bluuebunny/crossref_metadata_2025 huggingface dataset:
Dementia Meeting Centres: People Affected by Dementia Take the Lead
Authors: Galloway Graham , Evans Shirley , Coleman Ronald
Published: January 2024

Meeting Centres (MC) are a flexible, hyper-local model for dementia post-diagnostic support, which create engaging, enabling, and empowering spaces for families affected by dementia.

MCs offer ongoing warm and friendly expert assistance, including peer support, for people and families affected by dementia. The model originated in the Netherlands, led by Professor Rose-Marie Dröes at the Amsterdam University Medical Centers. Meeting Centres UK was established in 2018 and led by the Association for Dementia Studies (ADS), University of Worcester. In 2019 Kirrie Connections set up the first Scottish MC.

Prior to the COVID-19 pandemic, there were 13 MCs in the UK. Despite the pandemic, there are now 32 funded MCs in England and Wales and 14 in Scotland with the likelihood of another 10 being funded before the end of 2023.

Significant national and regional developments have taken place over the last three years. This has been driven by different policy decisions and funding opportunities across the three nations and has involved a variety of partnership working between academic, local authority, third sector, government and lived experience partners. The Scottish Government is supporting the development of a national MC network because of the recognition that capacity can be built, best practice shared, and communities empowered. In addition, the involvement of people affected by dementia is of paramount importance. In Scotland, this is being driven forward with a strategy board made up of a third people living with dementia, a third family carers and a third dementia professionals. This is being replicated in the new UK National MC Consortium.

In the presentation, the different contexts and approaches to MCs will be described and compared. The audience will gain an understanding of the flexibility of the MC model in meeting the needs of people affected by dementia in different communities; the MC grassroots community development approach; and the impact of the involvement of people affected by dementia in the meaningful ongoing coproduction of MCs.

Brooker, D., Evans, S., Dröes, R. M., (2016), Framing outcomes of post-diagnostic psychosocial interventions in dementia: The Adaptation-Coping Model and Adjusting to Change. Working with Older People. Vol 21: Issue 1 

Evans, S., Bray, J. and Brooker, D. (2021), ""How Meeting Centres continue to support people affected by dementia: report on UK COVID-19 impact"", Working with Older People, Vol. 25 No. 4, pp. 283-293. https://doi.org/10.1108/WWOP-12-2020-0060

Evans, S., Bray, J., Brooker, D. and Stephens, N. (2022), ""The essential features of Meeting Centres: development of the UK criteria for community support for people affected by dementia"", Working with Older People, Vol. ahead-of-print No. ahead-of-print. https://doi.org/10.1108/WWOP-03-2022-0009
Development of the Centering-Based Group Care Adaptation Framework, a supporting tool when implementing Centering-Based Group Care
Authors: Van Damme Astrid , Beeckman Katrien , Talrich Florence
Published: January 2024

Background: Centering-Based Group Care (CBGC) is an alternative way of delivering antenatal and/or postnatal care, and includes three core components: (1) health assessment, (2) interactive learning, and (3) community building. Despite the increasing interest in CBGC worldwide, implementation can be challenging and adaptations are required for sustainable implementation while maintaining the core components. Examples of site-specific adaptations for implementation are documented but are scattered and a hands-on tool for practice has not been created. This study aims to develop a CBGC adaptation framework that supports sustainable implementation within and across different contexts.

Methods: We conducted a context-analysis using a Rapid Qualitative Inquiry (RQI) approach in 26 sites in seven participating countries (Belgium, Ghana, Kosovo, South Africa, Suriname, The Netherlands, and United Kingdom) during the pre-implementation phase. We conducted 335 semi-structured interviews with service users (n=150) and with key stakeholders such as politicians, health care managers, health care providers, religious leaders (n=185). 10 focus group discussions with service users and 56 review meetings with the local research teams were included. In addition, national guidelines and documents were analysed for their CBGC-relevant content. RQI included data triangulation and investigator triangulation. We incorporated data from the RQI into the iteratively evolving adaptation framework and systematically discussed preliminary versions with country-specific research teams. Insights and feedback from these teams were incorporated to create the final version of the CBGC adaptation framework. 

Results: We identified six universal surface adaptations categories (content, materials, timing, location, group composition, facilitators), and five universal deep structure adaptations categories (self-assessment/medical check-up, scheduling CBGC into regular care, enrolment, (possible) partner organisations, financials). The CBGC Adaptation Framework provides an overview of the site’s adaptation needs, expected barriers and facilitators, and encourages the development of an action plan to apply these adaptations in practice.

Conclusion: The Adaptation Framework is a useful tool to identify surface and deep structure adaptation categories. In this way, it serves as a useful tool to provide the necessary support during the complex implementation of CBGC. Completing the framework raises awareness of multiple levels of adaptations that must be considered if sustainable implementation of CBGC is to be achieved.
Once upon a time homelessness: a comparative case study of two initiatives of multilevel intersectoral governance in Quebec
Authors: Maillet Lara , Neff Maïa , Goudet Anna , Godbout Isabelle , Fotso Aurelle Carole Jouego , Jacques Marie-Claude , Touati Nassera , Blain Samuel , Hyppolite Shelley-Rose , Landry Marjolaine
Published: January 2024

This communication focus on an analysis of the contextual factors that facilitate or constrain collaborative processes in intersectoral multilevel governance. How is this collaboration built? What are the brakes and the levers for?

To answer these questions, we will rely on comparative research conducted between 2019 and 2021 of two initiatives in two regions of Quebec (Canada): a local care team set up in 2013 and a day-center opened in 2021. This case study between two initiatives invites us to take a look at distinct and local systems, both based on collaboration between health and social services, institutional and community services in the homelessness. To carry out this research, we conducted 18 semi-directed interviews and 85 hours of participant observations.

Within this communication, we will compare the intersectoral collaboration of the two initiatives by the initial conditions driven the emergence, the characteristics of the organization (internal complexity), and the characteristics of the environments (external complexity) to the organization. Finally, and directly related to these initial conditions of implementation and the context, governance structures and collaboration processes (formal and informal) will be analyzed to understand the current modalities and forms of collaboration within the team (Bryson, Crosby and Stone framework). In this way, we will therefore present the articulation between clinical, strategic and tactical levels that allows (or not) organized governance.

This communication is part of an extensive research program since December 2016 to develop a systemic understanding of integrated collaborative processes and local intersectoral initiatives with people experiencing homelessness.
Core Governance Competencies for Successful Operational Leadership: Implications for Integrating Care for Older People
Authors: Burke Eileen
Published: January 2024

Rationale: Although, there has been significant academic focus on organisational leadership development, limited attention given to the pragmatic application of governance competencies to support sustainable quality healthcare within an ever-evolving governance framework.

Context: The current restructuring, of the Irish community healthcare system, lacks clear strategic direction, operational engagement, and collective commitment, from clinical and operational managers. This suggests an opportunity to consider pragmatic strategic leadership development opportunities with a priority focus on governance.  Although, governance structures have been established in some integrated care areas for older people areas e.g., integrated discharge planning structures, broader more inclusive processes are required to build on existing informal professional and managerial networks, to fulfil the required core functions.

Aims: The study aimed to identify a governance competence framework to support operational-based governance leadership of integrated care for older persons (ICPOP) in Dublin South Kildare West Wicklow Community Healthcare area (DSKWW-CH). It also aimed to generate practical pathways to accelerate the adoption of a governance competence framework, relating to operational leadership that can be utilised to navigate the evolving integrated care funding and legislative environment.

Methodology: Two data collection tools were utilised: an online survey of individuals employed as operational leaders (n=30) of an integrated care team for older person countrywide and a focus group with senior managers within older person services (n=15), with either local or national engagement with integrated care work. A mixed methodology approach adopted utilising both qualitative and quantitative processes, including a comparative analysis of the survey and focus group findings. This provided rich descriptive context based on a pragmatic paradigm, underpinning the validity of the governance competence framework applied as locally applicable.

Results: The sampled population evidenced knowledge-based competence, self-awareness of competence gaps, and transformational leadership behaviours aligned with the proposed governance competence framework. Five key themes emerged: 1. the importance of a clear strategic intent; 2. governance competence gap analysis to underpin team development activities; 3. structure redesign to reduce organisational barriers and challenges; 4. establishment of a safe accountability working culture and;  4. the use of systems for performance evaluation.

Conclusion: The adoption of the proposed six-factor governance competency framework can successfully support operational leadership of an integrated care teams for older persons. This framework promotes self-awareness of competence gaps and the application of transformation leadership behaviours.
Hospital transformation into regional health care
Authors: Hildebrandt Helmut
Published: January 2024

Hospitals in Germany are under enormous pressure. Legal reforms and shortages of nurses and doctors are forcing hospitals to review inpatient services to assess whether they can be provided on an outpatient basis. Legislation is now promoting such transformation processes through changes in hospital planning and financ-ing. Hospitals, thus, have become attractive partners and designers of regional integrated care solutions.

OptiMedis is currently supporting various hospitals in the planning and conceptualization of regional, inte-grated health care with more centralized inpatient services and increased outpatient care options Smaller hospitals, which are no longer needed for inpatient care after the centralization of inpatient services, can be transitioned towards regional outpatient care. Here, outpatient practices, rehabilitative facilities, therapists, CHN, social workers, case and care managers, among others, can then work together intersectorally under one roof. There are already some concepts and German words describing this: Intersectoral Health Center, Primary Care Center, and Extended Outpatient Care. It is important to determine what needs exist in each region.

This presentation will describe the different concepts pertaining to the transformation of smaller hospitals into regional outpatient intersectoral health care centers and discuss the implications for further development of integrated healthcare in Germany.
Workforce Capacity Building: Strategies for Interprofessional Education in Integrated Care
Authors: Bookey-Bassett Sue , Espin Sherry
Published: January 2024

Introduction: Integrated health services are recommended as an approach to manage and deliver person-centred care across different sectors throughout a person's lifespan (WHO, 2015). Training future and current health care professionals to work in integrated care systems requires additional knowledge, skills, and competencies. Interprofessional education (IPE) is recommended as a critical strategy in preparing the healthcare workforce for more integrated service delivery models (Bookey-Bassett et al., 2022). However, it is unclear what strategies are being used to implement IPE to support the development of the current workforce for integrated care, in Ontario hospital to home programs. 

Methods: This study explored the perceptions and experiences of key informants regarding how IPE is utilized in training current healthcare professionals to work in hospital to home integrated care programs in Ontario, Canada. A qualitative descriptive design was utilized. Key informants included 15 leaders from 13 integrated care programs representing varied healthcare settings across the province. Individual interviews were conducted, audio-recorded, and transcribed. Data analysis followed a thematic analysis approach (Braun & Clarke, 2006). Findings were elucidated through the lens of the interprofessional learning continuum model (Institute of Medicine, 2015) and current competencies for integrated care (Langins and Borgermans, 2015).

Key Findings: Thematic analysis revealed key themes reflecting participants’ understanding and experiences of IPE within their specific hospital to home integrated care programs; participants’ perceptions of informal and formal strategies to implement IPE within integrated care programs; current barriers and facilitators to implementing IPE in hospital to home integrated care programs; and recommendations for interprofessional and intersectoral collaboration to support workforce capacity and capability related to clinical and professional integration.

Conclusions: As new models of hospital to home integrated care are rolled out, IPE should be incorporated as part of the implementation process. Further, IPE should be context specific and adapted to meet the changing needs of patient populations, changing roles of health care providers, and integrated care frameworks.

Implications and next steps: Study findings provide important implications for health professions’ education including formal and informal continuing education. Findings are also relevant for leaders implementing integrated care programs across various practice settings. Next steps include consultation with practice partners and patient partners to co-design and pilot test an IPE intervention within a hospital to home integrated care program for surgical patients.
Demonstrating Integrated SDoH Impact in Behavioral Health
Authors: Roberts Kenneth , Freedland Tanya
Published: January 2024

Living environment is a proven social determinant of health and a key factor in substance use recovery. Recovery housing is often recommended for people seeking intensive outpatient treatment for substance use disorder and has frequently been combined with outpatient treatment by the treatment provider in a format termed “outpatient with lodging”. However, little research has been conducted into a community-based approach to integrating intensive outpatient treatment and independently operated recovery residences. The Center for Practice Transformation (CPT) at the University of Minnesota partnered with one of Minnesota’s largest non-profit substance use treatment providers to investigate the association between living in recovery residences while attending intensive outpatient treatment. This session will detail results indicating that integrating recovery residences and intensive outpatient programming is associated with improved recovery outcomes
The Teleton Integrated Care Approach to Deliver Rehabilitation Services and Promoting Inclusion for Children and Teenagers with Motor Disabilities in Chile - Implementation and lessons learned.
Authors: Saavedra Cristian
Published: January 2024

People with disabilities face significant barriers in order to get proper access to health care. According to the World Health Organization, they are three times more likely to be denied health care, four times more likely to be treated badly in the healthcare system and 50% more likely to suffer catastrophic health expenditure.

In Chile, 5,8% of the children and teenagers have some form of disability. Motor disabilities are one of the most prevalent in this age group.

Teleton is a non-profit network of 14 healthcare institutes providing rehabilitation care to 93,5% of children and teenagers with motor disabilities in Chile.

Conditions treated by Teleton include Cerebral Palsy, amputations, central nervous system diseases, neuromuscular diseases and other congenital or acquired diseases leading to a motor impairment.

Established in 1979 and mostly financed through a yearly national fundraising campaign, over the last 10 years Teleton has faced difficulties to provide adequate coverage and continuity of care to their patients.

As a response to these challenges, in 2015 Teleton developed an integrated multidisciplinary model of care including interventions from several specialties such as: physiatry, orthopedics, nursing, physiotherapy, occupational therapy, psychology, education, social work, art therapy, phono audiology and adapted sports therapy. The model follows the principles of the McColl Chronic Model of care.

As a core element, the model establishes the creation of specialized multidisciplinary teams of professionals taking care of a specific population from a diagnostic group. This feature allows the workforce to gain expertise and enhance coordination, thus improving the quality of care.

Similarly, the model allow patients to be treated by the same professionals who know their clinic history facilitating the delivery of care and patient satisfaction.

The aim of this paper is to explain the key components of this model including clinical processes, organization of delivery of care, clinical metrics, team coordination practices, and to present main results in terms of health coverage, health quality, administrative performance, governance and impact on patient functionality.
Using Population Segmentation to Identify Opportunities for Integrated Care in Ontario, Canada.
Authors: Wodchis Walter , Hall Ruth , Mondor Luke , Bai Yu-Qing (Chris)
Published: January 2024

Ontario, Canada has introduced Ontario Health Teams (OHTs) to advance integrated care and population health management. There are currently 54 OHTs covering a population of nearly 14 Million individuals. The teams are expected to plan and implement new care models that improve quadruple aim goals of patient and provider experience, health outcomes and cost efficiency. The Health System Performance Network (HSPN) is funded by the Ontario Ministry of Health to provide evaluation and research to support OHTs. The HSPN is using population segmentation alongside performance measurement to support OHTs to identify populations for improvement. OHTs are using the data provided by HSPN to target opportunities for improvement. This presentation summarizes the performance measures and population segmentation approach used in Ontario to advance integrated care and population health.

HSPN is using the British Columbia Health System Matrix (BCHSM), based on the Bridges to Health model to segment the population for each OHT. HSPN has identified 10 overall indicators of performance for OHTs ranging from premature mortality to continuity of physician care. There are also 5 measures respectively in several specific populations including older adults, mental health, and end of life. Indicators are also examined according to socioeconomic strata. This presentation will overview the population segmentation methodology, the ways that performance indicators vary according to population segments, and the ways that OHTs receive the data and are coached in the use of data to target and advance integrated care initiatives.

The BCHSM provides 14 different population segments ranging from non-users to low-users to frail older adults in the community to people at the end of life. Increasing frailty and clinical complexity is strongly related to the population segments/groups and premature mortality and total system costs correspond as well to increasing patient complexity. The BCHSM has high face-validity. Improvement indicators for mental health and health system priorities such as emergency presentations for mental health reasons and delayed discharge from acute hospital are also more common in specific population groups which helps to prioritize and target interventions. These data are supporting the development of specific integrated care programs to address health needs in underserved populations.
What knowledge and skills do community volunteers need to signpost palliative care needs to professionals? A qualitative study
Authors: Van Steenbergen Sabet , Vanderstichelen Steven , Statema Else Given , Deliens Luc , Dury Sarah , Chambaere Kenneth
Published: January 2024

Background: Volunteers often notice palliative care (PC) needs that healthcare professionals (HCP) and family caregivers miss, potentially playing an important signposting role. It is unknown what particular knowledge and skills are lacking and required to optimally fulfil this role in community homecare.

Aims: To explore the desired and required knowledge and skills for volunteers to recognize, describe and communicate PC needs to HCPs.

Methods: A qualitative study design with 7 focus groups (15 community volunteers, 20 HCP’s) and 10 in-depth interviews (6 community residents with PC needs, 4 informal caregivers).

Results: We identified 5 themes in our data: (1) the organization of community-based volunteer work, (2) the volunteer, (3) the resident with PC needs, (4) the volunteer – community resident relationship, and (5) communication/sharing of information with HCPs. Knowledge about types of PC needs and about community resources were considered important. Examples of required skills are: willingness to listen, being present, responding empathically, being able to relate to the person they visit, balancing personal distance and proximity, starting and maintaining non-threatening conversations, and building a relationship of trust with the resident. Insight into missing skills and knowledge was obtained by discussed experienced difficulties with regard to learning from other volunteers, finding the right information to help residents, exploring care signals with the resident and making their presence known and contributing to professionals.

Conclusion: In order to fulfill their signposting role, it is important that volunteers have knowledge about PC needs and community resources. Ideally, they have good relational skills, communication skills, observation skills and skills that enable them to provide practical help. Volunteers should make their presence and role known to professionals and find out what they can mean for each other.

Funding: Flemish Cancer Fund
Integrated care models for older adults with depression and physical multimorbidity: a scoping review
Authors: Tops Laura , Beerten Simon Gabriël , Vandenbulcke Mathieu , Vermandere Mieke , Deschodt Mieke
Published: January 2024

Objective: Multimorbidity, the coexistence of multiple chronic conditions occurring in one person at the same time, where one is not a known complication of the other, is a growing challenge in the care for older people with mental illness. In order to address both physical and mental illnesses in older people, integrated care management is required. The purpose of this scoping review was to provide a comprehensive overview of integrated care models for older adults (60+) with depression and physical multimorbidity. We identified the core components of the examined integrated care models and mapped the reported outcomes and implementation strategies.

Methods and analysis: We followed the methodology of Arksey and O’Malley’s.  MEDLINE, EMBASE, CINAHL and Cochrane Library were searched independently by two reviewers from inception to May 2022. Studies composed in English or Dutch concerning integrated care interventions for older adults with major depression and physical multimorbidity were included. We used the micro-level SELFIE framework to map the core concepts of integrated care models. Outcomes were divided in person-centered and service themes.

Results: After title and abstract and subsequent full-text screening, 38 studies were included describing 13 different care models. The majority (n=21) were randomized controlled trials, followed by observational studies (n=6), study protocols (n=5), qualitative studies (n=4), and feasibility studies (n=2). Studies were conducted in the North-America (n=28), Europe (n=6), Asia (n=3) and Australia (n=1). In all care models, a multidisciplinary team with a care coordinator was involved. Also treatment interaction, continuity of care, individualized care planning, tailored holistic assessment and self-management support were elements of all care models. Informal care giver involvement and shared decision making were less often described as core elements. Discrepancy was detected in the information systems and technology that different care models used. Only seven care models reported on financial aspects of the intervention, e.g. the reimbursement on participation or the provision of financial incentives.

A total of 32 different outcomes were evaluated in the primary studies. Patient outcomes, e.g. functional status and depression symptoms, are well described by all care models. In contrast, little attention is paid to service outcomes such as emergency department visits or therapy attendance. Only two studies briefly described the implementation strategies used in the study.

Conclusion: The core elements that comprise integrated care models are diverse. Future studies should focus more on implementation aspects of the intervention and describe financial parts, e.g. the cost of the intervention for the healthcare user, more transparently.

Key words: Collaborative care, integrated care, psychosomatic medicine, geriatric psychiatry, care models
Opportunities and Barriers to Embedding Community Development Approaches in Local Systems
Authors: Walters Elizabeth , Harden Angela , Findlay Gail , Curtis-Tyler Katherine
Published: January 2024

Background: Community development is a multi-faceted process which generates individual and community empowerment and can contribute towards reducing health inequalities, particularly in marginalised communities. Community development approaches refer to interventions, frameworks and programmes which work with communities to help them to identify their collective needs and challenges, and mobilises them to utilise available assets to generate long term change within the community. Funding for community development is typically provided on a short term ‘one off’ basis which limits its potential benefits. Continued investment, so that community development becomes normalised, is needed. Embedding community development within local systems, such as primary health care, local authorities and housing associations, is one way to achieve continued investment and to maximise benefits. However, there is little research on how to embed community development approaches within such systems. The research presented is part of a PhD project which aims to address this research gap. 

Methods: Semi-structured interviews with Key Informants, who have experience embedding community development approaches within systems, are currently being conducted and shall be completed in December 2022. Participants are being recruited through purposive sampling. The interview topic guides were reviewed by a Public and Patient Involvement (PPI) panel in June 2021 and were developed around the Consolidated Framework for Implementation Research (CFIR). Data analysis is being undertaken also using the five domains of the CFIR (intervention characteristics, outer setting, inner setting, individual characteristics and intervention processes) in NVivo.

Results: Preliminary results have shown that all five domains of the CFIR impact the embedding process. Funding is frequently described as a barrier to implementation, but some participants believe that funding is incorrectly identified as a barrier, with only limited funds needed to embed this way of working. It is frequently mentioned that a strong belief in the purpose of the project and key individuals driving systemic change within the organisation are key to long term implementation. Other current emerging themes include the significance of the political setting at both a local and national level, as well as a multidisciplinary and inter-sectoral approach being adopted being a facilitator to change.

Future Implications: The results of this research will be collated with other parts of the PhD research project on embedding community development approaches in systems to improve health and reduce inequalities, to generate guidelines on how systems can embed community development approaches into their way of working. A panel of community members will contribute towards the generation of these guidelines, which will be made available to any local system considering adopting a community development approach.
Still struggling with the governance of interprofessional elderly care in mandated collaboratives: a qualitative study
Authors: Chrifou Rabab , Braspenning Jozé , Grit Kor , Stalenhoef Hanna
Published: January 2024

Background: Governing interprofessional elderly care requires the commitment of many different organisations connected in mandated collaboratives. Research over a decade ago showed that the governance relied on clan-based mechanisms, while lacking formal rules and incentives for collaborations. Awareness and reflection were seen as first steps towards progression. We aim to re-identify critical governance features of contemporary mandated collaboratives by discussing cases introduced by the healthcare professionals and managers themselves.

Methods: Qualitative research took place from November 2019 to November 2020 in the Netherlands. First, the general setting of integrated elderly care was explored by interviewing healthcare managers and professionals (n=6). Second, in-depth interviews (n=24) were conducted with two different regional mandated collaboratives to learn more about critical governance features. The interviews were thematically analysed by the project team (authors) to synthesise the results and then were validated during a focus group.

Results: Little progress has been made in the governance of mandated collaboratives. The degree of formalization is kept low and the guiding principles of governance are trust and leadership. This approach meant that little attention is paid to the negotiation of interests, which makes it more difficult to implement the innovations in a sustainable manner. Moreover, the necessary resources are often lacking for the desired innovations. The fact that the mandated collaboratives are to a limited extent linked to the political or system level makes longer-term decisions and structural financing more difficult.

Conclusions: Although the reported cases are Dutch, the international scientific discussion is in line with our empirical results and is probably not limited to elderly care. Mandated collaboratives emerge to govern interprofessional elderly care, but after more than 10 years of international experience the mandated collaboratives still struggle to strike the right balance between formalization, trust and leadership. This makes it difficult to find available resources and to realize three-fold connectivity (care, organisation and system level). A more fundamental debate about our governance expectations of mandated collaboratives is needed to make focused progress.
Elderly Abuse: the importance of a scientific and a participatory approach
Authors: Messelis Els , Vanoutrive Dieter
Published: January 2024

Introduction: The world population of older adults, aged 60 and older, will double from 542 million in 1995 to 1.2 billion in 2025. Despite the fact that many of them are in good health, more and more people will face dementia, multiple problems and elder abuse (WHO, 2021).

In this abstract, we will concentrate on elder abuse, which is a complex and multifactorial problem but moreover a taboo subject which needs more community awareness.

Purpose: Human rights and people’s health of older adults are being violated and this needs to be addressed on a massive scale. Efforts have already been done in developing scientific insights concerning early diagnosis, risk and protective factors as well as evidence-based interventions.

The problem is that professionals and organizations in our country often work above, under or next to each other on the subject. Moreover, the voices of older adults are neglected. Therefore we are making a call to cooperate in a participatory way. Integrated care will be the future to prevent elder abuse and to cope with it. We can’t do it alone.

Methods: In 2022 we could raise awareness through public involvement as both were invited in two programs on the Belgian Television:

Canvas TV Documentary ‘Als je eens wist’ – series 3 – Canvas (made by Hilde Van Mieghem) – May 10th 2022: Rating: 189.158.

Canvas Contact Webinar ‘Hoe doorbreek je het taboe van ouderenmis(be)handeling’ (Interviewer Joris Hessels) - May 16th 2022: Rating: >100.

Results: In both programs we raised the importance of breaking the taboo, the need for professional cooperation and the importance to listen to the voices of older adults through storytelling. In the Webinar we also could come in discussion with the audience. So we could address the health demands.

Afterwards, co-design approach was set up by Odisee Advanced Education in cooperation with Vlaams Ondersteuningscentrum Ouderenmis(be)handeling (VLOCO), organizing an event called ‘Elderly Care is Safe Hands – The Power of Multidisciplinary Cooperation’ – 01st December 2022 – Brussels. Messelis e.a. will present an ‘Intervention Piramide on Elder Abuse’ to involve all kinds of professional organizations on different levels. Also a panel debate will be set up with different organizations and professionals.

Conclusions: Our insights teach us that a very long way has already been made in terms of attention to elder abuse. Despite the many new insights and impact analyses, the topic of elder abuse remains a taboo and underappreciated problem. Only the tip of the iceberg is ever revealed.

If we want to tackle the problem, we have to break the taboo and cooperate in a participatory way. Therefore we want to discuss with the international audience to learn other Evidence Based Practices. We also have a wake -up call for the legislator in order to create a clear legal framework. Governments can also do more to prevent and address elder abuse but also to support professional equipment’s and ‘antennas’. We never stand alone.
In what context does goal-oriented care thrive? A qualitative study investigating how contextual factors influence implementation efforts for goal-oriented care.
Authors: Anthierens Sibyl , Raeymaeckers Peter , Declercq Anja , Verté Emily
Published: January 2024

This study aims to explore how the concept of goal-oriented care is being picked up and adopted in Flanders, Belgium. Looking at the meso- and macro-level context: what drives the implementation process of goal-oriented care forward and what might hinder its uptake? This research helps individuals and organizations who want to introduce an innovation such as goal-oriented care inside their organization or in the broader primary care landscape by offering insights into an implementation process, in particular on how contextual elements influence implementation efforts.

We conducted qualitative research, performing in-depth interviews with n=23 respondents who are involved with the implementation of goal-oriented care within their professional function, either on project level or strategic/policy level. This way, we learned about the perspectives and lived experiences of a wide range of actors working for governmental institutions, non profit organizations, provider organizations, patient organizations, health or social care organizations and care councils. Data were collected using a semi-structured interview guide, audio recorded, and analyzed first inductively and then deductively using a categorization of constructs into structural, organizational, provider, patient, and innovation level factors, as described by Chaudoir et al. (2013).

Our preliminary findings suggest that facilitators for the implementation of goal-oriented care are mainly found on an organizational, provider and innovation level. Active commitment, overall recognition of goal-oriented care as quality of care and setting up a form of coordination are key. Most prominent barriers are found on a structural level, which shows that for goal-oriented care to be actually embedded in primary care the meso- and macro context structures and preconditions should be further shaped.

Our findings can contribute to further translate the concept of goal-oriented care into a practice-based intervention. It gives insight in how to perform a context scan for a primary care intervention and highlights the dynamics between contextual factors and implementation efforts. The next step is to define implementation strategies for goal-oriented care that come forward out of the identified barriers and facilitators.
Management of Patients with Hypertension at Family Medicine Practices at the Community Health Centre Ljubljana (Slovenia): A Protocol of a Cross-Sectional Study
Authors: Zavrnik Črt , Mihevc Matic , Virtič Tina , Lukančič Majda Mori , Ketiš Zalika Klemenc , Susič Antonija Poplas
Published: January 2024

Introduction: Hypertension is a major public health problem worldwide due to rapid urbanization, an aging population, and the global spread of unhealthy lifestyles. In 2011, model primary care practices were established in Slovenia to improve hypertension care at the primary level. Patients with hypertension undergo a standardized examination by a nurse practitioner every year. However, a proportion of patients with hypertension still do not meet the criteria for controlled disease. Therefore, there is an urgent need to identify the bottlenecks of current hypertension care in family medicine practices in Slovenia in order to improve it for the future.

Aim: The aim of this study is to develop a research protocol to evaluate the current management (both process and outcome) of patients with hypertension in family medicine practices in Community Health Centre Ljubljana (CHCL).

Methods: A cross-sectional study will be conducted. First, the list of patients with hypertension aged 30 years or older who were treated in primary care practices at CHCL in 2019 will be collected from the health information system. Individual clinical and demographic data will then be collected from clinical protocols of the same patient population. Descriptive statistics, logistic regression analysis, and linear regression analysis will then be performed to assess various aspects (parameters) of hypertension care.

Results: Data from a total of 15,186 patient visits will be analyzed. (1) The process of care will be assessed by the ratio of performed hypertension-specific visits, blood pressure measurement, screening for hypertension complications (nephropathy, peripheral arterial disease, and ECG signs of heart failure), and screening for hypertension comorbidities (hypercholesterolemia, type 2 diabetes, metabolic syndrome, and depression). (2) Treatment outcomes will be assessed by the ratio of blood pressure values, fasting glucose, LDL, and depression values in the target ranges. (3) The above variables will also be stratified by patient lifestyle factors (BMI, smoking status, physical activity, eating habits, and alcohol consumption), sociodemographic factors (age, gender, education, employment, and subjective assessment of financial status), treatment adherence assessment (regularity and correctness of medication intake, and dietary errors), and treatment motivation and empowerment assessment.

Conclusions: The proposed research protocol will provide evidence of bottlenecks in current hypertension care in family medicine practices in CHCL and identify potential opportunities for future expansion. It will also isolate the key (patient-related) determinants that lead to suboptimal management of the disease.
Network Table
Authors: Storms Roel
Published: January 2024

Network tables: Integrated care for people with severe psychiatric disorders.

Since 2010 there is the Psy107 initiative in Mental Health Care in Belgium. Aim is to downsize the number of people in Psychiatric Hospitals and to make a shift towards care in the community by organizing Networks of Mental Care and Circuits of Care.

The result of this shift is that people with severe psychiatric disorders are less hospitalized and for a shorter time. They stay longer in their natural environment. This means that first line professionals and mobile psychiatric teams are confronted with more complex situations and crises. Some show health care avoidance behaviour and are hard to reach.

This is where the “Network-tables” come in: on a monthly basis a ‘Network table’ is convened. A group of professionals from the general first line, the specialized second line and residential third line – all with affinity with mental disorders - come together for a multidisciplinary consultation.

A first line professional - who is confronted with a complex case or with health care avoidance behavior – can present his case to this ‘Network Table’. The partners round the table all have different specializations and the transdisciplinary approach, the look at the case from different perspectives helps to find solutions that wouldn’t have been found without this collaboration.

The aim of these Network Tables is to put the patient/client in the center and formulate some realistic goals. The ambition is to come to specific actions and make clear arrangements about who will be responsible for short term actions and for the continuity of care. It is also possible that the mobile healthcare professional visits the patient/client, for a few times, for making contact and exploring the problems.

The Network Tables started a year ago. The cases that are presented, come from different first line actors: social housing organization, social workers, jobcoaches… So far the Network tables managed to find solutions for all the cases.

All the participants were a bit surprised that working together can make such a big difference in finding solutions. Needless to say that these positive results are a powerful incentive to continue this new initiative.
Missed opportunities for integrated testing: An Evaluation of the implementation of TB and HIV EID Testing on the GeneXpert platform in Lesotho
Authors: Gwaza Gamuchirai , Leqheka Monkoe , Dittrich Sabine , Mots'oane Tsietso , Kao Kekeletso
Published: January 2024

Introduction: Integrated testing of TB and HIV can improve health outcomes and save costs. The GeneXpert (GX) instrument, a multi-disease testing platform, can allow for simultaneous HIV and TB testing. However, utilization of the platform for integrated testing remains suboptimal, and there are operational barriers to implementing integrated TB and HIV testing.

Methods: We evaluated the implementation of TB and HIV testing on the GX instrument for early infant detection (EID) of HIV and tuberculosis (TB) testing in thirteen health facilities in Lesotho. The data collection process used a survey questionnaire, semi-structured interviews, and a review of records at each health facility. Data was collected for the period 2017 and 2019.

Results: All thirteen health facilities had at least one GX instrument for TB or EID testing. In 2017, the average utilization rate for the GX instrument for TB and EID testing was 63% and 24%, while in 2019, the average utilization rate was 61% for TB testing and 27% for EID. However, none of the health facilities included testing for TB and HIV on the same GX instrument simultaneously. In general, utilization rates were sufficiently low that all the HIV and TB tests undertaken in 2017 and 2019 could have been performed using only the instruments currently dedicated to TB testing. All except for three sites (Scott, Motebang and Maluti) where the testing rates were high. 

Conclusion and Policy Implications: Much progress has been made in integrating TB and HIV activities in Africa. However, there is a missed opportunity for the integration of testing for TB and HIV on the GX instrument, which could save costs.

This evaluation highlights areas that need more focus and more detailed diagnostic network optimization exercises to improve service delivery and allocate stocks, staff, equipment, and training. Better coordination of donor support or increased flexibility in reporting of use will be important to maximize the use of resources, where integration may be more effective than purchasing new equipment. Monitoring and evaluation should be a routine part of the implementation and should be budgeted and demanded by policymakers and donors. Health facilities may require additional resources and technical support to improve data collection, analysis, and dissemination.

In conclusion, areas highlighted in this evaluation merit further exploration, such as the need to understand integrated testing models, including what works, why, and for which target groups. This will allow for effective targeted interventions to improve testing coverage across several diseases especially taking advantage of the multi-disease testing platforms.
30 by 2030 campaign
Authors: Farje Fiorella , De Sá e Silva Bianca
Published: January 2024

Primary Health Care (PHC) is a cornerstone of universal health coverage (UHC). To prevent diseases and holistically treat people, community-based primary healthcare systems need to be strengthened. PHC is an approach that aims to address physical, mental, and social health and well-being, and to provide comprehensive care for a person's health needs throughout life rather than focus on treating a specific set of diseases. To achieve this approach, we must strengthen horizontal PHC systems and encourage vertical programmes, including disease-specific programmes, to be developed, integrated, and implemented in the context of integrated Primary Health Care.

In early 2020 the WHO Collaborating Centre on Family Medicine and Primary Health Care launched the 30by2030 campaign (https://www.30by2030.net), whereby signatories are asking donors of vertical disease-oriented projects to invest at least 30% of their budgets for vertical programs in strengthening coordinated and integrated primary health care. The initiative is a pull of efforts of different organizations such as Wonca: World Organisation of Family Doctors, The Network: Towards Unity for Health (TUFH), African Forum for Primary Health Care, European Forum for Primary Care, PRIMAFAMED network, among others.

The 30 by 2030 has two aims: the first one is to inform and raise awareness of the impact of vertical programs on health systems. Most of the private and external funds, which represent one-third of the total spending of PHC, are channelled through programmes that focus on the health problems of specific population subgroups (e.g., HIV, tuberculosis, malaria) which also leads to inequity by disease. The second aim is to call for international donors to assign 30% of their vertical top-down, disease-oriented budgets to strengthen primary healthcare services through coordination, increased human resources and improved infrastructure.