bluuebunny/crossref_metadata_2025_split huggingface dataset:
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 &amp; 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 &amp; 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.