Task redistribution from general practitioners to nurses in acute infection care: A prospective cohort study.

AIM: To examine the impact of implementing nurse-led consultations compared to physician-led consultations on the frequency of follow-up contacts within 14 days following an acute infectious consultation. DESIGN: Monocentric, prospective cohort study. METHODS: The study was conducted in a multidisciplinary, capitation-based general practice in Belgium. Through analysis of patient files, the number of follow-up contacts within 14 days after an infection consultation was investigated to determine any difference between physician-led or nurse-led consultations. Secondary outcomes included pharmacological interventions and the prescribing behaviour of medical leave certificates. RESULTS: A total of 352 consultations were analysed, of which 174 conducted by physicians and 178 by nurses. No significant difference was found in the number of follow-up contacts. However, the probability of a pharmacological intervention by a physician was revealed to be significantly higher. The presence or absence of such pharmacological intervention did not significantly influence the number of follow-up contacts. CONCLUSION: This study demonstrates that nurses can be safely and efficiently utilized in acute infection care within a general practice setting. Although these results are promising, more extensive research is needed which incorporates the experiences of patients and healthcare providers. Furthermore, it is advisable to consider the experience and education of the nurses and incorporate them into the analyses. IMPACT: This study addressed the high workload on general practitioners by researching a task shift in the acute infectious, primary health care. The results demonstrate the feasibility of this task shift, which may have an impact on primary health care professionals (whose workload may be reorganized), as well as on patients for whom primary care may become more accessible. PATIENT OR PUBLIC CONTRIBUTION: This study includes direct patient data from people who presented themselves with acute infectious complaints in a primary healthcare practice.

Managing uncertainty in forecasting health workforce demand using the Robust Workforce Planning Framework: the example of midwives in Belgium.

BACKGROUND: In Belgium, the Planning Commission for Medical Supply is responsible for monitoring human resources for health (HRH) and ultimately proposing workforce quotas. It is supported by the Planning Unit for the Supply of the Health Professions. This Unit quantifies and forecasts the workforce in the healthcare professions on the basis of a stock and flow model, based on trends observed in the past. In 2019, the Planning Unit asked the KCE (Belgian Health Care Knowledge Centre) to develop additional forecasting scenarios for the midwifery workforce, to complement the standard historical trend approach. The aim of this paper is to present the development of such forecasting scenarios. METHODS: The Robust Workforce Planning Framework, developed by the Centre for Workforce Intelligence in the UK was used to develop alternative midwifery workforce scenarios. The framework consists of four steps (Horizon scanning, Scenario generation, Workforce modelling, and Policy analysis), the first two of which were undertaken by KCE, using two online surveys and five workshops with stakeholders. RESULTS: Three alternative scenarios are proposed. The first scenario (close to the current situation) envisages pregnancy and maternity care centred on gynaecologists working either in a hospital or in private practice. The second scenario describes an organisation of midwife-led care in hospitals. In the third scenario, care is primarily organised by primary care practitioners (midwives and general practitioners) in outpatient settings. CONCLUSIONS: The Robust Workforce Planning Framework provides an opportunity to adjust the modelling of the health workforce and inform decision-makers about the impact of their future decisions on the health workforce.

[Some aspects of ensuring patients' rights and accessibility of medical care in Austria, Belgium, Germany and Estonia].

The article devoted to ensuring the rights of patients and the availability of medical care in Austria, Belgium, Germany and Estonia notes the experience of creating an institute of independent ombudsmen who plays an important role in this issue. Basically, in these countries, the choice of a medical organization and a doctor is possible, and in Belgium the right to choose an insurance organization is granted. Patients in these countries are given the right to control the process of providing them with medical care, including its payment and joint decision-making with the doctor on treatment tactics. The State also ensures the patient's right to receive preventive and restorative services provided to children free of charge, and compensated for adults in 80% of cases. It is impossible not to recognize the high percentage of citizens of these countries, reaching 98%, satisfied with the medical services provided to them. However, in some countries there is an imbalance in the availability of medical care, which is expressed by high availability of family doctor services and low availability of specialist services, as in Estonia. Nevertheless, this does not cause an increase in the level of corruption in the medical spheres of these countries, which is below the European average. According to the totality of indicators of the availability of medical care, Germany is the leader among the analyzed countries.

Towards a standardized approach of assessing social context of persons receiving home care in Flanders, Belgium: the development and test of a social supplement to the interRAI instruments.

BACKGROUND: Apart from a person's physical functioning, the early identification of social context indicators which affect patient outcomes - such as environmental and psychosocial issues - is key for high quality and comprehensive care at home. During a home care assessment, a person's biomedical and functional problems are typically considered. Harder to define concepts, such as psychosocial well-being or living arrangements, are not routinely documented, even though research shows they also affect functioning and health outcomes. The purpose of this study is to develop and test a concise, integrated assessment (BelRAI Social Supplement) that evaluates these social context indicators for persons receiving home care to complement existing interRAI- instruments. METHODS: The development of the BelRAI Social Supplement is a multi-stage process, based upon the revised MRC-framework, involving both qualitative and quantitative research with stakeholders such as; clients, informal caregivers, care professionals and policy makers. The developmental process encompasses four stages: (I) item generation based on multiple methods and content validation by a panel of stakeholders (II) assessing feasibility and piloting methods, (III) early evaluation, and (IV) final evaluation. Stage II and III are covered in this paper. RESULTS: During Stages I and II, a testable version of the BelRAI Social Supplement was developed in an iterative process. In Stage III, 100 care professionals assessed 743 individuals receiving home care in Flanders between December 2018 and December 2019. Using inter-item correlation matrixes, frequency distributions and regular feedback from the participants, the BelRAI Social Supplement was improved and prepared for Stage IV. The updated version of the instrument consists of four main sections: (1) environmental assessment; (2) civic engagement; (3) psychosocial well-being; and (4) informal care and support. In total, the BelRAI Social Supplement contains a maximum of 76 items. CONCLUSIONS: The BelRAI Social Supplement was reviewed and shortened in close collaboration with care professionals and other experts in Flanders. This study resulted in an instrument that documents need-to-know social context determinants of home dwelling adults.

Health workforce development and retention in Guinea: a policy analysis post-Ebola.

BACKGROUND: The state of the Guinean health workforce is one of the country's bottlenecks in advancing health outcomes. The impact of the 2014-2015 Ebola virus disease outbreak and resulting international attention has provided a policy window to invest in the workforce and reform the health system. This research constitutes a baseline study on the health workforce situation, professional education, and retention policies in Guinea. The study was conducted to inform capacity development as part of a scientific collaboration between Belgian and Guinean health institutes aiming to strengthen public health systems and health workforce development. It provides initial recommendations to the Guinean government and key actors. METHODOLOGY: The conceptual framework for this study is inspired by Gilson and Walt's health policy triangle. The research consists of a mixed-methods approach with documents and data collected at the national, regional, and district levels between October 2016 and March 2017. Interviews were conducted with 57 resource persons from the Ministry of Health, other ministries, district health authorities, health centers and hospitals, health training institutions, health workers, community leaders, NGO representatives, and development partners. Quantitative data included figures obtained from seven health professionals' schools in each administrative region of Guinea. A quantitative analysis was conducted to determine the professional graduate trends by year and type of personnel. This provided for a picture of the pool of professional graduates available in the regions in relation to the actual employment possibilities in rural areas. The districts of Forecariah and Yomou were chosen as the main study sites. RESULTS: Limited recruitment and a relative overproduction of medical doctors and nurse assistants have led to unemployment of health personnel. There was a mismatch between the number of civil servants administratively deployed and those actually present at their health posts. Participants argued for decentralization of health workforce management and financing. Collaboration between government actors and development partners is required to anticipate problems with the policy implementation of new health workers' deployment in rural areas. Further privatization of health education has to meet health needs and labor market dynamics.

The views of migrant health workers living in Austria and Belgium on return migration to sub-Saharan Africa.

BACKGROUND: The negative consequences of the brain drain of sub-Saharan African health workers for source countries are well documented and include understaffed facilities, decreased standards of care and higher workloads. However, studies suggest that, if migrated health workers eventually return to their home countries, this may lead to beneficial effects following the transfer of their acquired skills and knowledge (brain gain). The present study aims to explore the factors influencing the intentions for return migration of sub-Saharan African health workers who emigrated to Austria and Belgium, and gain further insight into the potential of circular migration. METHODS: Semi-structured interviews with 27 sub-Saharan African health workers in Belgium and Austria were conducted. RESULTS: As mentioned by the respondents, the main barriers for returning were family, structural crises in the source country, and insecurity. These barriers overrule the perceived drivers, which were nearly all pull factors and emotion driven. Despite the fact that only a minority plans to return permanently, many wish to return regularly to work in the healthcare sector or to contribute to the development of their source country. CONCLUSION: As long as safety and structural stability cannot be guaranteed in source countries, the number of return migrants is likely to remain low. National governments and regional organizations could play a role in facilitating the engagement of migrant health workers in the development of the healthcare system in source countries.

Sergey Sukhanov, a Russian Physician in Professor Arthur Van Gehuchten's Lab - Based on Original 19th Century Documents.

In 1898, Russian physician Sergey Alexeevich Sukhanov (1867-1915) spent a 3-month traineeship in Professor Arthur Van Gehuchten's anatomy laboratory in Louvain (Belgium). A folder containing 17 handwritten documents in Russian was recently discovered in the archives of the Museum of the History of Medicine, First Moscow State Medical University. The letters give a lively account of Sukhanov's everyday observations, experiences and opinions while he was in Van Gehuchten's lab. We took a selection of these notes and put them into medical and historical context.

Content validity of workplace-based portfolios: A multi-centre study.

BACKGROUND: Portfolios are used as tools to coach and assess students in the workplace. This study sought to evaluate the content validity of portfolios as reflected in their capacity to adequately assess achieved competences of medical students during clerkships. METHODS: We reviewed 120 workplace portfolios at three medical universities (Belgium and the Netherlands). To validate their content, we developed a Validity Inventory for Portfolio Assessment (VIPA) based on the CanMEDS roles. Two raters evaluated each portfolio and indicated for each VIPA item whether the portfolio provided sufficient information to enable satisfactory assessment of the item. We ran a descriptive analysis on the validation data and computed Cohen's Kappa to investigate interrater agreement. RESULTS: The portfolios adequately covered the items pertaining to the communicator (90%) and professional (87%) roles. Coverage of the medical expert, collaborator, scholar and manager roles ranged between 75% and 85%. The health advocate role, covering 59%, was clearly less well represented. This role also exhibited little interrater agreement (Kappa < 0.4). CONCLUSIONS: This study lends further credence to the evidence that portfolios can indeed adequately assess the different CanMEDS roles during clerkships, the health advocate role, which was less well represented in the portfolio content, excepted.

The impact of professional and organizational identification on the relationship between hospital-physician exchange and customer-oriented behaviour of physicians.

BACKGROUND: Hospitals face increasingly competitive market conditions. In this challenging environment, hospitals have been struggling to build high-quality hospital-physician relationships. In the literature, two types of managerial strategies for optimizing relationships have been identified. The first focuses on optimizing the economic relationship; the second focuses on the noneconomic dimension and emphasizes the cooperative structure and collaborative nature of the hospital-physician relationship. We investigate potential spillover effects between the perceptions of physicians of organizational exchange and their customer-oriented behaviors. METHODS: A cross-sectional study was conducted on 130 self-employed physicians practicing at six Belgian hospitals. Economic exchange was measured using the concept of distributive justice (DJ); noneconomic exchange was measured by the concept of perceived organizational support (POS). Our outcomes consist of three types of customer-oriented behaviours: internal influence (II), external representation (ER), and service delivery (SD). RESULTS: Our results show a positive relationship between DJ and II (adjusted R(2) = 0.038, t = 2.35; p = 0.028) and ER (adjusted R(2) = 0.15, t = 4.59; p < 0.001) and a positive relationship between POS and II (adjusted R(2) = 0.032, t = 2.26; p = 0.026) and ER (adjusted R(2) = 0.22, t = 5.81; p < 0.001). No relationship was present between DJ (p = 0.54) or POS (p = 0.57) and SD. Organizational identification positively moderates the relationship between POS and ER (p = 0.045) and between DJ and ER (p = 0.056). The relationships between POS and II (p = 0.54) and between DJ and II (p = 0.99) were not moderated by OI. Professional identification did not moderate the studied relationships. CONCLUSION: Our results demonstrate that both perceptions of economic and noneconomic exchange are important to self-employed physicians' customer-oriented behaviours. Fostering organizational identification could enhance this reciprocity dynamic.

[The former medical faculty of Reims, famous place of medical training for students of Liège and the region of Liège]. / L'ancienne faculté de médecine de Reims, lieu de formation médicale réputé pour les étudiants de Liège et du pays de Liège.

The author, taking advantage of this meeting between the French Society of Medicine and the Centre for the history of Science and Technology in the city of Liège, provides us with a rectified list of all the Doctors in Medicine in Liège and its province who were promoted to the former Faculty of Medicine in Reims. New controls have been made thanks to the contribution of two registration books which give previous education establishments for the medical doctorate. This research has also been checked on the list established in the masterful work written by Marcel Florkin et Jean Kelecom, namely Kelecom Le monde médical liégeois avant la Révolution (Liège Medical World before the French Revolution).

Combining the Nurse Intuition Patient Deterioration Scale with the National Early Warning Score provides more Net Benefit in predicting serious adverse events: A prospective cohort study in medical, surgical, and geriatric wards.

OBJECTIVES: This prospective cohort study aimed to assess the predictive value of the Nurse Intuition Patient Deterioration Scale (NIPDS) combined with the National Early Warning Score (NEWS) for identifying serious adverse events in patients admitted to diverse hospital wards. RESEARCH METHODOLOGY/DESIGN: Data was collected between December 2020 and February 2021 in a 350-bed acute hospital near Brussels, Belgium. The study followed a prospective cohort design, employing NIPDS alongside NEWS for risk assessment. Patients were monitored for 24 h post-registration, with outcomes recorded. SETTING: The study was conducted in a hospital with a Rapid Response System (RRS) and electronic patient record wherein NEWS was routinely collected. Patients admitted to two medical, two surgical, and two geriatric wards were included. MAIN OUTCOME MEASURES: The primary outcome included death, urgent code calls, or unplanned ICU transfers within 24 h after NIPDS registration. The secondary outcome comprised rapid response team activations or changes in Do-Not-Resuscitate codes. RESULTS: In a cohort of 313 patients, 10/313 and 31/313 patients reached the primary and secondary outcome respectively. For the primary outcome, NIPDS had a sensitivity of 0.900 and specificity of 0.927, while NEWS had a sensitivity of 0.300 and specificity of 0.974. Decision Curve Analysis demonstrated that NIPDS provided more Net Benefit across various Threshold Probabilities. Combining NIPDS and NEWS showed potential for optimizing rapid response systems. Especially in resource-constrained settings, NIPDS could be used as a calling criterion. CONCLUSION: The NIPDS displayed strong predictive capabilities for adverse events. Integrating NIPDS into existing rapid response systems can objectify nurse intuition, enhancing patient safety. IMPLICATIONS FOR CLINICAL PRACTICE: The Nurse Intuition Patient Deterioration Scale (NIPDS) is a valuable tool for detecting patient deterioration. Implementing NIPDS alongside traditional scores such as NEWS can improve patient care and safety. The optimal NIPDS threshold to activate rapid response is ≥5.

The self-construal of nurses and doctors: beliefs on interdependence and independence in the care of older people.

AIM: To compare the self-construal of nurses and doctors and establish whether their roles affect perceptions of independence and interdependence. BACKGROUND: Previous research has identified that errors in patient care occur when health professionals do not work cohesively as a team and have divergent beliefs about collaboration. Thus, it is important to understand factors shaping these beliefs. Although these are usually explained by aspects of group norms, the concept of self-construal may serve as an underlying explanation. DESIGN: A quasi-experimental design was used. PARTICIPANTS: One hundred and two nurses and doctors working in three nursing homes in Belgium took part in this study in 2009. METHODS: Nurses' and doctors' self-construal was measured at their workplace, using Singelis' self-construal scale. Statistical differences between nurses and doctors were investigated using analysis of covariance. RESULTS: Results showed statistically significant differences between doctors' and nurses' self-construal. Doctors reported higher and dominant levels of 'independent self-construal' compared with nurses. There were no differences between nurses and doctors for interdependence. However, gender differences emerged with male doctors reporting lower levels of interdependent self-construal than male nurses. Conversely, female doctors reported higher levels of interdependent self-construal than female nurses. CONCLUSIONS: Differences in the roles and training of nurses and doctors and in knowledge of their interdependencies may explain differences in self-construal. This might be useful for understanding why nurses and doctors develop divergent attitudes towards teamwork. Training that focuses on sharing knowledge on team interdependencies may positively influence teamwork attitudes and behaviour.

Intercultural Competence Predicts Intercultural Effectiveness: Test of an Integrative Framework.

Why does someone thrive in intercultural situations; while others seem to struggle? In 2014, Leung and colleagues summarized the literature on intercultural competence and intercultural effectiveness into a theoretical framework. This integrative framework hypothesizes that the interrelations between intercultural traits, intercultural attitudes and worldviews, and intercultural capabilities predict the effectiveness with which individuals respond to intercultural situations. An empirically verified framework can contribute to understanding intercultural competence and effectiveness in health care workers, thus contributing to more equity in health care. The present study sets out to test this integrative framework in a specific health care context. Future health care practitioners (N = 842) in Flanders (Belgium) were questioned on all multidimensional components of the framework. Structural equation modeling showed that our data were adequate to even a good fit with the theoretical framework, while providing at least partial evidence for all hypothesized relations. Results further showed that intercultural capabilities remain the major gateway toward more effective intercultural behavior. Especially the motivation and cognition dimensions of cultural intelligence seem to be key factors, making these dimensions an excellent target for training, practical interventions, and identifying best practices, ultimately supporting greater intercultural effectiveness and more equity in health care.

Developing evaluation capacities in integrated care projects: Lessons from a scientific support mission implemented in Belgium.

The capacity of self-assessment, to learn from experience, to make information-based decisions, and to adapt over time are essential drivers of success for any project aiming at healthcare system change. Yet, many of those projects are managed by healthcare providers' teams with little evaluation capacity. In this article, we describe the support mission delivered by an interdisciplinary scientific team to 12 integrated care pilot projects in Belgium, mobilizing a set of tools and methods: a dashboard gathering population health indicators, a significant event reporting method, an annual report, and the development of a sustainable "learning community." The article provides a reflexive return on the design and implementation of such interventions aimed at building organizational evaluation capacity. Some lessons were drawn from our experience, in comparison with the broader evaluation literature: The provided support should be adapted to the various needs and contexts of the beneficiary organizations, and it has to foster experience-based learning and requires all stakeholders to adopt a learning posture. A long-time, secure perspective should be provided for organizations, and the availability of data and other resources is an essential precondition for successful work.

"Squeezed like a lemon": A participatory approach on the effects of innovation on the well-being of homecare workers in Belgium.

Innovative programs that emerge in response to the rapidly changing care needs of older adults provide an opportunity to study the transformations in working and employment conditions within the homecare sector. This study seeks to understand how innovations introduced in the homecare sector have affected the well-being of homecare workers providing non-medical domestic support to older adults who wish to age in place. Our study is based on a participatory approach involving homecare workers exposed to two innovations in Wallonia (Belgium) that relate to flexible working hours, worker training, and technological equipment. We conducted a literature review, six semi-structured individual interviews with managers, and eight workshops based on the 'Group Analysis Method' involving 9 to 12 homecare workers. The results revealed that the innovations deteriorated working conditions, intensified occupational psychosocial risk factors, and impacted work-life balance. This gave rise to tensions that ultimately had a negative impact on the well-being of workers and on the quality of their care relationship with older adults/caregivers, while also weakening the viability of the services. The workers proposed some avenues to improve and regulate these tensions.

Examining Care Assessment Scores of Community-Dwelling Adults in Flanders, Belgium: The Role of Socio-Psychological and Assessor-Related Factors.

One of the primary objectives of health systems is to provide a fair system by providing a comprehensive and holistic approach to caregiving rather than focusing on a single aspect of a person's care needs. This approach is often embodied by using standardized care assessments across health and social care settings. These assessments are completed by professional assessors and yield vital information regarding a person's health or contextual characteristics (e.g., civic engagement, psychosocial wellbeing, environmental characteristics, informal care). However, these scores may be subject to bias that endangers the fairness of the health system. In this study, we investigate to what extent socio-economic and psychological indicators and assessor-related indicators are associated with BelRAI Screener care assessment scores amongst 743 community-dwelling adults nested within 92 assessors in Flanders, Belgium. Findings indicate that there is significant variance in scores at the assessor-level. Socio-psychological characteristics of clients are associated with scores: being fluent in Dutch and providing informal care are associated with low care dependency, while living with children, feelings of depression, and the presence of an informal caregiver during assessment are associated with high care dependency. We discuss the importance of rigorous assessor training and the potential for socio-psychological factors to contribute to the allocation of welfare benefits in light of the Flemish home care system's potential (lack of) fairness.

[A Belgian medical board during World War II or the bad outcome of the law concerning the "Board of Medical Doctors " from 1938 (first part)]. / Un "Ordre des Médecins" de guerre (novembre 1941-septembre 1944) ou i'aboutissement dévoyé de la loi sur l'Ordre de 1938 (Première partie).

The medical profession regulation has always been a delicate subject to deal with. The need for one arose as early as the 17th century. Multiple attempts to create such a regulation occurred during the 19th and the 20th century, which led to the 1938 "Board of Medical Doctors" law. This law could not be applied then because of the Second World War. After the Belgian capitulation of May 28th 1940, the Germans and some members of professional or political movements wished to create a Medical Board that was totally different from the one proposed by the 1938 law. The background to this "33 Months Board" is analysed in this paper along with its functioning during the conflict. Among others this is based on the file dealing with the 1947 trial of this so called "Medical Board".