BackgroundThe scientific literature continues to advocate interprofessional collaboration (IPC) as a key component of primary care. It is recommended that primary care groups be created and configured to meet the healthcare needs of the patient population, as defined by patient demographics and other data analyses related to the health of the population being served. It is further recommended that the improvement of primary care services be supported by the delivery of feedback and performance measurements. This paper describes the theory underlying an interprofessional educational intervention developed in Quebec’s Montérégie region (Canada) for the purpose of improving chronic disease management in primary care. The objectives of this study were to explain explicitly the theory underlying this intervention, to describe its components in detail and to assess the intervention’s feasibility and acceptability.MethodA program impact theory-driven evaluation approach was used. Multiple sources of information were examined to make explicit the theory underlying the education intervention: 1) a literature review and a review of documents describing the program’s development; 2) regular attendance at the project’s committee meetings; 3) direct observation of the workshops; 4) interviews of workshop participants; and 5) focus groups with workshop facilitators. Qualitative data collected were analysed using thematic analysis.ResultsThe theoretical basis of the interprofessional education intervention was found to be work motivation theory and reflective learning. Five themes describing the workshop objectives emerged from the qualitative analysis of the interviews conducted with the workshop participants. These five themes were the importance of: 1) adopting a regional perspective, 2) reflecting, 3) recognizing gaps between practice and guidelines, 4) collaborating, and 5) identifying possible practice improvements. The team experienced few challenges implementing the intervention. However, the workshop’s acceptability was found to be very good.ConclusionOur observation of the workshop sessions and the interviews conducted with the participants confirmed that the objectives of the education intervention indeed targeted the improvement of interprofessional collaboration and quality of care. However, it is clear that a three-hour workshop alone cannot lead to major changes in practice. Long-term interventions are needed to support this complex change process.

Objective: To document the 6-month prevalence of posttraumatic stress syndrome (PTSS) in the older adult population and the validity of a PTSS Scale in an epidemiologic setting.Method: Data came from the Enquête sur la santé des aînés et l'utilisation des services de santé (ESA Services Study) conducted during 2012-2013 using a probability sample of older adults seeking medical services in primary health clinics. Results:Results showed that a first-order PTSS measurement model consisting of 3 indicators-the number of lifetime traumatic events, the frequency of reactions and symptoms of distress associated with the traumatic events, and the presence of consequences on the social functioning-was plausible. Reliability of the PTSS was 0.82. According to the PTSS, 11.1% of the older adult patients presented with PTSS, but only 21.7% of them reported an impact of their symptoms on their social functioning. The prevalence of older adults meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for full posttraumatic stress disorder (PTSD) reached 1.8%, and 1.8% of older adults reached criteria for partial PTSD. Our results also showed that women were more at risk to report PTSS than men and that older adults aged 75 years and older were less likely to report these symptoms than those aged between 65 and 74 years.Conclusions: PTSS is a common mental health problem among adults aged 65 and older and seeking health services in the general medical sector. Résultats : Nos résultats ont montré qu'un modèle de mesure du syndrome de stress posttraumatiques (SSPT) composé de trois indicateurs: le nombre d'événements traumatisants au cours de la vie, la fréquence des réactions et symptômes de détresse associée à des événements traumatiques et la présence des conséquences sur le fonctionnement social,

The main component of mammalian maternal care is milk production. The composition of milk has been hypothesized to determine offspring survival, and to vary with offspring sex. Few studies, however, have examined variation in milk composition of wild mammals in seasonal environments, where environmental conditions can impact the ability of mothers to provide care. We investigated individual differences in milk composition and offspring survival in wild eastern grey kangaroos (Macropus giganteus). We analyzed total protein and lipid concentrations in 103 milk samples from 91 females over 2 years. In a year of low forage production, few females that lactated were in poorer condition and produced milk of lower energy content compared to females lactating in a year of high forage production. Females nursing in late winter produced milk with more lipids compared to females at the same stage of lactation in late spring, whose milk had a higher proportion of protein. The milk of larger females contained more protein than lipid, and females in better condition allocated higher proportions of protein to sons than to daughters. Increased protein concentration in milk was correlated with offspring longevity, and this effect was stronger for sons than daughters. A seasonally modulated lactation strategy enables the adjustment of milk composition to available resources. Condition‐specific protein allocation in favor of sons for mothers of higher caring ability suggests adaptive sex‐biased maternal care in this highly sexually dimorphic mammal.

BackgroundImproving primary care for chronic disease management requires a coherent, integrated approach to quality improvement. Evidence in the continuing professional development (CPD) field suggests the importance of using strategies such as feedback delivery, reflective practice and action planning to facilitate recognition of gaps and service improvement needs. Our study explored the outcomes of a CPD intervention, named the COMPAS Project, which consists of a three-hour workshop composed of three main activities: feedback, critical reflection and action planning. The feedback intervention is delivered face-to-face and presents performance indicators extracted from clinical-administrative databases. This aim of this study was to assess the short term outcomes of this intervention to engage primary care professional in continuous quality improvement (QI).MethodsIn order to develop an understanding of our intervention and of its short term outcomes, a program evaluation approach was used. Ten COMPAS workshops on diabetes management were directly observed and qualitative data was collected to assess the intervention short term outcomes. Data from both sources were combined to describe the characteristics of action plans developed by professionals. Two independent coders analysed the content of these plans to assess if they promoted engagement in QI and interprofessional collaboration.ResultsDuring the ten workshops held, 26 interprofessional work teams were formed. Twenty-two of them developed a QI project they could implement themselves and that targeted aspects of their own practice they perceived in need of change. Most frequently prioritized strategies for change were improvement of systematic clientele follow-up, medication compliance, care pathway and support to improve adoption of healthier life habits. Twenty-one out of 22 action plans were found to target some level of improvement of interprofessional collaboration in primary care.DiscussionOur study results demonstrate that the COMPAS intervention enabled professionals to target priorities for practice improvements and to develop action plans that promote interprofessional collaboration. The COMPAS intervention aims to increase capability for continuous QI, readiness to implement process of care changes and team shared goals but available resources, climate and culture for change and leadership, are also important required conditions to successfully implement these practice changes.ConclusionWe think that the proposed approach can be very useful to support and engage primary care professionals in the planning stage of quality improvement projects since it combines key successful ingredients: feedback, reflection and planning of action.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1056-0) contains supplementary material, which is available to authorized users.

ObjectiveTo document the reliability and construct validity of the Family Violence Scale (FVS) in the older adult population aged 65 years and older.Method:Data came from a cross-sectional survey, the Enquête sur la santé des aînés et l’utilisation des services de santé (ESA Services Study), conducted in 2011–2013 using a probabilistic sample of older adults waiting for medical services in primary care clinics (n = 1765). Family violence was defined as a latent variable, coming from a spouse and from children.Results:A model with 2 indicators of violence; that is, psychological and financial violence, and physical violence, adequately fitted the observed data. The reliability of the FVS was 0.95. According to our results, 16% of older adults reported experiencing some form of family violence in the past 12 months of their interview, and 3% reported a high level of family violence (FVS > 0.36). Our results showed that the victim’s sex was not associated with the degree of violence (β = 0.02). However, the victim’s age was associated with family violence (β = −0.12). Older adults, aged 75 years and older, reported less violence than those aged between 65 and 74 years.Conclusion:Our results lead us to conclude that family violence against older adults is common and warrants greater public health and political attention. General practitioners could play an active role in the detection of violence among older adults.