Care In Flanders Research Articles

Patterns of shared meaning across personal narratives surrounding experiences with palliative care, serious illness, and the end of life

Prior observations of persistent public misconceptions and negative beliefs surrounding palliative care have led to extensive calls for public education on palliative care. Yet, the development of effective initiatives to improve public perceptions of palliative care is still hindered by a lack of research providing a deeper, contextualized understanding of the way people perceive and give meaning to palliative care. This study therefore set out to explore patterns of shared meaning across personal narratives surrounding experiences with palliative care, serious illness, and the end of life. These narratives were collected during a broad public engagement initiative on palliative care in Flanders, Belgium which included a call to share personal stories surrounding palliative care (which 72 persons did) as well as a Citizens' Forum in which 24 persons engaged in live conversations on palliative care. Reflexive thematic analysis was used to analyze the personal narratives and yielded four axes of meaning: 1) ‘Sense of Support’, describing feeling supported or abandoned on multiple levels with key elements of open and empathetic communication, being informed and listened to; 2) ‘Being-in-Time’, incorporating a renewed sense of temporality and the weight of uncertain prognosis; 3) ‘Constituting a Sense of Self while Coping with Life-Threatening Illness’, involving concerns surrounding role adjustments and posthumous reputation; and 4) ‘Going Through the Process of Dying’, unique to bereaved individuals' narratives, highlighting the importance of being informed during the dying process and honoring the wishes of the dying person. Together, these axes illuminate how both positive and stigmatized views on palliative care are shaped by broader patterns of meaning attribution, deeply ingrained in personal and social contexts. The identified narrative elements can play a crucial role in improving the content, reach, and impact of future public communication and education on palliative care, effectively enhancing public receptivity and engagement.

A description of long-stay patients in forensic psychiatric care in Flanders

ABSTRACT Long-term forensic psychiatric care and its population form a specific group within the forensic psychiatric field. The treatment goals, characteristics, and needs of this group are different from those of the wider forensic population. The focus of treatment for this group changes from risk reduction to quality of life and managing risk in the current context. In Belgium, forensic psychiatric care started slowly. This has resulted in a late onset of long-term forensic care. Consequently, there is a potentially large group of long-term forensic patients. The population of the long-stay unit in Flanders, Belgium, is described in this study. Clinical data of forensic long-stay patients were collected. The result was a description of the population in terms of risk profile and sociodemographic data. Compared to other studies, the results show an older population with more sexual offences and mostly a medium/high risk profile. Our findings suggest that the long-stay forensic population has specific challenges that require specific responses in the form of adapted care.

A 360<sup>0</sup> scan of primary care in Flanders: what is needed and how to address challenges to build a strong primary care.

The primary care (PC) in Flanders is going through a transition to realize integrated care (IC).
 Artevelde University of Applied Sciences (AUAS), as knowledge institution, wants to contribute to a strong PC and undertook a needs analysis incorporating the problems PC-actors are facing and the support AUAS could offer.
 A stakeholder mapping (e.g. care, welfare actors at micro-, meso- and macrolevel) was executed. 44 in dept interviews were conducted. After data-analyze, a member check (n=17) took place, followed by validation by the Flemish Patient Organization representing the person with care and support need, the Flemish Institute for PC, and the King Baudouin Foundation, a philanthropy organization.
 Key is the paradigm shift from supply-led care to person-centered care. Transformation towards IC encompasses various dimensions of integration: clinical, service, functional and organizational (Lewis et al.). Our findings showed obstacles on those dimensions. At the clinical level, care professionals and providers stressed the need for shared guidelines and protocols. At the service level, implementation of IC-services through interdisciplinary teams is hampered. Professionals do not know each other or what to expect, since they are mainly organized in ad hoc or fluid teams, hampering good collaboration. Participants indicated at the functional level the lacking of an integrated, patient-centered electronic record.Integration of organizations is still ongoing. Different obstacles within and without the sphere of influence of an organization were brought up, e.g., the current legal and financial framework.
 The participants indicated that both the PC- sector as well as education, research and policy hold a piece of the puzzle to facilitate the different forms of cooperation. 
 They reached out to educational institutions to coordinate their educational and lifelong learning programs more co-creatively and flexible. Basic courses should work on interdisciplinary courses to promote cooperation later in the field. There is a need for further development of the so-called t-shaped professional, a professional with skills and expertise in a single field, but the ability to collaborate across disciplines with experts in other areas and to apply knowledge in areas of expertise other than one's own.
 Lifelong learning should work out multidisciplinary education courses targeting broad topics and develop a tailor-made offer, including coaching of PC actors, organizations, and networks. 
 They also called for more cooperation between PC and research. Research must be tailor-mode and needs to speed-up. Support in all forms and phases of research is wanted. A willingness to work together as equal partners from scratch is formulated. Co-creation and transfer of research competence are key. In addition, mandate is given to researchers to report results to policy.
 Based on those findings AUAS is working together with PC to develop an ""academic collaborative center (ACC)"" a sustainably funded collaboration between end users, science, care practice and education with complete equality between partners. Central is co-creation with intensive and equal collaboration between various stakeholders, creating scientific knowledge in which the perspectives of the end users are central (f.i. implementation of IC in PC) and creating societal impact (improve quality of care) are ambitions that are intertwined.
 
 

Interdisciplinary collaboration in the diagnostic practice of the Integrated Youth Care in Flanders: A focus group study

Background: In 2020, the Flemish Centre of Excellence in Diagnostics (Kwaliteitscentrum voor Diagnostiek vzw) published the General Intersectoral Guidelines for Diagnostics (GIGD). The goal of the GIGD is to aid professionals working in different (mental) health care sectors in Flanders to implement high-quality diagnostic processes. The GIGD defines high-quality diagnostic processes by naming and explaining seven important practices. It is unclear, however, how the GIGD impacted the diagnostic field since its publication and to what extent the practices are implemented. Therefore, this study examined how one of those practices, namely interdisciplinary collaboration, is used in the Integrated Youth Care in Flanders and what the needs are to strengthen this practice further. 
 Methods: Focus groups were organized with professionals in diagnostics working in nine organisations of the Integrated Youth Care in Flanders, among which centers of mental health care, rehabilitation, developmental disability, student guidance, pediatric psychiatry, etc. The number of participants of each organisation ranged from 1 to 15, with no participants from the centers of pediatric psychiatry. In total, 65 professionals participated. In each focus group, an introduction in the GIGD was followed by a structured discussion about the way in which diagnostic processes are carried out in each organisation and how interdisciplinary collaboration is present and which difficulties are met during the process. 
 Results: Participants from all organisations agree that interdisciplinary collaboration is at the heart of good diagnostic trajectories within their own organisation. Important features concern the inclusion of multiple and diverse viewpoints in an interdisciplinary team with members from different backgrounds and levels of experience; a trusting atmosphere to discuss and promote different opinions; time and resources to allow an in-depth discussion; an (external) supervisor to moderate and guide group processes. Participants further highlight the importance of continuous and joint care across organisations in Child- and Youth care. However, several pitfalls were addressed, which seem hard to overcome, such as a lack of trust due to incomplete and erroneous knowledge about each other's professional operations, endless waiting lists thwarting appropriate continuation of care, and rigid policy requirements and restrictions. 
 Conclusion: All participating organisations understand the importance of interdisciplinary collaboration as a prerequisite for high-quality diagnostic processes and integrated care and long for more collaboration. However, several pitfalls and obstacles complicate matters. There is need for practical guidelines, information dissemination, workshops and intervisions, financial aid and more leeway in intersectoral endeavors to help professionals overcome these obstacles.

Reablement in Flanders: An exploration of the Flemish context. Voices of those receiving care.

Introduction: The primary care sector in Flanders, Belgium is undergoing an intense period of reform. Care is shifting from acute, disease oriented care to chronic, integrated care to incorporate health, well-being and quality of life.
 There is a need to understand and describe the chances for and barriers to reform of primary sector care services Reablement is an approach, or service model, that has been researched to a gold standard in different countries worldwide, and can be described as a multidisciplinary short term community based service aimed at helping people who receive home care to be more independent with their daily activities and to participate more in their wider communities. Results show cost savings, reduced readmission to hospital and reduced admissions to nursing homes as well as increased satisfaction for the client in their everyday meaningful activities.
 There is a need to understand the context in which a reablement service could occur by illuminating the daily living experiences of people who are living at home with a chronic condition and who are receiving paid home care in Flanders, the potential reablement service users. This study starts with describing the effect receiving home care has had on their daily lives, what their feelings are about this and whether the person had been able to continue to engage in their meaningful activities of daily living at home and in their wider communities.
 Methods: This qualitative design study utilises a phenomenological, epistemologically based approach in order to capture individual experiences. From data gathered through individual interviews, the aim was to illuminate the lived experiences of older people with chronic conditions and what it means to receive paid care at home. This study therefore adopted an Interpretative Phenomenological Analysis (IPA) methodology as this approach is particularly suitable for understanding the lived experience
 Results: 6 interviews, resulting in 6 hours of data were analysed. 9 themes were generated which illuminate the persons experiences, these themes are also reflected in the principals of person centred care and goal oriented care.
 The person receiving home care described how the system works means they feel powerless when regarding decisions around their care. The need for flexible and dynamic care was highlighted as was the persons need to engage in activities outside their home together with people they know. The person receiving care described how understanding them and who are they are is integral to good care, and that what they do is part of who they are and this needs to be taken into account by those providing care.
 Discussion and conclusion: This is the first study involving stakeholders in primary care in Flanders that looks at the chances for reablement.
 Working with national care providers we now aim to conduct Reable-Labs in different primary care settings in order to provide real life examples of reablement and its outcomes in the Flemish sector.

Towards more goal-oriented care through care coordination and care planning.

The increasing aging of our society is putting increasing pressure on the current organization of care and support. This moved the Flemish government to a thorough reform of primary care in Flanders. This was started in 2017. The reform involves changes in terms of content, structural support and instrumental support. All these changes should lead to care and support that can be organized using the principles of integrated care and goal-oriented care. The major challenges are: 
 - bring about a change in mentality among care providers toward these principles of integrated care and goal-oriented care;
 - make a connection between health care and welfare care, as well as between primary care and more specialized care, and align the processes of care and support. 
 In addition, it is necessary to translate the principles of goal-oriented care into practical tools and accelerate methodology development. We are working together with several partners in Flanders for this purpose. 
 In goal-oriented care, an important role is reserved for the care coordinator. The care coordinator is the focal point of the care team who, as a member of the care team, takes on the task of: 
 - maintain an overview of the care process; 
 - ensure that all care and support, determined on the basis of the person's care or support needs and translated into life goals and care and support goals, is coordinated, monitored and evaluated. 
 Care coordination in a care process maintains a focus on goals, both the person's own life goals and the care and support goals of the care team. 
 For implementing qualitative care coordination, the care and support plan is an indispensable tool within the Flemish reform. This care and support plan must: 
 - allow an overview of the sometimes multitude of care and support goals; 
 - be a means of communication between the members of the care team (including the person himself and his informal care); 
 - reflect the extent to which care agreements are met; 
 - allow the care process to be monitored, evaluated and adjusted if necessary. 
 
 
 In the near future we want to design this care and support plan in a digital way. 
 The care coordinator must have a wide range of competencies in order to coordinate the care process in a quality manner, including: 
 - mastering to perfection the methodology of goal-oriented care, interview techniques, conflict management, process guidance, process analysis, coordination and organization skills; 
 - being the point of contact for the person with a care and support need; 
 - be able to play the bridge between the person, informal care and professional care providers. 
 In this presentation, we focus on the role of the care coordinator throughout the care process and the planning aspect. We propose how the Flemish government want to develop this role in the future. We also reflect on the preconditions that are necessary to achieve a solid implementation of this role, and indicate what opportunities we see to promote and accelerate the change in mentality in this regard.

"Reablement in Flanders: An exploration of the Flemish context. Understanding stakeholders' perspectives."

Background: The primary care sector in Flanders, Belgium, is undergoing an intense period of reform. To incorporate health, well-being and quality of life, care is shifting from acute disease-oriented care to chronic integrated care. There is a need to reform primary care services more directed to community-based service, targeting person-centered care and self-management of people who receive home care and their systems.
 Reablement is an approach or service model that can be described as a multidisciplinary short term intervention aimed at maintaining and optimizing functional ability and independence of people who receive home care and to promote participation in the local community. The effectiveness of reablement has been researched to a gold standard in different countries worldwide. Results show cost savings, reduced readmission to hospital and to nursing homes as well as increased satisfaction for the professionals and for the people receiving home care. 
 Aim: The purpose of this study is to understand the stakeholder’s perspective on factors that might contribute to a successful and sustainable implementation of reablement in Flanders and factors seen as challenges to deploy this service. By understanding these perspectives, inferences can be made as to whether reablement in Flanders is desirable and feasible.
 Methods: To perform a context analysis, five focus group interviews were conducted with 35 stakeholders in primary care: patient associations, professional caregivers, health insurance funds, researchers, physiotherapists, occupational therapists, social workers and managers. The focus group interviews were transcribed and an hermeneutical analysis was conducted.
 Results: The analysis resulted in two main themes: facilitators and challenges for the implementation of reablement in Flanders.
 Facilitators are: the conviction that multidisciplinary collaboration will be more effective, shared decision making and planning will be encouraged, self management, person centered care, goal oriented and context oriented care will be optimized, continuity of integrated healthcare will be facilitated and the experience of informal caregivers will be better incorporated.
 Challenges are: lack of a clear definition of reablement in Dutch, people must be intrinsically motivated, the service must be financially and organizationally accessible to all, this approach requires a mindset shift of the healthcare professional, an efficient common communication system is essential and consultation must be financially supported for each person and healthcare professional involved in the service.
 
 In general, the goal and the added value of reablement were recognized by everyone as self-evident, but implementation of this service in the current healthcare system in Flanders requires an organizational shift from a supply driven to a demand driven care, a framework for multidisciplinary integrated cooperation and financial support, and sufficient time for both the people who receive home care and the health care professionals. 
 This is the first study involving stakeholders in primary care in Flanders looking at the chances for reablement. Working with primary care providers we now aim to conduct Reable-Labs in different primary care settings in order to provide real life examples and experiences of reablement and its outcomes in the Flemish sector.

The development process of four new digital tools in Flanders: how blended care could be an answer to the challenges of integrated care

Child and youth care services are facing several challenges these days, such as a high caseload, waiting lists, fragmented care, excessive focus on administration and staff shortages (Naert et al., 2017). These challenges are often obstacles for high-quality care, tailored to the needs of children, youngsters and their families. Innovative solutions, such as digital tools, can help to cope with these challenges. While international research shows that blended care (the combination of on- and offline care) is promising (Wentzel et al., 2016; Van Orden et al., 2018), research on blended youth care programs is scant (De Witte et al., 2021). In recent years, both governmental actors, researchers and nonprofit organizations in Flanders are increasingly involved in the implementation of digital approaches and are experimenting with blended care. As a result, practices are more and more convinced of the added value of digital tools. Initial research results show that these new applications could stimulate integrated care, help to build up a sustainable network for clients, focus on continuity of care, strengthen clients in their competences and give more ownership to children, youngsters and families about their care trajectory and their case files. These innovative tools may facilitate the conversation and lower the threshold for seeking and signing up for care.
 In this presentation, we will present four different digital applications that are being developed and implemented in youth care in Flanders: Opla, LifeCity, LifeTree and B-Adult. All four apps were created through a co-creation process involving clients, youth workers, researchers, government actors and software developers. Different research methods were used to develop these apps, such as workshops, interviews, focus groups, brainstorm sessions and user testings. On the ICIC23, we will discuss the development process of the four applications and tensions and obstacles we have experienced during the co-creation process with practitioners and young care leavers. Finally, we will present how we try to find an answer on the current challenges youth care is facing these days through using these new blended care programs.
 - De Witte, N., Joris, S., Van Assche, E., Van Daele, T., (2021). Technologische en digitale toepassingen in zorg & welzijn: een richtingwijzer. Leuven: Steunpunt Welzijn, Volksgezondheid en Gezin
 - Naert, J., Stevens, C., Roose, R., en Vanderplasschen, W. (2017), ‘Continuïteit in het hulpverleningstraject: interpretatief onderzoek naar de beleving van jongeren in de jeugdhulp‘, Orthopedagogiek: Onderzoek en Praktijk, 56(3-4), 55-70.
 - Van Orden, M. & den Hollander, N. (2018). Herstelgerichte ‘blended’ cognitieve gedragstherapie voor cliënten met een verslavingsproblematiek. Kansen en uitdagingen. Verslaving, 1 (1)
 - Wentzel, J., van der Vaart, R., Bohlmeijer, ET & van Gemert-Pijnen JE (2016). Mixing Online and Face-to-Face Therapy: How to Benefit From Blended Care in Mental Health Care. JMIR Ment Health, 3 (1)

"Citizens in charge. The role of citizens in the development of an inclusive, caring society."

If we really want to strive for an inclusive, caring society, we have to give a louder voice to citizens. As citizens each of us takes care for others: our partner, children, parents, neighbours, friends,... This voluntary involvement and commitment deserves more attention, recognition and support than it received until now. Because it's the foundation of every integrated care model.
 In recent years we tried to include citizens more in the policymaking process around integrated care in Flanders, but BurgersAanZet believes we can do better!
 BurgersAanZet is a partnership of 5 volunteer organizations (ArmenTeKort, Eigen Kracht Centrale, Lus, Home-Start Vlaanderen en Magenta) that wants to disseminate their accumulated expertise in setting up caring initiatives from citizens to citizens and letting them in charge of their life, care and assistance. 
 Citizens, professionals, local policymakers who seek inspiration, want to learn and want to get started, can apply to us.
 In this presentation for policymakers, caregivers, health care organizations and citizens we want to present the story of the Citizens' Platform of the Primary Care Zone in the Flemish Ardennes.
 In Flanders each Primary Care Zone is governed by a care council. This care council consists of many health care organisations, policymakers, caregivers as well as a few people with care and support needs. 
 The Primary Care Zone in the Flemisch Ardennes noticed that their voice was not always heard and that the professional services often took over. People's stories did not get the necessary space nor attention, there was a meeting culture, the pace was fast, results had to be achieved immediately... 
 In their search for doing differently they formed a Citizens' Platform and asked BurgersAanZet to facilitate this platform.
 The purpose was to provide time and space for citizens to think about themes that are important to them and to inquire into ways in which the integrated primary care in their region could become more person-centered, bottom-up instead of top-down. 
 
 In this presentation we would like to outline the development of this process: How did we get started? Who did we invite and how? What do we do and why do we do it? How do we make sure that citizens are in charge and stay the “owners” of the process and its results. What is the link with the care council and how does the citizens' platform communicate with the care council, the Primary Care Zone, with caregivers and other citizens.…
 A fascinating and challenging story of a process of connecting people with each other, with the things that matter in life, and with the care council.
 A story brought to you by Emilie Van Daele and with a video-contribution by Guy Janssens - a committed citizen - and Eline Huysmans - a staff member of the Primary Care Zone.
 
 You can find their stories here:
 - Interview with Guy Janssens: https://www.youtube.com/watch?v=72zazWoR-HU
 - Interview with Eline Huysmans: https://www.youtube.com/watch?v=IDWyKbEYzwc&t=370s
 
 
 

The "zorgkassen": a unique access point to social health insurance in Flanders

In Flanders all citizens with a care need can apply for a health care budget to assist them in the extra expenses they face due to their precarious health and social circumstances. The “zorgkassen” are the single point of contact for the Flemish social protection. This means they act as the single access point for all questions concerning both professionals and citizens. These questions concern not only billing but also care requests about the Flemish social protection. The main purpose of this system is making care in Flanders financially accessible. The “zorgkassen” also collect the solidarity contribution every Flemish citizen contributes obligatory to the system. With these contributions and government funding, the “zorgkassen” can support defined groups through care budgets. 
 During the presentation we will show how this system of a unique access point and the sectors involved contribute towards integrated care. Through a client’s testimonial, we will show why the care budget makes a difference and also allows citizens to live longer at home.
 THE SINGLE POINT OF CONTACT
 This single point of contact put into pratice, the ""zorgkassen"" are responsible for: applications, disbursements, information about an individual case and the rights in the different parts of Flemish social protection. It makes procedures to open social rights within the system as clear and simple as possible for the citizens as well as the sector and the government. Even though ”zorgkassen” are focusing on digitalisation, they remain physically accessible to citizens at the same time. 
 Some examples of how the ”zorgkassen” contribute towards integrated care:
 
 The use of Interrai instruments (‘BelRai’)’ to identify the care needs of vulnerable people in a standardized way through one set of assessment tools: 
 
 The data are registered electronically which facilitates the exchange of information between different care actors, such as between facilities or institutions and individual care actors. Research is pending to investigate the implementation of BelRai as a case mix financing tool.
 Example: with a total score of at least 13 points on the BelRai Screener, you qualify for a care budget.
 
 
 Equal treatment for all citizens by automatically granting social rights: 
 
 By digitalising the various parts of the Flemish social protection, the “zorgkassen” can maximize their commitment to automatically granting social rights. The single point of contact has all the information on an individual case, allowing applications to be handled more efficiently and transparently. 
 Example: Residents staying in a residential care center in Flanders are automatically entitled to a care budget. 
 
 Another example for which the “zorgkassen” are the single point of contact: funding the multidisciplinary client meetings 
 
 A multidisciplinary client meeting is requested when the care becomes too complex and additional coordination between the person, the informal care and the care team is needed. The multidisciplinary client meeting is a method that helps facilitate integrated care in practice and helps build the bridge between care and welfare.

Building a digital care and support plan: research as a starting point. A session for policymakers.

In 2018, the idea arose of building a digital care and support plan for primary care. The research on life goals and care goals during the COVID years allowed us to clarify informed choices in the ICT specifications and digital development can start in 2023.
 The reform of the primary care in Flanders envisioned a digital capstone. Therefore, a business analysis for a digital care and support plan was prepared in 2018. This digital care plan should:
 * facilitate goal-oriented and integrated care, 
 * give individuals with care and support needs control over their care planning, and 
 * allow care providers to collaborate interdisciplinary and coordinate their care within the care team. 
 The scope and associated resources were largely lacking at that time, and the subsequent COVID crisis prevented the project from even starting at all. 
 We used this pause to engage academia. We asked them what goal-oriented care might look like in practice: 
 * How do you integrate life goals into care planning? 
 * Can you create links between life goals and care goals?
 * In what ways can you link care goals to existing care scales? 
 The researchers' recommendations to these questions, gave us a clearer view of the possibilities and scope of our project. This information helped us to:
 * Write a clearer ICT specification
 * Clearly define the functional requirements
 * Propose an evidence-based approach to stakeholders
 * Prioritize the different digital modules to be developed
 * Engaging academics in a technical debate
 Do not underestimate the impact of sound research. Do not rush into an ICT project without fundamentally questioning the content and scope of the project. Consult academics who will work out the concepts in a research context with people in the field. Then build on this input.
 The inputs from the research questions are currently being used as a starting point for the digital modules on life goals and care goals. These modules are now being further refined with stakeholders and will serve as a starting point for ICT development this year.

How to improve the capacity of general practitioners? – a Flemish approach

“Barely any region left with freely accessible primary health care in Flanders.” This is one of the many newspaper headlines that was recently published to emphasize the fact that more and more general practitioners refuse to take in new patients, because they run out of capacity to provide patients with proper health care. Where does it go wrong? 
 Accessibilty to general practitioners is a hot topic for the Flemish policymakers. An aging population and an increase of mental health problems asks a lot from the general practitioners, as well as the shift of tasks from hospitals towards primary health care and the growing attention for prevention. However, is there a real shortage in general practitioners? Looking abroad learns that the number of general practitioners might not be the major cause of the capacity problem, but that the true bottleneck might lie in the way of organizing primary health care capacity and accessibility. Embedded in a landscape of health care where general practitioners mostly work on a self-employed base, and the fragmented governmental structure in Belgium as an extra obstacle makes this a major challenge for the near future.
 A dialogue between policy makers from all Belgian governments was opened to create a common approach: each government will take actions within their own authorities. The Flemish government worked out a plan to counter this massive challenge in primary health care through different initiatives, in cooperation with representatives of the general practitioners on the field, local authorities and umbrella organizations.
 Flanders commits itself by installing three major fundaments which can create change in the way general practitioners are organized: a first step is to create an accurate and up-to-date database of the current available general practitioners health care services compared with the local care need; in parallel the funding of general practitioners will be expanded in a way which stimulates interdisciplinary collaboration and optimizes health care capacity; on top of that the Flemish government is experimenting with new forms of primary care practices in which integrated care is the keystone and which are supported by local authorities and in close connection with welfare services. 
 These projects described above are in full development. On the working field more and more general practitioners are willing to put their shoulders under these initiatives to create solid solutions for the future. 
 The international audience of this lecture might recognize similar issues they encounter in their own countries and will be able to see similarities and differences compared to the Flemish context. By drawing these parallels one can have a broader view on the approach of improving health care capacity and accessibility. 
 These Flemish projects will be brought together with the initiatives from the other Belgian governments at a roundtable discussion to align all the initiatives on primary health care capacity and create a future proof primary health care capacity in Belgium.

Regional Strategic Planning of Care in Flanders based on population needs

Introduction: In 2014, Flanders started a process of re-designing the hospital care. This has led let to the recognition of 13 networks of hospitals in 2020. 
 Simultaneous we developed a framework for a Regional Strategic Care Plan (RSCP). The RSCP starts from demographic data and health indicators to determine future needs to which the future supply of the network must be tailored. The networks are asked to make such a RSCP for their network.
 Target: The increase in ageing, multimorbidity, complex disorders, chronic care,… require a new relationship between hospitals and between hospitals and other healthcare providers. With the RSPC we want to match the hospital care to the needs of the population, in consultation with other healthcare providers. More attention will go to task differentiation and new partnerships.
 The main principle has to be that basic care is organised close to the people, whereas more specialised care recruits from a wider environment. All healthcare providers will have to change from a supply-driven organisation of care towards person-centred care based on needs.
 Design: Studies on future population needs, on an optimal spread of the care offer and to create a framework for RSPC, based on future needs, actual demografic figures, …., were executed by a consortium of Deloitte and the Leuven Institute for Healthcare Policy.
 A computermodel was developed to visualise patient flows and to determine logical cooperation.
 The main goal of RSPC:
 
 Stimulate person-centred care
 Stimulate cooperation and networking between hospitals and with other healthcare providers
 Concentration of expertise and restricting the high-tech care supply
 Expenditure should match the current financial context and achieve a health-economic justifiable offer.
 
 Execution: At the moment the hospital networks are developing their RSPC based on the models that are provided to them. This is an intensive process in which the result must also be coordinated with other partners in the region. The RSPC will be evaluated by a committee consisting of representatives of hospitals, primary care and academics.
 Results: Based on the first plans sumitted, we see that the hospital networks will tailor their offer to the needs of the population and that they consult with other care partners in the region. It encourages hospitals to think about their future role and how it is fulfilled. The doctors are also involved to develop a long-term vision.
 On average, acute beds will be reduced by about 7%.
 Lessons learned: It is important to provide hospitals with a framework on which to base themselves to tailor their future offerings to the needs of the population and to encourage them to think about this.
 The division of powers between the federal government and the regions makes it difficult for hospitals to make choices.
 Next steps: Evaluate the current framework to see if improvements can be made and the model can be updated. Certainly in terms of the involvement of other care partners, additional incentives must be given.

Why and how Flanders wants to roll out goal-oriented, integrated care based on life goals.  A reflection between policymakers and policy organizations.

Flanders believes that integrated care can only be achieved by linking medical care, with welfare and social care, creating local government participation and including the voice of the patient and his or her caregiver in local and central policy processes. 
 In order to evolve from fragmented primary care to integrated care, a participatory procedure was mapped out in Flanders: since 2020 existing structures were changed and several tools have been developed to transform the way of care into goal oriented care. 
 The Flemish meso level was thoroughly rearranged: during the covid years population-based approach was rolled out by local care councils. The care council aims to install integrated, goal-oriented care within the local network of medical care providers, social and welfare providers and local authorities, in cooperation with the patient and his or her caregiver. Together with all these partners, the care council takes care of a population of at least 75,000 people.Finally primary care, and by extension the entire care scene, will evolve towards better goal-oriented, integrated care. This evolution is supported by the implementation of the digital care and support plan which is flanked by a the reform traject of palliative care in Flanders,
 The main goal of in Flanders care organization is putting the patient in the driving seat of the care-process which will be based on life goals
 For policymakers and organizations, this presentation aims to look back at the complex change process, outline future challenges and share lessons learned.
 We show how strategically chosen change management creates connection between welfare, social and medical care. How, the interaction between patient and caregivers and local authorities try to achieve integrated care in the local communities
 We show our complex challenge of introducing quality thinking and building organizational resilience for future crises within the young care council.
 We discuss the complexity of linking local priorities with global policy objectives and vice versa.

Scale-up of a chronic care model-based programme for type 2 diabetes in Belgium: a mixed-methods study

BackgroundType 2 diabetes (T2D) is an increasingly dominant disease. Interventions are more effective when carried out by a prepared and proactive team within an organised system — the integrated care (IC) model. The Chronic Care Model (CCM) provides guidance for its implementation, but scale-up of IC is challenging, and this hampers outcomes for T2D care. In this paper, we used the CCM to investigate the current implementation of IC in primary care in Flanders (Belgium) and its variability in different practice types.MethodsBelgium contains three different primary-care practice types: monodisciplinary fee-for-service practices, multidisciplinary fee-for-service practices and multidisciplinary capitation-based practices. Disproportional sampling was used to select a maximum of 10 practices for each type in three Flemish regions, leading to a total of 66 practices. The study employed a mixed methods design whereby the Assessment of Chronic Illness Care (ACIC) was complemented with interviews with general practitioners, nurses and dieticians linked to the 66 practices.ResultsThe ACIC scores of the fee-for-service practices — containing 97% of Belgian patients — only corresponded to basic support for chronic illness care for T2D. Multidisciplinary and capitation-based practices scored considerably higher than traditional monodisciplinary fee-for-service practices. The region had no significant impact on the ACIC scores. Having a nurse, being a capitation practice and having a secretary had a significant effect in the regression analysis, which explained 75% of the variance in ACIC scores. Better-performing practices were successful due to clear role-defining, task delegation to the nurse, coordination, structured use of the electronic medical record, planning of consultations and integration of self-management support, and behaviour-change intervention (internally or using community initiatives). The longer nurses work in primary care practices, the higher the chance that they perform more advanced tasks.ConclusionsBesides the presence of a nurse or secretary, also working multidisciplinary under one roof and a capitation-based financing system are important features of a system wherein IC for T2D can be scaled-up successfully. Belgian policymakers should rethink the role of paramedics in primary care and make the financing system more integrated. As the scale-up of the IC varied highly in different contexts, uniform roll-out across a health system containing multiple types of practices may not be successful.

A Tool for Assessing the Quality of Life of Adolescents in Youth Care: Psychometric Properties of the QOLYSS.

Quality of life (QOL) has gained increased interest as a critical pathway to better understanding the lives and circumstances of children and adolescents in both the general population and among specific populations. Yet, QOL assessment among youngsters in youth care services remains a highly under-researched topic. This study examines the suitability and psychometric properties of a new QOL self-report scale for adolescents between 12 and 18 years old in youth care: the Quality of Life in Youth Services Scale (QOLYSS). The provisional version of the QOLYSS was pre-tested in a sample of 28 adolescents in youth care to examine its applicability and feasibility. Next, a comprehensive evaluation of the psychometric properties of the field-test version was conducted in a sample of 271 adolescents in youth care in Flanders, Belgium (M = 15.43, SD = 1.73). Classical item and factor analyses were carried out per subscale, (test-retest) reliability and item-discriminant validity of the subscales were examined, convergent validity was explored, and confirmatory factor analysis was used to examine the goodness-of-fit of different measurement models. Reliability measures of the scale are satisfactory, results are indicative of convergent validity, and confirmatory factor analysis provides evidence for the eight correlated factors model. Future lines of research concerning the ongoing development and application of the QOLYSS are discussed.

Exploring readiness for implementing goal-oriented care in primary care using normalization process theory.

To use normalization process theory (NPT) to build a strategy for the implementation of goal-oriented care (GOC) in primary care in Flanders, Belgium. GOC is a possible approach to more coordinated and integrated care and tailors care to patients' personal life goals. The concept has gained interest among policy makers and researchers, but the main drivers for successful implementation are the primary healthcare professionals (PHCPs) who need to see added value of GOC in order to embed it into their daily practice. NPT, developed to understand the processes of implementing new ways of organizing care, offers a useful lens to understand adoption of GOC in primary care practice. PHCPs (n = 131) who participated in a 2-hour community meeting on GOC were asked to complete the Normalization MeAsure Development survey. This 23-item survey is based on NPT and describes participants' views about how an intervention would impact their work, their expectations about it, and whether it could become a routine part of their work. The NPT constructs coherence (sense-making work) and cognitive participation (relational work) showed positive tendency toward implementation of GOC. The participants had an initial understanding on GOC and there was much interest in supporting and start working with this approach. The other constructs collective action (operational work) and reflexive monitoring (appraisal work) will need further efforts to trigger implementation. A common ground is needed to integrate GOC as a common practice which can be achieved by intensive interprofessional collaboration.

Changes in the use and uptake of a national out-of-hours telephone triage service by younger and older patients seeking non-urgent unplanned care surrounding the COVID-19 pandemic in Flanders (Belgium)

ABSTRACT Background This study seeks to examine if and how the COVID-19 pandemic has prompted changes in the use and uptake of a national out-of-hours (OOH) telephone triage service by younger and older patients seeking non-urgent unplanned care in Flanders (Belgium). Methods A descriptive study was conducted using registry data obtained from the 1733 OOH telephone triage service in a Flemish region of Belgium. All calls received between 1 January 2019 and 31 December 2020 were analyzed. Results A significant association was found between patient age and period of call (χ2 = 594.54, p < .001). Calls made to the 1733 OOH telephone triage service were significantly less likely to be dispatched to a higher level of urgency by operators compared to calls made before the COVID-19 period (OR = 0.80, 95% CI [0.74–0.85]). While calls concerning older adults were significantly more likely to be dispatched to a higher level of urgency by operators compared to younger adults (regardless of period of call) (65 to 74 yrs: OR = 5.75, 95% CI [4.86–6.80]; 75 to 84 yrs: OR = 15.21, 95% CI [13.18–17.56]; ≥ 85 yrs: OR = 28.77, 95% CI [25.01–33.09]), only 6.7% of all COVID-19 related calls involved older adults over 65 years of age. Conclusion Findings showed that there was a general decline in the number of calls dispatched to a higher level of urgency by operators during the COVID-19 period but that there were differences in the use and uptake of these services by younger and older age segments.

Opioid prescribing in out-of-hours primary care in Flanders and the Netherlands: A retrospective cross-sectional study.

Increased opioid prescribing has raised concern, as the benefits of pain relief not always outweigh the risks. Acute and chronic pain is often treated in a primary care out-of-hours (OOH) setting. This setting may be a driver of opioid use but the extent to which opioids are prescribed OOH is unknown. We aimed to investigate weak and strong opioid prescribing at OOH primary care services (PCS) in Flanders (Northern, Dutch-speaking part of Belgium) and the Netherlands between 2015 and 2019. We performed a retrospective cross sectional study using data from routine electronic health records of OOH-PCSs in Flanders and the Netherlands (2015-2019). Our primary outcome was the opioid prescribing rate per 1000 OOH-contacts per year, in total and for strong (morphine, hydromorphone, oxycodone, oxycodone and naloxone, fentanyl, tapentadol, and buprenorphine and weak opioids (codeine combinations and tramadol and combinations) and type of opioids separately. Opioids were prescriped in approximately 2.5% of OOH-contacts in both Flanders and the Netherlands. In Flanders, OOH opioid prescribing went from 2.4% in 2015 to 2.1% in 2017 and then increased to 2.3% in 2019. In the Netherlands, opioid prescribing increased from 1.9% of OOH-contacts in 2015 to 2.4% in 2017 and slightly decreased thereafter to 2.1% of OOH-contacts. In 2019, in Flanders, strong opioids were prescribed in 8% of the OOH-contacts with an opioid prescription. In the Netherlands a strong opioid was prescribed in 57% of these OOH-contacts. Two thirds of strong opioids prescriptions in Flanders OOH were issued for patients over 75, in the Netherlands one third was prescribed to this age group. We observed large differences in strong opioid prescribing at OOH-PCSs between Flanders and the Netherlands that are likely to be caused by differences in accessibility of secondary care, and possibly existing opioid prescribing habits. Measures to ensure judicious and evidence-based opioid prescribing need to be tailored to the organisation of the healthcare system.

Prioritising Cases in Youth Care: An Empirical Study of Professionals’ Approaches to Argumentation

ABSTRACT Social workers must often decide about priority at a case level, in a context of scarce resources. These decisions are disputable and controversial, which raises the question on what grounds are they made in practice. This article addresses that question through an empirical study of real-life case discussions in youth care in Flanders, the Dutch-speaking part of Belgium. Toulmin’s argumentation model is used to analyse the data. The study finds that most case discussions are processed in a rather technical manner. But where there is active deliberation, key incidents show that the decision-makers undertake active and personal interpretation of the situation at hand, and that they also take a personal stance on the criteria for assigning priority. In other words, their practice can be understood as a hermeneutical activity. The article’s main conclusion is that the prioritisation process illustrates the moral-political core that is present in any social work decision-making practice. As this moral-political core seems to be hidden most of the time behind a technical-rational approach, questions remain whether the professionals involved are aware that it characterises their own judgements and whether insights into its nature are stimulated.