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Poorly executed care transitions from hospital to home can result in adverse outcomes, such as incorrect treatments, medication errors, patient dissatisfaction, rehospitalization, emergency department visits, and mortality. Integrated care services may improve the quality of these transitions, particularly for older, chronically ill patients who frequently move between care settings. This study aimed to (1) assess health-related quality of life (HRQoL) and older patients’ experiences during transitional care i and (2) compare these outcomes between patients residing within and outside an integrated care region in Belgium. This cross-sectional survey study was part of the European TRANS-SENIOR project. Participants included patients aged 65 and older who were discharged home from one of six acute hospital wards at University Hospitals Leuven, Belgium. HRQoL was measured using the EQ-5D-5 L and a Visual Analogue Scale (0–100). Patient experiences were assessed using the ‘Experiences with Hospital Care, Admission and Discharge’ instrument. Descriptive statistics were applied to the full sample, and comparative analyses were conducted between patients living inside versus outside an integrated care region. Statistical significance was set at p  < 0.05. A total of 119 questionnaires were completed. The mean age of participants was 81 years, and 54.2% were female. Over 70% reported issues with mobility, pain/discomfort, daily activities, and self-care. Patients reported high scores for the patient experience dimensions hospital accessibility, hospital safety and care received by physicians and nurses. However, lower scores were noted for treatment communication, admission conversations and hospital discharge processes. No statistically significant differences were found in HRQoL or most patient experience dimensions between those living within versus outside an integrated care region. This survey highlights areas for improvement in transitional care. This information can support hospitals and health care professionals in refining discharge, transfer and postdischarge processes for older patients with chronic conditions.

The aim of this paper was to describe the time trends in the prevalence of multimorbidity and polypharmacy in Flanders (Belgium) between 2000 and 2015, while controlling for age and sex. Data were available from Intego, a Flemish-Belgian general practice-based morbidity registration network. The practice population between 2000 and 2015 was used as the denominator, representing a mean of 159,946 people per year. Age and gender-standardised prevalence rates were used for the trends of multimorbidity and polypharmacy in the total population and for subgroups. Joinpoint regression analyses were used to analyse the time trends and breaks in trends, for the entire population as well as for specific age and sex groups. Overall, in 2015, 22.7% of the population had multimorbidity, while the overall prevalence of polypharmacy was 20%. Throughout the study period the standardised prevalence rate of multimorbidity rose for both sexes and in all age groups. The largest relative increase in multimorbidity was observed in the younger age groups (up to the age of 50 years). The prevalence of polypharmacy showed a significant increase between 2000 and 2015 for all age groups except the youngest (0-25 years). For all adult age groups multimorbidity and polypharmacy are frequent, dynamic over time and increasing. This asks for both epidemiological and interventional studies to improve the management of the resulting complex care.

Background:The COVID-19 crisis has led to rapid and far-reaching changes in digital health care, but little is known about what, why, and how changes occurred in eHealth use in Flemish general practice during the pandemic.Objective:This study aims to understand how general practitioners (GPs) perceive and evaluate eHealth solutions and their eHealth experience during the COVID-19 pandemic.Methods:This qualitative study was conducted using in-depth 1-on-1 semistructured interviews with the help of an interview guide. Several areas were identified beforehand to help assess the impact of the COVID-19 pandemic: perceptions of digital technologies in GP practices; changes in the use of these technologies during and after the COVID-19 pandemic; GPs’ adaptation to digitalization, benefits, risks, and challenges of eHealth; GPs motivations to change practice; and future perspectives on eHealth. In this study, purposive sampling and snowballing methods were used. Between October 2021 and April 2022, we interviewed 15 Dutch-speaking GPs in the Flemish region via the Zoom online conferencing tool.Results:GPs indicated that eHealth was used more frequently during the COVID-19 pandemic than before, a change that helped them reduce their workload, enabling greater accessibility to health care services and the complementary use of digital and physical consultations. Our findings suggest that physicians underwent a significant cognitive shift in their perceptions, causing them to be more open and prepared to adopt eHealth solutions. However, there remains significant doubt and uncertainty about digital literacy for certain groups, privacy, data security, reimbursement, and the burden of technical information and communication technologies (ICT) issues.Conclusions:The COVID-19 pandemic seems to have been a turning point for eHealth by Flemish GPs. eHealth is an essential complementary health care service that can reduce pressure on health care as well as increase health care accessibility. Sensitive aspects, such as privacy, data security, digital literacy, reimbursement, and the burden of technical ICT issues, are particularly emphasized. With our results, we can offer recommendations to health IT policymakers and developers that will help maintain the continuity of eHealth solutions beyond the COVID-19 pandemic, considering the expectations and sensitivities presented in the study.

Introduction: Frail older adults frequently experience transitions from hospital to home due to their complex care needs. Transitional care models (TCMs) are recommended to tackle adverse outcomes in frail patients. This review summarizes the use of integrated care components in addressing transitional care from hospital to home, provides an overview on reported outcomes and describes the impact of identified components on the outcomes hospital readmission and emergency department visit.Methods: This study is part of the European TRANS-SENIOR project. PubMed, CINAHL and Embase were searched for studies in English, German and Dutch that describe a TCM for frail older patients including both pre- and post-discharge components.Results: Seventeen studies, covering 15 TCMs were included. All TCMs describe a person-centred, tailored, pro-active and continuous transitional care service. Components like a small sized care team, intensive follow-up, shared decision making and informal caregiver involvement are likely to be associated with reduced hospital readmission and ED visits. Twenty-seven transitional care outcomes were reported: 19 service outcomes, six patient outcomes and two provider outcomes.Conclusion: Heterogeneity in content and outcomes complicates between-study comparison, yet several components were identified that improved care outcomes. Patient and provider outcomes should be included in future research.

Reablement is considered a complex intervention due to its multicomponent, person-centered, holistic approach promoting older adults’ active participation in daily activities. It is important to consider the unique context in which complex interventions are implemented, as contextual factors may interact and influence implementation outcomes. As part of the European TRANS-SENIOR project, this qualitative study aimed to gain insight into professionals’ experiences with reablement implementation in Dutch community care. Using the Consolidated Framework for Implementation Research, four focus groups were conducted comprising 32 professionals. Two groups were formed: one at operational level, including therapists, nursing staff, social workers, and domestic support; and one at organizational/strategic level, including project leaders, managers, directors, municipality representatives and health insurers. Participating care organizations had at least 6 months of experience with deploying and implementing reablement. Findings reflected three themes: (1) strength of interdisciplinary collaboration; highlighting significance of sharing goals and beliefs, (2) integrating the reablement philosophy into the organization; underscoring managements role in fostering support across all organizational layers, and (3) achieving a culture change in the healthcare system; emphasizing current funding models impeding value-based care tailored to the individual’s goals and needs. The results offer valuable insights for implementation of complex interventions, like reablement.

Background Although ‘frequent flyer’ hospital admissions represent barely 3 to 8% of the total patient population in a hospital, they are responsible for a disproportionately high percentage (12 to 28%) of all admissions. Moreover, hospital admissions are an important contributor to health care costs and overpopulation in various hospitals. The aim of this research is to obtain a deeper insight into the phenomenon of frequent flyer hospital admissions. Our objectives were to understand the patients’ perspectives on the cause of their frequent hospital admissions and to identify the perceived consequences of the frequent flyer status. Methods This qualitative study took place at the University Hospital of Leuven. The COREQ guidelines were followed to provide rigor to the study. Patients were included when they had at least four overnight admissions in the past 12 months, an age above 65 years and hospital admission at the time of the study. Data were collected via semi-structured interviews and encoded in NVivo. Results Thirteen interviews were collected. A total of 17 perceived causes for frequent hospital admission were identified, which could be divided into the following six themes: patient, drugs, primary care, secondary care, home and family. Most of the causes were preventable or modifiable. The perceived consequences of being a frequent flyer were divided into the following six themes: body, daily life functioning, social participation, mental status and spiritual dimension. Negative experiences were linked to frequent flying and could be situated mainly in the categories of social participation, mental status and spiritual dimensions. Conclusions Frequent hospital admissions may be conceived as an indicator, i.e., a ‘red flag’, of patients’ situations characterized by physical, mental, spiritual and social deprivation in their home situation.

People with diabetes have a high risk of developing micro- and macrovascular complications associated with diminished life expectancy and elevated treatment costs. Patient education programs can improve diabetes control in the short term, but their cost-effectiveness is uncertain. Our study aimed to analyze the lifelong cost-effectiveness of a nurse-led telecoaching program compared to usual care in people with type 2 diabetes from the perspective of the Belgian healthcare system. The UKPDS Outcomes Model was populated with patient-level data from an 18-month randomized clinical trial in the Belgian primary care sector involving 574 participants; trial data were extrapolated to 40 years; Quality Adjusted Life Years (QALYs), treatment costs and Incremental Cost-Effectiveness Ratio (ICER) were calculated for the entire cohort and the subgroup with poor glycemic control at baseline (\"elevated HbA1c subgroup\") and the associated uncertainty was explored. The cumulative mean QALY (95% CI) gain was 0.21 (0.13; 0.28) overall and 0.56 (0.43; 0.68) in elevated HbA1c subgroup; the respective incremental costs were €1,147 (188; 2,107) and €2,565 (654; 4,474) and the respective ICERs €5,569 (€677; €15,679) and €4,615 (1,207; 9,969) per QALY. In the scenario analysis, repeating the intervention for lifetime had the greatest impact on the cost-effectiveness and resulted in the mean ICERs of €13,034 in the entire cohort and €7,858 in the elevated HbA1c subgroup. Taking into account reimbursement thresholds applied in West-European countries, nurse-led telecoaching of people with type 2 diabetes may be considered highly cost-effective within the Belgian healthcare system. NCT01612520.

Objective: To assess the quality of antibiotic prescribing in primary care in Belgium, the Netherlands and Sweden using European disease-specific antibiotic prescribing quality indicators (APQI) and taking into account the threshold to consult and national guidelines. Design: A retrospective observational database study. Setting: Routine primary health care registration networks in Belgium, the Netherlands and Sweden. Subjects: All consultations for one of seven acute infections [upper respiratory tract infection (URTI), sinusitis, tonsillitis, otitis media, bronchitis, pneumonia and cystitis] and the antibiotic prescriptions in 2012 corresponding to these diagnoses. Main outcome measures: Consultation incidences for these diagnoses and APQI values (a) the percentages of patients receiving an antibiotic per diagnosis, (b) the percentages prescribed first-choice antibiotics and (c) the percentages prescribed quinolones. Results: The consultation incidence for respiratory tract infection was much higher in Belgium than in the Netherlands and Sweden. Most of the prescribing percentage indicators (a) were outside the recommended ranges, with Belgium deviating the most for URTI and bronchitis, Sweden for tonsillitis and the Netherlands for cystitis. The Netherlands and Sweden prescribed the recommended antibiotics (b) to a higher degree and the prescribing of quinolones exceeded the proposed range for most diagnoses (c) in Belgium. The interpretation of APQI was found to be dependent on the consultation incidences. High consultation incidences were associated with high antibiotic prescription rates. Taking into account the recommended treatments from national guidelines improved the results of the APQI values for sinusitis in the Netherlands and cystitis in Sweden. Conclusion: Quality assessment using European disease-specific APQI was feasible and their inter-country comparison can identify opportunities for quality improvement. Their interpretation, however, should take consultation incidences and national guidelines into account. Differences in registration quality might limit the comparison of diagnosis-linked data between countries, especially for conditions such as cystitis where patients do not always see a clinician before treatment. Key points The large variation in antibiotic use between European countries points towards quality differences in prescribing in primary care.  * The European disease-specific antibiotic prescribing quality indicators (APQI) provide insight into antibiotic prescribing, but need further development, taking into account consultation incidences and country-specific guidelines.  * The incidence of consultations for respiratory tract infections was almost twice as high in Belgium compared to the Netherlands and Sweden.  * Comparison between countries of diagnosis-linked data were complicated by differences in data collection, especially for urinary tract infections.

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.

Background Unmet needs for home support occur when any support services perceived by older people as needed are not being received. Not meeting these needs can negatively impact older adults’ quality of life, and increase health care utilization, hospitalizations, institutionalizations, or death. To date there is no consensus in how to define and assess these unmet needs. In parallel, previous research of factors associated with unmet needs for home support has mostly focused on factors at the micro level. Thus, this paper aims to identify the prevalence of unmet needs for home support among a home-dwelling older population and the factors at the macro, meso and micro levels contributing to them. Methods Using an ecological approach we identified multi-level factors associated with the presence of unmet needs for home support among the home-dwelling older population (aged 75+) in Switzerland. This is a secondary cross-sectional analysis of the INSPIRE Population Survey of home-dwelling older adults (n = 8,508) living in Basel-Landschaft in Switzerland, conducted as part of the TRANS-SENIOR Project. Prevalence of perceived unmet needs for home support was self-reported, using a dichotomized question. Multiple logistic regression analyses were performed to investigate the associations of factors at each level with unmet needs for home support. Results 4.3% of participants reported unmet needs for home support, with a median age of 81 years. 45.1% had private health insurance and 6.3% needed additional government support. Being a recipient of other type of government support (OR = 1.65; 95% CI = 1.17–2.29) (macro-); the use of transportation services (OR = 1.74; 95% CI = 1.15–2.57) (meso-); and feeling depressed (OR = 1.40; 95% CI = 1.06–1.85) or abandoned (OR = 2.60; 95% CI = 1.96–3.43) (micro-) increased odds of having perceived unmet needs for home support. Having a private health insurance (macro-) (OR = 0.63; 95% CI = 0.49–0.80), speaking Swiss-German (OR = 0.44; 95% CI = 0.24–0.88) or German (OR = 0.47; 95% CI = 0.24–0.98), having a high level of education [primary (OR = 0.48; 95% CI = 0.24–1.02); secondary (OR = 0.49; 95% CI = 0.25–1.03); tertiary (OR = 0.38; 95% CI = 0.19–0.82); other (OR = 0.31 (0.12–0.75)], having a high score of self-perceived health status [score ≥ 76 (OR = 0.42; 95% CI = 0.20–0.96)] and having informal care (OR = 0.57; 95% CI = 0.45–0.73), among others (micro-) were associated with decreased odds of having perceived unmet needs for home support. Conclusion Our study findings highlight the role of socio-economical inequality in the perception of unmet needs for home support in home-dwelling older adults. In order to address unmet needs in home-dwelling older adults, healthcare leaders and policy makers should focus on strategies to reduce socio-economic inequalities at the different levels in this population.