Major Health Issues in Nova Scotia: An Environmental Scan

# Reference Brief Notes
to implement the Code of Practice more rigorously, but while it
remains voluntary it is unlikely to solve the problem, in view of the
(relative) shortage of healthcare professionals in this country. Other
measures, including promoting the retention of locally trained staff in
the U.K., are urgently required.
Options for Expanding Continuing Care: Annotated Inventory of Reviews
# Reference Brief Notes
1. Forbes,DA and Neufeld,A. Looming n/a
dementia care crisis: Canada needs an
integrated model of continuing care now!
Can.J.Nurs.Res.; 2008; 40(1):9-16.
2. Kodner,DL. Whole-system approaches to
health and social care partnerships for the
frail elderly: An exploration of North
American models and lessons.
Health.Soc.Care.Community; 2006; 14(5):384-
90.
Irrespective of cross-national differences in long-term care, countries
confront broadly similar challenges, including fragmented services,
disjointed care, less-than-optimal quality, system inefficiencies and
difficult-to-control costs. Integrated or whole-system strategies are
becoming increasingly important to address these shortcomings
through the seamless provision of health and social care. This article
summarises the structure, features and outcomes of the Program of
All-Inclusive Care for Elderly People (PACE) programme in the
United States, and the Systeme de soins Integres pour Personnes
Agees (SIPA) and the Programme of Research to Integrate Services
for the Maintenance of Autonomy (PRISMA) in Canada. It concludes
with the identification of common characteristics which are thought
to be associated with the successful impact of these partnership
initiatives, as well as a call for further research to understand the
relationships, if any, between whole-system models, services and
3. McKay,JR. Continuing care research: What
we have learned and where we are going.
J.Subst.Abuse Treat.; 2009; 36(2):131-45.
4. McKay,JR. Continuing care in the treatment
of addictive disorders. Curr.Psychiatry Rep.;
2006; 8(5):355-62.
5. Oldman,C. Deceiving, theorizing and selfjustification:
A critique of independent
living. Crit.Soc.Policy); 2003; 23(1):44,62.
outcomes in integrated care for elderly people.
In the field of addiction treatment, the term continuing care has been
used to indicate the stage of treatment that follows an initial episode
of more intensive care. This article reviews controlled studies of
continuing care conducted over the prior 20 years. The results
indicate that continuing care interventions were more likely to
produce positive treatment effects when they had a longer planned
duration, made more active efforts to deliver treatment to patients,
and were studied more recently. The use of alternative service
delivery methods and care settings may also lead to greater
engagement and retention in continuing care, particularly among the
large numbers of individuals who do not want traditional, clinic-based
specialty care.
Newer models of continuing care in the addictions are designed to
improve the long-term management of substance use disorders by
engaging patients into flexible, or "adaptive," treatment algorithms
that change in focus and intensity as symptoms wax and wane over
time. This article describes some of these newer approaches to the
management of substance use disorders and presents recent research
on their effectiveness.
The article starts with an examination of some key paradigms of later
life and then employs their insights to expose the powerful and
deceptive discourse of 'independent living', which has recently been
one of social policy's most persuasive mantras. The theoretical
perspective that informs the whole article is that of postmodernism
with a critical gerontology perspective. The critique of independent