Cooperation Of Health Care Providers Research Articles

Integrated transmural care pathway for stroke patients after discharge from the hospital: the growth towards a total concept in cooperation with primary care partners in southwest-Flanders

Every year, nearly 27,000 Belgians suffer a stroke. After discharge from the hospital there is follow-up. In this best practice, we want to discuss the initiatives that AZ Groeninge has taken over the years to achieve an integrated transmural care pathway for stroke patients after discharge from the hospital in collaboration with primary care, regional GP-associations and home care organizations. 
 Transmural care pathway for stroke care: Prof. Dr. Peter Vanacker, neurologist AZ Groeninge, took the initiative in 2017 to roll out the transmural clinical care pathway for stroke in the south West-Flanders region together with GP-associations and neurologists from various hospitals. Other primary care partners were also involved such as the Pharmacists Association and home care organizations. 
 Through uniform cooperation of health care providers and coordinated follow-up to support stroke patients, they succeeded in offering better care to stroke patients after discharge.
 Guidelines were developed for GP's, home care nurses and pharmacists. To ensure continuity of care and enhance patient empowerment, a diary was also given to the patient to record key parameters and issues.
 In 2020, the care pathway was expanded with the Chronic Care Project "De Brug". 
 The following additional items were added:
 - commitment to communication between the care providers of the stroke team
 - commitment to the conversation ""good use of medicines"" after stroke
 - focus on clarifying questions
 - commitment to lifestyle through health vouchers that encouraged stroke patients to make lifestyle changes.
 Strokecoach: In AZ Groeninge, the transmural care pathway was supplemented with a specific coaching program for stroke patients.
 The strokecoach is responsible for a personal follow-up of stroke patients to promote therapy compliance, disease insight, reduction of their cardiovascular risk profile. The coaching process runs between 6 and 24 months depending on patient preference.
 Jobcontent of our strokecoach is to:
 - play an intermediary role between GP's, home care services and the hospital.
 - be point of contact for stroke care in the region.
 - do more intensive screening for early and late complications and compliance. Thus, complications are captured more quickly. Together with the primary care team, the strokecoach will motivate the patient to achieve health goals and prevent for stroke recurrence.
 Stroke2Gether: Electronic stroke recovery pathway.AZ Groeninge is also participating in the EFRO project "Stroke2Gether". This is a digital recovery pathway for stroke patients after discharge by a smartphoneapp. Medical en therapy follow-up and health prevention are built in, through monitoring, education and coaching, live and remote. In addition, there is also a rights recognition module so that patients are also guided more proactively in the administrative and financial aspects and care support in collaboration with the social services of the insurance companies.
 Decision: AZ Groeninge has already completed a long journey in cooperation with its primary care partners to arrive at an integrated care pathway for stroke patients.
 In the following years, the main focus will be on the evaluation and adjustment of the developed instruments and the cooperation to further optimize the aftercare for this patient group.

Views of psycho-oncologists, physicians, and nurses on cancer care-A qualitative study.

BackgroundAs worldwide cancer prevalence continues to increase, the challenges facing cancer care are also increasing. Various topics related to deficiencies in cancer care have been discussed repeatedly in the literature. The most frequently stated topics are the unmet psychosocial support needs of cancer patients, difficulties in multidisciplinary teamwork, difficulties in communication between physicians and patients, and issues in palliative care settings. However, there is little research regarding the views of health care providers on these topics. With the aim of gaining abundant information regarding the care of German cancer patients, this study explores the stances of psycho-oncologists, physicians, and nurses regarding the quality of cancer care.Materials and methodsSemi-structured interviews were conducted at the University Medical Center Hamburg-Eppendorf (UKE) and in different oncological outpatient offices in Hamburg; twenty-five interviews in total were conducted with health care providers. Interviews were semi-structured to gain a broad range of information on cancer care. The data were analyzed using thematic analysis by Braun and Clarke with an inductive, constant comparison approach to identify themes and categorized codes.ResultsThe following five principle themes were identified in the interviews: “psycho-oncological care”, “cooperation of health care providers”, “palliative care”, “health care provider-patient contact”, and “coordination and organization of care”. Participants seemed satisfied with the overall quality of cancer care in Germany. Nevertheless, the results showed deficiencies regarding communication among different health care providers and between health care providers and patients. Important findings in conjunction with these communication problems were a lack of psycho-oncological support, shortages in the oncology work force, language and cultural barriers, and deficient education in the communication of providers.ConclusionsThe statements of psycho-oncologists, physicians, and nurses on cancer care provide a suitable basis to conduct further focused research on the studied deficiencies in cancer care. In particular, communication in psycho-oncological care, communication within multidisciplinary teams, and health care provider-patient communication should be further explored with the aim of developing new ideas for improvements and thereby enhancing the quality of cancer care.

The Reform of the Czech Health Care System

The health care system is the only sphere traditionally dominated by the state that went through radical reform after the political changes at the end of 1989. The new health care system is strongly orientated towards the private provision of health care and is striving to introduce a sense of personal responsibility in individuals for the status of their health. It is possible to conclude that this fact is explicable by the strong support and active co-operation of health care providers in the preparation and realization of health care reform. The new system suffers from the common problem of all health care systems – the difficulty of controlling increases in costs. The reform of the health care system contributed to cost increases by imposing an additional administrative cost for the creation of a system of health insurance companies, by technical mistakes in the system of price regulation, and by introducing a pure fee-for-service reimbursement system in combination with an amateur fee-for-service Price List. Nevertheless the new system is compatible with the new market orientation of the whole economy and did not distort the accessibility or quality of health care. In future, the Czech health care system will most likely follow the path on which it has embarked during the last three years. It will concentrate on improvements in the structure of health insurance and price regulation, and on introducing cost-combating modifications of the fee-for-service system.