Perceived Impacts, Facilitators and Barriers, and Recommendations to Support Diabetes Self-Management for Older Persons in Canada Through the Aging, Community and Health Research Unit - Community Partnership Program (ACHRU-CPP).

Markle-Reid, Maureen; Ganann, Rebecca; Yous, Marie-Lee; Chambers, Tracey; Ploeg, Jenny; Fisher, Kathryn; Northwood, Melissa

Introduction: Older people (=65 years) living with multiple (=3) chronic conditions (MCC) and diabetes have reduced physical function, increased health services use, and interactions with multiple healthcare providers. They often rely on family/friend caregivers, which can lead to poor mental and physical health for caregivers. Self-management support interventions in this population can improve self-reported health and reduce falls. However, these programs typically do not provide care coordination between the health care system and beneficial community support services (e.g., seniors' centres, YMCA). The Aging, Community and Health Research Unit-Community Partnership Program (ACHRU-CPP) intervention was designed to promote selfmanagement among older adults with diabetes and MCCs. Evaluation of the implementation and effectiveness of the ACHRU-CPP is currently in progress in diverse populations and settings. This 6-month intervention is delivered by an interprofessional team from primary care and communitybased organizations with input from patient research partners through community advisory boards. It is a complex intervention that includes virtual/in-person home visits, group wellness sessions, case conferences, caregiver support, interprofessional collaborations, and nurse-led care coordination. Aim: To describe the perceived impacts, facilitators and barriers, and recommendations for the ACHRU-CPP from the perspectives of older persons with diabetes and MCCs, their caregivers, provider teams (comprised of a nurse, dietitian or nutritionist, kinesiologist or community program coordinator), and providers' managers. Methods: A qualitative descriptive study design was used. Participants from the pragmatic trial from 6 study sites in 3 Canadian provinces were included. Data collection consisted of 48 individual post-intervention interviews with older persons and caregivers, 8 interviews with managers, and 10 focus groups with a total of 18 providers. A directed content analysis approach informed by the Consolidated Framework for Implementation Research was used. Key findings: Older persons perceived that the intervention improved their ability to manage their MCCs, eating habits, and access to community-based services. Caregivers reported learning about community supports to support their well-being. Providers felt that the program enhanced interprofessional teamwork between health and social sectors (i.e., primary, home, and community care), and increased their understanding of patients' needs, community resources, and assessment tools. Implementation facilitators included using a team-based approach to provide individualized care for self-management of diabetes, and organizational leadership support. Implementation barriers included human resources constraints limiting providers' abilities to provide usual care and study home visits and a lack of access to medical records for some providers. Suggested recommendations were to provide home visits for patients with greater needs and incorporate information-sharing strategies (e.g., secure electronic database) to ensure that all providers have access to the same patient information. Conclusions: ACHRU-CPP fostered integrated care across health and social sectors that helped to better address the complex needs of older persons with diabetes and MCCs and their caregivers. Implications for transferability, sustainability, and limitations: ACHRU-CPP can support the care of older persons with diabetes and MCCs in different jurisdictions and be sustained by providing opportunities for interprofessional team collaboration across sectors. Despite positive findings, evidence for intervention effectiveness is needed to inform scale-up of the intervention more broadly.

DENMARK; CANADA; CHRONIC diseases & psychology; CAREGIVER attitudes; HEALTH services administrators; HEALTH services accessibility; SOCIAL support; EVALUATION of human services programs; ATTITUDES of medical personnel; HEALTH facility administration; SELF-management (Psychology); COMMUNITY health services; CONFERENCES & conventions; PRIMARY health care; PATIENTS' attitudes; INTERPROFESSIONAL relations; PSYCHOSOCIAL factors; PEOPLE with diabetes; COMORBIDITY; OLD age

International Journal of Integrated Care (IJIC), 2022, Vol 22, p1

1568-4156

Academic Journal

10.5334/ijic.ICIC22094