Pilot study of an integrated care model using the geriatric assessment tool.

BACKGROUND: Older people with type 2 diabetes mellitus often suffer from adverse medical and social conditions which are often unrecognized in routine care. Integrated care aims to address all these aspects and centers on the needs of the patient and not the disease. The Accessible Quality Healthcare project in Kosovo, is piloting an integrated care model for patients 65 years and over with type 2 diabetes mellitus, which also introduces comprehensive geriatric assessment and care planning. METHODS: In this study two groups (1) a central working group and (2) a multisectoral implementation group of health and social care professionals were established to develop a geriatric assessment form and an individual care plan form for this project. RESULTS: The groups decided to address the following problems in the geriatric assessment: activities of daily living, urinary incontinence, gait, balance, falls, depression, cognitive function, and frailty. The assessment is carried out by a nurse and a social worker in the living environment of the patient, and the individual care plan is drawn up jointly by a doctor, a nurse, and a social worker and includes (1) problems of the patient, (2) specific goals for each problem and (3) activities to reach the goals. CONCLUSION: This intervention is one of the first in the health system in Kosovo to implement integrated care in a very vulnerable population. Physical training will be an important tool to tackle many problems detected through the geriatric assessment and which are also associated with type 2 diabetes mellitus.

Integrating staff well-being into the Primary Health Care system: a case study in post-conflict Kosovo.

BACKGROUND: Staff well-being including stress awareness and stress management skills is usually not a priority in (mental) health policies. In Kosovo, the level of stress amongst primary health care (PHC) professionals is high because health professionals are part of the population seriously affected by conflict. The need to support staff and look after their well-being was recognised by the Director of the Centre for Development of Family Medicine, Head of Primary Care. In response, the Antares Foundation and the Kosovo Rehabilitation Centre for Torture Victims (KRCT), in close cooperation with the Centers for Disease Control and Prevention, implemented an integrated psycho-social capacity building programme for PHC professionals. CASE-DESCRIPTION: This case-study describes how staff well-being was integrated into the PHC system in Kosovo. This was accomplished through raising awareness on staff well-being and stress management as well as strengthening knowledge of and skills in stress management. Eighteen national PHC staff were trained and more than a thousand family doctors and nurses attended stress management workshops. A steering committee consisting of key stakeholders was responsible for overseeing the execution of the programme. This steering committee successfully advocated for integration of staff well-being and stress management in the revised mental health strategy 2014-2020. The curriculum developed for the training was integrated in the professional staff development programme for family doctors and nurses. The effectiveness of the programme was assessed through an evaluation (including a survey among PHC professionals trained under the programme). CONCLUSIONS: Evaluation findings showed that offering structured support, entailing the opportunity to discuss work related problems and providing tools to deal with stress related to work or personal life, helps staff to continue their professional tasks under challenging conditions. Evaluation findings suggest that results can be sustained through an integrated approach and involvement of key stakeholders. The case study may be of interest to policy makers involved in health reform processes and for managers implementing changes in complicated post conflict contexts. For both groups, acknowledgment of staff well-being could be a key ingredient in the motivation of staff and the quality of services.