Barriers and Facilitators to integrate Oral Health care for Older Adults in General (Basic) Care in East Netherlands. Part 2 Functional Integration.

OBJECTIVE: to synthesise a framework of barriers and facilitators in the functional integration of oral health care (OHC) into general health care for frail older adults at macro (system), meso (organisation and interprofessional integration) and micro (clinical practice) levels. BACKGROUND: Identification of these barriers and facilitators is expected to promote better and more appropriate care. METHODS: For this qualitative study, comprising 41 participants, representatives of 10 different groups of (professional) care providers, and OHC receivers (home-dwelling and nursing-home patients) were interviewed. Transcripts of the in-depth, topic-guided interviews were thematically analysed. In a subsequent workshop with 52 stakeholders, results and interpretations were discussed and refined. RESULTS: Two themes were identified: (1) compartmentalised care systems and (2) poor interprofessional and communication infrastructure. Barriers related to (1) included lack of integrative policies and compartmentalised healthcare education (macro level); poor embedding of OHC in care procedures, instruments and guidelines (meso level); and poor interprofessional skills (micro level). Barriers related to (2) included poor financial incentives for collaborative practices (macro level) and badly connected ICT systems (meso level). Identified facilitators included integration of an OHC professional into care teams, and interdisciplinary consultations (meso level); and integration of OHC in individual care plans (micro level). CONCLUSION: In The Netherlands, OHC for older people is at best poorly integrated into general care practices. Barriers and facilitators are interconnected across macro-, meso- and micro levels and between normative and functional domains and are mainly related to compartmentalisation at all levels and to poor interprofessional and communication infrastructure.

[What promotes and hinders integration of oral care in general care? Part 1. Vision, attitude and culture]. / Wat bevordert en belemmert integratie van mondzorg in de algemene zorg? Deel 1. Visie, houding en cultuur.

To identify facilitators and barriers to integrate oral health care into general healthcare for frail elderly, 41 participants from 10 different groups of (professional) caregivers and care-recipients (residents living at home and nursing home patients) in the east of the Netherlands were interviewed. They were asked about normative integration (vision, attitude, culture) at the macro (system), meso (organizational and interprofessional), and micro (patient care) level. After thematic analysis of the interviews, the results were refined on the basis of a workshop with 52 stakeholders. Subsequently, two main themes were identified: 1. a compartmentalized care culture in which oral healthcare and general healthcare are seen as two separate domains; 2. prioritization, awareness, and attitude towards oral healthcare integration. Barriers to integration are: low political attention (macro level); unclear responsibilities, hierarchical relationships, and lack of vision (meso level); poor awareness and low prioritization by healthcare providers and patients (micro level). Leadership (meso level), a supportive personality of individual caregivers, and ownership of patients (micro level) promote integration.

[What promotes and hinders integration of oral care in general care? Part 2. Policy, organization, implementation]. / Wat bevordert en belemmert integratie van mondzorg in de algemene zorg? Deel 2. Beleid, organisatie, uitvoering.

To identify facilitators and barriers to integrate oral healthcare into general healthcare for frail elderly, 41 participants from 10 different groups of (professional) caregivers and recipients (residents living at home and nursing home patients) in the east of the Netherlands were interviewed. They were asked about functional integration at the macro (system), meso (organizational and interprofessional) and micro (patient care) level. After thematic analysis of the interviews, the results were refined on the basis of a workshop with 52 stakeholders. Subsequently, two main themes for functional factors were identified: 1. compartmentalized care systems and 2. deficient interprofessional and communication infrastructure. Barriers to integration are lack of integrative policies, compartmentalized education (macro level), poor embedding of oral healthcare in healthcare procedures and diagnostic tools, poor communication systems (meso level) and poor interprofessional skills (micro level). The integration of oral healthcare providers in care teams, agenda-setting during interdisciplinary consultations (meso level) and integration of oral care and care in individual care plans (micro level) promote integration. Oral healthcare for the elderly is poorly integrated in general care in the Netherlands.

[Oral healthcare for frail and care-dependent older people in Germany and the Netherlands]. / Mondzorg voor kwetsbare en zorgafhankelijke ouderen in Duitsland en Nederland.

To improve oral health for frail and care-dependent older people, both intra- and extramurally, in the Euregio Rhine-Waal area in the Netherlands and Germany, we inventoried barriers to oral care for the target group according to the literature, the organisation of oral care in both countries and the implications of this organisation for daily and professional (oral) healthcare and oral care. Results show most identified barriers are common to both countries, but the organisation of oral healthcare differs in both countries. The main differences lie in the financing and organisation of oral care in the intramural situation. In the Netherlands, this is to a large degree regulated and organised on the basis of the Chronic Care Act (Wlz), using the Verenso Oral Care Directive for care-dependent clients as a base for enforcement. In Germany, on the other hand, the provision of oral care in the home situation is more effectively facilitated. In both countries, various initiatives have recently been employed to improve, among other things, information supply, education and financing of oral healthcare.

[Development, Application and Evaluation of a Concept for Safe Patient Identification in Hospital - How can Knowledge Transfer Succeed?] / Entwicklung, Anwendung und Evaluation eines Konzeptes zur sicheren Patientenidentifikation im Krankenhaus ­ Wie kann der Wissenstransfer gelingen?

Aim of the Study: In order to minimise the risk of patient misidentification in clinical settings, the German Coalition for Patient Safety published recommendations for safety patient identification in 2008. The aim of this study was to develop, implement and evaluate a theoretical framework of knowledge transfer. The purpose of the framework was to enhance hospital staff's ability to apply the recommendations for safe patient identification in the daily routine of patient care. Method: A data bank-based research and literature review have been conducted. Research topics were: knowledge transfer, change management and implementation science. Within the application of the concept group interviews were held with hospital staff and the interview material was evaluated using content analysis. On this basis a tailored multifaceted implementation strategy has been developed and applied in 8 hospital wards of 4 hospitals belonging to a communal hospital concern. The evaluation of the developed knowledge transfer concept was conducted 4 weeks after the concept application with a written questionnaire. Results: The developed framework concept of knowledge translation consisted of 4 phases built on top of each other: initiation phase; analysis phase; implementation phase; evaluation phase. The multifaceted implementation strategy included 3 interventions: a poster, a computer-based training and a guideline for team meetings. The survey yielded responses from 56 individuals: 96% declared that they know about the existence of the recommendations for safe patient identification; 86% said that they know about the content of the recommendations; 91% have striven to apply the recommendations in the daily routine of patient care; 71% stated that the recommendations for safe patient identification have become integral part in the daily routine of patient care. To become aware of the recommendations and its content the respondents have used on average 2.3 interventions, however the effect of the CBS was relatively small. Conclusion: The developed theoretical framework concept for knowledge transfer provides a way to integrate the recommendations for safe patient identification in the daily routine of patient care and to counteract risk factors promoting misidentification. Therefore a multifaceted implementation strategy is promising.

[Aging Brain Care Program from Indianapolis: Transferability to the German healthcare system]. / "Aging Brain Care Program" aus Indianapolis: Übertragbarkeit auf den deutschen Versorgungskontext.

BACKGROUND: New and innovative concepts of care management have been developed to improve the health of older adults with dementia and depression. AIM: This article describes the American aging brain care (ABC) program and the possible transfer to the German healthcare system is discussed. MATERIAL AND METHODS: The ABC medical home model in Indianapolis incorporates a specialized geriatric healthcare center which is affiliated to the Eskenazi Hospital as well as a program involving home-based domestic visits by healthcare personnel to affected people. The diagnoses are made in the geriatric center where therapy and treatment are also planned. These stages are carried out in a multiprofessional team, which identifies the individual needs of the patients and relatives and discusses these in family conferences as well as in close consultation with the primary care center of the hospital. The care, diagnosis and therapy are coordinated using a self-developed software for the program and via predetermined pathways and procedural instructions on the approach in the healthcare center and in the domestic visit program. RESULTS AND CONCLUSION: From the perspective of the authors the core elements of the program include not only the use of a home-based care model but also the selection and training of a new type of front-line care provider. Models like the program presented here show great promise for meeting the demands of a rapidly expanding population of vulnerable older adults.

["Retirement at 67": prerequisites for the ability of older female jobholders to continue working]. / "Rente mit 67" : Voraussetzungen für die Weiterarbeitsfähigkeit älterer Arbeitnehmerinnen.

The new Retirement Age Adjustment Act, enacted by the Federal Government in spring 2007 to raise the statutory retirement age to 67 years in Germany, poses a challenge for the jobholders concerned as well as for the companies. Especially older female jobholders are exposed to particular risks regarding their ability to continue working due to the cumulative concurrence of age-specific but also additional gender-specific employment patterns and risks. Their employment situation is influenced by age discrimination in terms of recruitment and human resource management. Furthermore, women were and are confronted with specific obstacles in the course of their working lives, such as, the problem of reconciling work and family life and care giving, lesser opportunities for development and advancement due to sectoral and work organizational circumstances and lower incomes. There has been an increase in part-time arrangements, marginal employment, and temporary jobs, which are all predominantly filled by women. If women do not manage to stay in gainful employment, they do not only individually face an insufficient old-age income but the national economy is also in danger of losing valuable human resources and social security contributions.