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Development of a national position paper for chronic care / Dominique Paulus in Health Policy, 111(2013)2 ([07/01/2013])
[article] Development of a national position paper for chronic care : example of Belgium [printed text] / Dominique Paulus , Author ; Koen Van Den Heede , Author ; Sophie Gerkens , Author ; Anja Desomer, Author ; Raf Mertens , Author . - 2013 . - 105-109.
Languages : English (eng)
in Health Policy > 111(2013)2 [07/01/2013] . - 105-109
Descriptors: Classification
W 1 Serials. Periodicals
Indexation
2011-50 ; Belgium ; Chronic Disease ; Health Care Reform ; Journal Article ; Long-Term Care ; Organisation and Administration ; Peer Review ; R190Abstract: The management of chronic diseases is a prime challenge of most 21st century health care systems. Many Western countries have invested heavily in care plans oriented towards specific conditions and diseases, such as dementia and cancer. The major downside of this narrowly focused approach is that treatment of multimorbidity is ignored. This paper describes the development and main stance of a national position that proposes streamlined reforms of the Belgian health care system to improve care for patients with multiple chronic diseases. We used a combination of methods to develop this stance: literature review and stakeholders’ consultation. The latter identified areas for improvement: efficiency of the health care system, coordination of care, investments in human care resources, informal caregivers’ support, better accessibility, and changes in the financial payment system. The position paper list 20 recommendations that are translated into about 50 action points to reform the health care system. Chronic care tailored to the patient's needs, including implementation of multidisciplinary teamwork, new functions, task delegation in primary care, and empowerment of the patient and informal caregivers are some major areas discussed. In addition, improved support, revised payment mechanisms, and setting up a quality system, along with the tailoring of patient care, can all facilitate delivery of high quality care in patients with chronic comorbidities. Link for e-copy: http://doi.rog/doi:10.1016/j.healthpol.2013.04.010 Format of e-copy: PDF [Open Access] Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=3706 [article]E-copies
Development of a national position paper for chronic care: Example of BelgiumURL Development of a position paper for chronic care in Belgium / Dominique Paulus / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2012)
Development of a position paper for chronic care in Belgium : Appendix [printed text] / Dominique Paulus , Author ; Koen Van Den Heede , Author ; Raf Mertens , Author . - Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre, 2012 . - 219 p. : Ill. ; A4. - (KCE Reports. Health Services Research (HSR); 190S) .
ISSN : D/2012/10.273/85 : € 0,00
Study 2011-50
Languages : English (eng)
Descriptors: Classification
W 84.3 Health Services Research (General)
Indexation
2011-50 ; Chronic Disease ; Health Care Reform ; Organisation and Administration ; R190Link for e-copy: https://doi.org/10.57598/R190S Format of e-copy: PDF (1,95 MB) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=3112 Copies(0)
Status No copy Organisatie van zorg voor chronisch zieken in België / Dominique Paulus / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2012)
Organisatie van zorg voor chronisch zieken in België : ontwikkeling van een position paper [printed text] / Dominique Paulus , Author ; Koen Van Den Heede , Author ; Raf Mertens , Author . - Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre, 2012 . - VIII, 166 p. : Ill. ; A4. - (KCE Reports A. Health Services Research (HSR); 190A) .
ISSN : D/2012/10.273/79 : € 0,00
Studie 2011-50
Languages : English (eng) Dutch (nla)
Descriptors: Classification
W 84.3 Health Services Research (General)
Indexation
2011-50 ; Chronic Disease ; Health Care Reform ; Organisation and Administration ; R190Abstract: Meer dan een kwart van de Belgische bevolking zegt aan een chronische aandoening te lijden, en door de vergrijzing neemt dit aantal steeds toe. In 2008 werd het nationaal programma “Prioriteit aan de chronisch zieken” gelanceerd, dat sterk de nadruk legde op goede informatie en op de toegankelijkheid van de zorg. In een volgende stap vroeg de minister van Volksgezondheid het Federaal Kenniscentrum voor de Gezondheidszorg (KCE) om samen met de FOD Volksgezondheid en het RIZIV een toekomstvisie voor de chronische zorg te ontwikkelen. Het KCE bestudeerde de internationale, wetenschappelijke literatuur, en keek naar het werk dat in binnen-en buitenland reeds rond chronische zorg gebeurde. Het betrok ook uitgebreid de mensen van het terrein, het beleid en de koepels van patiëntenverenigingen bij het onderzoek. Het resultaat: een ‘Position paper’ die meer dan 50 concrete acties voorstelt om de organisatie van de chronische zorg fundamenteel te hervormen.
Contents note: SCIENTIFIC REPORT 11 -- 1. THE CHALLENGE OF CHRONIC CARE 11 -- 1.1. CHRONIC CARE: A GROWING BURDEN FOR THE HEALTH CARE SYSTEMS. 11 -- 1.2. OBJECTIVE: DEVELOPMENT OF A POSITION PAPER FOR CHRONIC CARE IN BELGIUM 11 -- 1.3. SCOPE: FROM “CHRONIC DISEASE” TO “CHRONIC CARE BASED ON THE PATIENT’S NEEDS” 13 -- 1.3.1. Chronic disease: official definitions based on a listing of diseases 13 -- 1.3.2. The patient with “chronic disease”: frequently in the plural 13 -- 1.3.3. Chronic care as an answer to the patient’s needs 13 -- 1.3.4. on care (versus primary prevention and “health in all policies”) 15 -- 1.4. EPIDEMIOLOGY AND COSTS OF CHRONIC DISEASES 15 -- 1.4.1. Epidemiology 15 -- 1.4.2. Costs 16 -- 2. HIGHLIGHTS FROM THE INTERNATIONAL PERSPECTIVE 18 -- 2.1. VIEWPOINTS OF THE EUROPEAN UNION, THE UNITED NATIONS AND THE WORLD HEALTH -- ORGANIZATION 18 -- 2.1.1. Data sources 18 -- 2.1.2. International frameworks: calls for integrated care 18 -- 2.1.3. Shift towards integrated care: advocacy for organizational changes 21 -- 2.1.4. Role of primary care: hub of coordination 22 -- 2.1.5. Summary and conclusions 24 -- 2.2. CHRONIC CARE MODEL 26 -- 2.2.1. Elements of the chronic care model 26 -- 2.2.2. Evidence underlying the chronic care model 27 -- 2.3. HIGHLIGHTS FROM 4 COUNTRIES 28 -- 2.3.1. Methods 28 -- 2.3.2. Stakeholder collaboration: shared vision and leadership 29 -- 2.3.3. Information technologies and performance measurement. 31 -- 2.3.4. Engaging consumers 31 -- 2.3.5. Improving Health Care delivery: translation of the national/regional strategy at local level 32 -- 2.3.6. Aligning finance /insurance: incentives 32 -- 2.3.7. Outcomes 33 -- 2.3.8. Barriers in redesigning chronic care management 33 -- 2.3.9. Key points: lessons learned 33 -- 3. REASONING FRAMEWORK FOR A HEALTH SYSTEM ORIENTED TOWARDS CHRONIC CARE 34 -- 3.1. OBJECTIVE OF THIS CHAPTER 34 -- 3.2. DEVELOPMENT OF A VISION FOR A REFORM OF CHRONIC CARE IN BELGIUM 35 -- 3.2.1. General shape of the vision or root definition 35 -- 3.2.2. Core purpose 36 -- 3.2.3. Additional qualifications 36 -- 3.2.4. Expanded vision/root definition 38 -- 3.3. CONCEPTUAL MODEL: FUNCTIONAL ACTIVITIES REQUIRED FOR A CHRONIC CARE SYSTEM 39 -- 3.3.1. Plan, provide and co-ordinate routine care 40 -- 3.3.2. Provide acute episode response and specialized services 41 -- 3.3.3. Conduct early identification 42 -- 3.3.4. Support patient/informal caregiver empowerment (including self-management) 43 -- 3.3.5. Conduct health promotion and prevention activities 44 -- 3.3.6. Implement and follow-up a dynamic care model 45 -- 3.3.7. Six requirements for each activity 45 -- 3.4. CONCLUDING REMARKS 47 -- 4. CHRONIC CARE INITIATIVES IN BELGIUM 48 -- 4.1. OBJECTIVE OF THIS CHAPTER 48 -- 4.2. METHODS 48 -- 4.2.1. Data sources 48 -- 4.2.2. Data collection 48 -- 4.2.3. Inclusion and exclusion criteria 48 -- 4.3. NATIONAL PLAN: “PRIORITY TO CHRONIC PATIENTS!” 49 -- 4.4. DESCRIPTION OF THE INITIATIVES FROM THE FEDERAL PUBLIC SERVICE HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT AND FROM THE SICKNESS FUNDS 49 -- 4.4.1. Inventory of initiatives that target patients with a chronic illness 49 -- 4.4.2. Discussion: initiatives from the Federal Public Service Health, Food Chain Safety and environment and from the Sickness Funds 55 -- 4.5. DESCRIPTION OF INITIATIVES FROM THE NATIONAL INSTITUTE FOR HEALTH AND DISABILITY INSURANCE 56 -- 4.5.1. Health care system level 56 -- 4.5.2. Plan, provide and coordinate care in the primary care setting 57 -- 4.5.3. Self-empowerment of the patients 63 -- 4.6. KEY POINTS: CHRONIC CARE INITIATIVES IN BELGIUM 64 -- 5. RECOMMENDATIONS IN RELATION TO CHRONIC CARE: ANALYSIS OF KCE REPORTS 65 -- 5.1. OBJECTIVE OF THIS CHAPTER 65 -- 5.2. METHODS 65 -- 5.3. TAILORED DELIVERY SYSTEM DESIGN 65 -- 5.3.1. Strengthening primary care: illustration of type 2 diabetes care 66 -- 5.3.2. Organizational models that streamline transition between primary, secondary and tertiary care 67 -- 5.3.3. Organization of services for the older persons 67 -- 5.3.4. Organization of Palliative care services 69 -- 5.3.5. Organization of Mental Health Care Services 70 -- 5.3.6. Organization of rehabilitation services 70 -- 5.4. APPROPRIATE WORKFORCE 71 -- 5.4.1. Physician workforce planning 71 -- 5.4.2. Attractiveness, recruitment and retention of the GP profession 71 -- 5.4.3. Differentiated Nursing Practice 72 -- 5.4.4. The right function for the right health professional: physiotherapists and pharmacists 72 -- 5.4.5. Important role for the occupational physician and the advisory physician from the sickness funds 73 -- 5.4.6. Role for informal caregivers 73 -- 5.4.7. Curricula and continuous education based on needs 73 -- 5.5. APPROPRIATE FINANCING 74 -- 5.5.1. Financial accessibility 74 -- 5.5.2. Financing system for home care nursing 75 -- 5.5.3. Comparison of two financing systems for primary health care 76 -- 5.5.4. Financial initiatives for quality 76 -- 5.6. QUALITY PROCESSES 77 -- 5.7. DECISION SUPPORT 78 -- 5.7.1. Seamless care with regard to medications 79 -- 5.7.2. Self-empowerment in chronic dialysis 79 -- 5.8. CLINICAL INFORMATION SYSTEMS 79 -- 5.9. KEY POINTS: EVIDENCE AND RECOMMENDATIONS FROM KCE REPORTS 80 -- 6. FOCUS ON PATIENT EMPOWERMENT AND NEW PROFILES/ FUNCTIONS IN THE FIRST LINE OF CARE 82 -- 6.1. OBJECTIVE OF THIS CHAPTER 82 -- 6.2. METHODS 82 -- 6.3. HOW TO FOSTER THE PATIENT SELF-EMPOWERMENT ? INSIGHTS FROM A SYSTEMATIC REVIEW OF THE LITERATURE 82 -- 6.3.1. Scope of the literature review 83 -- 6.3.2. Methods 84 -- 6.3.3. Results of the search strategy 84 -- 6.3.4. Effectiveness of the interventions: results by disease 88 -- 6.3.5. Summary of the findings: analysis by type of intervention 94 -- 6.3.6. Conclusion: what elements make up successful interventions? 97 -- 6.3.7. Strengths of this review 98 -- 6.3.8. Caveats in the interpretation of results 98 -- 6.3.9. Key points: interventions to foster patient empowerment 99 -- 6.4. NEW PROFILES AND FUNCTIONS IN THE HEALTH CARE SYSTEM 99 -- 6.4.1. Objective: analysis of the possible changes within the workforce to tackle the future challenges of chronic care 99 -- 6.4.2. Methods 100 -- 6.4.3. New roles in health care: examples from the UK, Canada and The Netherlands 100 -- 6.4.4. Situation in Belgium 110 -- 6.4.5. Discussion: implementation of new functions and professions in the Belgian health care system 114 -- 6.4.6. Key points: new functions and roles in primary health care 115 -- 7. ORGANIZATION OF CHRONIC CARE IN BELGIUM: STAKEHOLDERS’ ANALYSIS 116 -- 7.1. OBJECTIVE OF THIS CHAPTER 116 -- 7.2. METHODS: CONSULTATION OF STAKEHOLDERS FROM DIFFERENT LEVELS 116 -- 7.2.1. Micro and meso levels: four brainstorming sessions and semi-structured interviews 116 -- 7.2.2. Macro level: two meetings with stakeholders 117 -- 7.3. RESULTS: STAKEHOLDERS’ VIEWS ON THE ORGANIZATION OF CHRONIC CARE IN BELGIUM 118 -- 7.3.1. Theme 1: continuum of care within lines of care and between lines of care calls for coordination 118 -- 7.3.2. Theme 2: Redefining the roles of health professionals and training 121 -- 7.3.3. Theme 3: Empowerment and support of the patient and his/her informal caregiver 124 -- 7.3.4. Theme 4: Payment system influences care 125 -- 7.3.5. Theme 5: Clinical information systems and e-Data 127 -- 7.3.6. Theme 6: Accessibility of care 129 -- 7.3.7. Strengths and limitations of this SWOT analysis 130 -- 7.4. KEY POINTS: HIGHLIGHTS FROM THE SWOT ANALYSIS WITH STAKEHOLDERS 131 -- 7.4.1. Lack of efficiency 131 -- 7.4.2. Coordination at micro level: a multidisciplinary primary care team is at the centre of a system designed for people with chronic care needs 131 -- 7.4.3. Coordination at the meso level: mid-level scale initiatives to improve seamless care between hospital and home care 131 -- 7.4.4. Task delegation and new functions in the health care system: the added value of medical assistants and qualified nurses 131 -- 7.4.5. Preventing institutionalization: importance of respite care and coaching the informal caregivers 132 -- 7.4.6. Patients and Informal care givers. Roles of their organizations 132 -- 7.4.7. Balancing payment systems 132 -- 7.4.8. Information systems 132 -- 7.4.9. Accessible care 133 -- 8. ANALYSIS OF COORDINATION STRUCTURES AND PROGRAMMES IN BELGIUM 134 -- 8.1. OBJECTIVE OF THIS CHAPTER 134 -- 8.2. BACKGROUND: HEALTH CARE SYSTEM, A COMPLEX ADAPTIVE SYSTEM 135 -- 8.3. COORDINATION STRUCTURES AND PROGRAMMES IN HEALTH CARE 135 -- 8.3.1. Coordination structures 135 -- 8.3.2. Coordination programmes 136 -- 8.4. KEY FEATURES OF COORDINATION STRUCTURES AND PROGRAMMES 136 -- 8.4.1. Coordination structures at micro level 136 -- 8.4.2. Need for a geographically integrated system at meso level 138 -- 8.4.3. Towards a uniform vision at macro level 138 -- 8.5. EVOLUTION OF COORDINATION STRUCTURES IN BELGIUM 139 -- 8.5.1. Micro level: from single-handed practices towards more collaboration 139 -- 8.5.2. Meso level: from home care coordinating centres (SIT/CCSSD) to Integrated Primary Care Systems (GDT/SISD) 140 -- 8.6. CARE PROGRAMMES: FIT WITHIN “MICRO” OR “MESO” HORIZONTAL STRUCTURES 142 -- 8.6.1. Local multidisciplinary Networks 143 -- 8.6.2. Alternative forms of care for older persons 143 -- 8.6.3. Palliative care platforms and teams 143 -- 8.7. FROM LESSONS LEARNED TO FUTURE PERSPECTIVES 144 -- REFERENCES 146 Link for e-copy: https://doi.org/10.57598/R190A Format of e-copy: PDF (1,93 Mb) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=3100 Copies(0)
Status No copy Organisation of care for chronic patients in Belgium / Dominique Paulus / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2012)
Organisation of care for chronic patients in Belgium : development of a position paper [printed text] / Dominique Paulus , Author ; Koen Van Den Heede , Author ; Raf Mertens , Author . - Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre, 2012 . - VI, 166 p. : Ill. ; A4. - (KCE Reports. Health Services Research (HSR); 190C) .
ISSN : D/2012/10.273/81 : € 0,00
Study 2011-50
Languages : English (eng)
Descriptors: Classification
W 84.3 Health Services Research (General)
Indexation
2011-50 ; Chronic Disease ; Health Care Reform ; Organisation and Administration ; R190Contents note: SCIENTIFIC REPORT 11 -- 1. THE CHALLENGE OF CHRONIC CARE 11 -- 1.1. CHRONIC CARE: A GROWING BURDEN FOR THE HEALTH CARE SYSTEMS. 11 -- 1.2. OBJECTIVE: DEVELOPMENT OF A POSITION PAPER FOR CHRONIC CARE IN BELGIUM 11 -- 1.3. SCOPE: FROM “CHRONIC DISEASE” TO “CHRONIC CARE BASED ON THE PATIENT’S NEEDS” 13 -- 1.3.1. Chronic disease: official definitions based on a listing of diseases 13 -- 1.3.2. The patient with “chronic disease”: frequently in the plural 13 -- 1.3.3. Chronic care as an answer to the patient’s needs 13 -- 1.3.4. on care (versus primary prevention and “health in all policies”) 15 -- 1.4. EPIDEMIOLOGY AND COSTS OF CHRONIC DISEASES 15 -- 1.4.1. Epidemiology 15 -- 1.4.2. Costs 16 -- 2. HIGHLIGHTS FROM THE INTERNATIONAL PERSPECTIVE 18 -- 2.1. VIEWPOINTS OF THE EUROPEAN UNION, THE UNITED NATIONS AND THE WORLD HEALTH ORGANIZATION 18 -- 2.1.1. Data sources 18 -- 2.1.2. International frameworks: calls for integrated care 18 -- 2.1.3. Shift towards integrated care: advocacy for organizational changes 21 -- 2.1.4. Role of primary care: hub of coordination 22 -- 2.1.5. Summary and conclusions 24 -- 2.2. CHRONIC CARE MODEL 26 -- 2.2.1. Elements of the chronic care model 26 -- 2.2.2. Evidence underlying the chronic care model 27 -- 2.3. HIGHLIGHTS FROM 4 COUNTRIES 28 -- 2.3.1. Methods 28 -- 2.3.2. Stakeholder collaboration: shared vision and leadership 29 -- 2.3.3. Information technologies and performance measurement. 31 -- 2.3.4. Engaging consumers 31 -- 2.3.5. Improving Health Care delivery: translation of the national/regional strategy at local level 32 -- 2.3.6. Aligning finance /insurance: incentives 32 -- 2.3.7. Outcomes 33 -- 2.3.8. Barriers in redesigning chronic care management 33 -- 2.3.9. Key points: lessons learned 33 -- 3. REASONING FRAMEWORK FOR A HEALTH SYSTEM ORIENTED TOWARDS CHRONIC CARE 34 -- 3.1. OBJECTIVE OF THIS CHAPTER 34 -- 3.2. DEVELOPMENT OF A VISION FOR A REFORM OF CHRONIC CARE IN BELGIUM 35 -- 3.2.1. General shape of the vision or root definition 35 -- 3.2.2. Core purpose 36 -- 3.2.3. Additional qualifications 36 -- 3.2.4. Expanded vision/root definition 38 -- 3.3. CONCEPTUAL MODEL: FUNCTIONAL ACTIVITIES REQUIRED FOR A CHRONIC CARE SYSTEM 39 -- 3.3.1. Plan, provide and co-ordinate routine care 40 -- 3.3.2. Provide acute episode response and specialized services 41 -- 3.3.3. Conduct early identification 42 -- 3.3.4. Support patient/informal caregiver empowerment (including self-management) 43 -- 3.3.5. Conduct health promotion and prevention activities 44 -- 3.3.6. Implement and follow-up a dynamic care model 45 -- 3.3.7. Six requirements for each activity 45 -- 3.4. CONCLUDING REMARKS 47 -- 4. CHRONIC CARE INITIATIVES IN BELGIUM 48 -- 4.1. OBJECTIVE OF THIS CHAPTER 48 -- 4.2. METHODS 48 -- 4.2.1. Data sources 48 -- 4.2.2. Data collection 48 -- 4.2.3. Inclusion and exclusion criteria 48 -- 4.3. NATIONAL PLAN: “PRIORITY TO CHRONIC PATIENTS!” 49 -- 4.4. DESCRIPTION OF THE INITIATIVES FROM THE FEDERAL PUBLIC SERVICE HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT AND FROM THE SICKNESS FUNDS 49 -- 4.4.1. Inventory of initiatives that target patients with a chronic illness 49 -- 4.4.2. Discussion: initiatives from the Federal Public Service Health, Food Chain Safety and environment and from the Sickness Funds 55 -- 4.5. DESCRIPTION OF INITIATIVES FROM THE NATIONAL INSTITUTE FOR HEALTH AND DISABILITY INSURANCE 56 -- 4.5.1. Health care system level 56 -- 4.5.2. Plan, provide and coordinate care in the primary care setting 57 -- 4.5.3. Self-empowerment of the patients 63 -- 4.6. KEY POINTS: CHRONIC CARE INITIATIVES IN BELGIUM 64 -- 5. RECOMMENDATIONS IN RELATION TO CHRONIC CARE: ANALYSIS OF KCE REPORTS 65 -- 5.1. OBJECTIVE OF THIS CHAPTER 65 -- 5.2. METHODS 65 -- 5.3. TAILORED DELIVERY SYSTEM DESIGN 65 -- 5.3.1. Strengthening primary care: illustration of type 2 diabetes care 66 -- 5.3.2. Organizational models that streamline transition between primary, secondary and tertiary care 67 -- 5.3.3. Organization of services for the older persons 67 -- 5.3.4. Organization of Palliative care services 69 -- 5.3.5. Organization of Mental Health Care Services 70 -- 5.3.6. Organization of rehabilitation services 70 -- 5.4. APPROPRIATE WORKFORCE 71 -- 5.4.1. Physician workforce planning 71 -- 5.4.2. Attractiveness, recruitment and retention of the GP profession 71 -- 5.4.3. Differentiated Nursing Practice 72 -- 5.4.4. The right function for the right health professional: physiotherapists and pharmacists 72 -- 5.4.5. Important role for the occupational physician and the advisory physician from the sickness funds 73 -- 5.4.6. Role for informal caregivers 73 -- 5.4.7. Curricula and continuous education based on needs 73 -- 5.5. APPROPRIATE FINANCING 74 -- 5.5.1. Financial accessibility 74 -- 5.5.2. Financing system for home care nursing 75 -- 5.5.3. Comparison of two financing systems for primary health care 76 -- 5.5.4. Financial initiatives for quality 76 -- 5.6. QUALITY PROCESSES 77 -- 5.7. DECISION SUPPORT 78 -- 5.7.1. Seamless care with regard to medications 79 -- 5.7.2. Self-empowerment in chronic dialysis 79 -- 5.8. CLINICAL INFORMATION SYSTEMS 79 -- 5.9. KEY POINTS: EVIDENCE AND RECOMMENDATIONS FROM KCE REPORTS 80 -- 6. FOCUS ON PATIENT EMPOWERMENT AND NEW PROFILES/ FUNCTIONS IN THE FIRST LINE OF CARE 82 -- 6.1. OBJECTIVE OF THIS CHAPTER 82 -- 6.2. METHODS 82 -- 6.3. HOW TO FOSTER THE PATIENT SELF-EMPOWERMENT ? INSIGHTS FROM A SYSTEMATIC REVIEW OF THE LITERATURE 82 -- 6.3.1. Scope of the literature review 83 -- 6.3.2. Methods 84 -- 6.3.3. Results of the search strategy 84 -- 6.3.4. Effectiveness of the interventions: results by disease 88 -- 6.3.5. Summary of the findings: analysis by type of intervention 94 -- 6.3.6. Conclusion: what elements make up successful interventions? 97 -- 6.3.7. Strengths of this review 98 -- 6.3.8. Caveats in the interpretation of results 98 -- 6.3.9. Key points: interventions to foster patient empowerment 99 -- 6.4. NEW PROFILES AND FUNCTIONS IN THE HEALTH CARE SYSTEM 99 -- 6.4.1. Objective: analysis of the possible changes within the workforce to tackle the future challenges of chronic care 99 -- 6.4.2. Methods 100 -- 6.4.3. New roles in health care: examples from the UK, Canada and The Netherlands 100 -- 6.4.4. Situation in Belgium 110 -- 6.4.5. Discussion: implementation of new functions and professions in the Belgian health care system 114 -- 6.4.6. Key points: new functions and roles in primary health care 115 -- 7. ORGANIZATION OF CHRONIC CARE IN BELGIUM: STAKEHOLDERS’ ANALYSIS 116 -- 7.1. OBJECTIVE OF THIS CHAPTER 116 -- 7.2. METHODS: CONSULTATION OF STAKEHOLDERS FROM DIFFERENT LEVELS 116 -- 7.2.1. Micro and meso levels: four brainstorming sessions and semi-structured interviews 116 -- 7.2.2. Macro level: two meetings with stakeholders 117 -- 7.3. RESULTS: STAKEHOLDERS’ VIEWS ON THE ORGANIZATION OF CHRONIC CARE IN BELGIUM 118 -- 7.3.1. Theme 1: continuum of care within lines of care and between lines of care calls for coordination 118 -- 7.3.2. Theme 2: Redefining the roles of health professionals and training 121 -- 7.3.3. Theme 3: Empowerment and support of the patient and his/her informal caregiver 124 -- 7.3.4. Theme 4: Payment system influences care 125 -- 7.3.5. Theme 5: Clinical information systems and e-Data 127 -- 7.3.6. Theme 6: Accessibility of care 129 -- 7.3.7. Strengths and limitations of this SWOT analysis 130 -- 7.4. KEY POINTS: HIGHLIGHTS FROM THE SWOT ANALYSIS WITH STAKEHOLDERS 131 -- 7.4.1. Lack of efficiency 131 -- 7.4.2. Coordination at micro level: a multidisciplinary primary care team is at the centre of a system designed for people with chronic care needs 131 -- 7.4.3. Coordination at the meso level: mid-level scale initiatives to improve seamless care between hospital and home care 131 -- 7.4.4. Task delegation and new functions in the health care system: the added value of medical assistants and qualified nurses 131 -- 7.4.5. Preventing institutionalization: importance of respite care and coaching the informal caregivers 132 -- 7.4.6. Patients and Informal care givers. Roles of their organizations 132 -- 7.4.7. Balancing payment systems 132 -- 7.4.8. Information systems 132 -- 7.4.9. Accessible care 133 -- 8. ANALYSIS OF COORDINATION STRUCTURES AND PROGRAMMES IN BELGIUM 134 -- 8.1. OBJECTIVE OF THIS CHAPTER 134 -- 8.2. BACKGROUND: HEALTH CARE SYSTEM, A COMPLEX ADAPTIVE SYSTEM 135 -- 8.3. COORDINATION STRUCTURES AND PROGRAMMES IN HEALTH CARE 135 -- 8.3.1. Coordination structures 135 -- 8.3.2. Coordination programmes 136 -- 8.4. KEY FEATURES OF COORDINATION STRUCTURES AND PROGRAMMES 136 -- 8.4.1. Coordination structures at micro level 136 -- 8.4.2. Need for a geographically integrated system at meso level 138 -- 8.4.3. Towards a uniform vision at macro level 138 -- 8.5. EVOLUTION OF COORDINATION STRUCTURES IN BELGIUM 139 -- 8.5.1. Micro level: from single-handed practices towards more collaboration 139 -- 8.5.2. Meso level: from home care coordinating centres (SIT/CCSSD) to Integrated Primary Care Systems (GDT/SISD) 140 -- 8.6. CARE PROGRAMMES: FIT WITHIN “MICRO” OR “MESO” HORIZONTAL STRUCTURES 142 -- 8.6.1. Local multidisciplinary Networks 143 -- 8.6.2. Alternative forms of care for older persons 143 -- 8.6.3. Palliative care platforms and teams 143 -- 8.7. FROM LESSONS LEARNED TO FUTURE PERSPECTIVES 144 -- REFERENCES 146 Link for e-copy: https://doi.org/10.57598/R190C Format of e-copy: PDF (1,95 MB) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=3103 Copies(0)
Status No copy Organisation des soins pour les malades chroniques en Belgique / Dominique Paulus / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2012)
Organisation des soins pour les malades chroniques en Belgique : développement d’un position paper [printed text] / Dominique Paulus , Author ; Koen Van Den Heede , Author ; Raf Mertens , Author . - Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre, 2012 . - VII, 166 p. : Ill. ; A4. - (KCE Reports B. Health Services Research (HSR); 190B) .
ISSN : D/2012/10.273/80 : € 0,00
Etude 2011-50
Languages : English (eng) French (fre)
Descriptors: Classification
W 84.3 Health Services Research (General)
Indexation
2011-50 ; Chronic Disease ; Health Care Reform ; Organisation and Administration ; R190Abstract: Plus d'un quart des Belges déclarent souffrir d'une maladie chronique et cette proportion augmentera encore, vu le vieillissement de notre population. En 2008, le programme national «Priorité aux malades chroniques !" mettait surtout l'accent sur l’information du patient et sur l'accessibilité des soins. Dans une seconde étape, la ministre de la Santé Publique a demandé au Centre fédéral d’expertise des soins de santé (KCE) de développer, en concertation avec l’administration de la Santé Publique et l'INAMI, une vision relative à l’organisation future des soins chroniques. Le KCE a analysé la littérature scientifique internationale et les initiatives actuellement en cours, en Belgique et à l’étranger, pour la prise en charge des maladies chroniques. Les experts du terrain et les décideurs ainsi que les représentants des organisations de patients ont également été impliqués dans cette étude. Le résultat : un "Position Paper" qui propose plus de 50 actions concrètes afin de réformer en profondeur l'organisation des soins chroniques. Contents note: SCIENTIFIC REPORT 11 -- 1. THE CHALLENGE OF CHRONIC CARE 11 -- 1.1. CHRONIC CARE: A GROWING BURDEN FOR THE HEALTH CARE SYSTEMS. 11 -- 1.2. OBJECTIVE: DEVELOPMENT OF A POSITION PAPER FOR CHRONIC CARE IN BELGIUM 11 -- 1.3. SCOPE: FROM “CHRONIC DISEASE” TO “CHRONIC CARE BASED ON THE PATIENT’S NEEDS” 13 -- 1.3.1. Chronic disease: official definitions based on a listing of diseases 13 -- 1.3.2. The patient with “chronic disease”: frequently in the plural 13 -- 1.3.3. Chronic care as an answer to the patient’s needs 13 -- 1.3.4. on care (versus primary prevention and “health in all policies”) 15 -- 1.4. EPIDEMIOLOGY AND COSTS OF CHRONIC DISEASES 15 -- 1.4.1. Epidemiology 15 -- 1.4.2. Costs 16 -- 2. HIGHLIGHTS FROM THE INTERNATIONAL PERSPECTIVE 18 -- 2.1. VIEWPOINTS OF THE EUROPEAN UNION, THE UNITED NATIONS AND THE WORLD HEALTH ORGANIZATION 18 -- 2.1.1. Data sources 18 -- 2.1.2. International frameworks: calls for integrated care 18 -- 2.1.3. Shift towards integrated care: advocacy for organizational changes 21 -- 2.1.4. Role of primary care: hub of coordination 22 -- 2.1.5. Summary and conclusions 24 -- 2.2. CHRONIC CARE MODEL 26 -- 2.2.1. Elements of the chronic care model 26 -- 2.2.2. Evidence underlying the chronic care model 27 -- HIGHLIGHTS FROM 4 COUNTRIES 28 -- 2.3.1. Methods 28 -- 2.3.2. Stakeholder collaboration: shared vision and leadership 29 -- 2.3.3. Information technologies and performance measurement. 31 -- 2.3.4. Engaging consumers 31 -- 2.3.5. Improving Health Care delivery: translation of the national/regional strategy at local level 32 -- 2.3.6. Aligning finance /insurance: incentives 32 -- 2.3.7. Outcomes 33 -- 2.3.8. Barriers in redesigning chronic care management 33 -- 2.3.9. Key points: lessons learned 33 -- 3. REASONING FRAMEWORK FOR A HEALTH SYSTEM ORIENTED TOWARDS CHRONIC CARE 34 -- 3.1. OBJECTIVE OF THIS CHAPTER 34 -- 3.2. DEVELOPMENT OF A VISION FOR A REFORM OF CHRONIC CARE IN BELGIUM 35 -- 3.2.1. General shape of the vision or root definition 35 -- 3.2.2. Core purpose 36 -- 3.2.3. Additional qualifications 36 -- 3.2.4. Expanded vision/root definition 38 -- 3.3. CONCEPTUAL MODEL: FUNCTIONAL ACTIVITIES REQUIRED FOR A CHRONIC CARE SYSTEM 39 -- 3.3.1. Plan, provide and co-ordinate routine care 40 -- 3.3.2. Provide acute episode response and specialized services 41 -- 3.3.3. Conduct early identification 42 -- 3.3.4. Support patient/informal caregiver empowerment (including self-management) 43 -- 3.3.5. Conduct health promotion and prevention activities 44 -- 3.3.6. Implement and follow-up a dynamic care model 45 -- 3.3.7. Six requirements for each activity 45 -- 3.4. CONCLUDING REMARKS 47 -- 4. CHRONIC CARE INITIATIVES IN BELGIUM 48 -- 4.1. OBJECTIVE OF THIS CHAPTER 48 -- 4.2. METHODS 48 -- 4.2.1. Data sources 48 -- 4.2.2. Data collection 48 -- 4.2.3. Inclusion and exclusion criteria 48 -- 4.3. NATIONAL PLAN: “PRIORITY TO CHRONIC PATIENTS!” 49 -- 4.4. DESCRIPTION OF THE INITIATIVES FROM THE FEDERAL PUBLIC SERVICE HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT AND FROM THE SICKNESS FUNDS 49 -- 4.4.1. Inventory of initiatives that target patients with a chronic illness 49 -- 4.4.2. Discussion: initiatives from the Federal Public Service Health, Food Chain Safety and -- environment and from the Sickness Funds 55 -- 4.5. DESCRIPTION OF INITIATIVES FROM THE NATIONAL INSTITUTE FOR HEALTH AND DISABILITY INSURANCE 56 -- 4.5.1. Health care system level 56 -- 4.5.2. Plan, provide and coordinate care in the primary care setting 57 -- 4.5.3. Self-empowerment of the patients 63 -- 4.6. KEY POINTS: CHRONIC CARE INITIATIVES IN BELGIUM 64 -- 5. RECOMMENDATIONS IN RELATION TO CHRONIC CARE: ANALYSIS OF KCE REPORTS 65 -- 5.1. OBJECTIVE OF THIS CHAPTER 65 -- 5.2. METHODS 65 -- 5.3. TAILORED DELIVERY SYSTEM DESIGN 65 -- 5.3.1. Strengthening primary care: illustration of type 2 diabetes care 66 -- 5.3.2. Organizational models that streamline transition between primary, secondary and tertiary care 67 -- 5.3.3. Organization of services for the older persons 67 -- 5.3.4. Organization of Palliative care services 69 -- 5.3.5. Organization of Mental Health Care Services 70 -- 5.3.6. Organization of rehabilitation services 70 -- 5.4. APPROPRIATE WORKFORCE 71 -- 5.4.1. Physician workforce planning 71 -- 5.4.2. Attractiveness, recruitment and retention of the GP profession 71 -- 5.4.3. Differentiated Nursing Practice 72 -- 5.4.4. The right function for the right health professional: physiotherapists and pharmacists 72 -- 5.4.5. Important role for the occupational physician and the advisory physician from the sickness funds 73 -- 5.4.6. Role for informal caregivers 73 -- 5.4.7. Curricula and continuous education based on needs 73 -- 5.5. APPROPRIATE FINANCING 74 -- 5.5.1. Financial accessibility 74 -- 5.5.2. Financing system for home care nursing 75 -- 5.5.3. Comparison of two financing systems for primary health care 76 -- 5.5.4. Financial initiatives for quality 76 -- 5.6. QUALITY PROCESSES 77 -- 5.7. DECISION SUPPORT 78 -- 5.7.1. Seamless care with regard to medications 79 -- 5.7.2. Self-empowerment in chronic dialysis 79 -- 5.8. CLINICAL INFORMATION SYSTEMS 79 -- 5.9. KEY POINTS: EVIDENCE AND RECOMMENDATIONS FROM KCE REPORTS 80 -- 6. FOCUS ON PATIENT EMPOWERMENT AND NEW PROFILES/ FUNCTIONS IN THE FIRST LINE OF CARE 82 -- 6.1. OBJECTIVE OF THIS CHAPTER 82 -- 6.2. METHODS 82 -- 6.3. HOW TO FOSTER THE PATIENT SELF-EMPOWERMENT ? INSIGHTS FROM A SYSTEMATIC REVIEW OF THE LITERATURE 82 -- 6.3.1. Scope of the literature review 83 -- 6.3.2. Methods 84 -- 6.3.3. Results of the search strategy 84 -- 6.3.4. Effectiveness of the interventions: results by disease 88 -- 6.3.5. Summary of the findings: analysis by type of intervention 94 -- 6.3.6. Conclusion: what elements make up successful interventions? 97 -- 6.3.7. Strengths of this review 98 -- 6.3.8. Caveats in the interpretation of results 98 -- 6.3.9. Key points: interventions to foster patient empowerment 99 -- 6.4. NEW PROFILES AND FUNCTIONS IN THE HEALTH CARE SYSTEM 99 -- 6.4.1. Objective: analysis of the possible changes within the workforce to tackle the future challenges of chronic care 99 -- 6.4.2. Methods 100 -- 6.4.3. New roles in health care: examples from the UK, Canada and The Netherlands 100 -- 6.4.4. Situation in Belgium 110 -- 6.4.5. Discussion: implementation of new functions and professions in the Belgian health care system 114 -- 6.4.6. Key points: new functions and roles in primary health care 115 -- 7. ORGANIZATION OF CHRONIC CARE IN BELGIUM: STAKEHOLDERS’ ANALYSIS 116 -- 7.1. OBJECTIVE OF THIS CHAPTER 116 -- 7.2. METHODS: CONSULTATION OF STAKEHOLDERS FROM DIFFERENT LEVELS 116 -- 7.2.1. Micro and meso levels: four brainstorming sessions and semi-structured interviews 116 -- 7.2.2. Macro level: two meetings with stakeholders 117 -- 7.3. RESULTS: STAKEHOLDERS’ VIEWS ON THE ORGANIZATION OF CHRONIC CARE IN BELGIUM 118 -- 7.3.1. Theme 1: continuum of care within lines of care and between lines of care calls for coordination 118 -- 7.3.2. Theme 2: Redefining the roles of health professionals and training 121 -- 7.3.3. Theme 3: Empowerment and support of the patient and his/her informal caregiver 124 -- 7.3.4. Theme 4: Payment system influences care 125 -- 7.3.5. Theme 5: Clinical information systems and e-Data 127 -- 7.3.6. Theme 6: Accessibility of care 129 -- 7.3.7. Strengths and limitations of this SWOT analysis 130 -- 7.4. KEY POINTS: HIGHLIGHTS FROM THE SWOT ANALYSIS WITH STAKEHOLDERS 131 -- 7.4.1. Lack of efficiency 131 -- 7.4.2. Coordination at micro level: a multidisciplinary primary care team is at the centre of a system designed for people with chronic care needs 131 -- 7.4.3. Coordination at the meso level: mid-level scale initiatives to improve seamless care between hospital and home care 131 -- 7.4.4. Task delegation and new functions in the health care system: the added value of medical assistants and qualified nurses 131 -- 7.4.5. Preventing institutionalization: importance of respite care and coaching the informal caregivers 132 -- 7.4.6. Patients and Informal care givers. Roles of their organizations 132 -- 7.4.7. Balancing payment systems 132 -- 7.4.8. Information systems 132 -- 7.4.9. Accessible care 133 -- 8. ANALYSIS OF COORDINATION STRUCTURES AND PROGRAMMES IN BELGIUM 134 -- 8.1. OBJECTIVE OF THIS CHAPTER 134 -- 8.2. BACKGROUND: HEALTH CARE SYSTEM, A COMPLEX ADAPTIVE SYSTEM 135 -- 8.3. COORDINATION STRUCTURES AND PROGRAMMES IN HEALTH CARE 135 -- 8.3.1. Coordination structures 135 -- 8.3.2. Coordination programmes 136 -- 8.4. KEY FEATURES OF COORDINATION STRUCTURES AND PROGRAMMES 136 -- 8.4.1. Coordination structures at micro level 136 -- 8.4.2. Need for a geographically integrated system at meso level 138 -- 8.4.3. Towards a uniform vision at macro level 138 -- 8.5. EVOLUTION OF COORDINATION STRUCTURES IN BELGIUM 139 -- 8.5.1. Micro level: from single-handed practices towards more collaboration 139 -- 8.5.2. Meso level: from home care coordinating centres (SIT/CCSSD) to Integrated Primary Care Systems (GDT/SISD) 140 -- 8.6. CARE PROGRAMMES: FIT WITHIN “MICRO” OR “MESO” HORIZONTAL STRUCTURES 142 -- 8.6.1. Local multidisciplinary Networks 143 -- 8.6.2. Alternative forms of care for older persons 143 -- 8.6.3. Palliative care platforms and teams 143 -- 8.7. FROM LESSONS LEARNED TO FUTURE PERSPECTIVES 144 -- REFERENCES 146 Link for e-copy: https://doi.org/10.57598/R190B Format of e-copy: PDF (1,94 Mb) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=3098 Copies(0)
Status No copy Position paper / Dominique Paulus / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2012)
PermalinkPosition paper / Dominique Paulus / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2012)
PermalinkPosition Paper / Dominique Paulus / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2012)
PermalinkStakeholders' perception on the organization of chronic care / Thérèse Van Durme in BMC Health Services Research, 14(2014) ([04/18/2014])
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