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While there has been a rapid growth of digital health apps to support chronic diseases, clear standards on how to best evaluate the quality of these evolving tools are absent. This scoping review aims to synthesize the emerging field of mobile health app quality assessment by reviewing criteria used by previous studies to assess the quality of mobile apps for chronic disease management. A literature review was conducted in September 2017 for published studies that use a set of quality criteria to directly evaluate two or more patient-facing apps supporting promote chronic disease management. This resulted in 8182 citations which were reviewed by research team members, resulting in 65 articles for inclusion. An inductive coding schema to synthesize the quality criteria utilized by included articles was developed, with 40 unique quality criteria identified. Of the 43 (66%) articles that reported resources used to support criteria selection, 19 (29%) used clinical guidelines, and 10 (15%) used behavior change theory. The most commonly used criteria included the presence of user engagement or behavior change functions (97%, n = 63) and technical features of the app such as customizability (20%, n = 13, while Usability was assessed by 24 studies (36.9%). This study highlights the significant variation in quality criteria employed for the assessment of mobile health apps. Future methods for app evaluation will benefit from approaches that leverage the best evidence regarding the clinical impact and behavior change mechanisms while more directly reflecting patient needs when evaluating the quality of apps.

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INTRODUCTION: In many developed countries, reforms of public healthcare systems are ongoing but do not always achieve desired results. In this article, we present the history of the healthcare system reform in the Canadian province of New Brunswick with the objective of analyzing its difficult steering by the state, in light of the dynamics between the actors involved. METHOD: Qualitative methods were chosen. Data collection includes semi-structured interviews (N = 39) with representatives of the State, such as health ministers, and other relevant stakeholders, such as managers, citizens or health professionals. RESULTS: The stakeholders were compelled by various aspects of the reform, for example francophone health care services, that had consequences on the trajectory of change. To stay on target, the State must adapt to the dynamic interactions of the actors involved. CONCLUSION: Reforms take place over a long period of time and their programming by the State can be very difficult, as it requires the mobilization of different types of instruments at its disposal. In order to influence the behaviour of the actors concerned, the State must define a goal whose general orientations are agreed upon, succeed in forging bonds of trust and managing resistance, and finally, use standardized data in order to provide a normative framework and evaluate the progress of the reform project.

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INTRODUCTION: In many developed countries, reforms of public healthcare systems are ongoing but do not always achieve desired results. In this article, we present the history of the healthcare system reform in the Canadian province of New Brunswick with the objective of analyzing its difficult steering by the state, in light of the dynamics between the actors involved. METHOD: Qualitative methods were chosen. Data collection includes semi-structured interviews (N = 39) with representatives of the State, such as health ministers, and other relevant stakeholders, such as managers, citizens or health professionals. RESULTS: The stakeholders were compelled by various aspects of the reform, for example francophone health care services, that had consequences on the trajectory of change. To stay on target, the State must adapt to the dynamic interactions of the actors involved. CONCLUSION: Reforms take place over a long period of time and their programming by the State can be very difficult, as it requires the mobilization of different types of instruments at its disposal. In order to influence the behaviour of the actors concerned, the State must define a goal whose general orientations are agreed upon, succeed in forging bonds of trust and managing resistance, and finally, use standardized data in order to provide a normative framework and evaluate the progress of the reform project.

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Digital technologies play a central role in strategies to improve access, quality and efficiency of health care and services. However, many digital health projects have failed to become sustainable and spread across health organizations and systems. This situation is partly due to the fact that these projects are often developed and evaluated by reducing the issues linked mainly to the technological dimension. Such tradition has paid little attention to the fact that technology is introduced into pluralistic and complex sociotechnical systems such as health organizations and systems. The aim of this article is to propose practical and theorical, non-prescriptive, elements of reflection that can serve as a basis for evaluating complex and innovative digital health projects. This reflection builds on the lessons learned from the application of a strategic framework for evaluating three major complex and innovative digital health projects in Quebec over the last 15 years.

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There is a growing recognition among oncologists that older patients differ from other cancer patients. Older patients present age-specific issues affecting the prevention and management of their cancer. Over the years, this has led to the development of the discipline of geriatric oncology, which is the set of practices elaborated to evaluate, treat, follow-up and rehabilitate the population of older cancer patients. Geriatric oncology is still struggling to establish itself in healthcare settings managing older cancer patients. Efforts are currently being made to make it a recognized medical specialty. Health policy makers have to have a grasp of the evolution of this discipline because it concerns a fast growing segment of the cancer patient population. To shed light on the literature about this field, we undertook a scoping review in which we identified relevant studies; charted the data from the selected studies, collated, summarized and reported the results. From 2043 references initially identified, we included 92 articles in our scoping review and extracted data from 88 articles. The included articles were classified into three major categories, namely Advancing the discipline, Organization of care and Nursing and support services for patient and their caregivers. This review affords researchers and policy makers a foundation to help conduct many other conversations on each theme and sub-theme.

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BACKGROUND: Although integrated care is drawing considerable attention from health care policy makers, little is known about integration of oral health care services into primary care in Quebec. Therefore, the objective of this study was to compile information and compare the aspects of primary oral health care in two public health care organizations. METHOD: An environmental scan was carried out in one rural and one urban primary health care organizations in Quebec. Data were collected from organizations' websites, operational documents, observational notes on facility visits, primary care meeting minutes, online pages of professional orders and face to face interviews (N = 74) and focus groups (N = 5), between November 2016 and October 2018. Thematic and Prior's documentation analyses were used to analyse the data. RESULTS: Three themes were identified: normative aspects of integrated care delivery, integration trajectories, and integration initiatives. In both organizations, the integration of oral health into primary care rooted in public health sectors and dental teams were the key players. While urban center showed informal linkages between dental and non-dental primary care providers, the rural organization succeeded in coordination processes, even though these were also informal. CONCLUSION: The majority of primary oral health care services are delivered in the public health sectors and the sustainability of integration initiatives in other primary health care sectors remains to be demonstrated. A better management of resources, as well as partnerships between public health care organizations and universities, could contribute to this integration.

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INTRODUCTION: In many developed countries, reforms of public healthcare systems are ongoing but do not always achieve desired results. In this article, we present the history of the healthcare system reform in the Canadian province of New Brunswick with the objective of analyzing its difficult steering by the state, in light of the dynamics between the actors involved. METHOD: Qualitative methods were chosen. Data collection includes semi-structured interviews (N = 39) with representatives of the State, such as health ministers, and other relevant stakeholders, such as managers, citizens or health professionals. RESULTS: The stakeholders were compelled by various aspects of the reform, for example francophone health care services, that had consequences on the trajectory of change. To stay on target, the State must adapt to the dynamic interactions of the actors involved. CONCLUSION: Reforms take place over a long period of time and their programming by the State can be very difficult, as it requires the mobilization of different types of instruments at its disposal. In order to influence the behaviour of the actors concerned, the State must define a goal whose general orientations are agreed upon, succeed in forging bonds of trust and managing resistance, and finally, use standardized data in order to provide a normative framework and evaluate the progress of the reform project.

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Digital technologies play a central role in strategies to improve access, quality and efficiency of health care and services. However, many digital health projects have failed to become sustainable and spread across health organizations and systems. This situation is partly due to the fact that these projects are often developed and evaluated by reducing the issues linked mainly to the technological dimension. Such tradition has paid little attention to the fact that technology is introduced into pluralistic and complex sociotechnical systems such as health organizations and systems. The aim of this article is to propose practical and theorical, non-prescriptive, elements of reflection that can serve as a basis for evaluating complex and innovative digital health projects. This reflection builds on the lessons learned from the application of a strategic framework for evaluating three major complex and innovative digital health projects in Quebec over the last 15 years.

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BACKGROUND: Although integrated care is drawing considerable attention from health care policy makers, little is known about integration of oral health care services into primary care in Quebec. Therefore, the objective of this study was to compile information and compare the aspects of primary oral health care in two public health care organizations. METHOD: An environmental scan was carried out in one rural and one urban primary health care organizations in Quebec. Data were collected from organizations' websites, operational documents, observational notes on facility visits, primary care meeting minutes, online pages of professional orders and face to face interviews (N = 74) and focus groups (N = 5), between November 2016 and October 2018. Thematic and Prior's documentation analyses were used to analyse the data. RESULTS: Three themes were identified: normative aspects of integrated care delivery, integration trajectories, and integration initiatives. In both organizations, the integration of oral health into primary care rooted in public health sectors and dental teams were the key players. While urban center showed informal linkages between dental and non-dental primary care providers, the rural organization succeeded in coordination processes, even though these were also informal. CONCLUSION: The majority of primary oral health care services are delivered in the public health sectors and the sustainability of integration initiatives in other primary health care sectors remains to be demonstrated. A better management of resources, as well as partnerships between public health care organizations and universities, could contribute to this integration.

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Recently, new models for the integration of oral health into primary care have been proposed. However, these models may be adopted by a variety of health care systems, and will reach successful outcomes only if they can be adapted to suit the local context. To this end, the objective of this study was to explore the perceptions of Quebec primary health care teams on the integration of oral health into primary care. A qualitative approach and interpretive description methodology were used to conduct the study within a case-study design. Purposeful sampling with maximum variation and snowball technique were used for recruitment of study participants. Seventy-four in-depth, semi-structured interviews and five focus groups were conducted with primary health care teams including health care providers and managers working in a rural and an urban health care center. The interview guide and study conceptual framework were based on the Rainbow model. Data collection and data analyses were conducted concurrently and continued until saturation was achieved. To analyze the data, four phases of qualitative analysis were followed. The thematic analysis included interview debriefing, transcript coding, data display, and interpretation. Data analysis was conducted both manually and with the use of Atlas-ti software. A total of four themes emerged from the interviews and focus group discussions. These themes covered all domains of the study theoretical model and included: 1) drivers of integration; 2) importance of integration; 3) professionals' role in integrated care; and 4) barriers and enablers of integration. In general, most of the barriers expressed by study participants were related to the organizational and system domains of integration. Primary health care teams who provide care in rural and urban areas in Quebec expressed their concerns on the absence of integrated oral health services. Implementation of governance policies, the prioritization of educational and management measures as well as inter-professional collaboration toward innovative care models could facilitate this integration.

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BACKGROUND: Despite its importance, the integration of oral health into primary care is still an emerging practice in the field of health care services. This scoping review aims to map the literature and provide a summary on the conceptual frameworks, policies and programs related to this concept. METHODS: Using the Levac et al. six-stage framework, we performed a systematic search of electronic databases, organizational websites and grey literature from 1978 to April 2016. All relevant original publications with a focus on the integration of oral health into primary care were retrieved. Content analyses were performed to synthesize the results. RESULTS: From a total of 1619 citations, 67 publications were included in the review. Two conceptual frameworks were identified. Policies regarding oral heath integration into primary care were mostly oriented toward common risk factors approach and care coordination processes. In general, oral health integrated care programs were designed in the public health sector and based on partnerships with various private and public health organizations, governmental bodies and academic institutions. These programmes used various strategies to empower oral health integrated care, including building interdisciplinary networks, training non-dental care providers, oral health champion modelling, enabling care linkages and care coordinated process, as well as the use of e-health technologies. The majority of studies on the programs outcomes were descriptive in nature without reporting long-term outcomes. CONCLUSIONS: This scoping review provided a comprehensive overview on the concept of integration of oral health in primary care. The findings identified major gaps in reported programs outcomes mainly because of the lack of related research. However, the results could be considered as a first step in the development of health care policies that support collaborative practices and patient-centred care in the field of primary care sector.

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OBJECTIVE: This scoping study has been conducted to map the literature and provide a descriptive synthesis on the barriers and facilitators of the integration of oral health into primary care. METHODS: Grounded in the Rainbow conceptual model and using the Levac et al six-stage framework, we performed a systematic search of electronic databases, organisational websites and grey literature from 1978 to April 2016. All publications with a focus on the integration of oral health into primary care were included except commentaries and editorials. Thematic analyses were performed to synthesise the results. RESULTS: From a total of 1619 citations, 58 publications were included in the review. Barrier-related themes included: lack of political leadership and healthcare policies; implementation challenges; discipline-oriented education; lack of continuity of care and services and patients' oral healthcare needs. The facilitators of integration were supportive policies and resources allocation, interdisciplinary education, collaborative practices between dental and other healthcare professionals, presence of local strategic leaders and geographical proximity. DISCUSSION AND PUBLIC HEALTH IMPLICATIONS: This work has advanced the knowledge on the barriers and facilitators at each integration domain and level, which may be helpful if the healthcare organisations decide to integrate oral health and dental services into primary care. The scoping review findings could be useful for both dental and medical workforce and allied primary healthcare providers. They could also guide the development of healthcare policies that support collaborative practices and patient-centred care in the field of primary care.

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AIM: The aim of this study was to describe the process of how nurse and physician managers in formalized dyads work together to address clinical management issues in the surgical division of one hospital setting. BACKGROUND: Nurse and physician managers are uniquely positioned to co-lead and transform healthcare delivery. However, little is known about how this management dyad functions in the healthcare setting. DESIGN: A constructivist grounded theory approach was used to investigate the process of how nurse and physician managers work together in formalized dyads in an urban Canadian university affiliated teaching hospital. METHODS: Data collection occurred from September 2013-August 2014. Data included participant observation (n = 142 hours) and intensive interviews (n = 36) with nurse-physician manager dyads (12 nurses, 9 physicians) collected in a surgical department. Theoretical sampling was used to elaborate on properties of emerging concepts and categories. RESULTS/FINDINGS: A substantive theory on 'intentional partnering' was generated. Nurses' and physicians' professional agendas, which included their interests and purposes for working with each other served as the starting point of 'intentional partnering'. The theory explains how nurse and physician managers align their professional agendas through the processes of 'accepting mutual necessity', 'daring to risk (together)' and 'constructing a shared responsibility'. Being credible, earning trust and safeguarding respect were fundamental to communicating effectively. CONCLUSION: Intentional partnering elucidates the relational components of working together and the strategizing that occurs as each partner deliberates on what he or she is willing to accept, risk and put into place to reap the benefits of collaborating.

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Purpose The purpose of this paper of inter-professional networks is to analyze the evolution of relationships between professional groups enacting new forms of collaboration to address clinical imperatives. Design/methodology/approach This paper uses a case study based on semi-structured interviews with physicians and nurses, document analysis and informal discussions. Findings This study documents how two inter-professional networks were developed through professional agency. The findings show that the means by which networks are developed influence the form of collaboration therein. One of the networks developed from day-to-day, immediately relevant, exchange, for patient care. The other one developed from more formal and infrequent research and training exchanges that were seen as less decisive in facilitating patient care. The latter resulted in a loosely knit network based on a small number of ad hoc referrals while the other resulted in a tightly knit network based on frequent referrals and advice seeking. Practical implications Developing inter-professional networks likely require a sustained phase of interpersonal contacts characterized by persuasion, knowledge sharing, skill demonstration and trust building from less powerful professional groups to obtain buy-in from more powerful professional groups. The nature of the collaboration in any resulting network depends largely on the nature of these initial contacts. Originality/value The literature on inter-professional healthcare networks focusses on mandated networks such as NHS managed care networks. There is a lack of research on inter-professional networks that emerged from the bottom up at the initiative of healthcare professionals in response to clinical imperatives. This study looks at some forms of collaboration that these "grass-root" initiatives engender and how they are consolidated.

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BACKGROUND: Depression is a major cause of work absenteeism that general practitioners (GPs) face directly since they are responsible for sickness certification and for supervising the return to work (RTW). These activities give GPs a key role in preventing long-term work disability, yet their practices in this regard remain poorly documented. The objectives of this study were therefore to describe GPs' practices with people experiencing work disability due to depressive disorders and explore how GPs' work context may impact on their practices. METHODS: We conducted semi-structured individual interviews with 13 GPs and six mental healthcare professionals in two sub-regions of Quebec. The sub-regions differed in terms of availability of specialized resources offering public mental health services. Data were anonymized and transcribed verbatim. Thematic analysis was performed to identify patterns in the GPs' practices and highlight impacting factors in their work context. RESULTS: Our results identified a set of practices common to all the GPs and other practices that differentiated them. Two profiles were defined on the basis of the various practices documented. The first is characterized by the integration of the RTW goal into the treatment goal right from sickness certification and by interventions that include the workplace, albeit indirectly. The second is characterized by a lack of early RTW-oriented action and by interventions that include little workplace involvement. Regardless of the practice profile, actions intended to improve collaboration with key stakeholders remain the exception. However, two characteristics of the work context appear to have an impact: the availability of a dedicated mental health nurse and the regular provision of clinical information by psychotherapists. These conditions are rarely present but tend to make a significant difference for the GPs. CONCLUSIONS: Our results highlight the significant role of GPs in the prevention of long-term work disability and their need for support through the organization of mental health services at the primary care level.

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BACKGROUND: the collaboration between geriatricians and cancer specialists holds significant potential for improving care outcomes for older cancer patients. The realisation of this collaboration partly depends on cancer specialists involving geriatricians in caring for their older patients. Yet only a few studies have focused on understanding the reasons for cancer specialists' choice to involve or not involve geriatricians in this care. OBJECTIVE: this study shed some light on the challenges of collaboration between geriatricians and cancer specialists. It describes the case of a hospital that established a clinic staffed by geriatricians to assist cancer treatment teams. The focus of this article is to identify and explain the patterns of referrals of cancer specialists to this clinic. RESULTS: our study suggests that the referral practices of cancer specialists are considerably influenced by their specialty. The cancer specialists who find more applied value from geriatric assessments tend to refer their patients to geriatricians. Medical oncology is the sub-specialty that struggles the most in practically using information from the assessments to adjust their treatment. Cancer specialists who regularly referred to the clinic were the ones who thought that geriatricians had a unique contribution to patient care with their assessments and also with their intervention in palliative and psychosocial care. These specialists were usually from surgery and radiation oncology. CONCLUSIONS: ageing confers an increased risk of developing cancer. Providing adequate care to older cancer patients is still a challenge. Our study opens the 'black box' of collaboration between two important groups of professionals who may intervene in this care.

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BACKGROUND: Although diabetes is a frequent complication of cystic fibrosis (CF), patients' behaviours tend not to comply with best practice recommendations. Using Leventhal's Common-Sense Model, we address this issue by exploring patients' representations of CF-related diabetes (CFRD) to better understand the discrepancy between patients' expected and observed health behaviours. METHODS: Semi-structured individual interviews were conducted with patients (n = 39) in six CF clinics in Quebec, Canada. These interviews were part of a larger research project on screening and management practices for CFRD. RESULTS: Illness representations differed between two groups of interviewed patients: (1) one group had either CF without dysglycemia or CF with impaired glucose tolerance; and (2) the other group had CFRD. Both representations were internally consistent and encompassed Leventhal's five dimensions of illness representation: illness identity, cause, timeline, consequences and control. CONCLUSIONS: Patients require specific information on CFRD. The screening phase could be a crucial time to help patients adjust their representations to fit the reality of CFRD.

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OBJECTIVE: This study was designed to analyse the adaptive strategies used by primary care professionals to provide more adapted and continuous services to patients with more than one chronic disease. METHODS: A qualitative case study was conducted in a primary care structure (GMF in Québec). Data were derived from two sources: semi-structured interviews and documents. Based on our thematic analysis of data, we illustrate the adaptive processes at play. RESULTS: Our analysis identified the challenges raised by the increased prevalence of patients with more than one chronic disease and how they influence adaptive strategic initiatives from professionals at the following levels: (1) the patients themselves, (2) the professional-patient relationship, (3) the relationships between professionals of the GMF (4) the relationships between the GMF and other healthcare organizations. The description of these phenomena illustrates the dynamic emergence ofa network form of organization. CONCLUSION: This phenomenon leads to transformation of the core of the healthcare production system. A deeper understanding of its emergence, impacts and management is necessary.

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