Les pratiques de gestion de cas, en contexte de réseaux de services intégrés pour personnes âgées en perte d’autonomie à domicile au Québec, domicilocentrisme innovant ou hospitalocentrisme renouvelé?
Keywords:
Intégration des services, coordination des services, gestion de cas, personnes âgées, soutien à domicileAbstract
Le Québec a, depuis les années 1990, amorcé un virage ambulatoire dans la prestation des services de santé et sociaux. En réponse à certains problèmes de coordination existants entre les acteurs interprofessionnels et interétablissements engendrés par ce modèle ambulatoire, que nous qualifions de domicilocentrique, le ministère de la Santé et des Services sociaux a implanté une vaste réforme d’intégration des services. Celle-ci favorisait l’implantation de dispositifs de coordination, dont celui professionnel de la gestion de cas. Dans cet article, nous analysons comment la gestion de cas, dans le contexte des réseaux de services intégrés pour personnes âgées en perte d’autonomie, participe aux politiques domicilocentriques. Pour faire ceci, nous avons réalisé une étude qualitative et exploratoire utilisant un devis de recherche de type étude de cas unique imbriquée. Pour chacun des trois centres de santé et de services sociaux que nous avons étudiés, nous avons employé trois méthodes de collecte de données : une analyse documentaire, une analyse thématique d’entretiens d’explicitation, et, de l’observation directe des pratiques des gestionnaires de cas. Nous constatons que la coordination avec les hôpitaux demeure au centre des activités des gestionnaires de cas, détournant en partie leur fonction de soutien à domicile vers les besoins des hôpitaux, où la libération rapide des lits de courte durée est encore considérée comme une priorité. Since the 1990s, the government of Quebec has undertaken a shift called "virage ambulatoire" (ambulatory care) in its delivery of health care and social care services. In response to a number of coordination related problems between interprofessional and interinstitutional actors engendered by the implementation of this ambulatory, or home-centric model, Quebec’s Ministry of Health and Social Services decided to implement a major reform pertaining to services integration. This involved the creation of different coordination devices, including the professional device of case management. This article analyses how case management, in the specific context of integrated care networks for frail elderly individuals, contributes to home-centric governmental policies. We conducted a qualitative exploratory study using an embedded case study design. In each of the three Health and Social Services Centres covered by our study, we used three data collection methods: a documentary analysis, face-to-face interviews, and direct observation of case mangers practices. We note that coordination with hospitals remains at the center of case managers’ activities, diverting in part their function regarding home care towards hospitals’ needs, where rapid discharge planning of short-term care beds is still viewed as a priority.
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