BACKGROUND: Despite being a key player in the healthcare system, training and practising general practice has become less attractive in many countries and is in need of reform. AIM: To identify political priorities for improving GPs' attraction to the profession and their retention within it. DESIGN AND SETTING: Stakeholder face-to-face survey in Belgium, 2008. METHOD: A total of 102 key stakeholders were recruited from policymakers, professional groups, academia, GP leaders, and the media. All interviewees were asked to score 23 policies on four criteria: effectiveness in attracting and retaining GPs, cost to society, acceptance by other health professionals, and accessibility of care. An overall performance score was computed (from -3 to +3) for each type of policy - training, financing, work-life balance, practice organisation, and governance - and for innovative versus conservative policies. RESULTS: Practice organisation policies and training policies received the highest scores (mean score ≥ 1.11). Financing policies, governance, and work-life balance policies scored poorly (mean score ≤ 0.65) because they had negative effects, particularly in relation to cost, acceptance, and accessibility of care. Stakeholders were keen on moving GPs towards team work, improving their role as care coordinator, and helping them to offload administrative tasks (score ≥ 1.4). They also favoured moves to increase the early and integrated exposure of all medical students to general practice. Overall, conservative policies were better scored than innovative ones (beta = -0.16, 95% confidence interval = -0.28 to -0.03). CONCLUSION:The reforming of general practice is made difficult by the small-step approach, as well as the importance of decision criteria related to cost, acceptance, and access.
BACKGROUND: Despite being a key player in the healthcare system, training and practising general practice has become less attractive in many countries and is in need of reform. AIM: To identify political priorities for improving GPs' attraction to the profession and their retention within it. DESIGN AND SETTING: Stakeholder face-to-face survey in Belgium, 2008. METHOD: A total of 102 key stakeholders were recruited from policymakers, professional groups, academia, GP leaders, and the media. All interviewees were asked to score 23 policies on four criteria: effectiveness in attracting and retaining GPs, cost to society, acceptance by other health professionals, and accessibility of care. An overall performance score was computed (from -3 to +3) for each type of policy - training, financing, work-life balance, practice organisation, and governance - and for innovative versus conservative policies. RESULTS: Practice organisation policies and training policies received the highest scores (mean score ≥ 1.11). Financing policies, governance, and work-life balance policies scored poorly (mean score ≤ 0.65) because they had negative effects, particularly in relation to cost, acceptance, and accessibility of care. Stakeholders were keen on moving GPs towards team work, improving their role as care coordinator, and helping them to offload administrative tasks (score ≥ 1.4). They also favoured moves to increase the early and integrated exposure of all medical students to general practice. Overall, conservative policies were better scored than innovative ones (beta = -0.16, 95% confidence interval = -0.28 to -0.03). CONCLUSION:The reforming of general practice is made difficult by the small-step approach, as well as the importance of decision criteria related to cost, acceptance, and access.
Introduction: Interprofessional Collaboration (IPC) has long been considered as an essential principle underpinning effective primary health care, [1]. The Belgian primary care level is characterized by a shortage of General practitioners (GPs), the absence of shared patients list between GPs and home nurses, and a diversity of practices and payment systems. The Belgian population is aging and suffering from chronic diseases [2]. It becomes essential to enable primary healthcare providers to face these sociodemographic changes and increased health and social care needs. We therefore aim at 1) assessing IPC between GPs and nurses; 2) identifying target priorities for improving IPC; and 3) endorsing their improvement projects. Methods: A participatory action research (PAR) was initiated based on the methodological scheme for health systems research of Mercenier [3]. Six groups of GPs and nurses were chosen based on diversity of practices, payment systems, environment, and resources. Researchers met on a monthly basis with participants of each area. The conceptual model of Reeves on teamwork was used as a descriptive model for this PAR[4]. Preliminary results (ongoing research): Each group performed a SWOT analysis of their collaborative practice. Identified strengths were about shared values and objectives, previous positive experiences of IPC, and recognition of each other's competencies and specific roles. Weaknesses revolved around managerial and informational fragmentation, hierarchical relations, lack of trust, lack of consideration, and lack of responsibilities clarification. Opportunities and threats were related to the different financing systems which impeded or facilitated multidisciplinary team meetings and communication, the weak functional integration, the shortage of workforces, the lack of shared patients list, and the lack of of interprofessional education. Two issues were co-identified as common priorities: communication and task delegation. Actions prioritized by each area were related to these two issues and took local needs into account. Discussions Communication could be supported locally by improved ICT tools, and dedicating time for multidisciplinary team meetings. Task delegation is a more challenging issue to address and rises questions related to the nurses training and continuing education, task clarification, restrictive legislation and payment system. IPC seems to be easier to achieve when healthcare professionals belong to the same organization, with shared patients list, spaces and communication tools, and consider themselves as a "team". Conclusions Benefits of interprofessional collaboration are widely agreed upon for the healthcare system in general. However, implementation of collaborative interventions depends of both governmental and local factors and has not yet been fully explored. Lessons learned IPC is more challenging to achieve in a context where healthcare providers don't share a patients population and effective communication tools. Limitations The PAR did not include patients, only a patient organization in the steering committee of this project. Suggestions for future research Future research should address patient's acceptance of task delegation. References 1. Morgan, S, Pullon, S and McKinlay, E. Observation of interprofessional collaborative practice in primary care teams: An integrative literature review. International Journal of Nursing Studies 2015; 52(7): 1217-30. DOI: https://doi.org/10.1016/j.ijnurstu.2015.03.008 2. Institut Scientifique de Santé Publique ISP. Enquête de santé belge par interview 2013. [Scientific Institute of Public Health. Health Interview Survey 2013]. Rapport I: Etat de santé et bien-etre. [in French]. [cited 2016 20 April]. Available from: https://his.wiv-isp.be/fr/Documents%20partages/SH_FR_2013.pdf 3. Grodos, D and Mercenier, P. La recherche sur les systèmes de santé: mieux comprendre la méthodologie pour mieux agir. Antwerpen: ITGPress, 2000. 114 p. (Studies in Health Services Organisation & Policy; 14). 4. Reeves, S, Lewin, S, Espin, S and Zwarenstein, M. Interprofessional Teamwork for Health and Social Care: Promoting partnership for health. UK: Chichester. Wiley-Blackwell. 2010. 191p.
Introduction: Interprofessional Collaboration (IPC) has long been considered as an essential principle underpinning effective primary health care, [1]. The Belgian primary care level is characterized by a shortage of General practitioners (GPs), the absence of shared patients list between GPs and home nurses, and a diversity of practices and payment systems. The Belgian population is aging and suffering from chronic diseases [2]. It becomes essential to enable primary healthcare providers to face these sociodemographic changes and increased health and social care needs. We therefore aim at 1) assessing IPC between GPs and nurses; 2) identifying target priorities for improving IPC; and 3) endorsing their improvement projects. Methods: A participatory action research (PAR) was initiated based on the methodological scheme for health systems research of Mercenier [3]. Six groups of GPs and nurses were chosen based on diversity of practices, payment systems, environment, and resources. Researchers met on a monthly basis with participants of each area. The conceptual model of Reeves on teamwork was used as a descriptive model for this PAR[4]. Preliminary results (ongoing research): Each group performed a SWOT analysis of their collaborative practice. Identified strengths were about shared values and objectives, previous positive experiences of IPC, and recognition of each other's competencies and specific roles. Weaknesses revolved around managerial and informational fragmentation, hierarchical relations, lack of trust, lack of consideration, and lack of responsibilities clarification. Opportunities and threats were related to the different financing systems which impeded or facilitated multidisciplinary team meetings and communication, the weak functional integration, the shortage of workforces, the lack of shared patients list, and the lack of of interprofessional education. Two issues were co-identified as common priorities: communication and task delegation. Actions prioritized by each area were related to these two issues and took local needs into account. Discussions Communication could be supported locally by improved ICT tools, and dedicating time for multidisciplinary team meetings. Task delegation is a more challenging issue to address and rises questions related to the nurses training and continuing education, task clarification, restrictive legislation and payment system. IPC seems to be easier to achieve when healthcare professionals belong to the same organization, with shared patients list, spaces and communication tools, and consider themselves as a "team". Conclusions Benefits of interprofessional collaboration are widely agreed upon for the healthcare system in general. However, implementation of collaborative interventions depends of both governmental and local factors and has not yet been fully explored. Lessons learned IPC is more challenging to achieve in a context where healthcare providers don't share a patients population and effective communication tools. Limitations The PAR did not include patients, only a patient organization in the steering committee of this project. Suggestions for future research Future research should address patient's acceptance of task delegation. References 1. Morgan, S, Pullon, S and McKinlay, E. Observation of interprofessional collaborative practice in primary care teams: An integrative literature review. International Journal of Nursing Studies 2015; 52(7): 1217-30. DOI: https://doi.org/10.1016/j.ijnurstu.2015.03.008 2. Institut Scientifique de Santé Publique ISP. Enquête de santé belge par interview 2013. [Scientific Institute of Public Health. Health Interview Survey 2013]. Rapport I: Etat de santé et bien-etre. [in French]. [cited 2016 20 April]. Available from: https://his.wiv-isp.be/fr/Documents%20partages/SH_FR_2013.pdf 3. Grodos, D and Mercenier, P. La recherche sur les systèmes de santé: mieux comprendre la méthodologie pour mieux agir. Antwerpen: ITGPress, 2000. 114 p. (Studies in Health Services Organisation & Policy; 14). 4. Reeves, S, Lewin, S, Espin, S and Zwarenstein, M. Interprofessional Teamwork for Health and Social Care: Promoting partnership for health. UK: Chichester. Wiley-Blackwell. 2010. 191p.
Abstract Background In order to address the challenges of an ageing population the Belgian government decided to allocate resources to the creation of geriatric day hospitals (GDHs). Although GDHs are meant to be a strategy to support general practitioners (GPs) caring for the frail elderly, few Belgian GPs seem to refer to a GDH. This study aims to explore the barriers and facilitating factors of GPs' referral to GDHs. Methods A qualitative study using focus group discussions (FGDs) was conducted. Fifteen FGDs were organized in the different Belgian regions (Flanders, Wallonia, Brussels). Results Contextual factors such as the unsatisfactory cooperation between hospital and GPs and organizational barriers such as the lack of communication on referral procedures between hospital and primary health care (PHC) were identified. Lack of basic knowledge about the concept or the local organization of GDH seemed to be a problem. Unclear task descriptions, responsibilities and activities of a GDH formed prominent points of discussion in all FGDs. Nevertheless a lot of possible advantages and disadvantages of GDHs for the patient and for the GP were mentioned. Conclusions In the case of poor referral to GDHs, focusing on improving overall collaboration between primary and secondary health care is essential. This can be achieved by actively delivering adequate information, permanent communication and more involvement of PHC in the organization and functioning of GDHs. The absence of a transparent health care system with delineated role definitions, seems to hinder the integration of new initiatives like GDHs in the care process. Strategies to enhance referral to GDHs should use a comprehensive approach.
BACKGROUND: In order to address the challenges of an ageing population the Belgian government decided to allocate resources to the creation of geriatric day hospitals (GDHs). Although GDHs are meant to be a strategy to support general practitioners (GPs) caring for the frail elderly, few Belgian GPs seem to refer to a GDH. This study aims to explore the barriers and facilitating factors of GPs' referral to GDHs. METHODS: A qualitative study using focus group discussions (FGDs) was conducted. Fifteen FGDs were organized in the different Belgian regions (Flanders, Wallonia, Brussels). RESULTS: Contextual factors such as the unsatisfactory cooperation between hospital and GPs and organizational barriers such as the lack of communication on referral procedures between hospital and primary health care (PHC) were identified. Lack of basic knowledge about the concept or the local organization of GDH seemed to be a problem. Unclear task descriptions, responsibilities and activities of a GDH formed prominent points of discussion in all FGDs. Nevertheless a lot of possible advantages and disadvantages of GDHs for the patient and for the GP were mentioned. CONCLUSIONS: In the case of poor referral to GDHs, focusing on improving overall collaboration between primary and secondary health care is essential. This can be achieved by actively delivering adequate information, permanent communication and more involvement of PHC in the organization and functioning of GDHs. The absence of a transparent health care system with delineated role definitions, seems to hinder the integration of new initiatives like GDHs in the care process. Strategies to enhance referral to GDHs should use a comprehensive approach. ; Peer reviewed
