Reshaping health care governance using pilot projects as public policy implementation instruments

Winter, Mélanie De

doi:10.4000/irpp.1422

Cited by 7 publications

(13 citation statements)

References 45 publications

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“…Collaboration between hospital‐based TM teams and primary care professionals is imperative for a significant group of patients. This is consistent with overall literature about care integration, where patient and providers coming from primary and hospital levels should work “as a team.” This is called clinical integration in Valentijn's rainbow model and should also involve professional, organizational, and administrative integration (Valentijn et al, 2015), which was tested in Belgium for people with chronic illnesses (Winter, 2022) and is certainly also relevant in the context of Covid‐19 patients. However, most TM teams had none to limited interaction with the GPs or primary care nurses.…”

Section: Discussionmentioning

confidence: 99%

Experiences with the implementation of remote monitoring in patients with COVID‐19: A qualitative study with patients and healthcare professionals

Grootven

Irusta

Christiaens

et al. 2022

J of Nursing Scholarship

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Introduction This study investigated how patients with COVID‐19, telemonitoring (TM) teams, general practitioners (GPs) and primary care nurses in Belgium experienced remote patient monitoring (RPM) in 12 healthcare organizations, in relation to the patients' illness, health, and care needs, perceived quality of care, patient and health system outcomes, and implementation challenges. Design A qualitative research approach was adopted, including focus group discussions and semi‐structured interviews. Methods Four different groups of participants were interviewed, that is, patients ( n = 17), TM teams ( n = 27), GPs ( n = 16), and primary care nurses ( n = 12). An interview guide was drafted based on a literature review. Interviews were transcribed verbatim, and NVivo was used for managing and analyzing the data. The QUAGOL method was used to guide the data analysis process and was adapted for the purpose of a thematic content analysis. Results All participants agreed that RPM‐reassured patients. The overall perceived value of RPM for individual patients depended on how well the intervention matched with their needs. Patients who did not have the necessary language (Dutch/French speaking) and digital skills, who did not have the right equipment (smartphone or tablet), or who missed the necessary infrastructure (no internet coverage in their region) were often excluded. Remote patient monitoring also reassured healthcare professionals as it gave them information on a disease they had little knowledge about. Professionals involved in RPM experienced a high workload. All TM teams agreed that quality of data was a key factor to ensure an adequate follow‐up, but they differed in what they found important. The logistic management of RPM was a challenge because of the contagious character of COVID‐19, and the need for an effective information flow between the hospital team and primary care providers. Participants missed clarification about who was accountable for the care for patients in the projects. Primary care nurses and GPs missed access to RPM data. All agreed that the funding they received was not sufficient to cover all the costs associated with RPM. Conclusion Healthcare professionals and patients perceive RPM as valuable and believe that the concept will have its place in the Belgium health system. However, current RPM practice is challenged by many barriers, and the sustainability of RPM implementation is low. Clinical relevance Remote patient monitoring (RPM) was perceived as a valuable intervention for patients with COVID‐19, but there were important concerns about unequal access to care. While the technology for RPM is available, the sustainability of implementation is low because of concerns with data quality, challenging l...

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Section: Discussionmentioning

confidence: 99%

Experiences with the implementation of remote monitoring in patients with COVID‐19: A qualitative study with patients and healthcare professionals

Grootven

Irusta

Christiaens

et al. 2022

J of Nursing Scholarship

View full text Add to dashboard Cite

show abstract

“…Critics might say that, by doing this, health care providers deny their own responsibilities. And indeed, some professionals, particularly the doctors, fear change, because their income would probably be impacted [27]. However, multiple bottom-up projects have been rolled out [28,40] and continue to face the same macro-level barriers, which can only be overcome by new laws and regulations, as pointed out by various opinion makers, such as academics, the former head of the NIHDI and representatives of professionals [41][42][43].…”

Section: Discussionmentioning

confidence: 99%

“…After the Sixth State Reform, the new ministries of health of the different governments agreed on a joint plan for the chronically ill, which took into account the 'Triple Aim' [26]. Its vision was that an integrated approach in medical, paramedical, psychosocial, nursing and social care is needed to guarantee coordinated service provision, including a new way of financing chronic care [27]. Part of this plan involved the Pilot projects in integrated care [28], which have the aim of testing this new approach and started in 2018.…”

Section: Introductionmentioning

confidence: 99%

What Makes Integration of Chronic Care so Difficult? A Macro-Level Analysis of Barriers and Facilitators in Belgium

Danhieux

Martens

Colman

et al. 2021

International Journal of Integrated Care

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“…The project ‘Integrated Care for Better Health’ (Integreo) that was launched by the Belgian government in 2016, follows this perspective of including stakeholders in the design of integrated care initiatives [ 9 ]. In Integreo, 12 pilot projects for integrated care were designed in co-creation with interested professionals from different local regions [ 10 ]. As a result, multidisciplinary local consortia were created to develop a plan with common visions and objectives within a certain geographical area in Belgium.…”

Section: Introductionmentioning

confidence: 99%

“…While it is desirable to involve professionals in the development process, it is an extensive process that often leads to challenges, such as additional workload, conflicting opinions and regular changes in scope. These challenges often create an uncomfortable climate of uncertainty, which might create additional burden for health care professionals [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Stakeholders’ experiences and perception on transitional care initiatives within an integrated care project in Belgium: a qualitative interview study

et al. 2023

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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.

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Reshaping health care governance using pilot projects as public policy implementation instruments

Cited by 7 publications

References 45 publications

Experiences with the implementation of remote monitoring in patients with COVID‐19: A qualitative study with patients and healthcare professionals

Experiences with the implementation of remote monitoring in patients with COVID‐19: A qualitative study with patients and healthcare professionals

What Makes Integration of Chronic Care so Difficult? A Macro-Level Analysis of Barriers and Facilitators in Belgium

Stakeholders’ experiences and perception on transitional care initiatives within an integrated care project in Belgium: a qualitative interview study

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