bluuebunny/crossref_metadata_2025 huggingface dataset:
Health related-quality of life and patient experiences regarding transitional care in hospitalized older adults: a survey study.
Authors: Leithaus Merel , Flamaing Johan , Goderis Geert , Verbeek Hilde , Deschodt Mieke
Published: January 2024

Introduction: Frail older patients with various care needs often undergo hospitalization and thus experience frequent transitions across different settings. Poorly performed care transitions can increase the risk of adverse outcomes. Implementing integrated care services can improve the quality of care transitions. The aim of this survey study was 1) to assess health related quality of life (hr-qol) and experiences with transitional care in older patients and 2) to compare these outcomes between patients who were living within an integrated care project (ICP) region vs. outside an ICP region in Belgium.

Methods: This study is part of the European TRANS-SENIOR project. We used a survey using the EQ-5D-5L instrument to measure the hr-qol and the ‘Experiences with hospital care,  admission and discharge’ instrument to measure patient experience. The survey questionnaire was given to frail patients aged 65 years and older and who were discharged home from one of six different wards of the University Hospital Leuven. Patients were asked to fill out the survey at home and send it back to the researchers. Descriptive analysis and inferential statistical analysis were conducted to summarize survey results, identify trends and validate hypothesis.

Results: 119 questionnaires were filled in and sent back. Patients had a mean age of 81 years and 54.2% were female. Problems with mobility, pain/discomfort, daily activities and self-care were reported in more than 70% of the participants. The average EQ-5D-5L visual analogue scale score was 56.97 out of 100 (SD 19.05). We observed high scores for the patient experience dimensions hospital accessibility, hospital safety and care received by doctors and nurses. However, in comparison to other experience dimensions, no clear positive trend was observed for treatment communication, admission conversation and hospital discharge.

Moreover, when comparing the outcomes between patients living in ICP and non-ICP regions, we saw no statistically significant differences in terms of hr-qol and patient experience.

Conclusion: The survey allowed to identify potential areas for improvement by assessing patient reported outcomes and experiences with transitional care. Similar challenges in patient experiences during information exchange concerning treatment, admission and discharge were identified in the whole patient population and within the ICP regions.
The Role and Experiences of Frontline Social Care Staff within Integrated Care
Authors: Hussain Mohammed
Published: January 2024

Background: This study explores the role of those frontline individuals working in care and support roles in ensuring that people receive Integrated Care and how they interact, collaborate and work in partnership with external professionals. Such staff are often central to the people’s experience of person-centred, co-ordinated care due to their frequent contact with people, their families and a multitude of professionals. Despite the centrality of their role, there  is a lack of research on these individuals with most research around Integrated Care focused on formal professions such as Nurses and Social Workers. 

Who is it for? This research study has been conducted for frontline social care staff within Integrated Care services and for all stakeholders involved in a person’s care ranging from Social Workers, CPNs, Housing support, health and local authorities. This will also be of interest to those responsible for managing future integrated services and to those implementing new Integrated Care programmes.

Who did you involve and engage with? This research study was led by a PhD Research student around an Integrated Mental Health Recovery Service for Adults in the Midlands region of England which had been implementing integrated care over the past five years. The service supports people to leave /avoid hospital or prison etc to develop new skills, manage their risks and to support the Mental Health Recovery journey for individuals. The emerging insights from this study will be shared with a lived experience panel in order to gain their perspectives.

What did you do? A scoping literature review was conducted which highlighted the limited number of research studies involving frontline social care and support staff. With the premise that all involved in Integrated Care are equal partners, a lack of literature on these individuals highlighted a gap in data. Qualitative semi-structured interviews are being conducted with social care staff and various professionals involved in the case study site, based on themes which emerged in the literature review.

What results did you get? This research study is part of a PhD Thesis due for completion in September 2023 and data gathering will be complete and initial analysis will be presented at the conference.

What is the learning for the international audience? The areas of learning will be around the key themes which emerge from the findings of the qualitative interviews on barriers and facilitators of Integrated Care based on the role and experiences of frontline social care staff, a group which has been under researched both within the UK and internationally.

What are the next steps? The insights from this research study will help to inform the Integrated service and the local areas to improve the support to people in services, to help advance practice within Integrated Care and for the future development of Integrated Care services and programmes.
The introduction and impact of a National Frailty Education Programme
Authors: Lang Deirdre , Carmel Hoey , Whitty Helen , Oshea Diarmuid
Published: January 2024

Background: Frailty is a dynamic functional state. Its onset and progression can be reduced and even reversed, if early intervention and correct management strategies are set in place. A number of reports suggest that healthcare professionals in general, have a poor understanding and view frailty as an inevitable part of ageing. In response the NCPOP developed The National Frailty Education Programme

Aim: The programme aim is to provide healthcare professionals with an enhanced understanding of frailty and frailty assessments; thereby ensuring earlier recognition of frailty, improved healthcare management, and better outcomes for older adults living with frailty.

Methods: A Test of Concept, using quality improvement (QI) methodology was employed. This allowed for small tests of change, which informed the development of the programme content and the programme delivery.

Results: From 21st September 2017 to December 2019 n=3045 healthcare professionals completed the programme. A further 87 staff attended the programme during 2020. 

97% of respondents rated the programme highly in relation to their level of enhanced understanding following participation in the study day.

In early 2020, due to the outbreak of the COVID-19 the pandemic face to face education had to cease. The impact of COVID-19 on older adults and the increased prevalence of frailty on this cohort meant the development of and access to an eLearning programme became a priority and an eLearning programme was developed.  A blended programme is due to be launched in 2023.

Impact: In 2018, the NFEP was awarded the Zenith Global Healthcare Award in recognition of its pioneer educational approach to the delivery of integrated interprofessional education. The programme has also been included in the European Union’s Joint Action on Frailty Prevention (Rodríguez-Laso et al., 2019), as a case study of good practice under Domain 7: Education and Training. Many other projects, publications and developments have arisen out of this programme including: the evolving Frailty Networks nationally, the inaugural meeting of the Irish Frailty Network of the Irish Gerontological Society in September 2019 , the first All-Ireland Frailty Network meeting in October 2021 , advisory inputs to the Northern Ireland Frailty Network in November 2021 towards developing a Frailty Education Programme for Northern Ireland, and many other initiatives and contributions to improve patient care. The programme has been cited internationally as an exemplar of an interprofessional approach to learning (Walsh, & Currid 2018, Adja, et al. 2020, Munro & Murphy, 2022, Romero-Ortuno, et al. 2022); in recognition, since 2022, Trinity College Dublin offers up to 5 annual scholarships to NFEP Facilitators for the online, standalone module in Assessment and Management of Frailty in Ageing Adults .
The development of the Dutch national model integrated care for childhood overweight and obesity
Authors: Halberstadt Jutka , Koetsier Leandra
Published: January 2024

Background: Childhood obesity is a chronic disease with negative physical and psychosocial health consequences. To manage childhood overweight and obesity, integrated care as part of an integrated approach is needed. In order to realise implementation of this integrated care, practical guidance for policy and practice is needed. The aim of this study is to describe the development of a Dutch national model of integrated care for childhood overweight and obesity and accompanying materials for policy and practice.

Methods: The development of the national model was led by a university based team in collaboration with eight selected Dutch municipalities who were responsible for the actual local realisation of the integrated care and with frequent input from other stakeholders. Learning communities were organised to exchange knowledge, experiences and tools between the participating municipalities.

Results: The developed national model describes the vision, process, partners and finance of the integrated care. It sets out a structure that provides a basis for local integrated care that should facilitate improvement of support and care for children with overweight or obesity and their families. The accompanying materials are divided into materials for policymakers to support local realisation of the integrated care and materials for healthcare professionals to support them in delivering the needed support and care.

Conclusions: The developed national model and accompanying materials can contribute to improvement of support and care for children with overweight or obesity and their families, and thereby help improve the health, quality of life and societal participation of these children. Further implementation of the evidence- and practice-based integrated care while evaluating on the way is needed.
Educational game “GUIDE in Health and Healthcare” to improve health literacy.
Authors: Goossens Joline , Lamote Sofie , Byl2 Stephanie , Vyncke Veerle
Published: January 2024

Research suggests that 33% of the Belgian population aged 15 years and over has a low level of health literacy (Charafeddine et al. 2018). Low health literacy is associated with greater use of health care services, and higher morbidity and mortality (Dewalt et al 2004). In the last decade, the emphasis is on a system approach to improve health literacy rather than focusing on individual behavioral change alone (Brach 2017). Although professionals in social and health organizations try to improve health literacy in their clients, few tools are available to guide such efforts. Therefore, an educational game “GUIDE in Health and Healthcare” (in Dutch: WEGWIJS in Zorg en Gezondheid) was developed to improve health literacy among clients. By playing the game, people gain more insight into the Belgian healthcare system.

The game was created by the workgroup “Health literacy” of 11 community health centers in Ghent in cooperation with educational game developer “De Aanstokerij” and several health and social organizations. The game was evaluated in six different settings through a questionnaire, observation, and focus group interviews with the participants and their supervisor.

The game is a board game with a digital component, and consists of 15 characters with different health and social needs. By guiding the characters to the most appropriate primary care organization, people collect points. The group with the most points wins.

An instructional video was developed for professionals and can be displayed during the conference.
Patient-experiences of osteoporosis care through an Integrated, People-Centred Health Services (IPCHS)-framework lens: an international perspective
Authors: Verdonck Caroline , Van Daele Ellis , Willems Ruben , Borgermans Liesbeth , Boeckxstaens Pauline
Published: January 2024

Introduction: Aligning healthcare systems worldwide to meet the challenge of caring for the world’s rapidly growing older population is among the most important goals of the World Health Organization (WHO) Decade of Healthy Ageing (2021-2030). This entails ensuring people have broad access to the most effective diagnostic and prevention strategies, treatments and care for diseases that disproportionately impact the aging, such as osteoporosis. Currently, health systems do not succeed in meeting the needs of osteoporosis patients. Previous studies have demonstrated unmet needs in terms of accessibility, affordability, patient-centredness and comprehensiveness. In order to reorient health care systems towards a more integrated approach supporting these rightful demands, the WHO has developed the framework on Integrated, People-Centred Health Services (IPCHS), encompassing five interdependent strategies and 20 substrategies that support health care delivery integration. Whilst these strategies are often implemented by stakeholders, the patient perspective with regard to these strategies is poorly understood. The study aims to analyse the gaps in osteoporosis care as experienced by patients and relate them to IPCHS-strategies.

Methods: Individual interviews were performed by two researchers, using a semi-structured interview guide. Interviews were held in English, Dutch, Spanish and French, recorded using screen recording, and transcribed at verbatim. Interviews were first analyzed deductively based on the IPCSH framework, assigning patient responses to one or more substrategies of the five IPCHS strategies. Afterwards, inductive analyses per sub-strategy were performed.

Results: Thirty-five (33 women, 2 men) patients from 14 countries were interviewed. From the 20 IPCHS substrategies, patients mostly reported difficulties and shortcomings they experienced in relation to “empowering and engaging individuals and families” such as patient education and shared decision making, and “coordinating care for individuals” with an emphasis on multidisciplinary care pathways, respectively. They also inclined a larger focus is needed on preventive services. High out-of-pocket payments were considered an important barrier in accessing services and comprehensive care. Patients advocated for stronger primary care-based services in which more continuity and follow-up is provided by a dedicated physician.

Conclusion: Improvements in integrated, people-centred osteoporosis care should focus on patient-reported experiences with care.

Ethical approval: Approval for the study has been provided by the Ethics Committee (EC) of Ghent University Hospital (BC-10951). All participants signed an informed consent form after receiving written and verbal information. This study has been made possible through a value-based partnership between Ghent  University and Amgen.
Scoping literature review and focus groups with healthcare professionals on psychosocial and lifestyle assessments for childhood obesity care.
Authors: Koetsier Leandra
Published: January 2024

Background: Childhood obesity is a complex disease resulting from the interaction of multiple factors. The effective management of childhood obesity requires assessing the psychosocial and lifestyle factors that may play a role in the development and maintenance of obesity. This study centers on available scientific literature on psychosocial and lifestyle assessments for childhood obesity, and experiences and views of healthcare professionals with regard to assessing psychosocial and lifestyle factors within Dutch integrated care.

Methods: Two methods were used. First, a scoping review (in PubMed, Embase, PsycInfo, IBSS, Scopus and Web of Science) was performed by systematically searching for scientific literature on psychosocial and lifestyle assessments for childhood obesity. Data were analysed by extracting data in Microsoft Excel. Second, focus group discussions were held with healthcare professionals from a variety of disciplines and domains to explore their experiences and views about assessing psychosocial and lifestyle factors within Dutch integrated care. Data were analysed using template analysis, complemented with open coding in MAXQDA.

Results:  The results provide an overview of relevant psychosocial and lifestyle factors that should be assessed and were classified as child, family, parental and lifestyle (e.g. nutrition, physical activity and sleep factors) and structured into psychological and social aspects.

Insights into how to assess psychosocial and lifestyle factors were identified as well, including talking about psychosocial factors, lifestyle and weight; the professional-patient relationship; and attitudes of healthcare professionals.

Conclusions: This study provides an overview of psychosocial and lifestyle factors that should be identified within the context of childhood obesity care, as they may contribute to the development and maintenance of obesity. The results highlight the importance of both what is assessed and how it is assessed. The results of this study can be used to develop practical tools for facilitating healthcare professionals in conducting a psychosocial and lifestyle assessment.
Development, piloting, and dissemination of a suicide prevention brief online course for non-health professionals
Authors: Belarra Begoña , López Puy , Portuondo Janire , Gómez-Alcalde Jose Luis , Gabilondo Andrea , Martin Susana
Published: January 2024

Introduction: The use of online gatekeeper training resources facilitates the dissemination of useful knowledge and skills for suicide prevention with an integrated care perspective and a focus in the community, especially in a context of a pandemic and of limited human and economic resources.

Aim: To develop and evaluate the impact of a short online gatekeeper training course in Spanish for non-health professionals in the community. To disseminate the course among this group of professionals as a free and easy to access online resource.

Methods: An expert panel developed the training after the review of the evidence and available programs. Evaluation was carried out in two phases (Pilot 1&2). In the 2nd pilot a greater variety of professional fields was included and the evaluation questionnaire was shortened. In both cases, a single group design of repeated measures (before, immediate post and 3 months post) was used as well as a one-factor analysis of variance with repeated measures. Participants responded to an ad-hoc online questionnaire which evaluated satisfaction, knowledge, self-confidence (pilot 1&2), and attitudes (pilot 2). We consecutively recruited all interested professionals in the community who responded to an invitation email sent by the public health coordinators in the counties. A dissemination plan in 4 stages has been developed in coordination with Public Health coordinators.

Results: Sample for the pilot was made up of 272 (53+219) professionals. Improvements in self-confidence, knowledge about suicide and attitudes were found, with statistically significant differences. Overall satisfaction with the training was 8.5 out of a maximum of 10. The dissemination phase is now starting. The aim is to reach as many professionals working with vulnerable groups as possible. Results of this phase will be available by May 2023.

Conclusions: Results of the evaluation pilot are promising and suggest the usefulness of this training to improve professionals' self-confidence and knowledge about suicide prevention. The challenge is to make this training available to the greatest possible number of community professionals.
Uncovering the black box: the potential of Realist Evaluation
Authors: Van Den Bulck Anne , Smeets Rowan , Tichler Anna , Geurten Rose , Hertroijs Dorijn , Elissen Arianne
Published: January 2024

Background and aim: Complex programs, with multiple components and many stakeholders involved, are rather the norm than the exception in the field of integrated care. Experimental designs, with a focus on íf programs work, often disappointingly fail to open the black box about ‘why and how’ complex programs work. With a focus on ‘what works, for whom, why, and under what circumstances’, Realist Evaluation (RE) offers a promising research paradigm to evaluate such programs in a transferable way. Furthermore, RE is highly participative: active involvement of all program stakeholders is key to unearth their perceptions about program functioning. The use of RE is growing steadily in social sciences. However, successful adoption of RE in practice may be challenging, as research in general is still largely dominated by ‘experimental thinking’ and it requires the active participation of a range of stakeholders. Therefore, we have designed a workshop called ‘Uncovering the black box: the potential of Realist Evaluation’. In this workshop, we not only aim to create awareness amongst fellow researchers of the potential of RE, but also gather insights into how these adoption challenges can be overcome to successfully use RE in research.

Who is it for? Our workshop is for everyone interested in thinking beyond the traditional golden standard of randomized controlled trials, and broaden their knowledge of research design. Both researchers conducting studies and those participating in studies (e.g. all kinds of stakeholders) can find and make this workshop valuable.

Workshop program: We will start with a short general introduction about RE, combined with an online question to the audience to gather their first impressions of RE (15 minutes). Then we will provide some example projects that use an RE approach (10 minutes). Next, a world-café method will be followed. This means that the audience will be divided into three groups, where each group discusses a different topic at a roundtable, being: advantages and opportunities (i.e. how RE could help you in your research), barriers (to apply RE to your research projects), and solutions to overcome the barriers. Each group has 15 minutes to discuss the topic in question at their table and write down their findings. Discussions are guided by the workshop organizers, who function as moderators. When time is up, all groups move on to the next roundtable with one of the other topics where they can add up their findings to those that were already put on paper. After 45 minutes, all groups discussed three topics. Finally, each moderator will give a plenary presentation of the findings of each topic, and the audience can share some final thoughts (15 minutes). We will end with a 5 minutes closing, asking the audience about what they found most striking during the workshop and if they think they would apply RE (more) in future.
Integration of processes related to the implementation of the mediGOAT platform in diabetic patient care.
Authors: Zwiefka Antoni , Wyrzykowski Andrzej , Waszkiewicz Krzysztof
Published: January 2024

Diabetes has always been viewed through the prism of the fact that any expenditure in this area is a threat to the budget of the entire health care system. Most often it is the progress of science that forces integration activities. An example may be the integration processes related to the implementation and creation of the mediGOAT platform, which are focused on its multi-functionality, i.e. the ability to connect many different measuring devices (Glucometer, CGM, SmartPen, Insulin Pump, GlucoActive) from many manufacturers. They are made up of smaller particles with their own rules and goals, such as engaging and evaluating activities. We meet with this, among others by implementing good practices.

As a result, such activities give the user more choice and independence from many native applications (manufacturers), and it enables cooperation with Google Health and iHealth (Apple). This makes it possible to use additional information provided by External Applications (meals, exercise, pressure, weight, ...) in the treatment process. In addition, it allows you to collect and store your medical records (including the results of medical tests). The indicated/selected medical/health data (in the future on-line measurements) can be provided to the doctor via the Portal, ensuring security (login via Apple and Google, Backup) and ease of use.

Additional knowledge is written at various levels of detail, scattered in different places, its origin is sometimes uncertain, which makes it unreliable. It is often oversized where it is not necessary, and various sources can contradict each other. Therefore, it is important to use trusted sources. Controlling blood glucose levels is important, as are the circumstances surrounding such a measurement, what you do and where you are. Mobile Continuous Glucose Monitoring, using CGM, enables up to 288 readings per day, giving you insight into information that fingerstick tests cannot match. CGM provides real-time glucose readings every five minutes throughout the day and night, notifying you of high and low values. The sensor continuously measures the glucose level just below the skin and transmits the data wirelessly to the display device via the transmitter. This enables an immediate reaction. A discreet sensor placed just under the skin (the automatic applicator introduces the sensor just under the skin with one press) measures the glucose level for the time specified by the manufacturer. Glucose data is sent wirelessly to the analysing and smart device via Bluetooth® or NFC technology. Such a device can be a compatible smartphone or other optional receiver that displays and archives glucose data in real time.
Design, implementation, and evaluation of a training on culturally sensitive care for nursing students: A pilot study
Authors: Claeys Ann , Berdai-Chaouni Saloua , Tricas-Sauras Sandra , De Donder Liesbeth
Published: January 2024

There is a need for culturally sensitive care for people with a migration background because of the increasing ethnocultural diversity in Western countries. Consequently, more and more training programs for health care providers are starting to implement these topics in curricula. However, while the content of culturally competent care is widely debated in nursing literature, a description of how students are and should be taught is lacking. Even more, studies have shown that merely increasing knowledge on ethnicity, culture or migration does not help to increase culturally sensitive behaviour of (future) healthcare providers. On the contrary it even leads to more stereotypical thinking. More critical self-awareness is needed among caregivers to overcome barriers such as othering (i.e., micro-racism by defining the other in an inferior way).

 

In response to abovementioned shortcomings, we developed, implemented and evaluated a course on culturally sensitive care in the curriculum of nursing students. Nursing students and caregivers were involved in the development of the course. This program (4h) aimed to increase self-awareness among caregivers about othering, racism and exclusion in society and in healthcare. The paper will describe the content of the program (building on the Johari Window model developed to increase awareness in interpersonal relations (Luft & Ingham, 1961), the pilot implementation and evaluation among 34 students. The program was well received by the participants. Success factors (i.e. profile of the teacher, self-awareness positionality) and working points (i.e. ethnic/minority-matching) were detected. This program will be adapted and further implemented in the curriculum based on the feedback.
Training for coordinating professionals as part of Dutch integrated care for childhood overweight and obesity – a mixed-methods evaluation
Authors: Koetsier Leandra , Boutalab Lamyae , Seidell Jaap , Baan Caroline , Halberstadt Jutka
Published: January 2024

Introduction: Healthcare professionals (HCPs) play an important role in childhood overweight and obesity care, yet they often feel ill-equipped to manage this complex and sensitive health problem. As part of Dutch integrated care for childhood overweight and obesity, a training for coordinating professionals (CPs) was designed and carried out. This study evaluates the training based on the four levels of Kirkpatrick’s model of training evaluation: (1) reaction, (2) learning, (3) behaviour, and (4) results.

Method: Eleven CPs who completed the training participated in this mixed-methods study. First, completed questionnaires on the four levels were analysed with Qualtrics. Next, the transcripts of semi-structured interviews on levels 1, 3 and 4 were analysed in MAXQDA using thematic analysis.

Results: On level 1, participants were satisfied with the training as it stimulated their professional and personal development, for instance awareness of prejudices about people with overweight and obesity. Barriers, improvements and needs from the training varied between participants based on their background. On level 2, CPs improved perceived knowledge about integrated care and its practice, skills for providing overweight and obesity care, coaching attitudes, and trust and commitment towards local integrated care. On level 3, the extent to which the learnings were practised depended on the experience and local context of the CP. Last, on level 4 CPs mentioned noticing post-training practical results for themselves, the child and the family, integrated care partners, and the participants’ organisation.

Conclusion: This study evaluated a training for CPs for the support and care they provide to children with overweight and obesity and their families as part of Dutch integrated care. The training contributed to improve perceived knowledge, skills and attitudes of CPs. This study recommends sufficient implementation of local integrated care, to optimally practise what was learned during the training. More on-time evaluations of the training and taking the perspective of the organisation into account is needed. This would improve the training and give CPs confidence to adequately provide support and care to children with overweight and obesity and their families.

Keywords: Pediatric obesity, education, health care providers, primary health care, mixed-methods appraisal
Smoking cessation encouragement by community pharmacists.
Authors: Vauterin Delphine , Tommelein Eline , Lahousse Lies
Published: January 2024

Background: Pharmaceutical care interventions have shown to improve health outcomes in specific patient populations. However, which smokers could be reached by community pharmacists in Belgium is unknown. Moreover, the impact of behavioural interventions for smoking cessation (such as brief motivational interviewing) on short term health outcomes remains unclear. Therefore, we aimed to describe the population reached and potential impact on health outcomes among persons who received a brief motivational interview by their community pharmacist.

Methods: Demographics of approached smokers in Flemish community pharmacies during the months May-June 2021, and objectifiable outcomes of a brief motivational interview were retrieved from the pharmacy database. Smoking cessation aids use as well as the impact on cough, inhaler or exacerbation medication use was evaluated 90 and 180 days after the encouragement. Data were analysed using the Mann-Whitney U test, ꭕ² test and binary logistic regression analysis.

Results: Community pharmacists provided a brief motivational interview to a broad population of smokers of both sexes, including young persons and persons without chronic medication use. Two out of three smokers were motivated to quit (67.7%) and a third of the included population (33.0%) purchased a smoking cessation aid on the index date (36.7% after 90 and 39.3% after 180 days). Smokers motivated to quit who purchased a smoking cessation aid on the index date had a significantly lower use of cough (OR = 0.37; p = 0.032) and inhaler medication (OR = 0.37; p = 0.009) after 90 days than those not motivated to quit. Effects were less pronounced after 180 days but still statistically significant for lower inhaler use (OR = 0.46; p = 0.031).

Conclusions: By implementing a brief pharmaceutical counselling in Belgian community pharmacies, a broad range of smokers can be reached and triggered to start smoking cessation aids with suggestive short-term health benefits.

Acknowledgements

The authors want to thank the Flemish Pharmacists Network (VAN) for training the pharmacists and Farmaflux and the Association of Pharmacists Belgium (APB) for providing the data with special acknowledgements to Karel Verlinde, An Vanthienen, Corine De Winter and Marc Buckens.
Identifying and providing management support for people at risk of frailty in general practice.
Authors: Nicholson Caroline , Job Jenny , Clark Debra , Arapova Julia
Published: January 2024

Background: Frailty, associated with increasing age and characterised by diminished strength and function, often remains undetected. Presentations of frailty often occur when a seemingly minor event results in a significant health crisis and unnecessary hospital admission, with substantial associated health care costs. Evidence suggests that targeted therapies may decrease the negative outcomes associated with being frail. In Australia frailty affects up to 25% of people aged ≥70 yet a standardised assessment of frailty amongst patients attending general practice is not routine. The FRAIL Scale, developed and validated internationally as a screening tool, requires five simple questions relating to fatigue, resistance, ambulation, illnesses, and weight loss to be answered to identify risk of frailty.

Method: Audit of 282 patients aged ≥75 years who had completed annual health assessments in ten Australian general practices, found only 2% had been assessed for all five FRAIL Scale components.

Outcome: To facilitate use of the FRAIL scale a FRAIL Scale App has been developed which can be built into the General Practice clinical support system. Our pilot study is investigating the 1) feasibility and adoption of the App by general practices recruited from two Australian regions (North Sydney/Brisbane South); 2) access to resources/referral options in the community to support identified need; 3) acceptability to providers/patients/carers of the risk of frailty assessment and management approach. The App has been adopted by 17 general practices recruited from the two regions and is an efficient and effective method to identify risk of frailty and provide management suggestions.

Implications: This study is providing an understanding of the services required in the community to support those who are pre-frail/at risk of frailty. A reduced burden to the hospital system, improved health outcomes and quality of life for older people who are at risk or living with frailty are potential benefits of an effective tool used routinely in general practice.

 

 

 

Key messages:

1.Risk of frailty is not being routinely assessed in general practice

2.The Frail scale tool can be easily incorporated into the practice workflow.

3.Risk of frailty management resources and services are required to support the implementation.
Evaluating the maturity of integrated care organizations
Authors: Majo Jocelyne , Peytremann-Bridevaux Isabelle , Carron Tania , Campisi David , Leroy Perrine , Castellani Pascale , Meylan Pascale , Périat Alain , Bosisio Francesca , Mathy Caryn
Published: January 2024

Introduction: Given the difficulty of measuring and demonstrating the added value of integrated care organizations over traditional ones by using conventional evaluation methods, we used—and adapted—the SCIROCCO Maturity Model for Integrated Care to be considered as a steering tool for integrated care organizations to measure their maturity over time and enable improvements.

Methods: Three organizations located in Switzerland that have brought together the local hospital (with inpatient and outpatient care services), the nursing home, the day center for elderly people, the home care services and the primary care practice will be evaluated using the adapted SCIROCCO tool and approach (SCIROCCO-POL). The original SCIROCCO validated tool assesses the readiness and capacity of a healthcare system, at the level of a region or country, to adopt and scale-up integrated care solutions by capturing stakeholders’ perceptions of current progress towards integration.¹ Following the SCIROCCO methodology, healthcare stakeholders will be asked to assess (individually and then through consensus-building workshops) the maturity of their integrated care organization along 12 dimensions (e.g. governance, funding, digital infrastructure, process coordination, citizen empowerment). Since we aimed at obtaining a steering tool for integrated care organizations, a revision of the SCIROCCO tool is necessary, so that 1) the description of each dimension is adapted to the language used by local healthcare actors, including non-specialists, in the context of an organization, and 2) the 0-5 rating scales follow the same logic throughout the dimensions in terms of maturity progression. This tailoring and systematization will allow us to build a tool that healthcare organizations can easily use to monitor their level of maturity and make progress towards integrated care. The adapted version of the SCIROCCO tool will be used within three integrated care organizations, allowing for comparison and knowledge transfer.

Results and next steps: Currently, the evaluation process is ongoing. At the end of the full SCIROCCO evaluation process, management bodies of the three integrated care organizations, in conjunction with their stakeholders, will be invited to define SCIROCCO’s priority dimensions and action plans to address the identified maturity gaps; they will also prepare strategic roadmaps for the three identified priority dimensions.

We propose to present the adapted version of the SCIROCCO tool that allows the assessment of an organization’s level of maturity towards integrated care, and to discuss its advantages and more specifically its use as a steering and improvement tool that integrated care organizations can use on a regular basis.

¹ https://www.sciroccoexchange.com/
"The “Amfora conversation”: reflecting on life and death when the end is near. An innovative practice empowering patients".
Authors: Morel Michèle
Published: January 2024

Death is part of life. Yet, few people are prepared for it. Many of those who are old or seriously ill, have the need to reflect on the past life, the nearing end and the things that matter. Talking about and sharing those deeper feelings and thoughts can be deeply liberating. It can create a closer connection between the ill or old person, the loved ones and the health care professionals. End-of-life conversations can stimulate the person to think about future care and, this way, contribute to advance care planning. And for loved ones it can have a preventive effect in the sense that it increases the chances of healthy grieving.

Who am I, where do I find strength, which meaning do I give to death? How do I look back on my life? What are my fears and my hopes? What do I wish to leave for those staying behind? Thinking and talking about these questions is not easy. The non-profit organization Amfora helps people to find language and create a tangible memory for loved ones, by means of an “Amfora conversation” resulting in a precious, carefully written end-of-life story. Amfora provides training to health care professionals and volunteers from various settings (hospitals, palliative care networks, facilities for people with disabilities and elderly care), so they can integrate the practice in their daily work.  

Integrated care reflects the whole of a person’s health needs. It means we focus on the totality of the person and his full context, beyond the disease or chronic condition. This is particularly important in palliative care and end-of-life care, where consensus exists about the four pillars of care: physical, psychological, social and spiritual/existential. This last pillar – which goes far beyond religion – is the most intimate and hidden dimension of care, yet it’s crucial because of its close connection to each of the other dimensions.

However, it remains a challenge for many palliative care professionals how to implement this non-medical, existential pillar in practice. This is where the Amfora conversation comes in: it has proven to be an accessible and effective way to empower people in having their spiritual/existential needs fulfilled. The Amfora concept is innovative because it is based on the journalistic interview method. The interviewer captures the essence of the person and gives it back in another form, so it can be passed on. End-of-life conversations are a form of care and should therefore be fully integrated in palliative care.
MISSION IMPOSSIBLE? Integrated services for people with SMI and SUD - The importance of good leadership and management.
Authors: Poverud Lars
Published: January 2024

Introduction: Better services for people with mental illness and substance use disorder (SUD) can be looked at as a Mission Oriented Innovation (MOI). People with severe mental illness (SMI) and SUD are often in the need of a range of different services, and different service models for coordinating such services have been introduced through the years.

Aim: This study explores what inhibits and promotes integrated services for people with SMI and SUD in the service model FACT – Flexible Assertive Community Treatment.

Methods: This is a qualitative explorative multiple-case study with the use of focus group interviews and reflexive thematic analysis (RTA) of team members in three different FACT-teams in Norway.

Results: In team A the themes ‘Poor and lacking communication’, ‘Culture & Attitude’ and ‘Some resources are missing’ inhibits integrated services. And ‘A holistic and open work environment’, ‘Systemic assertive’ and ‘Focus on social recovery’ promotes. In team B ‘Lack of resources’, ‘Incorrect focus or problem focused practice’ inhibits, and ‘Function recovery advocacy & practice – Function FACT’ and ‘Good triple Management’ promotes. In team C ‘Administration & Management matters’, ‘Segregation & Prioritizing’ and ‘External interaction’ inhibits, and ‘Skilled, creative & dedicated team members’, ‘The FACT service model’ and ‘Internal & external cooperation’ promotes.

Conclusion: Will be presented at the conference.

The study also has PPI - Personal and Public Involvement with the engagement of three peer co-researchers contributing to the research project INNOFACT from start to end. The next step is to summarize and conclude regarding the importance of good leadership and management that will be presented at the conference. Later on the peer co-researchers will interview the patients about the same research questions.

There are to our knowledge no studies about what inhibits and promotes integrated services for people with dual (and multiple) diagnosis in the service model FACT.
Regional Strategic Planning of Care in Flanders based on population needs
Authors: Peuskens Geert
Published: January 2024

Introduction: In 2014, Flanders started a process of re-designing the hospital care. This has led let to the recognition of 13 networks of hospitals in 2020. 

Simultaneous we developed a framework for a Regional Strategic Care Plan (RSCP). The RSCP starts from demographic data and health indicators to determine future needs to which the future supply of the network must be tailored. The networks are asked to make such a RSCP for their network.

Target: The increase in ageing, multimorbidity, complex disorders, chronic care,… require a new relationship between hospitals and between hospitals and other healthcare providers. With the RSPC we want to match the hospital care to the needs of the population, in consultation with other healthcare providers. More attention will go to task differentiation and new partnerships.

The main principle has to be that basic care is organised close to the people, whereas more specialised care recruits from a wider environment. All healthcare providers will have to change from a supply-driven organisation of care towards person-centred care based on needs.

Design: Studies on future population needs, on an optimal spread of the care offer and to create a framework for RSPC, based on future needs, actual demografic figures, ….,  were executed by a consortium of Deloitte and the Leuven Institute for Healthcare Policy.

A computermodel was developed to visualise patient flows and to determine logical cooperation.

The main goal of RSPC:

Stimulate person-centred care

Stimulate cooperation and networking between hospitals and with other healthcare providers

Concentration of expertise and restricting the high-tech care supply

Expenditure should match the current financial context and achieve a health-economic justifiable offer.

Execution: At the moment the hospital networks are developing their RSPC based on the models that are provided to them. This is an intensive process in which the result must also be coordinated with other partners in the region. The RSPC will be evaluated by a committee consisting of representatives of hospitals, primary care and academics.

Results: Based on the first plans sumitted, we see that the hospital networks will tailor their offer to the needs of the population and that they consult with other care partners in the region. It encourages hospitals to think about their future role and how it is fulfilled. The doctors are also involved to develop a long-term vision.

On average, acute beds will be reduced by about 7%.

Lessons learned: It is important to provide hospitals with a framework on which to base themselves to tailor their future offerings to the needs of the population and to encourage them to think about this.

The division of powers between the federal government and the regions makes it difficult for hospitals to make choices.

Next steps: Evaluate the current framework to see if improvements can be made and the model can be updated. Certainly in terms of the involvement of other care partners, additional incentives must be given.