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Fakha A, Leithaus M, de Boer B, van Achterberg T, Hamers JP, Verbeek H. Implementing Four Transitional Care Interventions for Older Adults: A Retrospective Collective Case Study. THE GERONTOLOGIST 2023; 63:451-466. [PMID: 36001088 PMCID: PMC10028228 DOI: 10.1093/geront/gnac128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Four interventions to improve care transitions between hospital and home or community settings for older adults were implemented in Leuven, Belgium over the past 4 years. These complex interventions consist of multiple components that challenge their implementation in practice. This study examines the influencing factors, strategies used to address challenges in implementing these interventions, and implementation outcomes from the perspectives of health care professionals involved. RESEARCH DESIGN AND METHODS This was a qualitative, collective case study that was part of the TRANS-SENIOR research network. Authors conducted semistructured interviews with health care professionals about their perceptions regarding the implementation. Thematic analysis was used, and the Consolidated Framework for Implementation Research guided the final data interpretation. RESULTS Thirteen participants were interviewed. Participants reported major implementation bottlenecks at the organizational level (resources, structure, and information continuity), while facilitators were at the individual level (personal attributes and champions). They identified engagement as the primary strategy used, and suggested other important strategies for the future sustainability of the interventions (building strategic partnerships and lobbying for policies to support transitional care). They perceived the overall implementation favorably, with high uptake as a key outcome. DISCUSSION AND IMPLICATIONS This study highlights the strong role of health care providers, being motivated and self-driven, to foster the implementation of interventions in transitional care in a bottom-up way. It is important to use implementation strategies targeting both the individual-level factors as well as the organizational barriers for transitional care interventions in the future.
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Affiliation(s)
- Amal Fakha
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Merel Leithaus
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Bram de Boer
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Theo van Achterberg
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Jan P Hamers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
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Leithaus M, Fakha A, Flamaing J, Verbeek H, Deschodt M, van Pottelbergh G, Goderis G. Stakeholders' experiences and perception on transitional care initiatives within an integrated care project in Belgium: a qualitative interview study. BMC Geriatr 2023; 23:41. [PMID: 36690954 PMCID: PMC9868499 DOI: 10.1186/s12877-023-03746-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/11/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND In 2015, a plan for integrated care was launched by the Belgium government that resulted in the implementation of 12 integrated care pilot project across Belgium. The pilot project Zorgzaam Leuven consists of a multidisciplinary local consortium aiming to bring lasting change towards integrated care for the region of Leuven. This study aims to explore experiences and perceptions of stakeholders involved in four transitional care actions that are part of Zorgzaam Leuven. METHODS This qualitative case study is part of the European TRANS-SENIOR project. Four actions with a focus on improving transitional care were selected and stakeholders involved in those actions were identified using the snow-ball method. Fourteen semi-structured interviews were conducted and inductive thematic analysis was performed. RESULTS Professionals appreciated to be involved in the decision making early onwards either by proposing own initiatives or by providing their input in shaping actions. Improved team spirit and community feeling with other health care professionals (HCPs) was reported to reduce communication barriers and was perceived to benefit both patients and professionals. The actions provided supportive tools and various learning opportunities that participants acknowledged. Technical shortcomings (e.g. lack of integrated patient records) and financial and political support were identified as key challenges impeding the sustainable implementation of the transitional care actions. CONCLUSION The pilot project Zorgzaam Leuven created conditions that triggered work motivation for HCPs. It supported the development of multidisciplinary care partnerships at the local level that allowed early involvement and increased collaboration, which is crucial to successfully improve transitional care for vulnerable patients.
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Affiliation(s)
- Merel Leithaus
- Academic Center for Nursing and Midwifery, Department of Public Health & Primary Care, KU Leuven, Leuven, Belgium
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Amal Fakha
- Academic Center for Nursing and Midwifery, Department of Public Health & Primary Care, KU Leuven, Leuven, Belgium
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Johan Flamaing
- Division of Gerontology and Geriatrics, Department of Public Health & Primary Care, KU Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Hilde Verbeek
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Mieke Deschodt
- Division of Gerontology and Geriatrics, Department of Public Health & Primary Care, KU Leuven, Leuven, Belgium
- Competence Center of Nursing, University Hospitals Leuven, Leuven, Belgium
| | - Gijs van Pottelbergh
- Academic Center for General Practice, Department of Public Health & Primary Care, KU Leuven, Leuven, Belgium
| | - Geert Goderis
- Academic Center for General Practice, Department of Public Health & Primary Care, KU Leuven, Leuven, Belgium
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Riordan F, O'Mahony L, Sheehan C, Murphy K, O'Donnell M, Hurley L, Dinneen S, McHugh SM. Implementing a community specialist team to support the delivery of integrated diabetes care: experiences in Ireland during the COVID-19 pandemic. HRB Open Res 2023. [DOI: 10.12688/hrbopenres.13635.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: While models of integrated care for people with chronic conditions have demonstrated promising results, there are still knowledge gaps about how these models are implemented in different contexts and which strategies may best support implementation. We aimed to evaluate the implementation of a multidisciplinary diabetes Community Specialist Team (CST) to support delivery of integrated type 2 diabetes care during COVID-19 in two health networks. Methods: A mixed methods approach was used. Quantitative data included administrative data on CST activity and caseload, and questionnaires with GPs, practice nurses (PN) and people with type 2 diabetes. Qualitative data were collected using semi-structured interviews and focus groups about the service from CST members, GPs, PNs and people with type 2 diabetes. We used the Consolidated Framework for Implementation Research framework to explain what influences implementation and to integrate different stakeholder perspectives. Results: Over a 6-month period (Dec 2020-May 2021), 516 patients were seen by podiatrists, 435 by dieticians, and 545 by CNS. Of patients who had their first CST appointment within the previous 6 months (n=29), 69% (n=20) waited less than 4 weeks to see the HCP. During initial implementation, CST members used virtual meetings to build ‘rapport’ with general practice staff, supporting ‘upskilling’ and referrals to the CST. Leadership from the local project team and change manager provided guidance on how to work as a team and ‘iron out’ issues. Where available, shared space enhanced networking between CST members and facilitated joint appointments. Lack of administrative support for the CST impacted on clinical time. Conclusions: This study illustrates how the CST benefited from shared space, enhanced networking, and leadership. When developing strategies to support implementation of integrated care, the need for administrative support, the practicalities of co-location to facilitate joint appointments, and relative advantages of different delivery models should be considered.
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Charlier N, Colman E, Alvarez Irusta L, Anthierens S, Van Durme T, Macq J, Pétré B. Developing evaluation capacities in integrated care projects: Lessons from a scientific support mission implemented in Belgium. Front Public Health 2022; 10:958168. [PMID: 36457330 PMCID: PMC9706216 DOI: 10.3389/fpubh.2022.958168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/06/2022] [Indexed: 11/16/2022] Open
Abstract
The capacity of self-assessment, to learn from experience, to make information-based decisions, and to adapt over time are essential drivers of success for any project aiming at healthcare system change. Yet, many of those projects are managed by healthcare providers' teams with little evaluation capacity. In this article, we describe the support mission delivered by an interdisciplinary scientific team to 12 integrated care pilot projects in Belgium, mobilizing a set of tools and methods: a dashboard gathering population health indicators, a significant event reporting method, an annual report, and the development of a sustainable "learning community." The article provides a reflexive return on the design and implementation of such interventions aimed at building organizational evaluation capacity. Some lessons were drawn from our experience, in comparison with the broader evaluation literature: The provided support should be adapted to the various needs and contexts of the beneficiary organizations, and it has to foster experience-based learning and requires all stakeholders to adopt a learning posture. A long-time, secure perspective should be provided for organizations, and the availability of data and other resources is an essential precondition for successful work.
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Affiliation(s)
- Nathan Charlier
- Department of Public Health, University of Liège, Liège, Belgium,*Correspondence: Nathan Charlier
| | - Elien Colman
- Department of Family Medicine and Population Health, University of Antwerp, Antwerpen, Belgium
| | - Lucia Alvarez Irusta
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Sibyl Anthierens
- Department of Family Medicine and Population Health, University of Antwerp, Antwerpen, Belgium
| | - Thérèse Van Durme
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Jean Macq
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Benoit Pétré
- Department of Public Health, University of Liège, Liège, Belgium
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Alvarez-Irusta L, Van Durme T, Lambert AS, Macq J. People with chronic wounds cared for at home in Belgium: Prevalence and exploration of care integration needs using health care trajectory analysis. Int J Nurs Stud 2022; 135:104349. [DOI: 10.1016/j.ijnurstu.2022.104349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/11/2022] [Accepted: 08/12/2022] [Indexed: 10/31/2022]
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What Makes Integration of Chronic Care so Difficult? A Macro-Level Analysis of Barriers and Facilitators in Belgium. Int J Integr Care 2021; 21:8. [PMID: 34754284 PMCID: PMC8555482 DOI: 10.5334/ijic.5671] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 09/01/2021] [Indexed: 12/30/2022] Open
Abstract
Introduction Although many countries have been implementing integrated care, the scale-up remains difficult. Macro-level system barriers play an important role. By selecting three key policies, which have implemented integrated care in Belgium over the last 10 years, we aim to go beyond the identification of their specific barriers and facilitators to obtain an overarching generic view. Methods 27 participants were purposefully selected, to include all important stakeholders involved on the macro-level in chronic care in Belgium. Semi-structured interviews were guided by a timeline of policies and an inductive thematic analysis was performed. Results Barriers and facilitators were identified on both health care and policy level. The major factors restraining the scale-up of integrated care are the fee-for-service reimbursement system, limited data sharing and the fragmentation of responsibilities between different levels of government. Remarkably, these factors strongly interact. Discussion This paper highlights the importance of homogenization of responsibilities of governments regarding integrated care and the interdependency of policy and health care system factors. A whole system change is needed instead of the current Belgian model of prolonged search for common ground between conflicting opinions. Political commitment and citizen participation will be crucial.
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Health and Social Care Reform in Scotland - What Next? Int J Integr Care 2021; 21:7. [PMID: 34754283 PMCID: PMC8555477 DOI: 10.5334/ijic.5633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 08/04/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction: This paper analyses the important enablers, barriers and impacts of country-wide implementation of integrated health and social care in Scotland. It offers insights for other systems seeking to advance similar policy and practice. Description: Landmark legislation was based on a shared vision and narrative about improving outcomes for people and communities. Implementation has involved coordination of multiple policies and interventions for different life stages, care groups, care settings and local context within a dynamic and complex system. Discussion: Relational and citizen led approaches are critical for success, but it takes time to build trusting relationships, influence organisational and professional cultures and cede power. Assessing national impacts is challenging and progress at a national level can seem slower than local experience suggests, due in part to the relative immaturity of national datasets for community interventions. Five years on there are many examples of innovation and positive outcomes despite increasing demographic, workforce, and financial challenges. However, inequalities continue to increase. Conclusion: Realising the true value from integration will require a stronger focus on place-based prevention and early intervention to achieve a fairer Scotland where everybody thrives. Solidarity, equity, and human rights must guide the next phase of Scotland’s story.
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