bluuebunny/crossref_metadata_2025 huggingface dataset:
Chef-led taste centers provide an accurate and integrated transmural approach to chemotherapy-induced dysgeusia in adult cancer outpatients
Authors: Geurden Bart , Corremans Marleen , Van den Wijngaert Lobke , Goossens Edwig , Vlaemynck Geertrui
Published: January 2024

Introduction: Taste changes are common during chemotherapy. Currently, limited evidence-based guidelines exist for the effective management of chemotherapy induced dysgeusia in adult cancer outpatients. In this study, chefs gastro-engineering combine medical and para-medical assessments with innovative insights from gastrological sciences such as selective taste management to improve the taste of bread for cancer outpatients.

Method: The oncologists from the participating hospitals referred eligible patients to a chef-led taste center. The chef gastro-engineering carries out a taste assessment and combines these results with the food preferences of the patient as well as any advice of the dietician and/or the speech therapist to develop personalized recipes, in this case a recipe for personalized bread.  The patients were asked to bake and consume this personalized bread at home, with the help of their family caregiver. The effects of this innovative self-care intervention were measured after 1 month follow-up.

Results: Included patients (N=112) are randomly divided in a bread-baking (intervention) group (N=54) and a control group (N=58). Over 80% of the bread baking patients perceived personalized bread as equally or more tasteful than usual bread despite their stressful chemotherapy-induced dysgeusia. After one month follow-up a significant loss of bodyweight (p .021) and Body Mass Index (p .025) is observed in the control group while in the bread-baking group this loss was not significant (p .968 and p .956 respectively).  Only 17% of the bread baking group required some telephone or online assistance in order to correctly apply their personalized recipe. In-depth Interviews with the patients and their caregivers revealed the highly empowering effect of this innovative self-care intervention. In 60% of the cases, the bread was prepared by the family caregiver. Compliance was high and no side effects were reported.

Conclusion: A chef-led taste center appears to be able to accurately and safely address the chemotherapy-induced dysgeusia in adult cancer outpatients. Thanks to this integrated and hyper-personalized approach to a stressful side effect of chemotherapy, more than 80% of the participants were able to enjoy tasty bread again despite dysgeusia. Given the positive effect on patient empowerment and since baking personalized bread at home is safe and feasible, this approach should be extended to other meal components. A chef-led taste center should be structurally anchored in the transmural integrated care pathway for adult cancer pati
Drivers that influence the development of care and service pathways for mental health clients in health and social service organizations
Authors: Longpré Caroline , Jubinville Maripier , Tchouaket Nguemeleu Eric
Published: January 2024

Background: Investigation, diagnosis, treatment, and follow-ups are the stages of care to be integrated into a care trajectory for clients requiring mental health care (MSSS, 2021). As a result of recent structural reforms, health care organizations are focusing on more integrated care and services in order to respond effectively to the complex needs of this clientele, which poses challenges for the institutionalization of clinical and management practices aimed at better integrating care and services.

Objective: To identify the drivers that influence the development of care and service pathways for mental health clients in health and social service organizations.

Method: Cross-sectional, descriptive, qualitative, single-case study (CISSS in Quebec) with nested levels of analysis covering the settings of a ""Mental Health Care"" trajectory. The settings include the first, second, and third levels of care. Guided by Longpré's (2017) framework (LO-DISS) linking governance, organizational, structural, and clinical processes with key organizational resources, an interview guide was developed. Clinical professionals, managers, and administrators (N = 10) participated in semi-structured interviews that were analyzed using a qualitative data processing tool (NVivo). Result: Drivers of integrated care and services for mental health care pathways have been identified for each component of the LO-DISS model (2017). These highlighted processes include interdisciplinary collaboration, the patient-partner approach, quality assessment mechanisms, the development of integrative roles (case manager), and the mobilization of environmental and technological resources (electronic records, an environment that supports confidentiality and collaboration). The findings support the notion that investments in resources, processes, also clinical and management practices are key to integrating care and services and providing quality of care.

Recommandations: Using the LO-DISS care and services integration model to support renewed clinical governance allows for the deployment of strategies aimed at formalizing clinical and management practices that link the various mental health care pathways experienced by the population.
Working towards inclusive integrated care: a possible lens
Authors: Berdai Chaouni Saloua
Published: January 2024

According to the World Health Organisation (WHO), integrated care’s primary goal is meeting people's needs. Whichever integrative care model is used, the way to gauge the success of this goal is the healthcare user's satisfaction with the care provided, and the extent to which their needs have been met. In the super-diverse context of most Western-Europe cities and regions this is a challenge.

Ethno-cultural diversity as one of the visible aspects of diversity resulting from migration is increasing within our population. The question is therefore how we ensure that integrated care is inclusive for this growing ethnocultural diversity among care users. Our studies involving older labour migrants with dementia and their caregivers, both informal and formal, in Belgium indicated that these older adults do not receive care that meets their needs. The reason for this misfit in care is still too often and one-sidedly sought in these older people’s cultural background. Much less attention is paid to the exclusionary mechanisms within the care system.

To sharpen the picture, we developed a conceptual lens for inclusive care. This lens looks at the influencing factors for inclusive care at micro, meso, macro and chrono levels. It helps us to observe the complexity of these influencing factors and to avoid the essentialist framework shaping the current debate on provision of care for the 'culturally other'. We detected three building blocks for complexity-responsive integrated care: 1) awareness of the intersectional position of the ‘other’, 2) the need for inclusive care organizations and inclusive care landscapes in a globalized world, and 3) addressing societal exclusionary mechanisms. These building blocks can be a starting point to recognize the intersectional identity of each person involved in care, including the care provider’s, as a stepping stone to inclusive responsive care. This implies that the exclusionary mechanisms associated with social positions are recognized and addressed at micro, meso and macro level. To conclude, the proposed intersectional inclusiveness is a path worth exploring in attempts to achieve the ultimate goal of integrated care: meeting the needs of all care users.
#NavigatingHealth - Building a Global Movement Empowering Patients to Navigate Health Systems
Authors: Slade Siân , Ryan Kay
Published: January 2024

Background: Whilst health reports talk about health systems shifts from reactive “one size fits all” to proactive personalised health care, the current reality is that health systems are challenging for patients and carers to navigate. Patients frequently experience gaps and barriers in healthcare. We talk about patient-centred care, but we do not have patient centred systems. The challenges are not new and patient navigation was extensively research by Professor Harold Freeman in the US over 30 years ago.

Audience: This presentation is for a multidisciplinary audience of patients, health professionals, policy managers and politicians focused on enabling patient-centred at a systems level.

Who did you involve and engage with? What was the approach and process undertaken?

Patients, professionals and policy makers in Australia and globally have been involved in what started as a national Community of Practice in Australia “Mind the Gap: #NavigatingHealth”.

The approach was tested for audience interest with a series of two webinars in September 2021 to set the scene of navigating health across a life journey of patient and provider experiences with a solutions focused approach on how to tackle the many challenges.

Following the success and interest of the webinars and as part of a focused advocacy and change management approach we developed a bimonthly Community of Practice. This is open to all those in Australia. Our focus in the first year was to make visible the many solutions being developed to support patients and to develop an engaged participatory community and build connection.

Further to the success in the first year, we have now expanded the approach at a global level running our first global webinar in November 2022 with speakers from Australia, the United States of America, Canada and the United Kingdom providing a connected approach across a life journey. This included lived experience of patients as well as presentations from non-governmental, medical and government organisations interweaving micro, meso and macro approaches (for example included American Cancer Society, NHS England).

What is the learning for the international audience? Problems that patients face navigating health systems in countries are common and consistent. Collaborating across disease and functional areas both within and across countries allows the opportunity to take a “big-picture” view to take a systems focused approach. This allows the solutions being developed to be coalesced at a systems level, remove duplication and leverage resources to benefit both patients, providers and policy makers to focus on a person-centred value-based healthcare approach across a life journey.

What are the next steps? Our next steps are to consolidate the learnings and scale. Whilst our initial focus has been high income countries we will be expanding the approach in 2023 to low and middle income countries using the same methodology.
Introducing a conceptual framework for reflective team dialogue to foster interdisciplinary collaboration in community health centers in Flanders & Brussels
Authors: Vyncke Veerle , Meeus Tom , Depoot Peter
Published: January 2024

Short intro:  By facilitating a reflective team dialogue on key elements of interdisciplinary care, the framework “Complementary Care” supports primary care teams in shifting from multidisciplinary to interdisciplinary collaboration.

Abstract: The Association of Community Health Centers (CHC) overarches a diverse set of 37 interdisciplinary primary care practices in Flanders and Brussels. The centers are funded  via a needs based capitation model. Although team collaboration is facilitated by practical and financial factors, there was a need for strengthening interdisciplinary collaboration. 

A reflective framework was developed by an interdisciplinary group of primary care professionals. It was described that the CHCs wanted to evolve from task shifting towards task sharing. In task shifting, care tasks are delegated from one team member to another team member. Task sharing however is a the uptake of integrated care by the whole team in shared responsibility and based on a shared vision of care, via the acknowledgment, recognition and optimal usage of the qualities in the interdisciplinary  team. A participative trajectory, including 47 primary care professionals from 11 different disciplines, led to the identification of six essential buildings stones to work towards task sharing: (1) the acknowledgment of other team members in their expert role, (2) the composition of the team, (3) self care, (4) shared ownership, (5)  speaking a common language and (6) a sense of equality within the team. The developed framework has been tested as a discussion tool in 5 interprofessional teams. Preliminary evaluation shows that it has led to the implementation of quick wins and more profound transitions towards integrated care. A further dissemination of the framework is planned trough in-site visits of CHCs.
Patient-GP-Pharmacist cooperation towards individualized tapering schemes for long term benzodiazepine users
Authors: Saevels Jan , Storme Michael , Straetmans Koen , De Rocker Hendrik
Published: January 2024

Long-term use of benzodiazepines and Z-drugs is associated with multiple side effects, such as increased sedation, fall risk, and an elevated risk of dependency and abuse. Avoiding initiation of treatment, or stopping treatment after a few weeks, is definitely the best-case scenario. But for patients that are already using benzodiazepines for more than 3 months (up to 20 years or more), a deprescribing methodology should be deployed. Abrupt withdrawal, particularly if the individual has been taking the drug in high doses, can result in severe symptoms, including psychotic reactions. The recommendation is for slow withdrawal, tapering the dosage gradually over a period of several months.

Pharmacy compounding of capsules has been a possibility for many years, and allows to prepare and dispense individualized dosages to patients. Medical practitioners such as GP’s have always had the possibility to prescribe dose reduction schemes for patients motivated to taper off. Unfortunately, as benzodiazepines are not reimbursed in Belgium, this came at a high cost for patients.

In 2022, pharmacy associations together with health insurance funds and the National Institute for Health and Disability Insurance (NIHDI) worked on a reimbursement scheme that allowed tapering off benzodiazepines. The patient-GP-pharmacist triangle is at the core of the scheme:

-Pharmacists raise awareness when dispensing prescribed benzodiazepines, and prepare and dispense individualized doses

-GP’s motivate patients to consider tapering and prescribe the programme

-Patients engage in a tapering path and are intensively followed by the GP and the pharmacist

Apart from the roles and responsibilities of the 3 parties, there are some rules set out to increase the change of successful tapering whilst keeping expenditure under control. For instance, a maximum daily consumption of 3 DDD set out, there is choice between 3 tapering schemes (5, 7 or 10 steps), and the total duration of the programme should not exceed 360 days.

Critical success factors of these programs are: intrinsic motivation of the patient, therapeutic contract with 3 parties concerned, absence of financial penalty for patients, and smooth communication between prescriber and preparer/dispenser.
How collaboration between (occupational) physicians and work actors foster successful reintegration to work after or during health problems.
Authors: Bassele Nikolaj , Germeys Lynn , De Roeck An , Vanacker Hilde
Published: January 2024

Incapacity to work has a high price tag. The longer someone is incapacitated for work, the more difficult it is to return to work. It is therefore of the utmost importance to give employees the opportunity to return to work at an early stage. Fortunately, in most cases employees with health problems return to work, whether or not through a (in)formal reintegration process. However, sometimes employees need more specialized support or guidance to return to work, either to their own employer in the same or an adjusted function, or to a new employer.

Two Belgian external services of prevention and protection at work (Idewe and Mensura) collaborated with the Flemish public employment service (VDAB). They aimed to foster and speed up the reintegration of incapacitated employees who could not return to their own employer. The pilot study ran from September 1, 2021 till December 31, 2022. The study included more than 300 incapacitated employees who were definitively unfit for their agreed work according to the assessment of the occupational physician.

During the pilot study the incapacitated employees were informed individually about the range of services VDAB and its partners have to offer to support the reintegration into the labor market. In addition, the study examined the outcomes of a fast and privacy-proof manner of voluntary registration from the occupational physician to VDAB. Moreover, the study examined the communication between the actors involved in the reintegration process, such as when and which information is needed.

During the presentation we will be able to present the final conclusion of the pilot study (e.g., which services were provided to support reintegration, how many incapacitated employees returned to work).
First steps towards a shared care model for spinal cord injury in rural Switzerland
Authors: Tomaschek Rebecca , Touhami Dima , Essig Stefan , Gemperli Armin
Published: January 2024

Background: Persons with spinal cord injury regularly consult primary and secondary care physicians for their holistic needs. However, in remote areas of Switzerland general practitioners (GPs) compensate for a potential undersupply of specialized services. Building collaboration and distributing roles between GPs and specialists is needed to improve the continuity of care for persons with spinal cord injury living in rural Switzerland. This intervention study aims to develop, implement and evaluate an integrated care model as a case in point.

Intervention: As part of the study, physicians from specialized spinal cord injury centers, specialized mobile nurses and GPs collaborate to improve patients' outcomes and providers’ experience with delivery of care. Measures to enhance collaboration include joint continuous medical education, training in the primary care practices and support for complex patients. Medical education topics cover the most prevalent secondary health conditions, as well as physicians’ priorities and interests for shared care. During the design of the intervention, persons with spinal cord injury and their families were engaged in a sounding board, where they expressed their wishes and concerns.

First results: Seven primary care practices were successfully recruited to expand competences in spinal cord injury care. Persons with spinal cord injury, living in the practices’ catchment area were invited to the practice. Mixed methods evaluate patient and health provider outcomes at specific time points. Baseline results on the collaboration between GPs and specialists, show high physician satisfaction ratings. Challenges in collaboration seem to be related to unclear roles and responsibilities due to different expectations among physicians. Between baseline and 1-year follow-up, significant differences were found in the average number of patients’ GP visits.

Next steps: As a second study phase, more primary care practices will be recruited. Healthcare professionals will discuss and negotiate their roles and responsibilities in round tables. To support a common understanding, a toolkit for primary care will be developed. Lastly, more components that enhance shared care should be introduced such as joint patient consultations or information exchange platforms.
Youth Wellness Hubs Ontario: A Youth Mental Health and Substance Use Learning Health System
Authors: Henderson Jo , Papadimitriou Maria , Darnay Karleigh
Published: January 2024

Problem and Context.  The need for youth-friendly early intervention services to meet the mental health, substance use, primary care, and other social needs of adolescents and young adults is well-documented. Clinicians and researchers in child and youth mental health have been calling for better integration of child, youth, and family-facing systems (e.g., health, mental health, child welfare, youth justice, education), as well as increased attention to holistic services that reflect the developmental, cultural, social, and health realities of children, youth and families. Integrated youth services are designed to address the gaps in youth mental health by providing youth-friendly, comprehensive services for youth ages 12 to 25, in a one-stop shop model of service delivery.

Who is it for? Service providers, researchers, clinicians, youth and families.

Who did you involve and engage with? A fundamental contribution of YWHO is the inclusion of meaningful youth and family engagement processes in service design, delivery, and evaluation. YWHO has youth and family advisory councils both at the provincial and local levels who contribute to planning and operations, including service planning, governance, training, evaluation, communications, and funding-related decision-making. A decade of research has supported the development of integrated youth services for youth mental health.

What did you do? This presentation will describe Youth Wellness Hubs Ontario, a province-wide initiative in Ontario, Canada to build and implement a one-stop-shop model of integrated youth services. The presentation will also describe the model’s values, core components, and services.

What results did you get? What impact did you have?  The demonstration phase of Youth Wellness Hubs Ontario was initiated in 2017-2018 with the implementation of 10 sites. In 2022, 22 IYS networks have been established. Youth Wellness Hubs Ontario is co-created with youth for youth aged 12 to 25 years old across diverse community contexts. Youth Wellness Hubs Ontario centres engagement and equity, and offers developmentally-appropriate services in an integrated, community-based walk-in format. As an initiative committed to continuous learning and quality improvement, Youth Wellness Hubs Ontario offers evidence-based and evidence-generating services, and measurement-based care. Youth Wellness Hubs Ontario is supported by backbone resources with expertise in implementation science, health equity, Indigenous practices, youth and family engagement, evaluation, and knowledge translation.

 

What is the learning for the international audience? Youth Wellness Hubs Ontario demonstrates the feasibility of integrated mental health and substance use early intervention services, offered in the context of a broad range of health and social services.

What are the next steps? Future directions include continuous learning and evaluation of the YWHO model in communities.
A plea for a meaningful life ... on the road with your own network
Authors: Hugens Skrolan
Published: January 2024

If someone becomes seriously ill, has a child with a disability, has a serious accident… a lot of organization is needed to arrange all medical care and necessary support for that person (and often for the family as well).

People testify; you are overwhelmed by your illness, you do what needs to be done, you go into survival mode… This survival mode is a major force in making sure people can arrange everything that needs to be arranged, but it also results in disregarding important questions such as 'what do I really want now?', 'how do I feel good in this situation?', 'how do I survive in the long term?'.

Fortunately, in such moments there are often other people like family and friends, who think of the “small bearers of luck in life”: which music can be played in their room, which friend can join them at a treatment, which cake is to be taken to the rehabilitation centre, how can the parents recharge their own batteries so they can keep on going? ...

Important human gestures, close ones and relatives who stay involved, fight for what's important, don't let go, are as important as good medical care and support.

People who call on Lus feel the need for a strong(er) "back-up group" or "loop (lus)" of family and friends, because they want to build a good and happy life, not just survive...

Lus-groups meet this requirement. Volunteers ensure that a Lus-meeting is guided so that subjects/themes that really matter are discussed. Concerns are talked about and plans are made to engage, also in fun things. All participants assess in what way(s) the central person’s talents/interests/wishes stay at the center of the gatherings. They discuss problems, celebrate/share successes and express gratitude. Great and small, genuine concerns are shared so that people can lead a meaningful life again. Having conversations that really matter, making choices based on this knowledge, those are the strengths of our groups.

Over time we see that people in Lus-groups slowly regain control of their own lives again and reciprocity grows back: the central person takes on the hosting, he helps an other, ....

People have been meeting in Lus-groups in Flanders for 20 years. At this time there are 120 active groups. This way, 700 people are involved in the lives of others and we form a web of caring Flemish citizens.

As a result of the expertise we built in our Lus-groups, we designed a model that highlights the 4 key elements of every lus-group. In the workshop we want to discuss those 4 themes. Through small excercises and testimonials we want to let the participants feel the Lus-vibe!
Awareness, Knowledge and Attitudes of the Brussels and Flemish-Brabant Population towards Paternal Perinatal Depression in Belgium
Authors: D'haenens Florence , Akalin Ayse , Demedts Dennis , Fobelets Maaike , Tricas-Sauras Sandra
Published: January 2024

Introduction: Paternal perinatal depression (PPND) occurs in 10% of fathers, which implies an important burden for families and public health services. A better understanding of the population awareness on the topic is essential to adequately identify and adequately support these cases.

Objective: This study aims to investigate the awareness, knowledge, and attitudes of the Brussels and Flemish-Brabant population in Belgium towards PPND, using the validated Depression in Dads (DDads) questionnaire.

Methods: A two-strands descriptive study was conducted in the Brussels’ Capital Region and in the province of Flemish Brabant, Belgium between March-May 2020 and March-May 2021. The sample included 314 adults, aged 18-65 years, Flemish speaking, and living in the previously cited provinces. The DDads Questionnaire was administered online via LimeSurvey© (an encrypted and secured online data collection service) due to the COVID-19 social distancing measures. Data were analysed using IBM SPSS 28.0 SPSS© Statistics for Windows©. Ethical approval was obtained from the Brussels’ University Hospital and the Vrije Universiteit Brussel (VUB) committees.

Results: In the case of respondents, anxiousness was the most frequently cited mental health problem as experienced by men during their partners’ pregnancy (82.4%) and during the postnatal period (68.4%). Although well recognized as mental health issue, and as a general health concern, paternal depression had low recognition by respondents, and it was considered by 37.3% of them as being “normal” during the process of fatherhood. New personality traits such as (withdrawal, avoidance, isolation, indecision, or irritability, amongst others) were regarded as a common symptom of PPND by 64.6% of respondents. When asked about best ways of coping -in the case of paternal depression- non-pharmacological approaches were mostly preferred. In the case of experiencing PPND, the main advice was to ask for support from informal networks (family or friends) whilst professional support from the mental health services was suggested only as a secondary option. Over 70% of respondents believed that paternal depression requires from a specialized treatment though. Only 39.2% of the respondents agreed that all men should be screened for depression symptoms during pregnancy, and 43.0% of participants agreed that those symptoms should also be checked after delivery.

Conclusion: Attitudes towards PPND appeared to be diverse. PPND and perinatal mental health terms seem to be poorly understood. A clear need to increase awareness concerning men’s mental health during pregnancy (of their partners) and PPND is patent. Better awareness may help fathers in difficulty to be identified earlier, for them to be better attended during this process, and to decrease PPND rates and ultimately improve perinatal mental health.
Unlocking the muse - Developing arts-based approaches for people with Parkinson’s disease
Authors: Stap Thieme , Koksma Jur , Crone Julia , Pelowski Matthew , Bloem Bas , Spee Blanca
Published: January 2024

Interventions considering the arts are increasingly gaining acceptance in the clinical-methodological repertoire, and in supporting people with diseases. However, current approaches are often limited considering the variety of offered creative activities and are neglecting the influence of the artistic context. Furthermore, there is often a focus on momentary well-being primarily and not on the impact on quality of life, missing centralization around the transferability of creative engagement and art-based interventions into daily life issues. The goal of our study is the implementation of a person-centered, art-based program.

We offer people with Parkinson’s a program wherein they participate in orientation sessions (playgrounds) to find preferred activities, and in specialization sessions (artist studio’s) to develop deep engagement/flow in the preferred activities. Self-direction by participants and a psychological safe environment, are the cornerstones of this program. The first group of participants (n=5) took part in a pilot study. A second pilot and full trial will take place early 2023.

The activities can address both instrumental (practical utilization) and non-instrumental (existential) creativity, with the upper goal to increase the individuum’s quality of life as the main outcome variable. Besides these three quantitative measures (pre/post), individual open interviews (pre/peri/post) are held and analyzed using thematic and grounded methodologies. We aim to distil the active ingredients to transform a person’s mindset and skill-set to learn that engaging with creativity is a tool for enhancing individual quality of life in a self-empowered manner. We will present the first outcomes of our study in this poster.
Integrated Care and Social Protection for Senior Citizens In West Africa: A Scoping Review
Authors: Banaru Abubakar Ibrahim , Banaru Abubakar Hafsat
Published: January 2024

Background: West Africa's population is aging at a rapid rate, and the prevalence of older adults with multiple chronic conditions is rising. However, there is little information available about healthcare policies for this age group in this region ten years after the Madrid International Plan of Action on Ageing (MIPAA). To manage the physical and psychosocial needs of senior citizens, a greater integration of healthcare services is required.

Methods: A scoping review was conducted adhering to the Joana Briggs Institute’s systematic scoping review protocol guidelines. A simple search strategy was developed to collate relevant articles from PubMed, Google Scholar, and AJOL, as well as policy databases, between 2002 and 2022. Articles were included if published in English and related to primary care, social care, and multi-morbidity among older persons in West Africa.

Results: The findings yielded three thematic issues. First, most West African countries have policies on healthy aging; however, only a few have coherent policies on access to healthcare for older people and the availability of social safety nets, highlighting the need for policymakers to provide coherence and avenues for integration. Secondly, while integration of non-communicable disease services focuses on individual-level services rather than multi-sectoral integration, there is also a poor focus on mental health and sexual and reproductive health integration. Finally the inherent capacity development needs and technical up-skilling requirements require a whole-system approach with contextual nuances.

Conclusion: The literature is increasingly recognizing an aging population and the prevalence of multi-morbidity in West Africa. Countries in West Africa, in response to the MIPAA, have formulated policies with regards to older persons' healthcare needs; however, improvements in clinical care at the individual setting level may not be sufficient. A deliberate whole-system approach that fosters multi-sectoral collaboration for integrated healthcare might go a long way toward better outcomes for senior citizens and a step forward toward universal health coverage.
Neighbourhood care meetings by BruZEL
Authors: Moortgat Dorrit
Published: January 2024

What is it about? The main task of the BruZEL primary care zone is to connect first-line care actors to ensure that people in need of care or assistance get the help and care they need in their own neighbourhood. 

Who is it for? Finding the help and care they need is a difficulty for many citizens, especially in the Brussels   Capital Region where the health care landscape is complex and fragmented. A first step in facilitating access to care is creating a local network of care providers to get to know each other and coordinate with one another. This ensures a multiple aim, e.g.:

* all citizens receive the help and care they need

* qualitative integrated care is provided in an effective way 

* care providers are more satisfied 

Who is involved? A staff member of BruZEL initiates, stimulates, inspires and leads the local network.  

This network involves all actors listed within the integrated care model: it is open to all health care providers and welfare workers, local authorities, citizens, teachers, shop owners...

What do we do? The neighbourhood care meeting assembles all actors mentioned above about 4 or 5 times a year either physically or online:

* to get to know each other (and each other’s work) better

* to exchange information

* to find local solutions for complex cases

Furthermore, they all exchange contact details in order to be able to address whenever necessary to everyone and to provide the answers ASAP.  Prerequisite is that they do not share sensitive information (GDPR compliant).

What are the results and the impact?

* (Health)care professionals know each other more and know what role they can play in the (health)care process. This knowing leads to better understanding which eventually results in a better collaboration

 

* Defining (health)care-related information and/or referral points with a broad view and therefore a key role

* People in need of care get adequate (local) help through their (health)care provider

* Creation of a local health and care map (work-in-progress)

* Possibility to detect recurring problems

What is the learning?

* It is a simple concept but it works!

* The connection in the bilingual Brussels Capital Region is not a problem as everyone can speak their own language

What are the next steps?

* This concept has so far been developed in 1 community (Jette). The idea is to extend it to others.

* Explore what is possible with the central role of the (health)care-related information and/or referral points 

* Achieve sustainability by handing over the meeting to local actors who can strengthen and formalize these steps towards integrated care
Shifting to person-centred service delivery with coordinated health and social outcomes
Authors: Upegui Héctor
Published: January 2024

CHSO is a person-centric service delivery model where health and social services are provided in a coordinated way to improve outcomes. It does not require merging agencies or governmental bodies, but it’s an approach that involves all stakeholders, including the person receiving the service. It’s a model to enhance the flow of service, so that the person doesn’t navigate alone through all this complexity, but that the system adequately rotates around the person. It goes beyond just aligning health and social care services, or just organising them as check lists for execution. It is about understanding the needs of the person, the service delivery process, the rationale behind it and the best route in reaching outcomes.

To provide person-centric care, health and social services need to improve their coordination of services. This paper presents and reflects on six elements identified through worldwide observations of ongoing care transformations.
Group Sessions Performance Feedback System to Promote Physical Activity and Heath Decisions- Making
Authors: Mendez-Zorrilla Amaia , Romero Sheila , Vicente-Saez Javier
Published: January 2024

Introduction: In recent times, there has been a boom in data analytics in different sectors (banking, retail...) this type of task facilitate decision-making or helps to better understand the needs of patients/users. Now, these techniques are also starting to be implemented in the world of physical activity, with different objectives. Among them may be the prevention/prediction of injuries, or obtaining the maximum performance, but they are also an element to analyze the physical activity of chronic patients, people with special needs or elderly people. This project promoted activities such as walking, physical activity in parks or in the gym in groups.

Objectives: The main objectives are:

- to capture and digitize all available information

- to design an interactive web application to help doctors, caregivers and patients themselves to make decisions about their health.

- to test the application results with the final users

Methodology: The data come from activity wristbands and video recordings of group exercise over several sessions (alt least 2-3 sessions).

The groups that have participated in the tests are composed of between 5 and 15 people (of legal age), and all of them with some kind of disability or chronic disease. The recordings have been made on a minimum of 3 sessions per group carried out on different dates and with repetition of exercises.

After extracting and digitizing all the data, it is stored in a database, and analyzed following the CRISP-DM methodology.

Results: The resulting application allows visualization of individual and collective statistics of measured variables, comparisons of performance between patients/users, and provides information in text that can be interpreted by anyone.

All users receive feedback after their sessions via cell phone, and they, as well as their doctors or caregivers, can review the detail in the interactive application.
A novel application of a self-report comprehensive assessment: Where do telephone assessments fit in home care practice?
Authors: Schumacher Connie , Correia Rebecca H , Hogeveen Sophie , Salter Megan , Donaldson Bailey
Published: January 2024

Introduction: In Canada, long-stay home care patients are a prevalent group of frail older adults living in the community. Home care patients have a high emergency department visit rate compared to those living independently without formal home care services. In March 2020, concerted efforts were put into place to reduce COVID-19 transmission and spread in health sectors, including older adult home care populations.

Description: The interRAI home care (HC) assessment is the practice standard for face-to-face comprehensive assessments in home care.  The interRAI Check Up is a comprehensive self-report assessment that can be completed in-person, by video call or telephone.  Check Up assessment items are consistent with the content items of interRAI HC.  During pandemic mandated restrictions, care coordinators used the Check Up to assess new and existing patients over the phone or by video call to ensure continuity of care. Feasibility and utility of the Check Up was evaluated through a staff survey and focus groups in two distinct regions of Ontario.

Discussion: A total of 48 care coordinators completed the survey, of which 7 consented to provide feedback in the focus groups. Care coordinators found the Check Up easy to pivot to during the pandemic, citing familiarity with questions and risk algorithms. The Check Up results were helpful in gaining an understanding of the patient’s medical issues, functional status, mood, and informal supports, while telephone and video assessments saved travel time. According to the care coordinators, patients and informal care givers were comfortable answering the questions over the phone and appreciative of interaction with a health professional. Although care coordinators were accustomed to telephone check ins, language barriers, hearing impairment, and inability to see the home environment were limitations.  Care coordinators found telephone assessments, using the Check Up, most beneficial in the absence of cognitive impairment and with patients previously known and assessed by the care coordinator. 

Conclusion: The interRAI Check Up was an efficient method of completing a comprehensive assessment over the phone.  Care coordinators found the Check Up to be best suited for reassessments and as a new assessment with stable, cognitively intact patients. Our findings support use of the interRAI Check Up as a promising and feasible addition to the suite of tools for home care coordination.
Primary Care Family Physicians’ Experiences with Clinical Integration: A Scoping Review of Qualitative and Mixed Reviews
Authors: Tseng L. Olivia , Kim Grace G , Newton Christie , Wan Yu Ho Julia , Hall David , Lee Esther , Howard Chang , Poureslami Iraj , Vasarhelyi Krisztina , Lacaille Diane , Mitton Craig
Published: January 2024

Background: Clinical (service) integration in primary care settings describes how healthcare services are coordinated over time across healthcare contexts to meet patient care needs. Promoting integrated care with interventions that lack systematic approaches can unintentionally increase the complexity and fragmentation of the healthcare system. To improve care integration and healthcare service planning, a systematic approach to understanding its many influencing factors is paramount. This phase I study aims to generate a comprehensive map of family physician (FP) perceived factors, across diseases and patient demographics, influencing how services are integrated for patients.

Methods: The protocol development is guided by Arksey and O’Malley’s scoping review methodology framework. Keywords and MeSH terms were contributed by a multidisciplinary team of healthcare professionals, researchers, and patient representatives through an iterative discussion. An Information Specialist with clinical research expertise tested keywords and MeSH terms to build a search strategy using MEDLINE. The strategy was then adjusted for the EMBASE and CINAHL databases. All identified articles were imported into Covidence platform, and 228 duplicates were removed. Two independent reviewers screened 1,771 studies by their titles and abstracts. Of them, 264 studies were reviewed in full text against the selection criteria and their references were hand-searched. A total of 91 articles were included, and over 2,800 factors were extracted. The factors are being or will be coded into themes the Clinical Integration Framework, a merging of two existing models identified from literature and modified. Within each theme, similar codes are clustered together as a subtheme.

Discussion: The identified factors will help develop a survey in Phase II study to ascertain high impact factors for intervention(s), as well as thematic and evidence gaps to guide future research. The study findings will be shared with stakeholders to promote awareness of clinical integration issues through multiple channels: publications and conferences for researchers and care providers, an executive summary for clinical leaders and policy makers, and social media for the public.
Above The Clouds: a loving way to look at perinatal loss.
Authors: Fransen Anneleen
Published: January 2024

Above the clouds is a charity organisation in Belgium, founded in 2016, by Anneleen, midwife and photographer, and Sharon, photographer and bereaved mother of Nina*. Our goal: give all bereaved parents in Belgium beautiful memories of their deceased baby. More than 4500 babies have since been photographed.

As a society we have lost the connection with death, although it is a key part of life. How can we look differently at mourning and loss and by doing so support bereaved parents and family and friends? What can we, as healthcare providers and human beings, do more to give parents who experience loss the best possible start in their mourning process?

Through real life stories we take the audience on a journey to change their view on mourning, loss and death. The importance of recognition, memories and the extremly hard but beautiful and important moment of saying goodbye.

The only way to heal our society in our way of looking at death and mourning, is creating awereness around the subject of perinatal loss and starting to look at it with different eyes from a loving point of view.
The 7 fundamental ways that mental health services should engage with carers and family.
Authors: Maybery Darryl
Published: January 2024

Having a parent with a mental illness doubles the risk of children also developing a mental health problems later in life.  However, the influence of parental mental illness can be negated by targeted and integrated care.  Thirty six percent of clients attending adult mental health services (AMHS) have children under 18 (Ruud et al., 2019) and when mental health service providers, service users and their carers/family successfully integrate their care and perspectives, widespread benefits flow to all stakeholders.  However, mental health services do not commonly engage with carers or family.  This presentation describes (a) an extensive review of the literature and (b) mixed method feedback from 134 carers/family members about what they received and wanted from mental health services.  The findings triangulate carer/family PPI with multiple diverse literatures, to confirm 7 fundamental engagement practices that carers/family want from health services.  International delegates will understand from this presentation the ‘fundamental’ ways that mental health services should engage with carers and family of mental health service users.  They will also understand how and why such engagement is ‘fundamental’ to the wellbeing of both service users, their carers and family members.
The implementation of I.ROC as a way to use client goals as drivers to organise mental health care and improve mental health care through outcome monitoring.
Authors: Deloof John
Published: January 2024

De MaRe uses the Indivdual recovery outcome counter (I.ROC) as a way to organise mental health care starting from the individual client needs and goals. Clients are put in the drivers seat of their own recovery proces by being able to set their goals on the HOPE-framework (home, opportunity, people, empowerment) and determing their own needs in health care. Health care workers developed a toolkit to meet clients needs and facilitate the recovery proces.

By processing the data the health care facility can use generalised input as an outcome monitor and improve the health care service for clients.

Generalised data can also be used to benchmark the provided care with peer centers in Flanders