Multiprofessional Care Research Articles

Organisation and management of multi-professional care for cancer patients at end-of-life: state-of-the-art from a survey to community and hospital-based professionals.

Providing timely and satisficing End-of-Life care (EOLC) is a priority for healthcare systems since aging population and chronic diseases are boosting the global demand for care at end-of-life (EOL). In OECD countries the access to EOLC is insufficient. In Italy, the average rate of cancer patients assisted by the palliative care (PC) network at EOL was 28% in 2021, with high variability in the country. Among theItalian regions offering the best coverages, Tuscany has a rate of about 40%, but intraregional variation is marked as well. The study aims to explore the delivery of EOLC to adult cancer patients in public facilities in the Tuscany region through survey data collection among professionals. Two online surveys were delivered to Directors of community-based PC Functional-Units (FUs) and Directors of hospital-based medical-oncology units. All FU Directors responded to the survey (n = 14), and a response rate of 96% was achieved from hospital-unit Directors (n = 27). The results highlight the availability of numerous dedicated services, but reveal heterogeneity among and within organisations, including variations in the professionals involved, pathways, and tools adopted. Care continuity is supported by institutionalized collaboration between hospital and community settings, but hindered by fragmented care processes and heterogeneous transition pathways. Late referral to PC is perceived as a major constraint to EOLC. Developing structured pathways for patient transition to end-stage PC is crucial, and practices/processes should be uniformly implemented to ensure equity. Multi-professional care should be facilitated through tailored supporting tools. Both hospital-unit and FU Directors suggest developing shared pathways between organisations/professionals (82% and 80% respectively) and digital information sharing (61% and 80% respectively). Hospital and community-based professionals have similar perceptions about the concerns and challenges to EOLC provision in the region, but community-based professionals are more sensitive to the importance of improving communication on PC to the public and early discussing EOLC with caregivers. This finding suggests the need of enhancing hospital personnel's awareness about these issues. Professional training and the capacity to assess patients' needs and preferences should be improved. The identified needs can inform future research and interventions to improve the quality and outcomes of EOLC for cancer patients.

Translation, adaptation and initial validation of the Oldenburg Burnout Inventory (OLBI) in Río de la Plata health personnel

The study addresses the translation, cross-cultural adaptation and initial validation of the Oldenburg Burnout Inventory (OLBI) questionnaire into Spanish, particularly for the context of health personnel. The OLBI, based on the Job Demands - Resources Model, evaluates burnout and job disengagement. After a rigorous methodological process, two versions of the questionnaire were carried out, followed by a pilot test and cognitive interviews. Comprehension problems were identified in a question related to work disconnection. Adjustments were made to the final version, which was validated with a multiprofessional pediatric palliative care group. The results showed adequate reliability for the Exhaustion scale and acceptable for the Disconnection scale. The importance of considering the particularities of the work context in adapting the instrument was highlighted. Although limitations, such as sample size, are acknowledged, it is suggested that the OLBI – UY version is promising and can be used in future studies for a more comprehensive psychometric analysis. This study represents an original contribution by addressing the adaptation of a relevant instrument for measuring burnout in Spanish-speaking health personnel in the Río de la Plata.

An evaluation of a quality improvement initiative examining benefits and enablers and challenges and barriers of implementing and embedding core clinical supervision in primary care

Background Core Clinical Supervision has become a valued activity that impacts on the culture and organisational delivery of healthcare. It embeds good practice to ensure that staff have a high skill set, desirable professional attitudes, and provide high quality evidence-based care. It also helps to support good clinical governance and enhances staff retention (CQC 2013). A supervision framework has been adopted and adapted from the ‘General Practice – Developing confidence, capability, and capacity. A Ten Point Action Plan for General Practice Nursing’ ( NHS England 2018 ) and applied at scale across Yorkshire and the Humber, with minimal impact on clinical capacity, quality, and safety. This initiative coincides with general practice (and the wider health service) being under enormous pressure managing the effects of the COVID-19 pandemic, with impact on staff wellbeing and retention. The main aims are to evaluate the impact of embedding the Core Supervision training across primary care practice and strengthen course content for future delivery. Methodology and Methods A quantitative approach using an online survey, was completed by multi-professional primary care staff who had completed the Core Supervision Training. Findings Practitioners indicated that they required protected time due to competing demands and visible senior buy in to undertake core supervision. Additionally, practitioners who had participated or supervised sessions felt the benefits on staff wellbeing and indicated that it improved patient care delivery. Conclusion and Implications Survey findings suggest further research on embedding core supervision within primary care and a focus on national and local strategies are required. Standardised learning outcomes across the regions to ensure transferability of supervision practice and review training in supervision processes, particularly around conducting a supervision session.

1833P JUMP_START: Optimization of multiprofessional care for young patients with colorectal cancer

1833P JUMP_START: Optimization of multiprofessional care for young patients with colorectal cancer

Implementation of a digital distress detection system in palliative care: qualitative data on perspectives of a multiprofessional palliative care team

BackgroundDigital health technologies such as sensor systems are intended to support healthcare staff in providing adequate patient care. In the Department of Palliative Medicine (University Medical Center Freiburg), we developed and implemented a noninvasive, bed-based sensor system in a pilot study. The aim was to detect distress in patients who were no longer able to express themselves by monitoring heart and respiratory rates, vocalizations, and movement measurements. The sensor system was intended to supplement standard care, which generally cannot guarantee constant monitoring. As there is a lack of data on how healthcare professionals experience such a techno-digital innovation, the aim of this study was to explore how the multiprofessional palliative care team who piloted the sensor system perceived its potential benefits and limitations, and how they experienced the broader context of healthcare technology and research in palliative care.MethodsWe conducted a qualitative interview study with 20 members of the palliative care team and analyzed the recorded, verbatim transcribed interviews using qualitative content analysis.ResultsThe sensor system was described as easy to use and as helpful support for patients, care staff, and relatives, especially against the backdrop of demographic change. However, it could not replace human interpretation of stress and subsequent treatment decisions: this remained the expertise of the nursing staff. A potential reduction in personnel was expected to be a risk of a digital monitoring system. The special conditions of research and digital health technologies in an end-of-life context also became clear. Specifically, healthcare staff were open to health technologies if they benefited the patient and were compatible with professional nursing and/or palliative care attitudes. Additionally, a patient-protective attitude and possible interprofessional differences in priorities and the resulting challenges for the team became apparent.ConclusionsA potential digital solution for distress monitoring was considered useful by palliative care practitioners. However, interprofessional differences and compatibility with existing palliative care practices need to be considered before implementing such a system. To increase user acceptability, the perspectives of healthcare professionals should be included in the implementation of technological innovations in palliative care.

A multifaceted risk management program to improve the reporting rate of patient safety incidents in primary care: a cluster-randomised controlled trial

BackgroundWhile patient safety incident reporting is of key importance for patient safety in primary care, the reporting rate by healthcare professionals remains low. This study aimed to assess the effectiveness of a risk management program in increasing the reporting rate within multiprofessional primary care facilities.MethodsA nation-wide cluster-randomised controlled trial was performed in France, with each cluster defined as a primary care facility. The intervention included professional e-learning training, identification of a risk management advisor, and multidisciplinary meetings to address incident analysis. In the first observational period, a patient safety incident reporting system for professionals was implemented in all facilities. Then, facilities were randomised, and the program was implemented. Incidents were reported over the 15-month study period. Quasi-Poisson models were used to compare reporting rates.ResultsThirty-five facilities (intervention, n = 17; control, n = 18) were included, with 169 and 232 healthcare professionals, respectively, involved. Overall, 7 out of 17 facilities carried out the entire program (41.2%), while 6 did not hold meetings (35.3%); 48.5% of professionals logged on to the e-learning website. The relative rate of incidents reported was 2.7 (95% CI = [0.84–11.0]; p = 0.12). However, a statistically significant decrease in the incident rate between the pre-intervention and post-intervention periods was observed for the control arm (HR = 0.2; 95% CI = [0.05–0.54]; p = 0.02), but not for the intervention arm (HR = 0.54; 95% CI = [0.2–1.54]; p = 0.23).ConclusionThis program didn’t lead to a significant improvement in the patient safety incident reporting rate by professionals but seemed to sustain reporting over time. Considering that the program was fully implemented in only 41% of facilities, this highlights the difficulty of implementing such multidisciplinary programs in primary care despite its adaptation to the setting. A better understanding of how risk management is currently organized in these multiprofessional facilities is of key importance to improve patient safety in primary care.Trial registrationsThe study has been registered at clinicaltrials.gov (NCT02403388) on 30 March 2015.

Patients’ and caregivers’ perception of multidimensional and palliative care in amyotrophic lateral sclerosis – protocol of a German multicentre study

IntroductionAmyotrophic lateral sclerosis (ALS) is an inevitably fatal condition that leads to a progressive loss of physical functioning, which results in a high psychosocial burden and organizational challenges related to medical care. Multidimensional and multiprofessional care is advised to meet the complex needs of patients and their families. Many healthcare systems, including Germany, may not be able to meet these needs because non-medical services such as psychological support or social counselling are not regularly included in the care of patients with ALS (pwALS). Specialised neuropalliative care is not routinely implemented nor widely available. Caregivers of pwALS are also highly burdened, but there is still a lack of support services for them.MethodsThis project aims to assess the perceptions and satisfaction with ALS care in Germany in pwALS and their caregivers. This will be achieved by means of a cross-sectional, multicentre survey. The examination will assess, to which extend the patients’ needs in the six domains of physical, psychological, social, spiritual, practical and informational are being met by current care structures. This assessment will be linked to mental well-being, subjective quality of life, attitudes toward life-sustaining measures and physician-assisted suicide, and caregiver burden. The study aims to recruit 500 participants from nationwide ALS centres in order to draw comprehensive conclusions for Germany. A total of 29 centres, mostly acquired via the clinical and scientific German Network for Motor Neuron Diseases (MND-NET), will take part in the project, 25 of which have already started recruitment.PerspectiveIt is intended to provide data-based starting points on how current practice of care in Germany is perceived pwALS and their caregivers and how it can be improved according to their needs. Planning and initiation of the study has been completed.Trial registrationThe study is registered at ClinicalTrails.gov; NCT06418646

Sicherstellung der hausärztlichen Versorgung in Deutschland – Befunde einer quantitativen Befragung von Allgemeinmediziner*innen

ZusammenfassungHintergrundAngesichts der Gefahr einer Verknappung niedergelassener Allgemeinmediziner*innen stellt sich die Frage, welche Konzepte wirksame Beiträge leisten können, um eine drohende Mangelversorgung abzuwenden. Bis dato fehlt es an Studien, die beleuchten, wie Hausärzt*innen aus ihrer beruflichen Erfahrung zu verschiedenen Ansätzen zur langfristigen Sicherstellung der Primärversorgung stehen.Ziel der ArbeitZiel der Studie war es, Positionen, Haltungen und Erfahrungswerte von Hausärzt*innen mit Blick auf eine Sicherstellung der allgemeinmedizinischen Breitenversorgung zu ermitteln.MethodenIm Zuge einer Online-Befragung wurden zwischen Februar und Juni 2023 insgesamt 4176 Hausärzt*innen befragt. Über die deskriptive Analyse hinaus erfolgte zur Ermittlung von signifikanten Unterschieden zwischen 2 Gruppen ein t‑Test bei unabhängigen Stichproben.Ergebnisse42 % beobachten im Umfeld einen merklichen Schwund allgemeinärztlicher Praxen. 53 % bescheinigen der Hausarztmedizin eine sinkende Attraktivität für den ärztlichen Nachwuchs, was 3 Problembereichen zugeordnet wird: 1) Stellung der hausärztlichen Versorgung im Gesundheitswesen, 2) Voraussetzungen in Aus- und Weiterbildung, 3) Arbeitsbedingungen. Zur Sicherung der Hausarztmedizin sprechen sich die Befragten v. a. für folgende Ansatzpunkte aus: Einrichtung eines Primärarztsystems (85 %), vermehrte Förderung von Interesse und Berührungspunkten in Aus- und Weiterbildung (80 %), Stärkung multiprofessioneller ambulanter Versorgungszentren (64 %), Restrukturierung von Curricula (56 %) und Zulassungskriterien zum Medizinstudium (50 %), Reform der allgemeinmedizinischen Weiterbildung (53 %).DiskussionHausärzt*innen haben eigene Vorschläge und Präferenzen, die Expertisen und Sachverständige ergänzen. Bei der Planung, Implementierung und Evaluation von Maßnahmen zur Stabilisierung der hausärztlichen Versorgung sollten Allgemeinmediziner*innen konsequenter als bislang involviert werden.

COVID-19 profiles in general practice: a latent class analysis

BackgroundGeneral practitioners (GPs) were on the front line of the COVID-19 outbreak. Identifying clinical profiles in COVID-19 might improve patient care and enable closer monitoring of at-risk profiles.ObjectivesTo identify COVID-19...

HbA1c changes in a deprived population who followed or not a diabetes self-management programme, organised in a multi-professional primary care practice: a historical cohort study on 207 patients between 2017 and 2019

BackgroundDiabetes self-management (DSM) helps people with diabetes to become actors in their disease. Deprived populations are particularly affected by diabetes and are less likely to have access to these programmes. DSM implementation in primary care, particularly in a multi-professional primary care practice (MPCP), is a valuable strategy to promote care access for these populations. In Rennes (Western France), a DSM programme was designed by a MPCP in a socio-economically deprived area. The study objective was to compare diabetes control in people who followed or not this DSM programme.MethodThe historical cohort of patients who participated in the DSM programme at the MPCP between 2017 and 2019 (n = 69) was compared with patients who did not participate in the programme, matched on sex, age, diabetes type and place of the general practitioner’s practice (n = 138). The primary outcome was glycated haemoglobin (HbA1c) change between 12 months before and 12 months after the DSM programme. Secondary outcomes included modifications in diabetes treatment, body mass index, blood pressure, dyslipidaemia, presence of microalbuminuria, and diabetes retinopathy screening participation.ResultsHbA1c was significantly improved in the exposed group after the programme (p < 0.01). The analysis did not find any significant between-group difference in socio-demographic data, medical history, comorbidities, and treatment adaptation.ConclusionsThese results, consistent with the international literature, promote the development of DSM programmes in primary care settings in deprived areas. The results of this real-life study need to be confirmed on the long-term and in different contexts (rural area, healthcare organisation).

Patient concerns and palliative psychology interventions within an inpatient palliative care service

Multi-professional inpatient palliative care services are increasingly complementing palliative care in hospitals alongside palliative care units. The present study aims to investigate the nature and frequency of patient concerns and palliative psychological interventions in the context of palliative psychological work, as well as the perceived quality of outcomes in an inpatient palliative service. Palliative psychological interventions for terminally ill patients at the inpatient palliative care service at Leipzig University Hospital were investigated in a prospective follow-up evaluation study. Psychological distress (distress thermometer) as well as the perceived quality of the results of the palliative psychological support (from the therapist`s perspective) were recorded. Patient concerns and psychological conversation topics and interventions were recorded. Descriptive and regression analytic procedures were used. Over a year, 355 patients in the inpatient palliative care service received psychological support, 304 participated in the study (mean age 63.8 years, 55% male, 89% oncological disease). An average of 3 palliative psychological interviews were conducted; 64% of patients reported high psychological distress (M=6.5). The most common patient concerns and topics within the interviews were dealing with emotions (87%), resources (83%), conflicting care and autonomy issues (77%) and hope (76%); significantly less common were spiritual concerns (2%) or the patient's legacy (9%). The most frequently used palliative psychological interventions included: support in illness processing and acceptance (74%) or in emotional-relieving interventions (98%) as in normalisation (75%), active listening (97%) or emotional containment (95%). Regression analysis showed that an oncological (vs. non-oncological) disease, a high number of palliative psychological interviews and interventions, comprehensive information regarding the palliative dimension of the diagnosis as well as undisturbed contact in the initial interview had a positive effect on the perceived outcome quality. The study results show that palliative psychologists play an important role in inpatient palliative care teams and should be involved as early as possible in the course of the disease. There is a need for improvement, especially in the palliative psychological care of non-oncological patients.

DemStepCare: Risk-stratified support for primary care-based dementia care - evaluation from general practitioner's view

The innovation fund project DemStepCare aimed to optimize multi-professional care through case management, risk stratification, and crisis outpatient clinic. Here, the evaluation results from the perspective of the general practitioners are presented. A quantitative survey was carried out at three time points regarding acceptance, benefit assessment and sensitivity to dementia of the general practitioners. In addition, qualitative interviews were conducted. Satisfaction with the overall project was high. Added value and relief factors were perceived and more effective and stable dementia care was achieved through collaboration with case management. Physicians reported increased subjective competence in diagnostics and disease management. The results confirm the benefit and effectiveness of DemStepCare from general practitioner's perspective.

The territorial nature of the Primary Health Care of Brazil's Unified Health System (SUS): the proliferation of community medical clinics in the Metropolitan Region of Belém, State of Pará, Brazil

The scope of this article is an analysis of the proliferation of community medical clinics in the municipalities that comprise the Metropolitan Region of Belem. An investigation was conducted into the performance of the primary health care network of Brazil's Unified Health System, with a view to getting a better understanding of the reasons for, and origins of, the proactive stance of the community health sector. The discussion is based on the review of primary and secondary data, obtained via fieldwork in 119 community clinics in the Metropolitan Region of Belem, and information from Brazil's Unified Health System data center. It was revealed that the community health clinic sector has benefited extensively in recent years from the intensification of underfunding of Brazil's Unified Health System, especially the primary health care network, which is undergoing a process of fragmentation. This is directly responsible for the reduction and disruption of multiprofessional primary health care teams, in addition to the losses suffered in the supplementary health sector. The community clinics adopt an spontaneous and contradictory care model created by the private sector to meet the repressed demand of Brazil's Unified Health System.

Therapeutic healthcare professional staffing requirements in intensive care units

Therapeutic healthcare professionals in the multiprofessional intensive care unit (ICU) team are important for early mobilization, dysphagia therapy, and psychosocial care of critically ill patients. Despite the high relevance of therapeutic healthcare professions for care in ICUs, there are no recommendations on the specific staffing of therapists in ICUs. Considering the main areas of activity of the individual professional groups and based on productivity time, arequirements analysis for staffing ICUs of different care levels with physiotherapists, occupational therapists, speech therapists, and psychologists was performed. For every 10beds in the highest care level (LoC3), 1.28full-time equivalent (FTE) physiotherapists, 0.91FTE occupational therapists and speech therapists, and 0.80FTE psychologists should be employed. In order to implement multiprofessional patient treatment and support for relatives in the ICU, it is essential to employ aproportionate number of therapeutic healthcare professionals.

Role and relevance of dentists in a multiprofessional palliative care team: results of a cross-sectional survey study

PurposeDespite the multiprofessional concept surrounding palliative care patients (PCPs) and their high prevalence of oral issues, licensed dentists (LDs) are often not included in their treatment team. This study aimed to examine the current state of cooperation and to determine whether and how LDs should be included in the care for PCPs.MethodsThis single-centre cross-sectional study was conducted at the University Hospital Muenster, Germany. We surveyed three participant groups: PCPs, LDs, and healthcare professionals (HCPs). Questionnaires were tailored for each group, with some questions common for comparison.ResultsThe study encompassed the results of 48 questionnaires from LDs, 50 from PCPs along with 50 from HCPs. Consensus was reached among all parties (LDs: 73% (n = 35/48); HCPs: 94%, n = 47/50; PCPs: 60%, n = 30/50) that involving LDs in the treatment concept is favourable. On the other hand, a significant discrepancy emerged in the perception of the dental treatment effort required by PCPs. While LDs (81%; n = 39/48) and HCPs (64%; n = 32/50) were convinced of increased effort, PCPs (34%; n = 17/50) largely did not share this perspective. To enhance patient care and formulate appropriate treatment plans, LDs consider both training (58%; n = 28/48) and guidebooks (71%; n = 34/48) to be valuable and would attend or use such resources.ConclusionThis study sheds light on the current gaps in including LDs in palliative care teams and emphasizes the importance of multidisciplinary collaboration to address oral health needs effectively. Development of continuing education options and collaborative models between LDs and HCPs needs to be further expanded in future.

The multi-professional health care practice in the primary care setting. Expectations of healthcare users and future general practitioners

Introduction. L’augmentation de la prévalence des maladies chroniques et la diminution du nombre de médecins généralistes constituent de nouveaux enjeux pour les soins primaires. Les maisons de santé pluriprofessionnelles (MSP) semblent être une des réponses adaptées à ces enjeux. Objectif. Explorer les attentes des usagers du système de santé et celles des étudiants de 3e cycle (E3C) de médecine générale concernant la création d’une MSP. Méthode. Étude qualitative. Des entretiens individuels et collectifs ont été menés auprès d’usagers du système de santé de Pélussin et des E3C de médecine générale de Saint-Étienne, entre 2019 et 2021. Une analyse thématique réflexive a été menée jusqu’à suffisance théorique des données. Résultats. Huit usagers et douze étudiants ont participé aux entretiens. La MSP attendue était décrite comme un regroupement de professionnels de santé autour du médecin généraliste, sur un site unique et accessible. La création d’une MSP nécessitait un investissement humain qui pouvait être délégué à une tierce personne et un investissement financier avec une participation de la municipalité. Elle permettait d’organiser les soins et était un lieu d’échanges qui laissait place au relationnel entre usagers et professionnels et entre professionnels. La coordination et la continuité des soins proposées intégraient les étudiants pour une pratique plus réflexive. Les attentes semblaient divergentes quant à la présence des spécialistes non-médecins généralistes : cardiologues pour les étudiants et ophtalmologues pour les usagers. Une divergence a été constatée concernant les horaires d’ouverture, avec une amplitude d’ouverture plus courte pour les usagers. Conclusion. La MSP s’inscrit dans le paysage de soins primaires, alliant des conditions de travail optimales pour les professionnels et une amélioration des soins.

Communication in the ICU: An Unintended Nocebo Effect?

To identify medical phrases utilized by the critical care team that may have an unintended impact on the critically ill patient, we administered an anonymous survey to multi-professional critical care team members. We elicited examples of imprecise language that may have a negative emotional impact on the critically ill. Of the 1600 providers surveyed, 265 offered 1379 examples (912 unique) which were clustered into 5 categories. Medical jargon (eg, "riding the vent") was most prevalent (n = 549). There were 217 negative suggestions (eg, "you will feel a stick and a burn"). Hyperboles (eg, "black cloud") were common (n = 198) while homonyms (ie "he fibbed") accounted for 150 examples. Phrases such as "code brown in there" were categorized as metonyms (n = 144). 121 metaphors/similes (eg, "rearranging deck chairs on the Titanic") were provided. Phrases that have the potential to negatively impact critically ill patient perceptions are commonplace in critical care practice. Whether these everyday communication habits lead to an unintended nocebo effect on mental health outcomes of the critically ill deserves further study.

An IT-supported multidimensional approach for frailty screening in community-dwelling older adults

Introduction: Frailty in older adults is characterised by a dynamic state of vulnerability with weakness and reduced physiological reserve leading to an increased risk of worsening in quality of life, falls, institutionalisation, disability and death [1]. The COVID-19 pandemic is an example of how an infectious hit can determine an increased mortality especially among older and vulnerable population subgroups [2], as well as a deterioration in their quality of life due to loneliness and limited access to health and social services. Frailty syndrome is a complex interplay between several factors, including, but not limited to, natural physiological changes in ageing, multi-morbidities, malnutrition, living environment, genetics and lifestyle [3]. Early screening for frailty risk factors in the community-dwelling older adult population allows preventive interventions on the clinical and social determinants of frailty, avoiding adverse events and contributing to improve the resilience of health care systems.&#x0D; Method: Programma Mattone Internazionale Salute (ProMIS), the Italian Ministry of Health's programme for innovation of regional health systems [4], built up a working group (WG) on Frailty, including doctors, nurses, home care professionals, physiotherapists, pharmacists, psychologists, dieticians, social workers, physical trainers and policy makers, to develop a proactive and integrated approach to detect frailty and its risk factors in community-dwelling older adult population.&#x0D; Results: The participatory activity of ProMIS’ WG led to the identification of an integrated approach aimed to connect the SUNFRAIL tool for the early identification of frailty in the over-65 population [5] to other in-depth scales for the assessment of specific dimensions of frailty, guiding subsequent diagnostic assessments for health promotion, disease prevention and intervention. An IT tool was developed for data collection, SUNFRAIL+, which includes, in addition to SUNFRAIL tools, the validated scales for screening the nine domains of frailty, which automatically generates alerts, thanks to which targeted interventions will be activated in the compromised domains. A national multi-centre observational study protocol has been designed to validate the approach by assessing the impact of early, integrated, and multi-professional care on the quality of life of the community-dwelling older adult population and the professional’s satisfaction.&#x0D; Conclusion and discussion: The study design builds on the tool developed by the SUNFRAIL EU project [6], and provides the background for bridging multidimensional interventions to prevent frailty and mitigate its consequences on quality of life and functional ability in community-dwelling older adults, exploiting available services in the different health care services. The study will also provide the information needed to design a logical model integrating coherent interventions in the framework of specific frailty domains.

Changing landscapes: helping caregivers, an experience from Tuscany.

Introduction: While multi-professional care interventions are guaranteed through an integrated care model, sometimes there is no possibility to support full-time assisting patients’ families in terms of allowing them the time for their life and home management activities. The role of the caregiver is essential throughout the day to address the patient’s needs: in this way, an appropriate level of well-being can be assured to who is undergoing the last stages of illness. The growing need for forms of support caregivers who assist those patients at home, generated a reflection by the family and community nurses operating in the territory of Pistoia, Tuscany. &#x0D; Targeted population and stakeholders: Caregivers and families that care for under 63 patients in the end-stages of disease. &#x0D; Timeline: The project started in 2022 and will not be interrupted. &#x0D; Highlights: The patient may be untreatable, but never incurable: the healthcare professionals take care of the person and until the end. This resolution gave rise to the idea of a project called "Quick Assistance”, aimed at expanding the available services at the local level. It provides a package of 20 hours of a healthcare assistant presence at home to be used by the families needing them and provided by private firms. The activation of the service is guaranteed by the professionals’ network that revolves around the patient (Family and Community Nurses, GPs), that can identify a manifest, latent or unexpressed need and provide the appropriate response. The project is supported by the Società della Salute Pistoiese, a public entity constituted by Municipalities and the Local Health Autority for the associated exercise of territorial, socio-sanitary, and social activities. Where needs arise, care must be available to the patient and to the caregivers. This is the way in which the Tuscan NHS engages with the population, that is implementing the concept of integrated care at the microlevel, with the goal of enabling the extended concept of “patient” (patients and caregivers) to be at the centre of the care coordination. In other words, the system is adapting to the real needs expressed by the population, filling “unintentional gaps” that derive from an ongoing population knowledge process: through a participatory approach, solutions are shaped. This was the case of a 63-year-old patient in the last stages of illness that couldn’t benefit from the services offered by the system being him under 65, age above which the NHS provides for a very wide range of services, designed for elderly and fragile people. &#x0D; Conclusions: The project aims to provide support to families in the surveillance and assistance of the patient. “Quick Assistance” strengthens the implementation of care provision at home and is effective in reducing the caregiver burden to prevent a more serious condition, as the caregiver’s burnout. The latter becomes more frequent in modern societies: that is due to changing cultural and social characteristics that have delegated the function of proximity and presence to external subjects.

The Tyrolean Federal Institute for Integrated Care (LIV Tyrol)

A constantly increasing life expectancy of society leads to an increase in severe chronic diseases, which are accompanied by negative effects on the quality of life for patients and an increasing number of hospital admissions as well as long hospital stays. This poses major challenges for the healthcare system and requires innovative and integrated approaches in order to provide high quality healthcare.&#x0D; Therefore, the Tyrolean Federal Institute for Integrated Care (LIV Tyrol) was founded from a joint initiative of the federal state government of the Province of Tyrol and the social insurance institutions to target the above mentioned challenges and reduce burdens for the health care system by developing and implementing integrated care approaches and programs for different chronic diseases. Integrated care is understood to be patient-oriented, continuous, cross-sectoral, interdisciplinary and/or multiprofessional care based on standardized care concepts.&#x0D; LIV Tyrol aims for optimal care for patients – especially patients suffering from chronic diseases – at their homes in order to increase their quality of life on the one hand and, on the other hand, to relieve the healthcare system through innovative approaches. As a result, different disease management programs are developed, implemented, coordinated, operated and evaluated.&#x0D; They include disease management programs for patients with heart failure (HerzMobil Tirol), dementia (Demenz Tirol), patients who suffered a stroke (Schlaganfallpfad Tirol) or in need of palliative care (Hospiz- und Palliativversorgung). LIV Tyrol also coordinates the care management for the Province of Tyrol, Austria and the post-Covid care. Some of these programs are supported by telemedical solutions including telemonitoring systems to provide a secure framework for patient care outside the hospital and to allow for immediate measures when needed. Furthermore, different registries, such as the Austrian birth registry, the Tyrolean cancer registry, the Tyrolean arthroplasty registry, or the Tyrolean diabetes registry are located and operated at the Institute of Clinical Epidemiology, which is part of LIV Tyrol. LIV Tyrol also supports data management and analytics for (clinical) problems but also provides an important contribution to quality assurance within the Tyrolean healthcare system.&#x0D; In order to implement such disease management programs, a close collaboration of different stakeholders is needed. Stakeholders of LIV Tyrol include but are not limited to health-policy makers, social insurance institutions, healthcare providers (hospitals, resident practitioners, other health-related professions), research institutions, and patients. &#x0D; An institution like LIV Tyrol is unique in the Austrian health care system and contributes to optimal care security for patients in Tyrol and poses hub for new, innovative and flexible integrated care models.&#x0D; To make the health care system fit for the future, the federal and state governments have agreed to expand integrated care. The federal government of Tyrol has therefore commissioned the Tyrolean Federal Institute for Integrated Care to implement these targets and to design, organize and coordinate integrated care initiatives throughout the province of Tyrol.&#x0D;