Background Adults with chronic conditions who also suffer from mental health comorbidities and/or social vulnerability require services from many providers across different sectors. They may have complex health and social care needs and experience poorer health indicators and high mortality rates while generating considerable costs to the health and social services system. In response, the literature has stressed the need for a collaborative approach amongst providers to facilitate the care transition process. A better understanding of care transitions is the next step towards the improvement of integrated care models. The aim of the study is to better understand care transitions of adults with complex health and social care needs across community, primary care, and hospital settings, combining the experiences of patients and their families, providers, and health managers. Methods/design We will conduct a two-phase mixed methods multiple case study (quantitative and qualitative). We will work with six cases in three Canadian provinces, each case being the actual care transitions across community, primary care, and hospital settings. Adult patients with complex needs will be identified by having visited the emergency department at least three times over the previous 12 months. To ensure they have complex needs, they will be invited to complete INTERMED Self-Assessment and invited to enroll if positive. For the quantitative phase, data will be obtained through questionnaires and multi-level regression analyses will be conducted. For the qualitative phase, semi-structured interviews and focus groups will be conducted with patients, family members, care providers, and managers, and thematic analysis will be performed. Quantitative and qualitative results will be compared and then merged. Discussion This study is one of the first to examine care transitions of adults with complex needs by adopting a comprehensive vision of care transitions and bringing together the experiences of patients and family members, providers, and health managers. By using an integrated knowledge translation approach with key knowledge users, the study’s findings have the potential to inform the optimization of integrated care, to positively impact the health of adults with complex needs, and reduce the economic burden to the health and social care systems.

This paper aims to identify challenges and opportunities related to the integration of social determinants of health (SDH) into primary healthcare at an international symposium in Orford, Quebec, Canada. A descriptive qualitative approach was conducted. Three focus groups on different topics were led by international facilitators. Two research team members took notes during the focus groups. All the material was analyzed using a thematic analysis according to an inductive method. Many challenges were identified, leading to the identification of potential opportunities: integrate the concept of SDH in all phases of the training curriculum for health professionals to foster interprofessional and intersectoral collaboration and sociocultural skills; organize healthcare for better outreach to vulnerable populations; organize local and regional committees to develop management frameworks to produce and use territory-specific data; develop dashboards for primary healthcare providers describing the composition of their territory’s population; work collaboratively, rallying primary healthcare providers, community organization delegates, patient partners, citizens, and municipality representatives around common projects. Discussions prompted new directions for further primary healthcare research, among which are building on best practices in the literature and in the field, and engaging various stakeholders in research, including vulnerable populations, while focusing on patient experience.

 L'article présente une réflexion sur l'entrepreneuriat de petite taille en contexte de mobilité « Nord-Sud ». Il se penche sur le cas de jeunes Européens, âgés de 25 à 35 ans, de classe moyenne et oeuvrant dans la métropole de Mexico, en s'appuyant sur les résultats préliminaires d'une recherche ethnographique combinant observations et entrevues semi-dirigées. Ces résultats suggèrent qu'un éthos entrepreneurial valorisant l'autonomie, la créativité et l'innovation est au coeur des projets professionnels de ces jeunes. Alors que la littérature sur l'entrepreneuriat en contexte migratoire se concentre sur les liens familiaux, ethniques et transnationaux développés par les migrants, cet article démontre que le projet entrepreneurial des participants prend forme plutôt à travers l'expression de leur individualité. abstract  This article concerns small-scale entrepreneurship in a "North-South" migration context. I look at the case of young middle-class Europeans operating small businesses in Mexico City. I use the preliminary results of ethnographic research combining observations and semi-directed interviews. I suggest that a certain entrepreneurial ethos, valuing autonomy, creativity and innovation, is at the heart of the professional projects of these young people. While the literature on migrant-based entrepreneurship focuses on the social, ethnic and transnational bonds developed by migrants, I show that the entrepreneurial project of the participants under study takes shape through the expression of their individuality.

Commonly described as the passage from school to practice, transition to practice, as a concept, as yet to be explored in-depth, is clearly circumscribed and conceptualised to better address the issues experienced by new health professionals when they begin their professional practice. This study intends to describe how the process of transition to practice is represented and studied within various health disciplines, particularly in pharmacy. A scoping review design was chosen to sort out a corpus of published papers on the transition to practice. The primary objectives of this review are to clarify the key concepts related to the transition to practice, make sense of the available literature and evidence on the transition to practice in health disciplines, detect gaps in the current knowledge, particularly in pharmacy, and identify relevant lines of inquiry that would provide a better understanding of this critical and vital process.