Figure 1
Salut+Social integrated care model implementation and intervention plan. A. Study design flowchart. B. Integrated care model (left) and Intervention (right) schemes.
Table 1
Demographic characteristics of patients and caregivers.
| PATIENTS | N | % |
|---|---|---|
| All patients | 127 | 100 |
| SEX | N | % |
| Female | 82 | 65 |
| Male | 45 | 35 |
| AGE | MEAN | SD |
| Age | 79.59 | 15.91 |
| CIVIL STATUS | N | % |
| Widow/er | 58 | 46 |
| Married | 45 | 35 |
| Single | 22 | 17 |
| Divorced | 2 | 2 |
| EMPLOYMENT | N | % |
| Retired | 105 | 83 |
| Disabled | 17 | 13 |
| EDUCATION LEVEL | N | % |
| Illiterate | 10 | 8 |
| Primary education | 111 | 87 |
| Secondary education | 5 | 4 |
| Higher education | 1 | 1 |
| HEALTH CONDITION | N | % |
| Complex chronicity | 62 | 49 |
| Home care program patient | 52 | 41 |
| Dementia | 21 | 17 |
| Stroke | 20 | 16 |
| Neurodegeneration | 12 | 9 |
| Advanced chronicity | 5 | 4 |
| CAREGIVERS | N | % |
| All caregivers | 122 | 100 |
| KINSHIP | N | % |
| Offspring | 58 | 48 |
| Partner | 28 | 23 |
| Parents | 7 | 6 |
| Grandparents | 1 | 1 |
| Brother/Sister | 4 | 3 |
| Niece/Nephew | 7 | 6 |
| Grandchildren | 1 | 1 |
| Son/Daughter-in-law | 5 | 4 |
| REMUNERATED | N | % |
| Yes | 10 | 8 |
Table 2
Professionals’ characteristics and degree of compliance with intervention.
| PROFESSIONALS | N | % |
|---|---|---|
| All professionals | 58 | 100 |
| PROFESSIONAL PROFILE | N | % |
| Primary care nurse | 19 | 33 |
| General practitioner | 13 | 22 |
| Health referee | 10 | 17 |
| Social referee | 4 | 7 |
| Social worker (community) | 9 | 16 |
| Social worker (hospital) | 2 | 3 |
| Social educator | 1 | 2 |
| DEDICATION TO INTERVENTION | N | % |
| Full-time | 1 | 2 |
| Part-time | 57 | 98 |
| COORDINATED ACTIVITIES (INSIDE THE INTERVENTION) | N | % |
| Patients followed-up | 257 | 91 |
| Joint home visit | 24 | 8.5 |
| Joint interviews | 1 | 0.5 |
| COORDINATED ACTIVITIES (INSIDE AND OUTSIDE THE INTERVENTION) | N | % |
| New case registration | 544 | 88 |
| Joint meetings | 74 | 12 |
| SALUT+SOCIAL APP USAGE | N | % |
| All activities | 1005 | 100 |
| ACTIVITIES BY DIRECTIONALITY | N | % |
| From Health to Social | 513 | 51 |
| From Social to Health | 492 | 49 |
| ACTIVITIES BY PROFESSIONAL PROFILE | N | % |
| Primary care nurse | 238 | 23 |
| General practitioner | 89 | 9 |
| Health referee | 167 | 17 |
| Social referee | 268 | 27 |
| Social worker (community) | 190 | 19 |
| Social worker (hospital) | 19 | 2 |
| Social educator | 34 | 3 |
Figure 2
Effect of the Salut+Social intervention on patients’ perceived health-related quality of life. A. EQ-5D-3L global punctuation (mean ± SD) at baseline, 6 months and 12 months after the initiation of the intervention. B. EQ-5D-3L global punctuation (mean) by health condition at baseline, 6 months and 12 months after the start of the intervention. C-G. Proportion of patients (n) at each severity level in the dimensions of pain and malaise (C), anxiety and depression (D), mobility (E), self-care (F) and usual activities (G) of the EQ-5D-3L at different times. Statistical analysis was by Student’s t test in (A) and McNemar’s test in (C-G). * p < 0.05, ** p < 0.01.
Figure 3
Effect of the Salut+Social intervention on patients’ treatment adherence and chronic patient experience. A. Percentage of patients (%) showing appropriate treatment adherence according to the Morsiky-Green dichotomous questionnaire. B. Mean score (SD) obtained for each question of the IEXPAC questionnaire 6 and 12 months after the beginning of the intervention. Statistical analysis was by McNemar test in (A) and Wilcoxon test in (B).
Figure 4
Effect of the Salut+Social intervention on patients’ engagement with social services. A. Proportion of patients (n) with different grades of social dependency assignment. B. Proportion of patients (n) with home assistance or daycare center assignment. Statistical analysis involved the McNemar test in (A) and (B). *p < 0.05, ***p < 0.001.
Figure 5
Effect of the Salut+Social intervention on caregiver overload. A. Mean (SD) caregiver burden score according to Zarit test at baseline and 6 and 12 months post-intervention. B. Mean (SD) hours/week of informal and remunerated caregivers’ time spent in caring. Statistical analysis was by McNemar test in (A); *p < 0.05.
Table 3
Moderating effect of patients’ sociodemographic characteristics on the grade of intervention’s exposure.
| DEPENDENCY OR (95% CI) | P VALUE | HOURS OF CARE BETA (SD) | P VALUE | |
|---|---|---|---|---|
| Age | 0.94 (0.91–0.98) | 0.001 | 0.12 (0.04) | 0.008 |
| Sex (Male) | 0.89 (0.30–2.58) | 0.826 | 1.18 (1.48) | 0.426 |
| Medium-grade morbidity | 0.62 (0.19–2.03) | 0.426 | 3.03 (1.43) | 0.035 |
| Maximum-grade morbidity | 4.20 (1.01–17.41) | 0.048 | 4.41 (1.75) | 0.012 |
Table 4
Effect of patients’ sociodemographic characteristics and exposure to the intervention on health-related quality of life.
| EQ-5D-3L BETA (SD) | P VALUE | |
|---|---|---|
| Intercept | 0.71 (0.09) | <0.001 |
| Age | –0.001 (0.001) | 0.322 |
| Sex (men) | 0.055 (0.039) | 0.163 |
| Stroke | –0.071 (0.048) | 0.141 |
| Complex chronic patient | –0.042 (0.034) | 0.223 |
| Advanced chronic disease | –0.136 (0.079) | 0.086 |
| Neurodegeneration | –0.117 (0.066) | 0.076 |
| Dementia | –0.084 (0.050) | 0.094 |
| Dependency | –0.068 (0.019) | 0.009 |
| Hours of care | –0.006 (0.002) | <0.001 |