bluuebunny/crossref_metadata_2025 huggingface dataset:
Person centred care: good practises in an ambulatory mental healthcare setting
Authors: Heip Tine , Van den steen Jochen
Published: January 2024

Introduction: BW IPSO is an organisation that started out as a variety of small organisations in the late 1970.  By offering people with a mental illness the possibility to live in sheltered housing, with the guidance of mental healthcare workers, the organisation intended to improve the quality of life for this population. Over the years the organisation grew, merged and became BW IPSO. We now offer 118 places of supported living, going from group homes, to small appartements provided by the organisation, as well as guiding people in their own (social) home.

Description: Throughout the years, apart from housing and mental health, other life domains became more and more important. The mental healthcare worker became a case manager . In our multiprofessional team we follow the principles of FACT  and SRH . If the resident wishes so, the case manager can also become a care coordinator. The principles of SRH comprise of three key aspects: presence-oriented, recovery-oriented and strength-oriented. So together, the resident and mental healthcare worker, will explore every life domain and investigate if the resident wishes to ameliorate or change something on a particular domain. Self-direction in the process is crucial. The life domains are physical health, mental health, administration, living and general daily life activities, religion and meaning, meaningful daily activities/work, social network, learning. The mental healthcare worker walks next to the resident throughout his/her path. A path that may lead to all different kinds of settings, f.e. specialized residential (mental) healthcare, community health centres, ambulatory psychologist/psychiatrist but also a workplace, regular welfare organisations, family, friends… When a resident decides to leave our organisation, (s)he can also choose to stay in ‘follow-up’. This means that the mental healthcare worker will still see this person but less frequent. It is a way to prevent fractions in the care continuum and gives the very important opportunity to shift to a more intensive form of care when needed. Providing continuity in care is essential in our line of work. To make this possible, BW IPSO invests maximum efforts to form partnerships with other organisations or initiatives. Building relations in health systems is vital. Innovations in such systems are affected by collaboration. In making these investments, we aim to give our residents the possibilities to try new things, make connections and improve overall quality of life.

Conclusion: Over time, many healthcare services have become fragmented, people who are less empowered miss out on proper care. This also applies for a majority of people who suffer of a (severe) mental illness. As an organisation we strive for continuity of care, collaborative partnerships, patient centred care with maximum ownership. We achieve this with a multidisciplinary team of experienced mental health workers in partnership with other organisations and the network of de person in need.
Diffusion of person-centred care within 27 European countries – interviews with managers, officials, and researchers at the micro, meso, and macro levels
Authors: Rosengren Kristina , Carlström Eric
Published: January 2024

Purpose: This study aimed to describe facilitators and barriers in terms of regulation and financing of healthcare due to the implementation and use of person-centred care (PCC).

Design/methodology/approach: A qualitative design was adopted, using interviews at three different levels: micro=hospital ward, meso=hospital management, and macro=national board/research. Inclusion criteria were staff working in healthcare as first line managers,

hospital managers, and officials/researchers on national healthcare systems, such as Bismarck, Beveridge, and mixed/out-of-pocket models, to obtain a European perspective.

Findings: Countries, such as Great Britain and Scandinavia (Beveridge tax-based health systems), were inclined to implement and use person-centred care. The relative freedom of a market (Bismarck/mixed models) did not seem to nurture demand for PCC. In countries with an autocratic culture, that is, a high-power distance, such as Mediterranean countries, PCC was regarded as foreign and not applicable. Another reason for difficulties with PCC was the tendency for corruption to hinder equity and promote inertia in the healthcare system.

Originality and practical implications: Fragmented health systems divided by separate policy documents or managerial roadmaps hindered local or regional policies and made it difficult to implement innovation as PCC. Therefore, support at the managerial level, together with patient rights supported by European countries’ laws, facilitated the diffusion of PCC.

Keywords: Europe, Health systems, Managers, Person-centred care, Qualitative content analysis
Factors Influencing Influenza Vaccination Uptake Among Community-Dwelling Older Adults: A Mixed-Methods Study
Authors: Yi Xu , See Min Ting  Alicia , Aloweni Fazila Abu Bakar , Koh Chun Hui Fion , Tan Cheng Gaik Irene , Xin Xiaohui , Gan Wee Hoe , Low Lian Leng , Lim Su Fee
Published: January 2024

Background: Despite making the influenza vaccine accessible and affordable, vaccination rates remained low among community-dwelling older adults. Therefore, this study aimed to explore the factors influencing vaccine uptake and impact of COVID-19 on vaccine uptake among community-dwelling older adults in Singapore.

Methods: A mixed methods study involving a survey and face-to-face semi-structured interviews were conducted between September 2020 and July 2021. Community-dwelling older adults aged ≥ 65 years were recruited from 27 Community Nurse Posts. Data on participants’ demographics, health condition(s), vaccination status, attitudes towards influenza infections and vaccinations, willingness to pay, intention for future vaccination and source of information were collected via the survey. Semi-structured interviews were conducted to understand vaccination experiences, key enablers and barriers, and the impact of COVID-19 on vaccine uptake. All interviews were analyzed using Braun and Clarke’s thematic analysis. Quantitative data were analyzed using descriptive statistics, chi-square tests and multinomial logistic regressions.

Results: A total of 235 participants completed the survey. Living arrangement was a statistically significant contributing factor for influenza vaccine uptake (ꭓ2= -0.139; p=0.03). Participants who lived alone were 2.5 times more likely to be vaccinated than those living with others (OR=2.504, 95% CI: 1.294-4.842, p=0.006). Avoidance of getting infected (82.5%), avoidance of transmission to others (84.7%), and advice from healthcare professionals to receive vaccination (83.4%) were key enablers while concerns about possible side effects (41.2%), effectiveness of vaccine (42.6%), and not having enough information (48.1%) were barriers. Twenty participants were interviewed. The findings were congruent with the survey results. Five themes were identified as follows: 1) Perceived importance of influenza vaccination, 2) Sphere of influence, 3) Healthcare schemes and medical subsidies, 4) Psychological impediments, and 5) Inconsistent emphases at various touch points.

 

Conclusion: Greater public health efforts are needed to reach out to the larger population of older adults of different living arrangements, and those concerned about the possible side effects and effectiveness of the influenza vaccine. Healthcare professionals need to provide more information to address these concerns, especially during COVID-19, to encourage vaccine uptake.

Keywords: older adult, influenza, vaccine, vaccination, barrier, enabler, mixed methods
Research based youth care?!: An equal partnership between youth, their network, professionals, and researchers in youth care.
Authors: O'Driscoll Julia Villanueva , Willegems Vicky
Published: January 2024

In the interdisciplinary research program VOICe (Voicing youth at social risk) at the Vrije Universiteit Brussel, we focus on developing collaborative research practices with young people ‘at social risk’. We share the mission to enable young people and professionals to enter a dialogue in an equal and investigative manner about what they really find important in their daily life context and to adjust this together if necessary. For the past ten years we have been developing collaborative research practices in education in collaboration with schools under the name ‘Research based School?!' to enhance the learning and well-being of students. We would like to further explore, adapt, and possibly roll out this experience with a collaborative model in the context of youth care. This project is based on the idea that quality of care stands or falls with the expertise and commitment of the facility.

“Research based youth care?!” sees a facility as an environment in which everyone bears a responsibility in each other's development. The focus is on the provision that dares to come forward as a learning community. This learning community enhances the growth of all involved by challenging them to tackle questions in partnership.

This project embraces a collaboration model in which care providers, researchers, young people, and their network adopt an investigative attitude together. The use of problem-solving strategies and the exchange of knowledge through participation in a learning community with structured research activities are paramount in this project. It is important that the youth, their network, and the professionals realizes that a problem he/she is confronted with in the facility also affects others (colleagues, management, parents, other youth…). By including these different perspectives, the problem is supported within the entire social context and the chance of carrying out improvement actions is greater.

In a first step, we will build a basis for the collaborative model within youth care, in which we will bring involved parties together to discuss the conditions for equal participation between young people, their network, professionals, and researchers. We have started experience experts and managers sharing their experiences in a professional learning community and to enter a dialogue to design a workable model to further involve other professionals and youth in subsequent phases.

With this trajectory, the university and the professional field join forces with the aim of professionalizing themselves and promoting the development of young people, starting from their own practice; relevant for the facility, the care provider, the youth, and their network; as a full partner; and in dialogue between practice and theory.
Including citizens in collaborative projects in integrated health care through the living lab approach: how to attract participants, build a panel database, engage with end users, and keep them motivated
Authors: Vandenhoudt Hilde , Adriaensen Ingrid , De Witte Nele , Broeckx Leen , Vermeylen Sascha , Helsen Kim , Weyers Glenn , Van der Auwera Vicky
Published: January 2024

Introduction: The living lab approach allows citizens to be directly involved in projects in integrated healthcare to ensure that the development of topics is tailored to their needs and priorities and that their values are respected all throughout ideation and development. Be it through providing insights to researchers, participating in the collection and analysis of information on their health and well-being, or initiating and co-constructing the protocols of a project, citizens can be involved in many ways. They are the experts of their own lives!

Aims & methods: While setting up a community living lab, the development of a large-scale panel of citizens is an intensive, but necessary action. This community forms a large-scale co-creation and test environment of individuals willing to contribute to the development of new concepts, services, or products.

A user panel fulfills two core functions: Firstly, the panel is needed as a recruitment (data)base for the various experiments/research projects that will run within the living lab (as well as facilitating scalability). The panel must be well profiled and easily accessible, so it can be quickly activated. 

Secondly, this test panel aims to act as a benchmark for the living lab. It is the breeding ground from which specific needs and requirements, but also certain trends, can be identified bottom-up. This information can serve as a basis for defining new projects.

In this presentation, we will highlight: 

What the requirements are for a representative reference group to run projects

How different profiles and organisations can be approached and attracted

The importance of network building

How a panel database can be built and managed

Which techniques can be used to profile panel members

How to keep panel members interested and motivated to contribute to projects on a regular basis

Key findings: LiCalab has over 10 years of experience in working with citizens in innovation projects. It takes time to build a test panel and it will always remain a work in progress. The main learnings from this journey are that you need to be a trusted partner for both citizens and intermediaries as well as care organisations. An ethical approach, committed and inclusive communication, and an attractive story are key.

Conclusions: Citizens are motivated partners in designing future-proof and inclusive healthcare. A well profiled database and a close one-on-one connection with members is an intensive but rewarding approach for all parties that want to build new solutions together with end users.

Implications: Local authorities, care organisations and companies increasingly acknowledge the importance of citizen involvement to design better solutions corresponding to the needs of end users.
Frailty status and medication use in community-dwelling older patients with polypharmacy: a community pharmacy study.
Authors: Carrein Marie , Mehuys Els , Petrovic Mirko , Sutter An De , Christiaens Thierry
Published: January 2024

Background and Objective: Frailty is a concept that refers to the deterioration of several organ systems and is characterized by the inability to provide an adequate response to stressors. While mainly used in the field of geriatrics, the concept is extending to other disciplines. Frail older people are more at risk for adverse drug reactions and also more often use potentially inappropriate medication, suggesting that they could benefit the most from medication reviews. With this community pharmacy study we aimed to determine prevalence of frailty in a cohort of community-dwelling older people with polypharmacy, and to describe their medication use. These data can form the basis for optimized patient selection for medication review by community pharmacists.

Methods: An observational study was carried out from November 2019 until August 2020 in 196 community pharmacies in Belgium. Participants (≥70 year, ≥5 chronic drugs, community-dwelling) were consecutively included in the study. Frailty was assessed using the Fried phenotype, operationalized by SHARE-FI75+. Each patient completed a self-administered questionnaire collecting sociodemographics, current medication use, difficulties with basic activities of daily living and unplanned hospital admission. Cognitive status was assessed by Mini-Cog©.

Results: A total of 875 patients were included in the study. Mean age was 79,3 ±5,9 years and 488 (55,8%) were female. Participants used a median of 8 [IQR 6-10] medicines. Most frequently used drugs were: antithrombotic agents (used by 71,1%  of the sample), lipid modifying agents (67,4%) and β-blocking agents (53,8%).

Almost 15% of patients were identified as frail, 52,4% as pre-frail and 32,8% as robust. Frailty criteria most commonly present in the cohort were weakness (67,8%) and fatigue (49,7%). 32,1% of the patients were assessed as potentially positive for cognitive impairment. More than 40% of the patients had ≥1 limitation in basic activities of daily living, with difficulties taking a bath/shower as the most common limitation (29,7%). One in 5 patients reported an unplanned hospital admission in the 6 months prior inclusion.

Conclusion: The prevalence of (pre-)frailty among community-dwelling older patients with polypharmacy is high. Based on the current findings we will try to develop a quick and reliable method to identify these patients in the community pharmacy, in order to perform stratified medication reviews.
Utilizing dyadic and triadic family interviews to better understand the integrated care needs of older adults: Examples from a Canadian study exploring the needs of older adults at risk of admission to long-term care facilities.
Authors: Campbell-Enns Heather
Published: January 2024

Background and purpose: In family sciences, the scientific study of families and close interpersonal relationships, dyadic and triadic interviewing is utilized to gain a more complete understanding of the experiences of families, as well as individuals within families. Family-based methods have been more commonly used in pediatric research, yet they have great utility in older adult integrated care research as well, particularly when older adults experience a decline in their health and family members become more involved in their care. The aim of this presentation is to describe the use of dyadic and triadic interviews as a research method when the research focuses the lives of older adults.

Methods: A Canadian study exploring the needs of older adults at risk of admission to long-term care facilities illustrates the use of family-based research methods in an older adult population. In this qualitative study, older adults and their family members were interviewed as individuals, dyads, and triads.

Results: Data was collected from 24 participants using family-based methods. The data was analyzed in multiple ways so that the experiences of individuals and groups were more fully understood. Overall, the main problem experienced by at-risk older adults and their family members was uncovered, including breakdowns related to an integrated healthcare system.

Conclusion: Reflections on the use of family-based methods with older adults will be presented, including how this data informed integrated care planning in this context. Further, this presentation will highlight how this method compares with focus groups, how and why dyadic and triadic interview data might be analyzed, and how this data can provide robust information to lead to a more informed integrated healthcare system.
How to improve the capacity of general practitioners? – a Flemish approach
Authors: Kemper Irma
Published: January 2024

“Barely any region left with freely accessible primary health care in Flanders.” This is one of the many newspaper headlines that was recently published to emphasize the fact that more and more general practitioners refuse to take in new patients, because they run out of capacity to provide patients with proper health care. Where does it go wrong?

Accessibilty to general practitioners is a hot topic for the Flemish policymakers. An aging population and an increase of mental health problems asks a lot from the general practitioners, as well as the shift of tasks from hospitals towards primary health care and the growing attention for prevention. However, is there a real shortage in general practitioners? Looking abroad learns that the number of general practitioners might not be the major cause of the capacity problem, but that the true bottleneck might lie in the way of organizing primary health care capacity and accessibility. Embedded in a landscape of health care where general practitioners mostly work on a self-employed base, and the fragmented governmental structure in Belgium as an extra obstacle makes this a major challenge for the near future.

A dialogue between policy makers from all Belgian governments was opened to create a common approach: each government will take actions within their own authorities. The Flemish government worked out a plan to counter this massive challenge in primary health care through different initiatives, in cooperation with representatives of the general practitioners on the field, local authorities and umbrella organizations.

Flanders commits itself by installing three major fundaments which can create change in the way general practitioners are organized: a first step is to create an accurate and up-to-date database of the current available general practitioners health care services compared with the local care need; in parallel the funding of general practitioners will be expanded in a way which stimulates interdisciplinary collaboration and optimizes health care capacity; on top of that the Flemish government is experimenting with new forms of primary care practices in which integrated care is the keystone and which are supported by local authorities and in close connection with welfare services.

These projects described above are in full development. On the working field more and more general practitioners are willing to put their shoulders under these initiatives to create solid solutions for the future.

The international audience of this lecture might recognize similar issues they encounter in their own countries and will be able to see similarities and differences compared to the Flemish context. By drawing these parallels one can have a broader view on the approach of improving health care capacity and accessibility.

These Flemish projects will be brought together with the initiatives from the other Belgian governments at a roundtable discussion to align all the initiatives on primary health care capacity and create a future proof primary health care capacity in Belgium.
Skin cancer counselling by Belgian community pharmacists
Authors: Van Vaerenbergh Frauke , Lahousse Lies
Published: January 2024

Background: Skin cancer is a leading form of cancer in Belgium. The increasing incidence and associated economic and societal burden require more investments in population-based prevention strategies. Pharmacists can play a role in increasing awareness and promoting sun protection given their expertise and proximity. However, which persons could be reached by community pharmacists for skin cancer awareness in Belgium is unknown. Moreover, whether this increased awareness is associated with increased sun protection remains unclear. Therefore, we aimed to describe the population reached and potential impact on sun protection purchases among persons who received skin cancer counseling by their community pharmacist.

Methods: Demographics of approached persons in Flemish community pharmacies during the months May-June 2022, and the content of the skin cancer counseling were retrieved from the pharmacy database. Sun protection purchases and dermatologist visits (indirectly retrieved through prescriptions by a dermatologist) were evaluated up to three months after the skin cancer counseling.

Results: Community pharmacists provided skin cancer counseling to a broad population of visitors (n= 822, 69% females, interquartile range 44 to 71 years old). During the campaign, 822 visitors received a leaflet with skin cancer prevalence and sun protection importance. On top of that, 335 visitors (41%) received additional counseling content. Skin type sensitivity was checked and sun protection recommended at 267 visitors (32%). Typical characteristics of melanoma were discussed with 118 visitors (14%) and 37 visitors (5%) were referred to a physician for further information or due to a skin spot. Overall, one out of three visitors purchased a sun protection product (32%) on the day of the counseling (increasing up to 42% after three months). During three months follow-up, visitors receiving additional counseling had a higher chance to visit a dermatologist compared to those only receiving the leaflet (HR=1.8 ; p<0.05).

Conclusions: By providing skin cancer counseling in Belgian community pharmacies, a broad range of predominantly female citizens was reached and triggered to purchase sun protection, with increased dermatology visits for those receiving additional counseling.

Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Acknowledgements

The authors want to thank the Flemish Pharmacists Network (VAN) for training the pharmacists and Farmaflux and Association of Pharmacists Belgium (APB) for providing the data with special acknowledgements to Karel Verlinde, An Vanthienen, Corine De Winter and Marc Buckens.
Fifteen years journey of a private speech & language therapy service in rural Ireland - navigating the needs of the local communities and expanding collaborations.
Authors: Lisiecka Dominika , O'Shea David
Published: January 2024

Private Kerry SLT clinic (KSLTC) was started in January 2007 in rural Ireland, at the time when out-patient services were limited. At that early stage, there was only one speech & language therapist (SLT) in the KSLTC providing the service a few hours per week. The majority of referrals came from medical consultants. Over the years, by maintaining a flexible approach to local community needs, KSLTC expanded and gradually changed the focus of care. Currently, there are seven therapists providing the SLT service in collaboration with local charities, schools, primary care, disability and acute services.

This presentation is for anyone interested in collaborative private and public care and this could contribute to the delivery of integrated care.

We aim to present the evolution and the current delivery of a small private service, which is based on local collaborations and distributed leadership.

We would like to discuss:

-how KSLTC evolved in response to the key developments in the public system, such as the reconfiguration of disability services for children or introduction of integrated care services for older people.

-what are the service priorities and how they align with the needs of the local communities.

-what are the main challenges and opportunities to progress collaborations with external services / agencies.

KSLTC has been engaging in local collaborations since the beginning. Initially, the service provided by the KSLTC was guided by the requests of the local consultants and therefore the focus was medical in nature. Over the years it became apparent that the biggest community needs are in the area of early intervention, disability and autism. KSLTC entered various collaborations to ensure the service provided privately is integrated with the public system and where possible the funding was sought to subsidise the session cost for the clients. One example of the above collaboration is working jointly with a group of parents of children with Down syndrome and a group of parents with autism to co-design the delivery of SLT service. As a result, the services provided are not only clinic based, but are also delivered in the local schools, day centres and in people’s homes. The service is being evaluated jointly with the group of parents’ representatives.

There every-day practice in KSLTC is based on the culture of mutual trust and respect. To provide an efficient service, a flexible approach guided by the service users’ needs is paramount. The integration with the public systems brings multiple opportunities, but also challenges. We hope that our experiences can be valuable to other professionals interested in managing and delivering clinical services with limited resources, private and public collaboration of care, and distributed leadership.
Integrated care in epilepsy: A scoping review of the key components of health and social care delivery
Authors: Spanos Samantha , Hutchinson Karen , Zurynski Yvonne , Rapport Frances , Goodwin Nicholas
Published: January 2024

Introduction: Epilepsy is the most common neurological condition globally, and is associated with significant behavioural, physical, and psychological burden. People living with epilepsy and their families often face extreme difficulty receiving timely and efficient healthcare due to the fragmented nature of epilepsy care delivery and the predominance of hospital-based services. The need to integrate epilepsy care services across healthcare sectors and shift care into community settings has become increasingly clear, but the range and type of integration that has occurred worldwide is unknown. This scoping review aimed to identify recommended and/or implemented models of integrated care for epilepsy, or common elements of integrated care models, to broaden current understanding of the progress toward integrated care in epilepsy.

Methods: Three literature searches were conducted (in 2020 and 2022) across four databases (PubMed, Medline, Embase, and Web of Science) for integrated, shared, coordinated, or person-centred care models and approaches with a focus on epilepsy. Recommended, developed, or implemented models of integrated care for epilepsy were identified, and data were synthesised into the common elements of integrated care featured in the literature.

Results: A total of 295 studies were identified across the three searches, from which 35 studies were deemed eligible and were included in this scoping review. Most studies were conducted in the USA or Ireland, and qualitative study designs were most common. Fourteen models of integrated care were identified; eight had been implemented, and six were advocated for implementation. Twelve common elements of integrated care were synthesised, associated with cross-sector collaboration and training, transition and self-management services, and technological advancements to optimise communication between healthcare providers.

Discussion: There is a growing evidence base supporting the need for an integrated, holistic, and person- and family-centred approach to epilepsy care delivery. Substantial progression has been made design and develop integrated care services for epilepsy, but significant challenges are associated with implementing these services. Lack of readiness for change can stifle efforts toward shifting epilepsy care from hospital to community settings, and governance structures across sectors can prevent continuity and coordination of care. Clearer guidelines for epilepsy care and educational interventions in community settings are needed, as well as greater resources to balance workload targets with tailored, patient-centred care.
Optimising & Integrated Effective Diabetic Foot Services at the Regional Scale: The NHS Midlands Model
Authors: Robbins Tim , Khakh Shaneela , Din Yasser , Hart Sarah , Shorrick Peter , Murthy Narasimha
Published: January 2024

Introduction: Diabetic foot disease represents a costly and challenging complication for healthcare services internationally, and one the diabetes complications associated with the highest degree of morbidity and mortality. It is estimated that between five and seven cent of people with diabetes will have a diabetic foot ulcer at some point in their lives, at an estimated cost of £935 million to the NHS. It is well recognised that effective diabetic foot care requires multidisciplinary care approaches. Whilst pockets of locally effective integrated care have been proven, scaling this to regional models has proved difficult. Here we present an effective optimised approach to integrated diabetic foot care in the Midlands Region as a model for other services internationally.

Methods: Four pillars are underpin effective change at a regional level in the United Kingdom covering 5.4 million people. These pillars are (1) Utilisation of standardised audit data as a driver for change, (2) Regional self appraisal and peer review (3) Cross-boundary integrated root cause analysis and (4) adoption, piloting and testing of new digital technologies. We present an example of “guerrilla PPI” to facilitate real-time representative patient and public involvement. Central to the success was an infographic base communication and dissemination strategy with a focus on prevention.

Results: Successful creation of a 300 person multidisciplinary foot care network including podiatrists, consultants, diabetes nurses, commissioners, community representatives, transformation leads, Diabetes UK, patient representatives and nurse specialists. Peer review, root cause analysis and audit presentation data across the whole of the Midlands region covering all diabetes providers. High impact bespoke infographics presented for all sub-regions to further drive change. Major 6 month amputation rates from reduced from 2.9% in 2014/2015 to 2.1% in 2020/2021 and reduction in audit active ulcer rates from 47.1% to 42.4%despite the pandemic environment.

Conclusions: Effective integrated diabetic foot care can be delivered at the regionally scale for large populations if underpinned by a defined network with shared vision, transparent structures and shared Trust. Cross-organisation working is fundamental but can be enabled through standardised peer review, audit, root cause analysis and self-appraisal models.
Physical Activity on Referral in Brussels
Authors: Akin Alev
Published: January 2024

Since 2017, Huis voor Gezondheid has been coordinating the Physical Activity On Referral project in Brussels with the approval of the Flemish Government. The aim of this project is that doctors motivate their patients to adopt a more active lifestyle and that people from Brussels move more.  If the patient is sufficiently motivated, the doctor can refer this patient to the Physical activity on referral-coach via a referral letter. The coach motivates and supports the patient on their way to a more active lifestyle. He does this through motivational interviewing and by sounding out which low-threshold exercise initiatives the patient wants to integrate into his daily life.

In principle, every inhabitant of the Brussels-Capital Region can be referred to the coach. The project is mainly intended for people with an inactive lifestyle and for people with certain health risks or health problems for which exercise has already been shown to have a positive influence. Children cannot be referred, interested persons must be at least 18 years old.

The project pays attention to the vulnerable population by mapping the local low-threshold exercise offer and by providing lower rates for people with an increased allowance for the coach. In Brussels especially this group is important to include and to pay extra attention to.

In short, this project focuses on prevention, on keeping people healthy for as long as possible through integrated care.

Scope of the project: The project  currently is active in 4 municipalities in Brussels: Anderlecht, Sint-Jans-Molenbeek, Schaarbeek and Brussels-city.

Partners: Physical Activity On Referral starts from a local intersectoral network in which local and regional partners from different sectors are represented such as local authorities, doctors, health and welfare services, providers of low-threshold exercise options, organizations that reach vulnerable groups,…. Each municipality consists of an intersectoral network. These regional partners are crucial for the succes of the project. Without all these partners, we would not be able te reach as many citizens as we do now.

The interventions: Every year, Huis voor Gezondheid organizes several intersectoral local antennas within each municipality to discuss the progress of the project. In addition, Huis voor Gezondheid is also organizing a major event to bring all partners together of the project.

Results: Since 2017 to the end of 2021 we have reached a total of 464 patients

2017: 14 patients

2018: 115 patients

2019: 154 patients

2020: 85 patients

2021: 96 patiënts

Learnings and next steps: The evaluations of patients and doctors show that patients move more after following a trajectory with the coach. In 2023 we will implement the project within the municipality of Jette.
Integrated Assertive Outreach in Norway since 2015
Authors: Poverud Lars
Published: January 2024

The purpose of this video presentation is to show the development in community mental health in Norway from 2015 until today. We have imported the service model ACT - Assertive Community Treatment from the USA (2007) and FACT - Flexible Assertive Community Treatment from the Netherlands (2013). In both service models we have integrated primary care services and specialist health care services in one team here in Norway, unlike many other countries. 

The video presentation was made for the ten-year anniversary for EAOF - The European Assertive Outreach Foundation in 2021, and was then presented by professor emeritus Torleif Ruud and Tor Helge Tjelta.
“When you are a parent of an autistic child, the responsibility is put on you a lot” - Learning from parents’ experiences and expectations of speech and language therapy services for autistic children in Ireland.
Authors: O'Shea David , Lisiecka Dominika , McGarty Patrick
Published: January 2024

Autism is a neurodevelopmental disorder, characterized by deficits in social communication and interaction, restricted interests, and repetitive behaviours. Historically framed within the medical model paradigm, there are increasing calls from the autistic community to reframe autism, using the social model paradigm and embracing neurodiversity. Autistic individuals account for 1-2% of the population and access a variety of services, such as Speech & Language Therapy (SLT), which support autistic individuals' engagement in society.

There is a disparity of SLT services available for autistic people in Ireland and parents’ perceptions of services have not been investigated before. We aimed to investigate the parental experiences and expectations of SLT services for autistic children and make recommendations for stakeholders of autism service provision. This presentation is relevant to anyone interested in researching service users’ / parental perceptions and how they can guide the provision of care.

This research formed a part of a Master’s degree. It was developed by a team of researchers representing SLT and social care services. The initial idea originated from clinical practice, where parents often voiced their concerns and expectations of care.

Interpretative Phenomenological Analysis was used as a methodological framework for this study. Participants were parents of autistic children living in the Munster province of Ireland, and they were not previously known to the research team. Individual, semi-structured interviews were carried out to identify participants’ understanding of how they made sense of their experiences. Data was analysed in depth at an individual level before group analysis took place.

 

Five themes emerged during group analysis:

1) The journey of parenting an autistic child,

2) The journey of experiencing services for autistic children,

3) The journey of navigating SLT services,

4) The journey of evolving therapeutic relationships and desirable clinical qualities,

5) The journey of evolving parental expectations of changes to services for autistic children.

Parents’ understanding of SLT services for autism was fraught with doubts about the public health system and the financial burden of accessing private services. Parents’ searches for services revealed significant wait times and barriers to access supports. Parents desired speech and language (SLTs) with clinical experience and understanding of parents’ roles in SLT. The need for reduced waiting periods for services and compassionate support for families of autistic children was also reported.

Findings provide insight into parents’ evolving expectations and suggested changes for services for autistic children, which are important for autism service providers. Future research should focus on autistic individuals’ and SLTs experiences of SLT services for autism.
The Health and Social Care Regional Integration Fund in Wales: developing new Models of Integrated Care
Authors: Cohen Rachel
Published: January 2024

The Health and Social Care Regional Integration Fund (RIF) is a 5-year funding Programme for the period 2022 to March 2027. The aim of the RIF is to establish and mainstream six new national models of integrated care to achieve the vision of A Healthier Wales: the Welsh Government’s long-term plan for Health and Social Care. It is a key lever for change and transformation across the health and social care. The RIF’s priority population groups are:

Older people including people with dementia

Children and Young People with Complex Needs

People with Learning Disabilities and

        neurodevelopmental conditions

Unpaid carers

People with emotional and mental health wellbeing needs

The person-centred outcomes framework for the fund was co-productively developed with Wales’s Regional Partnership Boards, who will use their collective resources to support the

delivery of the new models of care. This oral presentation aligns to the Person-Centred Care: focus on integration of goals and needs theme, and to 3 of the 9 pillars of integrated care as follows:

Shared values and vision

People as partners in health and care

Resilient communities and new alliances

The presentation will describe how the Communities of Practice (CoPs) established as part of the RIF have, through shared learning and consideration of good practice examples, been pivotal in identifying the likely core components of the new models of care, such as ‘What Matters’ conversations, which focus on people’s individual goals and the “needs” that they consider most important in their lives. We will also describe how the CoPs have helped to ensure that a person-centred approach drives our reporting and evaluation procedures, as well as the development of projects and the delivery of their services. The challenges of monitoring and comprehensive, robust evaluation in this specific context will be discussed, and we will explore the forthcoming challenges in terms of scaling-up new models of care to an all-Wales national level.
Implementing new teamwork models in primary care – perceptions of professionals
Authors: Ruotsalainen Salla , Hietapakka Laura , Sinervo Timo
Published: January 2024

Introduction: Finland is facing a large-scale health and social services reform in 2023. The aims of the reform are among others to improve access to care, equity of services and care continuity. In our study, we had one region, with three different organizations, that had implemented new teamwork models. These models aimed to improve multiprofessional co-operation and patients’ care continuity within the primary care services. In this study, we aimed to investigate how the new teamwork models are perceived by the professionals in health and social services (HSS) centers.

Methods: In total, we are aiming to conduct approximately 20 semi-structured interviews with professionals working in primary care HSS centers (the interviews are still ongoing). There were 8 semi-structured, pair or individual, interviews that were included in this study. The participants were from four different HSS centers, and they represented professionals from different occupational groups (nurses, specialized nurses, physicians, social workers). The interviews will be analyzed using Grounded Theory.  

Results: Preliminary analyses showed that employees felt that their co-operation with other professionals had improved and working in the same building or hallway enhanced co-operation. However, a lot of the co-operation level was dependent on the familiarity with other professionals. Regarding the teamwork model, the professionals thought for instance, that the model was ‘a half-way’ model, the wheel was re-invented with the model and that it was just crammed into the HSS center. On the other hand, the professionals described that they were fairly satisfied with their co-operation with other professionals in their own health and social services center. Nurses and physicians were closely co-operating on a daily basis, whereas other professionals, such as social workers were not that integrated into the teams. Strain and time pressure emerged from the interviews since new tasks had been given to the participants, especially for nurses. Turnover of employees and lack of physicians was further perceived burdening.

Conclusions: There were positive and negative sides of the new teamwork models. The models had been implemented fairly recently and therefore they were seen as not reached their full potential yet. In addition, professionals perceived that patient’s care continuity was smooth across actors. However, in some organizations the professionals feared that the reform will worsen the situation.
Development of an accelerated curriculum for clinical psychology doctoral students in substance use disorders and integrated care.
Authors: Reyes-Estrada Marcos , Nazario-Serrano Juan , Rodriguez-Díaz Gilda
Published: January 2024

Recently, a significant increase in the population with Substance Use Disorders (SUD) and Opioid Use Disorders (OUD) has been documented. This scenario is a complex one that adversely impacts disadvantaged populations and health systems in Puerto Rico. Similarly, limited access to adequate health services for the population with SUD/OUD has been studied. In addition, there is a need for trained behavioral health professionals with the right competencies to offer evidence-based services to people with SUD/OUD. This scenario points out the need for clinical psychology doctoral programs with specialized curriculum in SUD/OUD and integrated care at a reasonable time that allows for expanding the base of competent professionals in these services. OBJECTIVE: This work aims to discuss the results of developing and validating a curriculum for evidence-based behavioral health clinical training in SUD/OUD and integrated care in one (1) year. METHOD: A specialized SUD/OUD and integrated care curriculum were developed to achieve the objective. The curriculum developed was evaluated by a panel of experts. The recommendations were integrated into the final version of the curriculum. RESULTS: The curriculum revised in its final version contains thirty-three (33) training distributed in the following areas of focus: 1) SUD; 2) OUD; 3) Primary Care; 4) Integrated Care; 5) Tele-Psychology. The thematic areas of the training are distributed in three levels of complexity: basic, intermediate, and advanced. DISCUSSION: The accelerated curriculum for clinical training in SUD/OUD and integrated care developed offers a crucial opportunity to train professionals at the doctoral level with the necessary competencies to work with people affected by SUD and OUD. In addition, it offers a unique opportunity to integrate theory and practice in one (1) year, increasing the base of trained professionals. This program is a crucial opportunity to continue strengthening access to specialized and integrated services for SUD and OUD and close the disparity gaps that impact the population affected by SUD and OUD.