Thérèse Van Durme

Assessing the adequacy of pressure ulcer prevention in hospitals: a nationwide prevalence survey

Introduction The development of a pressure ulcer is an adverse event and is often avoidable if adequate preventive measures are applied. No large-scale data, based on direct patient observations, are available regarding the pressure ulcer preventive interventions used in hospitals. Purpose The aim of this study was to obtain insight into the adequacy of interventions used to prevent pressure ulcers in Belgian hospitals. Methods A cross-sectional, multi-centre pressure ulcer prevalence study was performed in Belgian hospitals. The methodology used to measure pressure ulcer prevalence was developed by the European Pressure Ulcer Advisory Panel. The data collection instrument includes five categories of data: general data, patient data, risk assessment, skin observation and prevention. Results The total sample consisted of 19 968 patients. The overall prevalence of pressure ulcers Category I–IV was 12.1%. Only 10.8% of the patients at risk received fully adequate prevention in bed and while sitting. More than 70% of the patients not at risk received some pressure ulcer prevention while lying or sitting. Concusion Generally, there is a limited use of adequate preventive interventions for pressure ulcers in hospitals, which reflects a rather low quality of preventive care. The implementation of pressure ulcer guidelines requires more attention. The pressure ulcer prevention used in practice should be re-evaluated on a regular basis.

Interventions to delay institutionalization of frail older persons: design of a longitudinal study in the home care setting.

BackgroundOlder people usually prefer staying at home rather than going into residential care. The Belgian National Institute for Health and Disability Insurance wishes to invest in home care by financing innovative projects that effectively help older people to stay at home longer. In this study protocol we describe the evaluation of 34 home care projects. These projects are clustered according to the type of their main intervention such as case management, night care, occupational therapy at home and psychological/psychosocial support. The main goal of this study is to identify which types of projects have the most effect in delaying institutionalization of frail older persons.Methods/designThis is a longitudinal intervention study based on a quasi-experimental design. Researchers use three comparison strategies to evaluate intervention - comparison among different types of projects, comparisons between older persons in the projects and older persons not benefiting from a project but who are still at home and between older persons in the projects and older persons who are already institutionalized. Projects are asked to include clients who are frail and at risk of institutionalization. In the study we use internationally validated instruments such as the interRAI Home Care instrument, the WHO-QOL-8 and the Zarit Burden Interview-12. These instruments are filled out at baseline, at exit from the project and 6 months after baseline. Additionally, caregivers have to do a follow-up every 6 months until exit from the project. Criteria to exit the cohort will be institutionalization longer than 3 months and death. The main analysis in the study consists of the calculation of incidence rates, cumulative incidence rates and hazard rates of definitive institutionalization through survival analyses for each type of project.DiscussionThis research will provide knowledge on the functional status of frail older persons who are still living at home. This is important information to identify determinants of risk for institutionalization. The identification of effective home care projects in delaying institutionalization will be useful to inform and empower home care providers, policy and related decision makers to manage and improve home care services.

Stakeholders’ perception on the organization of chronic care: a SWOT analysis to draft avenues for health care reforms

BackgroundAdequate care for individuals living with chronic illnesses calls for a healthcare system redesign, moving from acute, disease-centered to patient-centered models. The aim of this study was to identify Belgian stakeholders’ perceptions on the strengths, weaknesses, opportunities and threats of the healthcare system for people with chronic diseases in Belgium.MethodsFour focus groups were held with stakeholders from the micro and meso level, in addition to two interviews with stakeholders who could not attend the focus group sessions. Data collection and the discussion were based on the Chronic Care model. Thematic analysis of the transcripts allowed for the identification of the strengths, weaknesses, opportunities and threats of the current health care system with focus on chronic care.ResultsInformants stressed the overall good quality of the acute health care system and the level of reimbursement of care as an important strength of the current system. In contrast, the lack of integration of care was identified as one of the biggest weaknesses of today’s health care system, along with the unclear definitions of the roles and functions of health professionals involved in care processes. Patient education to support self-management exists for patients with diabetes and/or terminal kidney failure but not for those living with other or multiple chronic conditions. The current overall fee-for-service system is a barrier to integrated care, as are the lack of incentives for integrated care. Attending multidisciplinary meetings, for example, is underfinanced to date. Finally, clinical information systems lack interoperability, which further impedes the information flow across settings and disciplines.ConclusionOur study’s methods allowed for the identification of problematic domains in the health system for people living with chronic conditions. These findings provided useful insights surrounding perceived priorities. This methodology may inspire other countries faced with the challenge of drafting reforms to tackle the issue of chronic care.

Comparing interprofessional and interorganizational collaboration in healthcare: A systematic review of the qualitative research

BACKGROUND Interprofessional and interorganizational collaboration have become important components of a well-functioning healthcare system, all the more so given limited financial resources, aging populations, and comorbid chronic diseases. The nursing role in working alongside other healthcare professionals is critical. By their leadership, nurses can create a culture that encourages values and role models that favour collaborative work within a team context. OBJECTIVES To clarify the specific features of conceptual frameworks of interprofessional and interorganizational collaboration in the healthcare field. This review, accordingly, offers insights into the key challenges facing policymakers, managers, healthcare professionals, and nurse leaders in planning, implementing, or evaluating interprofessional collaboration. DESIGN This systematic review of qualitative research is based on the Joanna Briggs Institutes methodology for conducting synthesis. DATA SOURCES Cochrane, JBI, CINAHL, Embase, Medline, Scopus, Academic Search Premier, Sociological Abstract, PsycInfo, and ProQuest were searched, using terms such as professionals, organizations, collaboration, and frameworks. METHODS Qualitative studies of all research design types describing a conceptual framework of interprofessional or interorganizational collaboration in the healthcare field were included. They had to be written in French or English and published in the ten years between 2004 and 2014. RESULTS Sixteen qualitative articles were included in the synthesis. Several concepts were found to be common to interprofessional and interorganizational collaboration, such as communication, trust, respect, mutual acquaintanceship, power, patient-centredness, task characteristics, and environment. Other concepts are of particular importance either to interorganizational collaboration, such as the need for formalization and the need for professional role clarification, or to interprofessional collaboration, such as the role of individuals and team identity. Promoting interorganizational collaboration was found to face greater challenges, such as achieving a sense of belonging among professionals when differences exist between corporate cultures, geographical distance, the multitude of processes, and formal paths of communication. CONCLUSIONS This review sets a direction to follow for implementing changes that meet the challenge of a changing healthcare system and the transition towards non-institutional care. It also shows that collaboration between nurses and healthcare professionals from different healthcare organizations is still poorly explored. This is a major limitation in the existing scientific literature, especially given the potential role that could be played by nurses in enhancing interorganizational collaboration.

Exploring Home Care Interventions for Frail Older People in Belgium: A Comparative Effectiveness Study

To examine the effects of home care interventions for frail older people in delaying permanent institutionalization during 6 months of follow‐up.

Erratum to: A comprehensive grid to evaluate case management’s expected effectiveness for community-dwelling frail older people: results from a multiple, embedded case study

Background Case management is a type of intervention expected to improve the quality of care and therefore the quality of life of frail, community-dwelling older people while delaying institutionalisation in nursing homes. However, the heterogeneity, multidimensionality and complexity of these interventions make their evaluation by the means of classical approaches inadequate. Our objective was twofold: (i) to propose a tool allowing for the identification of the key components that explain the success of case management for this population and (ii) to propose a typology based on the results of this tool.

The implementation of evidence-based nutrition guidelines in an acute geriatric setting

Introduction: The increasing old-age dependency ratio implies future reduction of human resources available to provide services. Little information is available about the level of qualification, contractual aspects, payment and working conditions of home care workers and the existence of staff shortages and recruitment problems in different countries. Methods and Materials: This presentation is based on the results of the EC-financed EURHOMAP project. Indicators have been developed in this project to map the home care systems in Europe, including details of human resources. In 2009 and early 2010, EURHOMAP partners have collected data on these indicators in 31 countries in collaboration with experts in these countries. Results were described in uniformly structured country reports and fed back to national experts for validation. Results: In many countries numbers of those working in private organisations are not available. Furthermore financial incentives and working conditions will be compared, as well as the task division between home care workers and to what extent educational requirements are explicitly formalised. Mechanisms of quality control of human resources differ strongly (e.g. recertification of nurses; rules for the education of home care nurses). An interesting phenomenon, related to pressures to increase efficiency, is the transfer of tasks or substitution which is taking place between home care workers of different qualification levels. In contrast to the provision of technical nursing, the provision of personal care and domestic aid is less strictly related to specific qualifications. Conclusion: Shortages in human resources are a common problem in many countries, but expectedly most in countries just having developed home care. There is a strong variation in mechanisms of quality control of home care professionals; in the level of education required; and in the strength of the position of home care workers. (aut. ref.)Introduction: Besides the ageing of populations there are many more factors that have an influence on home care demand or supply; such as increased mobility; changing character of family structures; intergeneration solidarity; labour participation of women and the labour market for home care. This presentation will sketch the current trends, problems and how they can be tackled. The year 2025 is still far away but we will try to look ahead without losing the sense of reality. Methods and Materials: This presentation is drawn upon the EC financed EURHOMAP project, which included an inventory of contextual factors, problems related to policy, financing and delivery of home care and future challenges in each country. The study has collected a wealth of data in each of 31 countries on a large set of indicators. Results: Trends influencing home care will be presented. We will notice that different trends may apply to groups of countries. The possible effects of more or less general problems will be explored, such as scarcity of financial and human resources. Besides less general, but still burning problems in some countries, will be examined; for instance the lack of integration and coordination between types of home care services; inequalities resulting from decentralisation of authority; limited access to home care services for middle income groups; and absent or poor control of the quality of services. Examples will be presented of how countries respond to the earlier mentioned challenges. Conclusion: Some problems, such as those related to financial and human resources apply to most countries and are expected to be persistent. Private models of provision may also be considered to be of growing importance. However, cross-country differences in trends and problems will continue to exist, especially between countries with a long tradition of home care and those where it was recently developed. (aut. ref.)