Underlying motivations hampering Flemish primary care physicians from overcoming the barriers in osteoporosis care: an EMR-facilitated clinical reasoning study.

BACKGROUND: Over half of the European population aged minimum 65 years presents with at least two chronic diseases. Attention towards these diseases exhibits disparities, with limited primary care physician (PCP) attention for osteoporosis. This was confirmed in a previous integrated osteoporosis care (IOC) project in which notable difficulties to enlist PCPs arose. Consequently, this study was initiated in Flemish PCPs for in-depth analysis of underlying mechanisms hampering PCPs to fully commit to osteoporosis care. METHODS: A qualitative Electronic Medical Record (EMR)-facilitated clinical reasoning study was conducted. A semi-structured interview guide was employed to guide PCPs from reflections on their own patients to broader views regarding osteoporosis care. An inductive thematic analysis was performed using NVivo 12. RESULTS: Thirteen PCPs were interviewed. They stated that osteoporosis patients often had complex (medical) profiles. PCPs emphasised the ongoing necessity for prioritisation within this context. This leads to a competition for PCP attention during consultations at three levels: i. between acute versus preventive care; ii. between primary fracture prevention and other preventive services and iii. between secondary fracture prevention and other preventive services; spanning eight areas of competition: disease significance, perceived impact, PCP awareness, the patient agenda, PCP competence, PCP support, perceived patient burden, and efficiency of care provision. Applicability of these areas of competition differed between levels. CONCLUSION: The intricate context in which PCPs operate, creates a competition for PCP attention leading to a lack of attention for fracture prevention. To preserve efforts in fracture prevention, areas of competition should be systematically addressed. TRIAL REGISTRATION: Approval for the study has been provided by the Ghent University Hospital Ethics Committee (BC-09797).

Cost of illness in patients with post-treatment Lyme disease syndrome in Belgium.

BACKGROUND: A proportion of patients with Lyme borreliosis (LB) report long-term persisting signs and symptoms, even after recommended antibiotic treatment, which is termed post-treatment Lyme disease syndrome (PTLDS). Consensus on guidance regarding diagnosis and treatment is currently lacking. Consequently, patients suffer and are left searching for answers, negatively impacting their quality of life and healthcare expenditure. Yet, health economic data on PTLDS remain scarce. The aim of this article is therefore to assess the cost-of-illness related to PTLDS, including the patient perspective. METHODS: PTLDS patients (N = 187) with confirmed diagnosis of LB were recruited by a patient organization. Patients completed a self-reported questionnaire on LB-related healthcare utilization, absence from work and unemployment. Unit costs (reference year 2018) were obtained from national databases and published literature. Mean costs and uncertainty intervals were calculated via bootstrapping. Data were extrapolated to the Belgian population. Generalized linear models were used to determine associated covariates with total direct costs and out-of-pocket expenditures. RESULTS: Mean annual direct costs amounted to €4618 (95% CI €4070-5152), of which 49.5% were out-of-pocket expenditures. Mean annual indirect costs amounted to €36 081 (€31 312-40 923). Direct and indirect costs at the population level were estimated at €19.4 and 151.5 million, respectively. A sickness or disability benefit as source of income was associated with higher direct and out-of-pocket costs. CONCLUSIONS: The economic burden associated with PTLDS on patients and society is substantial, with patients consuming large amounts of non-reimbursed healthcare resources. Guidance on adequate diagnosis and treatment of PTLDS is needed.

Closing the gap in osteoporosis management: the critical role of primary care in bone health.

OBJECTIVE: The World Health Organization issued a call to action for primary care to lead efforts in managing noncommunicable diseases, including osteoporosis. Although common, osteoporosis remains underdiagnosed and undertreated. Primary care practitioners (PCPs) are critical in identifying individuals at risk for osteoporosis and osteoporotic fractures; however, recent advances in assessment, diagnosis, and treatment of osteoporosis have not been incorporated into clinical practice in primary care due to numerous reasons including time constraints and insufficient knowledge. To close this gap in clinical practice, we believe PCPs need a practical strategy to facilitate osteoporosis assessment and management that is easy to implement. METHODS: In this article, we consolidate information from various global guidelines and highlight areas of agreement to create a streamlined osteoporosis management strategy for a global audience of PCPs. RESULTS: We present a systematic approach to facilitate osteoporosis assessment and management that includes four steps: (1) identifying patients at risk through proactive screening strategies, (2) investigating and diagnosing patients, (3) intervening with personalized treatment plans, and (4) implementing patient-centered strategies for long-term management and monitoring of patients. CONCLUSION: Primary care has a central role in ensuring the incorporation of key elements of holistic care as outlined by the World Health Organization in managing noncommunicable diseases including osteoporosis; namely, a people-centered approach, incorporation of specialist services, and multidisciplinary care. This approach is designed to strengthen the health system's response to the growing osteoporosis epidemic.

Osteoporosis is a chronic condition associated with aging in which bones become "porous" and weak, and are more likely to break (i.e., fracture) even with minimal trauma such as tripping or falling from a standing height. A broken bone is a serious condition that not only affects daily activities, but can also lead to reduced quality of life, need for caregiver support, work loss, hospital and rehabilitation costs, nursing home costs, and increased mortality. Although osteoporosis is common, it is often undiagnosed or untreated, leaving many people at risk for experiencing broken bones. A broken bone increases the risk of more broken bones. Given the growing size of the aging global population, osteoporosis and the risk of broken bones represent an urgent problem and growing burden. We need ways to make it easier for primary care practitioners (PCPs), such as family physicians, internists, physician assistants, nurse practitioners, and nurses, to include osteoporosis care as part of routine clinical visits. In this article, we discuss the critical role of PCPs in early detection, diagnosis, and treatment of osteoporosis as they are often the first point of contact for at-risk patients. We present a simple, four-step approach to help PCPs and patients navigate the journey from osteoporosis diagnosis to a treatment plan. The four steps are to: (1) identify at-risk patients by screening for weak bones or osteoporosis, (2) perform necessary tests to diagnose patients, (3) develop a personalized treatment plan, and (4) determine long-term strategies for managing and monitoring bone health.

Implementation and operationalization of Integrated People-Centred Health Services delivery strategies in integrated osteoporosis care (IOC) initiatives: a systematic review.

Integrated Osteoporosis Care (IOC) has been emerging over the past decade. To support integrated care initiatives, the World Health Organisation (WHO) has developed the Integrated People Centred Health Services (IPCHS) framework, which consists of five interdependent strategies. Five electronic databases (PubMed, Embase, World of Science, CINAHL, and Scopus) were searched for relevant studies published from January 1, 2010 to December 2022. Initiatives implementing collaborative practices and at least two IPCHS strategies were included. Quality assessment was performed using the Effective Public Health Practice Project checklist. Seventy-six publications describing 69 implementations met the inclusion criteria; 90% of them were implemented at the hospital level, and over half focused on secondary fracture prevention. Three implementations captured all five IPCHS strategies, and half applied three. Substrategies targeting individuals as beneficiaries were frequently employed. Substrategies requiring fundamental shifts (e.g., systemic coordination and updating) were seldomly implemented. Substantive heterogeneity in substrategy operationalization was observed. Patient education, standardized care, team-based care, care coordinators, and health care provider training were commonly pursued. IOC interventions have focused mainly on secondary fracture prevention in a hospital setting and have been narrowly operationalized. Future implementation should: employ all five IPCHS strategies; better align programmes, providers, and regulatory frameworks, while adapting funding mechanisms; and operationalize broader and more innovative substrategies.Registration: This review has been registered at the international prospective register of systematic reviews PROSPERO (CRD42021250244).

The effectiveness and cost-effectiveness of an integrated osteoporosis care programme for postmenopausal women in Flanders: study protocol of a quasi-experimental controlled design.

Osteoporosis causes high individual and societal burden, due to limited attention to fracture prevention. Integrated care for chronic conditions has shown to facilitate management of these conditions, improving clinical outcomes alongside quality of life and cost-effectiveness. This manuscript describes an integrated osteoporosis care programme that will be implemented in primary care. OBJECTIVE: To provide a comprehensive description of a quasi-experimental study design in which a newly developed integrated osteoporosis care (IOC) programme for the management of postmenopausal osteoporosis (PO) in primary care (PC) is implemented and will be compared with care as usual (CAU). METHODS: A literature research was performed and expert meetings have been taking place, which has led to the development of a complex PC intervention based on framework for integrated people-centred health services (IPCHS). RESULTS: This manuscript describes the developmental process of the preclinical phase of a quasi-experimental real-world design and the interventions as a result of this process that will be implemented during the clinical phase, along with the evaluation that will take place alongside the clinical phase: An integrative approach for the management of PO in primary care was developed and will be implemented in greater region of Ghent (GRG), Belgium. The approach consists of a complex intervention targeting patients and PC stakeholders in osteoporosis care (e.g. general practitioners (GPs), physiotherapists, nurses, pharmacists). A comparison will be made with CAU using medication possession ratios (MPR) of included patients as primary outcome. These data will be obtained from the national health database. Secondary outcomes are physician outcomes, patient-reported outcome measures (PROMs), and patient-reported experience measures (PREMs). A cost-effectiveness evaluation will be performed if the programme appears to be effective in terms of MPR. TRIAL REGISTRATION: ClinicalTrials.gov : NCT03970902.

Системы здравоохранения в борьбе с неинфекционными заболеваниями: время для амбиций

Европейский регион ВОЗ достиг значительного прогресса в области снижения бремени неинфекционных заболеваний (НИЗ) за счет осуществления межсекторальных действий и укрепления систем здравоохранения, которые являются двумя ключевыми обязатель-ствами в рамках основ европейской политики здравоохранения Здоровье-2020 и Целей в области устойчивого развития. Однако в настоящее время существуют дополнительные возможности для ускорения этого прогресса. Данный отчет содержит прагматичные и реализуемые рекомендации в отношении мер политики в области укрепления систем здравоохранения с тем, чтобы позволить им более эффективно реагировать на вызовы, связанные с НИЗ. Данный отчет основан на контекстуализированных и многопрофиль-ных оценках существующих в системах здравоохранения барьеров в области борьбы с НИЗ в 12 странах Европейского региона ВОЗ. Эти оценки указывают на наличие возможностей для ускоренного улучшения показателей борьбы с НИЗ и снижения неравенства посредством осуществления более всеобъемлющих и согласованных ответных мер со стороны систем здравоохранения. Помимо страновых оценок, данный отчет опирается на опубликованные труды, информационные записки о передовой практике, и опыт экс-пертов. Отчет фокусируется на отдельных областях укрепления систем здравоохранения, включая стратегическое руководство, не-прерывное и интегрированное предоставление услуг (общественное здравоохранение, первичная медико-санитарная помощь и услу-ги специалистов), ориентированность на человека, кадровые ресурсы здравоохранения, финансирование, лекарственные средства и решения в области информационных технологий. Он определяет области для возможных действий, направленных на укрепление ответных мер систем здравоохранения на НИЗ, с учетом ресурсных ограничений и с особым акцентом на уязвимые группы населения.

An Instrument to Measure Maturity of Integrated Care: A First Validation Study.

INTRODUCTION: Lessons captured from interviews with 12 European regions are represented in a new instrument, the B3-Maturity Model (B3-MM). B3-MM aims to assess maturity along 12 dimensions reflecting the various aspects that need to be managed in order to deliver integrated care. The objective of the study was to test the content validity of B3-MM as part of SCIROCCO (Scaling Integrated Care into Context), a European Union funded project. METHODS: A literature review was conducted to compare B3-MM's 12 dimensions and their measurement scales with existing measures and instruments that focus on assessing the development of integrated care. Subsequently, a three-round survey conducted through a Delphi study with international experts in the field of integrated care was performed to test the relevance of: 1) the dimensions, 2) the maturity indicators and 3) the assessment scale used in B3-MM. RESULTS: The 11 articles included in the literature review confirmed all the dimensions described in the original version of B3-MM. The Delphi study rounds resulted in various phrasing amendments of indicators and assessment scale. Full agreement among the experts on the relevance of the 12 B3-MM dimensions, their indicators, and assessment scale was reached after the third Delphi round. CONCLUSION AND DISCUSSION: The B3-MM dimensions, maturity indicators and assessment scale showed satisfactory content validity. While the B3-MM is a unique instrument based on existing knowledge and experiences of regions in integrated care, further testing is needed to explore other measurement properties of B3-MM.

Health systems respond to noncommunicable diseases: time for ambition

The WHO European Region has made great progress in reducing the burden of noncommunicable diseases (NCDs) by taking intersectoral action and strengthening health systems, two key commitments in Health 2020, the European health policy, and the Sustainable Development Goals. However, there are now opportunities to accelerate the process. This report provides pragmatic and actionable policy recommendations on how to strengthen health systems so that they can respond more effectively to the challenges posed by NCDs. The report is motivated by contextualized and multidisciplinary assessments of health system barriers to tackling NCDs in 12 countries in the WHO European Region. These assessments show that there are opportunities to bring about rapid improvements in NCD outcomes and reduce inequalities through a more comprehensive and better aligned health system response. In addition to the country assessments, the report draws on published literature, good practice briefs and expert experiences. The report focuses on selected areas of health system strengthening, including governance, continuous and integrated delivery of services (public health, primary care and specialist care), people-centredness, the health workforce, financing, medicines and information solutions. It identifies where action can be taken to strengthen the health system response to NCDs, taking account of resource constraints and placing special emphasis on vulnerable populations

Медицинские сестры в Финляндии: профилактика неинфекционных заболеваний на протяжении всего жизненного цикла: информационный обзор по передовому опыту

Медицинские сестры государственного сектора здравоохранения Финляндии обеспечивают руководство и предоставление высококачественных профилактических медицинских услуг на протяжении всего жизненного цикла человека. Финская система является образцом применения интегрированного эффективного подхода к охране здоровья на протяжении всего жизненного цикла посредством приоритизации профилактики и укрепления здоровья, межпрофессионального сотрудничества и перераспределения обязанностей между врачами и медсестрами, с сохранением качества оказываемой медицинской помощи и достижением положительных результатов в отношении здоровья финского населения, в том числе в удовлетворении потребностей граждан. В интегрированную цепочку служб государственного медицинского обслуживания входят клиники охраны здоровья матери и ребенка, школьников и студентов, службы гигиены труда и медицинские учреждения для пожилых и престарелых граждан. Предлагаемые услуги отражают национальные цели в области укрепления здоровья на протяжении всего жизненного цикла, определенные для разных возрастных групп.

Public health nurses in Finland: a life-course approach to the prevention of noncommunicable diseases: good practice brief

In Finland, registered public health nurses manage and deliver high quality preventive health services throughout a person’s life-course. The Finnish system is exemplary, as an integrated, effective life-course approach to health through its emphasis on prevention and health promotion, interprofessional collaboration and task-shifting from doctors to nurses, while safeguarding the quality of care and achievement of good health outcomes in the Finnish population, including the satisfaction of its citizens. An integrated chain of public health services is delivered through maternal and child health, school health and student health clinics, occupational health and adult and elderly health care facilities. The services offered reflect national life-course-related health goals that are defined for different age groups.

Межсекторальные сети охраны психического здоровья в Бельгии: пример успешной реформы системы охраны психического здоровья посредством реорганизации модели предоставления услуг: информационный обзор по передовому опыту

Бельгия сделала выбор в пользу проведения общенациональной реформы сектора охраны психического здоровья в ответ на необходимость улучшения ориентированных на население подходов к оказанию медицинской помощи людям с психическими расстройствами, что явилось императивом обеспечения ее эффективности. Реформа была направлена на укрепление предложения услуг на общинном уровне и сокращение числа больничных коек в психиатрических больницах; она способствовала улучшению интеграции медицинской помощи, улучшению социальной реабилитации и выздоровления пользователей медицинскими услугами, включая улучшение качества жизни пациентов и лиц, осуществляющих уход за ними. Центральное место в реформе занимают межсекторальные сети охраны психического здоровья, предлагающие услуги по индивидуальной поддержке, профилактику, стационарную и амбулаторную психиатрическую помощь, первичную медико-санитарную помощь, дневной уход, а также профессионально-техническую, жилищную и социальную помощь. Общенациональная реформа согласуется с Комплексным планом действий ВОЗ в области психического здоровья на 2013–2020 гг., в котором предлагается осуществить переход от институционального медицинского обслуживания к созданию системы медицинского обслуживания в области психического здоровья на общинном уровне. Реформа способствовала улучшению долгосрочной стабильности состояния пациентов и сокращению срока их пребывания в больнице. Она также способствовала значительному сокращению числа больничных коек в психиатрических больницах в связи с расширением индивидуальной поддержки людей с психическими заболеваниями на первичном уровне.

Multisectoral mental health networks in Belgium: an example of successful mental health reform through service delivery redesign: good practice brief

Belgium has opted for a nationwide reform of the mental health sector in response to the need for improved people-centred approaches for people with mental health conditions, an efficiency imperative. The reform aimed to strengthen the community-based supply of care and to reduce the number of psychiatric hospital beds; it improved care integration, social rehabilitation and service users’ recovery, including users’ and carers’ quality of life. Central to the reform are multisectoral mental health care networks offering outreach services, prevention, in-and outpatient mental health services, primary care, day care, and vocational, housing and social care services. The nationwide reform is in line with WHO’s Mental Health Action Plan 2013–2020, calling for a shift from institutional care to community services. The reform contributed to improving the long-term health of patients and reducing hospital stays. It also significantly reduced the number of psychiatric hospital beds in favour of outreach services to people with mental health conditions.

Health systems respond to noncommunicable diseases: compendium of good practices

This report is a compendium of 22 good practices that showcase successes in the health system response to noncommunicable diseases in the WHO European Region. It complements the report of the WHO Regional Office for Europe Health systems respond to noncommunicable diseases: time for ambition. The good practices highlight effective policy instruments from 16 Member States reflecting the diversity of the Region in terms of health system development and geographical, political and historical context. Lessons learnt from these good practices highlight the fact that there are no magic bullets or single solutions: good-practice tools reach their full potential if implemented in the context of a comprehensive and aligned systemic approach.

A Policy Guide on Integrated Care (PGIC): Lessons Learned from EU Project INTEGRATE and Beyond.

Efforts are underway in many European countries to channel efforts into creating improved integrated health and social care services. But most countries lack a strategic plan that is sustainable over time, and that reflects a comprehensive systems perspective. The Policy Guide on Integrated Care (PGIC) as presented in this paper resulted from experiences with the EU Project INTEGRATE and our own work with healthcare reform for patients with chronic conditions at the national and international level. This project is one of the largest EU funded projects on Integrated Care, conducted over a four-year period (2012-2016) and included partners from nine European countries. Project Integrate aimed to gain insights into the leadership, management and delivery of integrated care to support European care systems to respond to the challenges of ageing populations and the rise of people living with long-term conditions. The objective of this paper is to describe the PGIC as both a tool and a reasoning flow that aims at supporting policy makers at the national and international level with the development and implementation of integrated care. Any Policy Guide on Integrated should build upon three building blocks, being a mission, vision and a strategy that aim at capturing the large amount of factors that directly or indirectly influence the successful development of integrated care.

How to Improve Integrated Care for People with Chronic Conditions: Key Findings from EU FP-7 Project INTEGRATE and Beyond.

BACKGROUND: Political and public health leaders increasingly recognize the need to take urgent action to address the problem of chronic diseases and multi-morbidity. European countries are facing unprecedented demand to find new ways to deliver care to improve patient-centredness and personalization, and to avoid unnecessary time in hospitals. People-centred and integrated care has become a central part of policy initiatives to improve the access, quality, continuity, effectiveness and sustainability of healthcare systems and are thus preconditions for the economic sustainability of the EU health and social care systems. PURPOSE: This study presents an overview of lessons learned and critical success factors to policy making on integrated care based on findings from the EU FP-7 Project Integrate, a literature review, other EU projects with relevance to this study, a number of best practices on integrated care and our own experiences with research and policy making in integrated care at the national and international level. RESULTS: Seven lessons learned and critical success factors to policy making on integrated care were identified. CONCLUSION: The lessons learned and critical success factors to policy making on integrated care show that a comprehensive systems perspective should guide the development of integrated care towards better health practices, education, research and policy.

Results of the Belgian Sentinel Network of General Practitioners on the Involvement of Therapists in Stroke Rehabilitation.

This study examines which therapists are involved in the rehabilitation of stroke survivors in Belgium at different points in time. A nationwide registration of stroke patients was provided by 199 and 189 family physicians working in sentinel practices for the years 2009 and 2010 respectively. 326 patients who were diagnosed with stroke were included. Patients with paralysis/paresis received significant more physiotherapy after one month (63%) compared to non-paralysed patients (38%) (P = 0.005). Residing in a nursing home was associated with higher proportions of patients receiving physiotherapy, both after one (P = 0.003) and six (P = 0.002) months. 31% of patients with aphasia were treated by a speech and language therapist after one month, which decreased after six months to 20%. After six months, the patients in a nursing home received significant more often speech and language therapy (P = 0.004), compared to patients living at home. The proportion of patients receiving stroke rehabilitation services provided by physiotherapists, speech/language therapists and occupational therapists is rather low, especially 6 months after the critical event.

Повышение уровня компетентности медицинских кадров в целях организации согласованного/комплексного предоставления медицинских услуг: рабочий документ

В данном документе представлен перечень компетенций, которые следует развивать и закреплять медицинским работникам для реализации системы предоставления скоординированных/комплексных медицинских услуг. С этой целью в документе предлагается цикл процесса закрепления компетенций, определения стратегий, необходимых на уровне предоставления услуг, и выявления возможных инструментов реализации, а также дается описание благоприятствующих условий на уровне системы здравоохраненияи обзор функций и обязанностей основных заинтересованных сторон.