bluuebunny/crossref_metadata_2025 huggingface dataset:
Leading cultural change in health care: practice-based evidence.
Authors: Raes Ruth
Published: January 2024

Background: Management literature provides bookshelves full of theory on how to lead change projects. Leading and facilitating change projects in such complex contexts as the implementation of integrated primary care zones or compassionate cities and communities however, asks for more than just a theory.

Objective: The workshop aims to present and discuss a hands-on model from a practice based evidence point of view. It is based upon and documented by the experiences and examples of both the change projects in Compassionate Bruges and Herzele and the transition project towards integrated care and the creation of primary healthcare zones in Flanders. The practice evidence is substantiated by a literature review of very different domains, amongst which that of implementation theory.

We start by presenting the frameworks, values and beliefs the facilitators/project teams used to start these projects and share the observations of where they stayed upright or rather failed. We discuss our observations on the causes of these results as well as the alternative strategies we developed to cope with the obstacles we encountered.

We than present a first framework in which we try to capture the key elements of leading change in complex systems and the levers for handling the interdependence between those elements. We invite participants to check their own experiences against ours and each other’s. This will happen in smaller discussion groups. By thoroughly debating experiences, we evaluate to which extent our model is coherent and applicable in other healthcare change contexts. We conclude with a plenary exchange and wrap-up.

Learning outcome: At the end of the workshop, participants will have obtained increased awareness of looking at change processes in health care from a complexity point of view; increased awareness of the underlying processes of cultural change; increased awareness of the key elements a leader/facilitator can steer upon to create the best possible context in which cultural change can take place; new inspiration through input of fellow participants on how to further implement the change process they themselves are in.
An integrated, stepped care organizational model for diagnostic evaluations along the care trajectory of children with a developmental disorder.
Authors: Cloet Eva , Leys Mark
Published: January 2024

Introduction: The field of multidisciplinary diagnostic evaluations for children with a developmental disorder in Flanders, Belgium, is heterogeneous and characterized by severe accessibility problems. However, children with a developmental disorder need timely and adequate diagnostics during their trajectory of care and support. This policy support research project develops an organizational model of integrated of care and networking adapted to diagnostic needs in different phases as well as the particularities of the Flemish institutional field. 

Methods: Homogeneous focus groups were performed with stakeholders from six types of governmental regulated organizations offering specialized diagnostic evaluations in Flanders (Centres for Developmental Disorders, Centres for Ambulatory Rehabilitation, Autism Reference Centres, Mental Healthcare Centres, Pupil Guidance Centres, and Ambulatory Services for Paediatric Psychiatry). A topic list was developed, based on a literature review on relevant themes. Qualitative data was categorized and iteratively compared per theme between focus groups by researcher and data triangulation. A member check validation was organized. 

Results: 59 experts participated in 6 focus groups. Because of poor participation, the focus group with stakeholders from paediatric psychiatry was cancelled. The focus groups learn that it currently lacks coordination of activities, there is no shared vision on the content and goals diagnostic evaluation, there is an unequal regional distribution of organizations. Interorganizational and interprofessional collaboration is restricted to referral, without integration of care. There is poor mutual trust in the quality of the diagnostic assessments between organizations. Mutual knowledge on activities and expertise, lacks. Regulations hamper interorganizational collaborations as well as different financing mechanisms between organizations. Current organization of the field focuses on organizations’ interests and do not take into account the specific children’s and context’s diagnostic needs during their trajectory.  

Conclusion: A patient-centred, integrated, stepped care, network model integrating general specialized and highly specialized knowledge and expertise (for different developmental disorders) across organizations borders in a well thought regional approach, is expected by all stakeholders to improve accessibility to specialized diagnostic evaluations adapted to the care trajectory of the child with a developmental disorder.
Effectiveness of contact tracing for COVID-19 in Belgium
Authors: Willem Lander , Kremer Cécile , Boone Jorden , Arrazola de Oñate Wouter , Hammami Naïma , Faes Christel , Hens Niel
Published: January 2024

Contact tracing and investigation can prevent infectious disease transmission when carried out promptly. Data obtained from contact tracing also provides unique information on transmission dynamics that can be useful for policy making. The proportion of secondary infections arising from index cases that were previously identified as a close contact, hence “known index cases”, has been indicated by ECDC as a key performance indicator for contact tracing. Few empirical studies have been  published on the effectiveness of contact tracing and investigation during the COVID-19 pandemic.

Using data from the Belgian COVID-19 contact tracing (Sept 2020 – Dec 2021), we investigated the impact of contact tracing on onward transmission. Known index cases were compared to those not previously identified as close contact. More specifically, we compared their traced contacts and secondary cases as well as the serial interval, representing the time from illness onset in the primary case to illness onset in the secondary case. In addition, we investigated contact and transmission characteristics by age.

Known index cases, previously informed about their exposure, were linked to fewer high-risk contacts and secondary infections. In addition, they presented a lower secondary attack rate compared to those not previously identified by contact investigation, suggesting behavioural changes. Also, a shorter serial interval was observed for known index cases. In addition to breaking transmission chains, contact tracing provides important information on  transmission characteristics. When exploring age-specific data, we observed increased transmission rates from children to adults during the circulation of Delta and Omicron variants without an increase in contact rates between these age groups.

The lower secondary attack rates for known index cases suggest that contact tracing in Belgium has been effective in reducing onward transmission. Their lower number of traced contacts and shorter serial interval are indicative that individuals aware of their exposure to SARS-CoV-2 were more reserved in their social contact behaviour. This reflects the mandatory quarantine for high-risk contacts. Our study also shows that in times of high burden on the healthcare system, key performance indicators of contact tracing should be interpreted with caution in light of changing intervention strategies. Many external factors influence the effectiveness of contact tracing like testing policy and compliance, the cooperation of index cases, and the imposed and adopted quarantine and isolation policies.
Assessed and self-perceived unmet needs for mental health care in the general population in Antwerp
Authors: Rens Eva , Van den Broeck Kris , Dom Geert , Remmen Roy , Michielsen Joris
Published: January 2024

Introduction: A public mental health care approach requires knowledge about which proportion of the population needs mental health care, and which people need it but don’t seek or receive it and why.

Who is it for? We investigated (unmet) needs for mental health care in the general population to optimize the distribution of mental health care services, which benefits all Antwerp citizens who need mental health care.

Involvement and engagement: Important stakeholders who were involved are the (Antwerp) psychiatric hospitals, who funded the research and were involved in the design of the study and interpretation of results. The involvement and engagement of (ex) patients in mental health care was limited, but a pilot test of the survey was conducted with this group.

Method: A representative sample was invited in 2021 to participate in a population survey about mental wellbeing and mental health care use in Antwerp. A total of 1208 individuals aged 15 – 80 years old participated. We investigated unmet needs for mental health care using a normative approach (assessed mental health problems) and subjective approach (self-perceived mental health problems)

Results: A total of 10.4% of the sample was defined as having a need for mental health care but only half of them used health care for their mental health, resulting in a population prevalence of 5.5% clinically assessed unmet mental health needs. Among all people who did not use mental health care, 12.1% perceived a mental health need (fully unmet), and 23.3% of mental health care users perceived the care as insufficient (partially unmet), leading to a total population prevalence of 14.0% perceived unmet needs. However, more women and younger people perceived unmet needs, while clinically assessed unmet needs were higher among men and older people.

Learning: Estimates of met and unmet mental health needs are complex given the diversity of operationalizations of different levels of need, and can only be established by a dialectic of individual and populational perspectives. Assessed and perceived (unmet) mental health needs are both relevant and complementary but are related to different factors. Nonetheless, a general conclusion is that the prevalence of unmet mental health needs is high. Some vulnerable groups should be targeted for detection of mental health problems and interventions, for example through outreaching care.

Next steps: Further research should explore how assessed and perceived needs interact, and how this is predictive of help seeking and mental health outcomes.
Bringing stakeholders on board in the development of integrated care through the Theory of Change approach
Authors: Kadi Selma , Ondas Karin
Published: January 2024

Similar to other fields, research and implementation in the field of long-term care (LTC) provision in the community increasingly focuses on taking on participative approaches to improve the quality of LTC. However, levels of participation differ vastly in terms of needed resources, aims and opportunities - ranging from informing experts by experience to co-design and involvement in action research. Our presentation is targeted at providers, policy makers and researchers who aim for engaging diverse stakeholders in the development of LTC in the community. We will present how InCARE included a wide range of stakeholders, including experts by experience, in developing three pilot projects aiming at improving LTC for older people in Spain, North Macedonia and Austria. We will focus on how we used the Theory of Change (ToC) approach and subsequent stakeholder workshops in the Austrian pilot project context. This participation process started in 2021 and aimed at informing and engaging stakeholders in the field of LTC in the province of Styria. Two consecutive participatory Theory of Change workshops prior to the project implementation phase both contributed to the quality of the pilot project by adapting it to the local context, and also heightened interest locally and regionally. Subsequent stakeholder workshops tackled issues raised in the ToC workshops, such as financing of LTC provision and relief options for informal carers. Starting the project during a time of thorough Covid-19 restrictions, the ToC workshops had to be conducted online. For various reasons, we decided to use online formats also for subsequent stakeholder workshops in the year 2022. We will present the advantages and challenges of using Theory of Change for stakeholder engagement, including the structuring of the process, the adaptation to the local context, how to heighten a sense of ownership, and what resources are needed. We will also highlight the advantages and disadvantages of online formats, including possibilities for a less-hierarchical communication. Taking the implementation of the local pilot project as an example, we will also link our experience to questions of participation, representation by proxy, self-representation and political representation.
Down to the bone: a pilot study into the effectiveness of 3D versus 2D learning in anatomy education.
Authors: Maldoy Marjan , Vandenbossche Vicky , Audenaert Emmanuel , Van Daal Tine , Uyttebroek Leen
Published: January 2024

Possessing excellent anatomical knowledge is crucial for every health care trainee, including medical and physiotherapy students. Hands-on sessions in the dissection class form the cornerstone of anatomy education. Recent years increasing student numbers and decreased availability of time within the anatomy dissection room, forces the development of alternative teaching methods to use the dissection class as efficiently as possible. Most alternatives include video recordings and books (2D), but also 3D high-fidelity models (3D-HFM). These are anatomically accurate, morphable and dynamic 3D models that result from scanning cadaveric specimens. It is assumed that 3D-HFM have some learning benefits over 2D-models. Development of 3D-HFM is a cost- and time-consuming task and the effect of 3D learning into anatomy education needs to be further evaluated before it can be properly integrated into the program. Therefore, a pilot study is set-up to investigate the learning effect of manipulable 3D-HFM.

The pilot study focuses on the effect of using static 2D atlas-type models (2D-ATM) versus manipulable 3D-HFM on learning processes and outcomes when studying and preparing for hands-on osteology of the skull in first-year physical therapy students. 10 students will be randomly assigned into 2 groups (n=5). Students will be invited one-by-one to the Antwerp Social Lab. After having measured their prior anatomy knowledge and spatial ability, students will watch a knowledge clip explaining the basics of the skull. Then, depending on the condition, students are given either static 2D-ATM or manipulable 3D-HFM to study (as if for an exam) the osteology. While learning, students’ eye movements and electroencephalography (EEG) are collected to capture students’ cognitive load. Log data of their actual manipulation of the 2D-ATM or 3D-HFM is collected as well. When finished, students are given a post-test that maps their anatomical knowledge about the osteology of the skull using (1) nominal questions on pictures and x-rays, and (2) more complex questions capturing students’ insight. Finally, a practical test on a physical skull bone is administered that requires students to recognize certain structures and underlying relationships.

 

This pilot will form the basis of a broader research into innovation in anatomy education. Further research is needed to investigate to what extent online 3D-HFM are appropriate to improve the learning process and outcome compared to 2D-ATM. These studies should also examine the effect of 3D-HFM can compensate for the decreased time spent in the dissection room.
National survey evaluating patient and organisational characteristics of short-term residential care facilities in the Netherlands.
Authors: Van Den Besselaar Judith , Arntzen Rebekka , MacNeil-Vroomen Janet , Hertogh Cees , Buurman Bianca
Published: January 2024

Background: Short-term residential Care (STRC) is a recent, bed-based care concept for older adults aimed to avoid nursing home admission in the Netherlands.

Objective: To describe characteristics of patients admitted to STRC and the main organizational differences between facilities.

Methods: Patient characteristics were identified using a national STRC database (2018 and 2019). Organizational comparisons of STRC facilities were collected through an cross-sectional email survey sent to all facilities.

Results: Of the 68,682 older adults admitted to STRC, patients were mostly female (35%), living alone (64%), with at least 10 medications prescribed (60%). Of the 36660 patients admitted in 2018, 43.4% died within 24 months and 25.5% is living in a nursing home. Of the 176 STRC facilities that responded, 30.1% delivered care at an independent ward, 27.3% was within a geriatric rehabilitation care ward, and 33.5% at a ward in long-term care. The median number of beds was 8, with a range from 1 to 40. Most facilities admitted patients in evenings, nights, or weekends. Almost all wards employed registered nurses and paramedics.

Conclusions: Patients admitted to STRC have multiple medical problems, suggested by the high number of medication, and often have palliative care needs. Facilities providing STRC differ by the location of the ward, the number of beds, and frequency of medical rounds and multidisciplinary consultations. There is a pressing need to develop standards for STRC to effectively deliver care.
Avoiding Hospital Admissions and Delayed Transfers of Care by Improved Access to Intermediate Care: A Simulation Study
Authors: Arntzen Rebekka , Van Den Besselaar Judith , Bekker Rene , Buurman Bianca , Van der Mei Rob
Published: January 2024

Objective: The current waiting times for intermediate care in the Netherlands prohibit timely access, leading to unwanted and costly hospital admissions. For the city of Amsterdam, we propose alternative policies for improvement of intermediate care and estimate the effects on the waiting times, hospitalization, and the number of patient replacements.

Design: Discrete Event Simulation (DES) study.

Participants: Data was used of older adults that received intermediate care in Amsterdam, The Netherlands, in 2019. For this target group, in- and outflows and patient characteristics of the intermediate care were identified.

Methods: A process map of the main pathways into and out of the intermediate care was. Non-public microdata of Statistics Netherlands was used to quantify the process map, after which a DES was performed.

Results: By means of a sensitivity analysis with the DES, we show that the waiting times are not a result of a lack in bed capacity, but are due to an inefficient triage and application process. Older adults have to wait a median of 1.8 days for admission, leading to hospitalization. If the application process becomes more efficient and evening and weekend admissions are allowed, we estimate that the number of unwanted hospital admissions can be reduced from ca. 51% to 3%.

Conclusion: This study shows that the bottleneck in a care system is not always solved by increasing bed capacity. A data-driven approach is essential to identify problems’ true causes and appropriate solutions, which results in strongly increased cost-effectiveness and patient satisfaction.
Establishing the aims, format and core standards of a frailty at the front door model of care: a mixed methods consensus study
Authors: O'Shaughnessy Íde , Harnett Patrick , Fitzgerald Christine , Ahern Emer , Robinson Katie , O'Connor Margaret , Shchetkovsky Denys , Galvin Rose
Published: January 2024

Background: Substantial investment has been given to scale up of Frailty at the Front Door (FFD) teams in Ireland. These teams reflect a component of an integrated model of care developed by the National Clinical Programme for Older People (NCPOP) and give practical expression to implementing bespoke pathways for older people living with frailty. The aim of the FFD team is to improve the experience and outcomes of older people >65 living with frailty presenting to emergency and acute care services. Whilst scale up is advancing, further collaborative work is required to agree a set of core standards and recommendations to ensure consistency of design, implementation, and evaluation.

Aim: To build national multi-stakeholder consensus on the core components and standards of the FFD model of care for older adults.

Methods: This was a mixed methods study comprising World Café focus groups and a Delphi methodology. Utilising a participatory approach, World Café focus groups were conducted with FFD key stakeholders (n=88) including patient representatives. Participants discussed key pillars of the FFD model of care with the aim of developing a set of evidence-based interventions and recommendations. Thematic analysis was completed using NVivo software. Insights from the World Café focus groups were used to develop the online Delphi survey. Engagement with a Public and Patient Involvement (PPI) panel of older adults and informal caregivers were incorporated to guide the development of the survey. This was designed using an online survey tool, Qualtrics. The survey was designed to obtain specific information from participants in Likert scale format. The Delphi survey was emailed to participants from the initial World Café consensus event in November 2022 and a real time approach is being employed whereby participants will be informed of aggregated responses until formal consensus is reached.

Results: Data collection is ongoing with consensus on the core components and standards of the FFD model of care expected in Spring 2023.

Impact: FFD teams are a valuable component on an integrated care pathway for older persons. Differences have emerged in terms of operational delivery, clinical design and evaluation as a result of their emergent nature. This mixed methods study using a co-design approach will support an evidence-based, patient sensitive model of care that will ensure consistency of approach and outcomes.
"I am not just a place for implementation. I should be a partner": A qualitative study of patient perceptions of their involvement in care in Saudi Arabia
Authors: Alkhaibari Reeham Ahmed , Smith Merry Jennifer , Forsyth Rowena
Published: January 2024

Introduction: Patient involvement in care is a major component of high quality care and is becoming  recognized worldwide with many benefits for improving patient outcomes. However, little is known about patient involvement in care in the Middle East region. 

Objectives: To evaluate patients’ perceptions of their involvement during their interactions with health care providers in Saudi Arabia.

Methods: A qualitative exploratory study using semi structured interviews was conducted from February 2022 to March 2022. Responses were transcribed and analysed using a thematic data analysis approach.

Results: We conducted seven interviews with patients with diabetes ranging in age from 19 to 69 years old. We identified the following themes:1) patients’ perceptions of their involvement in care, 2) barriers to patient involvement, 3) effective communication, 4) empathy, and 5) culture. We found that patients had minimal knowledge of patient involvement in care

Conclusion: There is a clear need to improve education and awareness of patient involvement in health care in Saudi Arabia. By educating patients about the possibilities of patient involvement and explaining their role it will make it easier for patients to understand appropriate levels of involvement. In addition, there is a need to understand and establish frameworks which acknowledge the impact of culture on patient centred care in Saudi Arabia.

Key words: patient involvement, patient centered care, Saudi Arabia
Understanding the Role of Social Support in the Adherence to the Hypertension Continuum of Care in Cambodia
Authors: Savina Chham , Buffel Veerle , Van Olmen Josefien , Chhim Srean , Ir Por , Wouters Edwin
Published: January 2024

Introduction: Hypertension (HTN) is a major public health problem and a leading cause of cardiovascular diseases and deaths globally. A continuum of HTN care is necessary for people living with HTN since this chronic disease requires comprehensive life-long healthcare management. Several studies have examined the factors influencing the adherence to HTN care. Socio-demographic and economic characteristics are commonly studied as influencing factors of each step of the cascade of HTN care, yet little is known about the effect of social support on the cascade of HTN care. Therefore, our study aims to assess the role of social support on the cascade of HTN care in Cambodia.

Method: We performed a population-based survey (5070 individuals aged over 40 and over) to generate a cascade of care for HTN and assess the levels of social support in Cambodia. The cascade shows the patients’ flow in the health system and where they are lost (dropped) along all steps of the cascade from (i) prevalence, (ii) screening, (iii) diagnosis, (iv) treatment in the last 12 months, (v) treatment in the last 3 months, (vi) to being under control. Social support was assessed using the 8-item Medical Outcomes Study Social Support Survey. Multivariate logistic regression was used to determine the effect of social support (from a family member) on each step of the cascade.

Results: Among people living with HTN, 22.4%, 27.0%, 21.6% and 28.9% reported receiving low, medium, high and very high levels of social support respectively. Higher levels of social support were found in female adults, married adults, adults aged over 60, as well as those living in a household of 4 to 5 members and those receiving some or having completed primary education. Participants who received medium and very high levels of social support had two times the odds of receiving treatment for HTN as participants with low levels of support both in the last 12 months and the last 3 months. While, participants who had high level of social support had five times the odds of receiving treatment for HTN (both in the last 12 and 3 months) as participants with low levels of social support.

Conclusion: Social support from a family member is strongly associated with treatment compliance in the HTN cascade of care in Cambodia. Our findings suggest an exploration of using social support as a tool to promote adherence to treatment programs for HTN care.

Implication for applicability/transferability

Families are a potential source of social support for hypertensive patients to overcome social barriers and execute disease management tasks especially for treatment compliance. Promoting social support through a social intervention could be a viable path to improve care for hypertensive patients since chronic illness care poses challenges for isolated patients, but could be made easier with the assistance from family.
Towards a more integrated approach of housing and care for persons with a disability in Flanders
Authors: Van Acker Nina
Published: January 2024

Aiming to offer persons with disabilities more opportunities to live independently and more inclusive, the Flemish government radically revised its subsidies for care and care infrastructure for persons with disabilities. Since 2016, subsidies for care are no longer allocated to care providers, but directly to the person with disabilities. In 2018, brick-and-mortar subsidies for care infrastructure were replaced with subject-specific investment subsidies. In this oral paper, we present the results of a study carried out in 2019 aiming to evaluate the impact of this more demand-driven subsidisation on the housing situation of persons with a disability.

The evaluation was carried out by academic researchers, but set up in co-design with the Housing Agency Flanders, the Flemish Department responsible for care, care organisations, social housing providers, municipalities and organisations supporting persons with a disability. Persons with a disability receiving a care budget were invited to respond to a survey about their living conditions and how these changed after receiving the care budget. Another survey was send to care organisations and social housing providers and contained questions on the impact of the policy change on their investment decisions. After analysing the data, discussions with stakeholders were held to deepen the understanding of the results.

Persons with disabilities reported in their answers to the survey changes in housing choices, housing quality and housing costs and linked these to the policy changes. Housing and care providers reported how their investment strategies were affected. The results of the study reveal how even after a few years the effects of a more demand driven subsidization are visible. Moreover, the study provides an example of how policy outcomes in one policy field (housing) can be affected by policy initiatives in another policy field (care). As such, the study stresses the need for more transversal research in studying housing policy outcomes and the need for an integrated policy approach.

The presentation of the study will be followed by a presentation of one of the initiatives of the Housing Agency Flanders aiming at a better integration of these two distinct policy fields. The Agency is currently the driver of diverse incentives and experimental innovations for a more sustainable housing policy and initiatives. The Agency launched a call in 2017 for the development of experimental and innovative housing forms, focusing on building ‘common housing’ or ‘leasehold’ models. For a period of 6 years, 28 initiatives can develop an innovative practice exempt from housing regulation. In several initiatives, the aspect of care is intrinsically related to the experiment and innovation. We will present initiatives that provide an inclusive co-housing solution for people who need intensive and long-term care. Goal is to develop new housing initiatives, detect difficulties and gaps in legislation and explore possibilities to enroll these practices in Flanders.
Physical, psychological and social frailty among community-dwelling older adults in five European countries: a longitudinal study to support the development of personalized care.
Authors: Ye Lizhen , Van Grieken Amy , Zhou Shuang , Alhambra Borrás Tamara , Markaki Athina , Clough Gary , Bilajac Lovorka , Raat Hein
Published: January 2024

Background: Frailty is defined as a state with increased vulnerability in functioning across multiple physiological systems when facing stressors. Often three domains of frailty are considered: physical, psychological, and social. These three domains of frailty may relate to each other and develop over time. This study aimed to gain insight into the associations between physical, psychological and social frailty in order to support personalized prevention and care for older adults.

Methods: Participants were 1781 older adults in the population-based Urban Health Centres Europe (UHCE) project. Repeated assessments of physical, psychological, and social frailty and covariates were collected at baseline and one-year follow-up. Linear regression analyses were conducted to examine the unidirectional associations. Cross-lagged panel modelling was used to assess bi-directional associations.

Results: The mean age of participants in this study was 79.57 years (SD=5.54). More than half were female (61.0%) and completed secondary education (64.0%). A bi-directional association existed between physical and psychological frailty (effect of physical frailty at baseline on psychological frailty at follow-up: β=0.14, 95%CI:0.09, 0.19; reversed path: β=0.05, 95%CI:0.01, 0.09). A stronger effect from physical to psychological frailty was observed (Wald test for comparing lagged effects: P<0.05). A unidirectional association indicated that a higher level of physical frailty was associated with a higher level of social frailty over one-year (β=0.05, 95%CI:0.01, 0.68). No associations were found between social and psychological frailty.

Conclusion: This longitudinal study suggests that among community-dwelling older adults, a reciprocal relationship may exist between physical and psychological frailty, with a stronger effect from physical to psychological frailty. Also, a higher level of physical frailty was associated with a higher level of social frailty. Further research is needed to validate our findings and explore the underlying pathways. Meanwhile, public health professionals should be aware of the associations between physical, psychological and social frailty in order to provide personalized prevention and care.
A role of nurse e-prescription in GPs’ time reorganization
Authors: Owczarczyk Anna , Bogdan Magdalena , Zuk Pawel , Guzek Marika , Sarnowski Andrzej
Published: January 2024

The digitization of Polish health care began before 2000, but recent years, especially the period of the COVID pandemic, accelerated it. The basis of the digital ecosystem of medical services is the e-health system P1. P1 consists of digital services: e-prescription, e-referral, DMR, and applications: Internet Patient Account, MojeIKP, office.gov.pl, as well as solutions improving the processes of planning and implementing health care services.

One of the most popular e-tools used in medical services is the e-prescription. It was first issued in 2018, and since 2020 it has been a permanent element of e-services. Its advantages are, for example:

-accelerating and facilitating the process of issuing prescriptions,

-ensuring the correctness of issuing an e-prescription,

-this prescription cannot be lost, because it is ""in the patient's phone"" and on his electronic account

-the doctor has an access to all e-prescriptions filled by the patient

-it enables the National Health Fund to keep accurate statistics on issued and dispensed prescriptions

Since January 2016, nurses and midwives in Poland have had the right, with some restrictions, to prescribe basic medicines (on their own) and to continue prescription medicines ordered by a doctor, with the exception of narcotics and psychotropic drugs. That has given an easier access to certain health services for Polish patients.

Currently, both e-prescriptions and the nurse prescribing, as a systemic solution, allow Polish doctors for saving their time and spending it more effectively on the complex needs of their patients. 

The aim of this study is to present the data of nursing prescribing as well as to show how nurse e-prescription influences the time saving by doctors.

The study is based on the statistical data and the initial simulation was carried in Medical and Diagnostic Center LTD. An in-depth analysis may deliver crucial knowledge not only for single doctors, but also health managers and politicians.

 

The study covers the years 2016-2022 and answers the following research questions:

1.How many e-prescriptions have been issued since the implementation of the e-prescription by doctors and nurses/midwives?

2.How has nursing prescription evolved due to digitalization – comparative study of statistical data

3.How many nurses do regularly issue e-prescriptions (at least once a month)?

4.What is the possibility of saving time by the doctors when prescription visits are carried out by nurses?

5.What challenges do e-prescriptions face as a tool that serves the medical personnel, patients and the whole health system?
Identifying risk factors for becoming obese: a record linkage longitudinal study in metropolitan Sydney using the 45 and Up Study
Authors: Vuong Kylie , Alamgir Kabir A Y M , Conway Damian , Williamson Margaret , Harris Mark , Barr Margo
Published: January 2024

Background: Obesity is the fourth leading cause of mortality globally. Australia has one of the world’s highest rates of adult obesity, with 31% being obese in 2017/2018, and increasing. If this trend continues, the Australian Bureau of Statistics predicts 18 million Australians will be obese or overweight by 2030. We aimed to identify risk factors for becoming obese among people aged 45 years and older.

Methods: A record linkage longitudinal study of people from metropolitan Sydney was undertaken using data from the: 45 and Up Study at baseline (2005-2009) and first follow-up (2012-2015); Medicare Benefits Schedule; Pharmaceutical Benefits Scheme; and deaths registry. We examined risk factors for becoming obese (Body Mass Index [BMI]:30-40) at follow up (5-7 years after baseline), separately for people within the: healthy weight range (BMI:18.5- < 25), and overweight range (BMI: 25- <30) at baseline. We considered demographics, modifiable behaviours, health status, primary care usage, and medication use as covariates. Crude and adjusted relative risks (RR) were measured using Poisson regression model.

Results: At follow up, in the healthy weight range cohort, 1.1%(180 of 16,205) people became obese, and in the overweight range cohort, 12.7%(1,939 of 15,266) people became obese. In both cohorts, the following were associated with an increased risk of becoming obese: current smokers, physical functioning limitations, allied health services use through team care planning and use of psychiatric medications, while alcohol consumption and adequate physical activity were found to be protective. In the healthy weight cohort, high psychological distress was associated with an increased risk of becoming obese. In the overweight cohort, being female and full-time work were associated with increased risk, while older age was found to be protective.

Conclusions: These findings should assist primary care clinicians to identify patients with characteristics that place them at risk of becoming obese for intervention.
Pilot Randomized Controlled Trial of Multi-Disciplinary Community-Based Biofeedback Vs Health Promotion Programs on Mental Health And Drug Use Among People Experiencing Homelessness
Authors: Nyamathi Adey
Published: January 2024

Background: PEH are most vulnerable to COVID-19 due to high levels of chronic disease and social isolation. However, in Skid Row Los Angeles, there are limited resources for mental health and drug treatment services. Biofeedback (BF) has been found to decrease depression and substance use among drug users; however, no studies have assessed the impact of BF on PEH during the COVID-19 pandemic.

Aim: Our multi-disciplinary team designed and pilot tested an 8-week Heart Rate Variability-Biofeedback (HRV-BF) intervention, utilizing a nurse-led, Community Health Worker model of care with 50 people experiencing homelessness (PEH) as compared with a Health Promotion (HP) program. Our goal was to establish feasibility of the program, and to assess effects HRV-BF on measures of HRV, mental health and drug use as compared to HP.

Methods: Utilizing Community Based Participatory Research (CBPR) principles, a community advisory board was established to refine the HRV-BF intervention and assess acceptability and feasibility. We enrolled 40 PEH and randomized into HRV-BF vs HP program and assessed a) impact on anxiety and depression; b) HRV and cortisol indices; and c) drug and alcohol use among all participants.

Results: In total, 40 PEH were enrolled with 36 completing the intervention; 17 HRV-BF and 19 HP. Majority were male (80%) and were equally Black (37.5%) or Hispanic (35%). The mean age of PEH was 49 (SD 16.7), median age 53. The HRV measure RMSSD (root mean square of successive differences between normal heart beats, a time-based variable reflecting vagally mediated HRV), assessed during the resting 5-minute period, showed significant increases in 71% of participants (75% among HRV-BF and 68% among HP), using paired t-tests with natural log transformed variables, p=0.004, and by non-parametric tests, p= 0.006 (p values one-sided).   Across the sample, PHQ-9 (depressive symptoms) showed marginally significant improvement (p= 0.09). Anxiety and Mental Health Inventory scores showed improvement, though not significant. Between-group analysis showed the HRV-BF group had better GAD-7 and MHI scores at 8 weeks (post-intervention), though not statistically significant. Chronic disease was found to be high in both groups (67% among HRV-BF and 82% among HP). No significant differences were found in terms of substance use.

Conclusions:   As the first known study to date examining the role of a biofeedback self-regulation training on biomarkers of stress/mental health measures among PEH, our study shows feasibility and acceptability among the study population and positive initial results for both arms of the study. We plan to extend the follow-up period beyond the intervention period of 8 weeks to establish the sustainability of the intervention.

Funding: Susan Samueli Integrative Health Institute Pilot Studies Award
Bibliotherapy in practice: shared reading as integrated care
Authors: Pieters Jürgen , Ghyselinck Zoë , Kerre Tessa
Published: January 2024

This workshop aims to present the outlines of a research project situated in the interdisciplinary research domain of bibliotherapy: the use of literature in healthcare contexts. With this project we want to demonstrate that different syndromes and pain experiences require a diversification of the (prescribed or non-prescribed) texts and the associated reading practice. On the one hand, the project aims to refine the international discourse of bibliotherapy on this central point. On the other hand, through concrete reading and co-reading sessions with participants from different medical backgrounds (cancer patients, the elderly, patients in rehabilitation, renal dialysis patients), we aim to gain a sharper insight into various bibliotherapeutic needs associated with specific syndromes. The project brings together a team of literary scholars and medical experts who, with their joint efforts, want to make a significant contribution to the interdisciplinary domain of health humanities and narrative medicine.

In the project we want to find out how literary texts have a therapeutic effect in specific care contexts and we want to increase that effect through a better understanding of the functioning of that text. We assume that the therapeutic effect of literary texts is determined by an interplay between the text itself (with its specific characteristics), the way and circumstances of reading and the mental and physical state of the patient-reader.

In the workshop we want to present the outline of the project and together with participants simulate a shared reading session.
Tools to start a multidisciplinary collaboration.
Authors: Akin Alev
Published: January 2024

In general: Huis voor Gezondheid was one of the first organizations to start developing an instrument in 2013 to support general practitioners and pharmacists in organizing medical-pharmaceutical meetings at a local level. The instrument was developed in close collaboration with Brusano (supporting professionals in primary care) and Pharmacy Brussels (Pharmacy Association of Brussels). A few years after the development (in 2015) of this tool, the NIHDI (National Institute for Health and Disability Insurance) also recognized the importance of an medical-pharmaceutical meeting. They made subsidies available to develop medical-pharmaceutical packages and to encourage GPs and pharmacists to organize meetings at a local level. The packages are bilingual (Dutch and French) and recognized by the NIHDI .

Following on from this concept, we have recently developed a support package to improve the collaboration between general practitioners and physiotherapists . And this in close collaboration with Domus Medica (professional association for general practitioners) and AXXON (professional association for physiotherapists). Currently, the support package is only available in Dutch. In the short term, we also want a French version and we hope to receive recognition from the NIHDI.

These tools are a start to multidisciplinary collaboration. To be able to offer patients high-quality care, we need to look beyond our own field of expertise. Different healthcare professionals can complement each other so that a goal can be achieved together that a healthcare provider is not capable of alone.

The purpose of these methodologies: These tools aim to encourage and improve collaboration between certain professional groups. The package(s) consist of various themes that are ready for use and can be used immediately to help organize and structure the desired multidisciplinary meeting.

Results: During such local meetings, the various professional groups get to know each other better and exchange experiences. In addition, they make clear agreements about how they will work together in the future. And all this in function of offering quality care to the patient.

Next steps: Following on from these methods, Huis voor Gezondheid has now also started developing a local medical-psychological meeting for general practitioners and psychologists. And this in close collaboration with VVKP (Flemish Association of Clinical Psychologists), Domus Medica (professional association for general practitioners), the Brussels GP circle and the Brussels networks for mental health.
Aiming for equity in care provision
Authors: Andreassen Hege
Published: January 2024

Since the introduction of the triple aim for health quality improvement around 2008 the suggested multi-layered approach to quality improvement has gained ground. The idea is that when working for quality improvement in the health and care sector one needs to have several aims in sight at the same time. Originally the three aims singled out were: enhancing patient experience, improving population health, and reducing costs. These were then expanded to include an additional goal of improving the work life of health care providers (the quadruple aim). Now, the last addition to the idea is a new layer; namely equity (the quintuple aim).

This presentation addresses the discussion on how to work towards the newly added aim on equity. In Scandinavia and elsewhere in Europe we are moving towards more integrated care, but also more complex care economies consisting of an increasing number of private and public providers that in various ways depend also on domestic agents. Indeed, the ongoing transformations of care work holds in it several potential routes for change when it comes to equity, and it is of vital importance we keep our gaze on these issues to ensure a desired outcome.

From gender research it has been pointed out that research addressing inequality and equity in (care) work, often remain on an individual micro level, when instead we need to lift our gaze to culture and social structure to get the whole picture. To meet this challenge the concept of gender regimes can be helpful; it points to the variation in the political and organizational contexts in which care work institutions are founded and embedded. The presentation will explore weather this approach, in combination with a look towards care economy as a societal field going across domestic, public and private spheres, can allow for a conceptual discussion on how we can succeed in increasing awareness of equity and inclusion in health care improvement work.