bluuebunny/crossref_metadata_2025_split huggingface dataset:
Putting proportionate universalism into practice: challenges and tools
Authors: Van Brussel Leen 
Published: January 2024

Proportionate universalism is a well-know strategy in the effort of reducing social health inequalities. It refers to the resourcing and delivering of universal services and interventions at a scale and intensity proportionate to the degree of the need of the target group. However, putting the principle of proportionate universalism into practice, is highly challenging. Applying proportionate universalism demands for a systematic thinking exercise about similarities, unique characteristics and differences of and between different subgroups, especially those most at risk, that are part of the broader target group (e.g. inhabitants of Flanders).
Developing a well thought out strategy of proportionate universalism requires an answer to the following questions:
-What are the high-risk subgroups that require special attention?
-Can the needs, interests, concerns, barriers, … of the high-risk groups be integrated in a universal approach that serves the entire target group?
-What ‘proportionalities’ need to be added to the universal approach so that high-risk groups are definitely served?
-Are there particular needs, barriers, concerns, … of high-risk groups that are very specific and different from those of other subgroups, which requires the development of a ‘categorical’ service, intervention,… targeting one specific subgroup?
We developed a user guideline, ‘Determining your proportionate universalism strategy’, which supports professionals in the field of prevention and health promotion to reflect upon these questions and formulate answers to them.
In addition to this guideline, we developed an inspirational guide including 10 methods that help professionals putting proportionate universalism into practice: ‘Health promotion for and with socially vulnerable populations: 10 methods for an inclusive approach’. These methods are well known for their potential in health promotion for and with underserved and socially vulnerable groups. The methods are visually presented and clustered in a ‘cake’ and divided into four categories: 1/ ‘getting to know’, 2/ reach, 3/work together and 4/empower and advocate. Each method is furnished with good practices from the field. During the months to come, focus will go to the implementation of both tools (the user guideline and the inspiration guide) in the sector of prevention and health promotion in Flanders.

In this presentation, we will present both tools and focus on how they can be used to support the development and implementation of inclusive health promoting interventions that follow the principle of proportionate universalism. We will refer to multiple good practices to illustrate the tool’s added value for professionals and policy makers.
Implementation of an asynchronous general practitioner‑to‑specialist&nbsp; eConsult service (eConsultant) in Australia
Authors: Job Jenny , Jackson Claire , Liddy Clare , Nicholson Caroline , Donald Maria 
Published: January 2024

Background: With the rise in demand for specialist care across Australia, patients are experiencing excessive delays for specialist input, linked with subsequent deterioration in health. eConsultant is an outpatient substitution model which has been evaluated and implemented extensively internationally. It provides an asynchronous, digital, clinician-to-clinician advice service, giving GPs remote access to specialist support for patient care within 3-business days. This study, the first to track implementation of an eConsultant service in Australia, identifies barriers and enablers to adoption prior to broader implementation.
Method: Our prospective mixed-methods observational study included semi-structured interviews with GPs and stakeholders to understand determinants of implementation. GPs send a Request-for-Advice (RFA) to the specialist and advise patients to schedule a timely follow-up appointment to discuss the eConsultant advice. Adoption (program enrolment/usage by GPs & GP practices) was assessed.
Results: The study is underway in 12 rural/remote and 10 urban general practices. To date, RFAs have been generated for 178 patients (mean age 59.5yrs, 63% rural, 37% urban). The GPs mean time to response by the eConsultant was 1.7 (SD 2.3) days and patients mean time to specialist input (initial GP to GP follow-up appointment) was 13.0 (SD 2.7) days (well below average waiting times for OPD appointments). Qualitative interviews conducted with 11 GPs and 4 stakeholders highlight the benefits of eConsultant to providing efficient/timely access to specialist support for GPs and their patients.
Conclusion: eConsultant is feasible in Australia with benefits to the health system of timely specialist support for patients without the cost of subsidised patient travel, face-to-face visits, and potentially preventable hospital admissions. eConsultant provides GPs with a reliable, auditable record of advice given by specialists, an opportunity for GP practice capacity building and more direct partnership with specialist colleagues. eConsultant offers a streamlined evidence-based option, implementable state-wide, to support patients and primary care providers.
Partnership “Integrated Broad Intake” (IBI)
Authors: Devos Inne 
Published: January 2024

Three primary health care organizations are working together to ensure that the barrier is lowered for vulnerable groups to make effective use of all kinds of rights, both financial and social. This partnership “Integrated Social Care” wants to combat non take up and wants to increase the accessibility of social services by working proactively and by outreach.
To set up such partnership depends on the local context. A careful analysis and knowledge of the field, involvement of all relevant actors and the target group itself, are essential to make it work. Client participation is a crucial aspect.
Every citizen can turn to a partner of this partnership for all questions related to health, work, care, finances and social problems. Nevertheless, this partnership focuses on the most vulnerable citizens who do not (yet) receive the social rights they are entitled to.
Colleagues from different ranks of the public social welfare center (OCMW), the social work center (CAW) and the social work department of the health insurance funds (DMW) work together on solutions, along with other local partners and service users.
The partnership ""Integrated Social Care"" is not an organizational model, but it is a way of offering solutions to vulnerable citizens with complex welfare questions that you cannot find within your own organization alone. This partnership provides neutral information on local social help and service options. They investigate and realize social rights, clarify questions and refer to appropriate local social help and services in a neutral way. A client no longer has to go to different services. Social workers from this different organizations find each other so that the necessary expertise is shared. They work by client centered focus and in a proactive and outreaching way to detect people who were previously under the radar.
This network is strengthened with local partners, such as poverty associations, community work and family doctors. The local government has the final responsibility.
The process guidance provided by the Flemish government to realize this partnership in practice is through the principles of Service Design. In fact, Service Design is both an attitude (customer orientation), a methodology (co-creation with users and employees) and a set of tools (a collection of techniques to develop aid and social services). So, it is not only talking about it, but it's about working in practice with and for the target group.

Several scientific studies have given us insights to improve the local implementation of this partnership. And we are still learning. The 59 different partnerships ""Integrated Social Care"" are also inspired by each other by using an online platform and by participating guided moments where they exchange good practices.
The objective is a rollout across Flanders in 2022-2023 and a structural embedding of the working principles of “Integrated Social Care” in 2025.
Measuring and Improving Adherence in Primary Health Care – best practices from Medical and Diagnostic Center in Siedlce, Poland
Authors: Owczarczyk Anna , Bogdan Magdalena , Zuk Pawel , Kalisz Małgorzata 
Published: January 2024

Adherence is defined as patient compliance with agreed treatment recommendation in order to achieve a therapeutic result. It could be described as combination of three behaviors: compliance, persistence and concordance. “Compliance” is the extent to which a person’s behavior is consistent with the medical advice. In practice, this means following the doctor’s recommendations. “Persistence” means systematic and persistent application of therapy. Finally, “Concordance” is the collaboration between the patient and the doctor in the choice of therapy. Adherence is therefore based on: acceptance of the agreed therapy, adherence to its principles and systematic adherence to the recommendations.
In order to reproduce all three of those components, Medical and Diagnostic Center (MDC) in Siedlce, Poland has developed four dimensions to measure adherence in:
-intake of medication,
-registration for and appearance on compulsory medical visits,
-degree to which patient evaluates the importance of taking medication for their health,
-patient’s active participation in caring for their health.
First two dimensions measure patient’s compliance and persistence. The issues therefore concern both the fact that certain measures are taken and their regularity. Two other domains consider patient’s concordance. Importantly, fourth dimension focuses on patient role in their health. It assumes that the patient, who is responsible for his or her health, should not only follow the rules of adherence by participating passively in the treatment process, but should also play an active role: they should maintain adequate nutrition, exercise regularly, restrict the use of stimulants or quit smoking. Patients should also be transparent with their doctors about the medicines they are taking.
Adherence of patients in MDC is evaluated by means of patient interview with open-ended questions, but also by verifying data on patient’s weight, filling out prescriptions and registration for compulsory medical visits, including carrying out of preventive check-ups. This is thanks to connected IT system between primary care facilities and pharmacies.
Studies in European countries show that about half of chronically ill patients have problems adhering to prescribed treatment. Encouraging patients to monitor their behaviors, empowering them in making informed decisions around their heath and holding them accountable are key strategies to minimize non-adherence and ensure effectiveness of therapy.
The contribution of the charge nurse in integrated healthcare
Authors: Jubinville Maripier 
Published: January 2024

Background: A charge nurse (CN) is defined as a nurse who holds a clinical-administrative management position. The role requires five essential skills: leadership; interpersonal communication; clinical-administrative caring; problem solving; and knowledge and understanding of the work environment. According to Plourde (2012), these skills can be divided into sub-skills that are needed in practice by CNs when upholding appropriate standards of quality of care in healthcare delivery. These skills are also essential for CNs when facilitating the process of integrated care within healthcare facilities. However, the scientific literature describes less-than-ideal work performance by CNs that relates to a lack of specialized and adapted training. Necessary skills are poorly addressed in the education of CNs, and they receive little formal support upon entry to practice. CNs play an essential role in coordinating processes surrounding integrated care in healthcare facilities, however the literature is scarce on this role of the CN. Objective: To demonstrate the extent to which the CN, by fulfilling their role, contributes to integrated care within healthcare facilities. Methods: A scoping review using the Joanna Briggs Institute (2020) framework was performed. Using a prepared search strategy, CINAHL, MEDLINE, Cairn, and grey literature databases were queried for articles written in French or English and published between 2000 and 2022. Articles mentioning at least one of the five CN skills named by Plourde (2012) were selected. Articles were analyzed according to “Leviers et obstacles au développement de l’ISS” by Longpré (2017) (Facilitators and barriers to the development of the integrated care model) which describes essential elements to consider in order to foster integrated healthcare. Results: 150 articles were retained and analyzed. These articles describe CN skills and how they are operationalized in practice. It was found that the skills and sub-skills of the CN are often addressed in articles describing integrated care, including for example the coordination of a patient's care during their hospitalisation. In addition, CNs allow for accessibility, continuity and integration of care. As such, CNs are key player in the implementation and development of better integrated care. Conclusion: This study illuminates the relevance of providing essential CN training that reinforces the CN skill set which in turn improves the quality and safety of integrated care in healthcare facilities.
Quality Care Program: Raise awareness, motivate and coach community-pharmacists to provide high-quality pharmaceutical care.
Authors: Saevels Jan , De Wulf Isabelle , Duquet Nathalie , De Rocker Hendrik 
Published: January 2024

Apart from providing pharmaceutical care when dispensing prescribed medicines, responding to the demand for an OTC drug or advice, is another core task of the community pharmacist. By asking the correct questions, the pharmacist collects all the necessary information to accurately estimate a patient's specific health problem. Pharmacists have a social responsibility and guarantee the responsible delivery of health products and medicines at all times, especially when it concerns non-prescription medicines or in the context of self-care. By providing this person centered care, pharmacists can distinguish themselves from other dispensing channels and can justify why the dispensing of medicines, including OTC medicines, is reserved for the pharmacy.
This brought the Association of Pharmacists Belgium (APB), together with the training institutes for pharmacists, the local pharmacists' associations, and the Belgian universities, to set up the Quality Care Program. The aim of this program is to raise awareness, to motivate and to coach community-pharmacists to provide high-quality care. The program consists of 4 main components:
1. Scientific education: knowledge is the foundation when it comes to quality of care. In addition to cooperation with the training institutes, the existing educational material is collected at a central location.
2. A knowledge test that assesses the knowledge, skills and attitude of pharmacists. The test is intended to be constructive, to confirm that people are doing well or to indicate which points deserve more attention in the pharmacist's approach.
3. Pharmacy Simulator, a serious game (educational video game), is a virtual learning program in which pharmacists learn in a playful way to ask their patients the right questions.
4. A patient perception study aims to provide feedback to pharmacists about how they approach patients with their demand for an over-the-counter medicine in their pharmacy.
The Quality Care Program was launched in 2021. Each year, the emphasis is on two therapeutic drug groups. Meanwhile, 4 cycles have already been organized on analgesics, laxatives, emergency contraception and reflux for which the global results have been published after each cycle. In the coming months we will investigate how the pharmacy simulator can be better applied and how pharmacists can learn from each other.
Integration of real-world data into clinical data for better personalised treatment of breast-cancer patients
Authors: Ruszanov Anett 
Published: January 2024

REBECCA is 4-year project funded under the European Union’s Horizon 2020 research and innovation programme. The project aims to tap into the potential of Real World Data to provide personalised treatment and care to breast cancer patients or cancer survivors. The ultimate goals of REBECCA are to advance clinical research by moving beyond randomised controlled trials and to improve post-treatment in breast cancer to increase patients’ quality of life.
REBECCA stands for REsearch on BrEast Cancer induced chronic conditions supported by Causal Analysis of multi-source data. The project is built around two axes: 1) clinical research by analysing data to better understand how treatment affects quality of life, and 2) patient management to improve interventions and care choices at the individual level.
Currently, randomised controlled trials (RCT) are the gold standard in clinical research. However, there are several limitations of using RCTs for complex chronic conditions such as breast cancer as patients may suffer from different conditions that are influenced by various variables. Moreover, RCTs usually only include a small population sample and researchers do not have control over the independent variables. REBECCA aims to move beyond RCTs by using real-world, observational data.
Real-World Data in REBECCA is collected through sensor and log data retrieved via electronic health records and innovative technical tools developed by the project consortium such as mobile apps and wearable devices (e.g. smartwatches or fitness bands). Patients’ real-life behaviour can thus be monitored, including their physical activity, eating habits, sleep, local environment and information related to their online interaction. Once collected, the real-world data is then processed to extract indicators, which are consequently used to infer causal relationships with PROMS and complex chronic conditions. The causal modelling then indicates causalities and sheds light on confounders.
Causal modelling will enable health managers and practitioners to measure the safety and effectiveness of breast cancer treatments and measure their impact on the quality of life after breast cancer treatment, to improve clinical outcomes and PROMs, and to help develop personalised recommendations and treatments based on the data collected by each patient, thus increasing the value for patients.
The proposed oral poster session aims to demonstrate through evidence how innovative digital tools collecting patients’ data from informal life settings in a non-invasive manner can be integrated to clinical data gathered in formal care settings and how these different sets of data together can support the provision of personalised treatment and care for breast cancer patients. This integrated care method also highlights the benefits of detailed patient monitoring and individualised patient lifestyle consultations in patient care workflows. "
Measuring goal progress using the goal-based outcome (GBO) measure in Youth Wellness Hubs Ontario – an integrated youth mental health service
Authors: Chiodo Debbie , Darnay Karleigh , Henderson Jo 
Published: January 2024

Problem and Context. There is a growing body of evidence indicating that the prevalence of mental health difficulties, in particular anxiety and depression, is increasing among youth, and many young people in this age group (12-25 years) do not get adequate mental health support. Recently, a global movement to transform youth mental health services is underway with the establishment of integrated youth services (IYS) that offer youth-specific care and emphasize early intervention and prevention, developmentally and culturally- informed services, community engagement, evidence-based and evidence-informed interventions, and youth and family engagement. While outcome data has an important role in enhancing the effectiveness of care for youth mental health, having young people define for themselves the area they feel should be the focus of in an intervention are also common measures used in IYS settings. Goal-setting has been used in therapy for several decades, and agreement on goals between young person and their clinician is thought to be central to successfully building a good therapeutic relationship and improving outcomes.
Who is it for? Service providers, researchers, clinicians, youth and families.
Who did you involve and engage with? Participants were young people (>5000) who engaged with a Youth Wellness Hub service between April 2020 and October 2022. The data for this study comprised over 15,000 goals. Youth can set up to one, two or three goals at each visit using the Goal-Based Outcome (GBO) tool. Inductive thematic analysis was employed on the types of goals set by young people.
What did you do? The aim of this study was to explore the type of service goals set by young people who are engaging with integrated mental health services. The study also looked at whether services facilitated progress in goals as set by young people.
What results did you get? What impact did you have? The analysis identified a number of goal-related themes related to improving mental health, reducing substance use and other addictions, improving physical health, service navigation, and self-improvement. Data from presentation to last assessment will be reviewed to examine change in progress on goals over time.
What is the learning for the international audience? Understanding the clinical utility of an idiographic measure like the GBO with young people accessing community-based services is critical because the tool allows for capturing aspects of young people’s lives that are of importance to them that may not be as easily captured on standardized outcome tools.
What are the next steps? Future directions include continuous learning and evaluation of the GBO in integrated care settings and examining the association between goal progress and standardize outcomes.