitamin D has diverse and extensive effects on the immune system, including activating innate immunity and reducing the overactive adaptive immune response. A systematic review was performed to identify and synthesize the best available evidence on the association between vitamin D level and risk of COVID-19, adverse outcomes and possible benefits of supplementation in aged 60 years or over. Methods: A literature search was performed in PubMed© and Scopus© for all publications from inception published before 15 March 2021. Studies reporting data from aged patients on vitamin D use and COVID-19 were included. Basic science articles, editorials and correspondence were excluded. Publication year, study design and setting, characteristics of the study population were extracted. This study is registered with PROSPERO, under the number CRD42020223993. Results: In total, 707 studies were identified, of which 11 observational studies were included in the final review. Four studies compared vitamin D-supplemented COVID-19 patients to non-supplemented patients, and seven compared patients with vitamin D deficiency to patients without deficiency. In all four studies, patients with vitamin D supplementation had better rates of primary clinical outcomes (death, the severity of the disease, oxygen therapy requirement…). In studies comparing patients with vitamin D deficiency and patients without vitamin D deficiency, those without vitamin D deficiency had better primary clinical outcomes (death rate, the severity of the disease, oxygen therapy requirement, invasive mechanical ventilation need…). Conclusion: This systematic review seems to support an association between vitamin D deficiency and the risk of COVID-19 in aged people. In addition, vitamin D deficiency appears to expose these subjects to a greater risk of adverse outcomes. Because of its simplicity of administration, and the rarity of side effects, including vitamin D in preventive strategies for certain viral diseases, it appears to be an attractive option.

Published
2021

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