Interprofessional collaboration between general practitioners and primary care nurses in Belgium: a participatory action research.

Given the sociodemographic challenges facing the Belgian primary care system, it is essential to strengthen interprofessional collaboration (IPC) between healthcare providers. Therefore, our aims for this study were to assess IPC between general practitioners (GPs) and nurses; identify target priorities for improving IPC; and facilitate the planning and implementation of the proposed improvement strategies. Based on diversity criteria, six groups of GPs and nurses were chosen for a participatory action research. Participants performed a SWOT analysis of their IPC to identify strengths and weaknesses of their collaboration practice configurations. Main factors limiting IPC were related to the type of financing system which impeded or facilitated multidisciplinary team meetings, a weak functional integration, and a lack of interprofessional education. Overall, communication and task delegation were co-identified as common priorities. Actions prioritized by each group were related to these two priorities and accounted for local, specific needs. Communication could be supported through improved tools and dedicating time for multidisciplinary team meetings. Task delegation was more challenging and raised questions related to nurses' training, legislation, and payment systems. IPC seems to be easier to achieve when healthcare professionals belong to the same organization and consider themselves a team.

Exploring the diverse career trajectories of general practice graduates in the French-speaking part of Belgium: An interview study.

BACKGROUND: Several European countries face a shortage of general practitioners (GPs), in part due to GP attrition. Most studies of GP attrition have focussed on why GPs decide to leave. Yet understanding why GPs decide to remain may also elicit potential interventions to reduce attrition. OBJECTIVES: This study examined GP graduates' career trajectories and underlying decisions to elucidate the factors influencing GP attrition. METHODS: We conducted semi-structured interviews of early to mid-career general practice graduates having completed training in Belgian French-speaking universities between 1999 and 2013. We sampled participants from three categories: full-time GPs, part-time GPs, no longer working as GPs. We analysed each participant's career trajectory and broke it down into major phases. We performed thematic analysis of the factors influencing participants' trajectories. We compared and contrasted trajectories to develop a typology of career trajectories. RESULTS: We identified six types of career trajectories: 'stable' (never considered leaving general practice), 'reaffirmed' (had considered leaving but made substantial changes whilst remaining), 'reactional reorientations' (had left to escape the challenges of general practice), 'inspired reorientations' (had left to pursue a different job), 'reorientations out of loyalty' (had never wanted to practice as GPs and had remained true to their original professional aspirations) and 'mobiles' (valued change and did not want to set-up practice). CONCLUSION: Reasons GPs leave the profession are multiple. The typology that emerged indicates that only some of the career trajectories would benefit from interventions to reduce attrition such as improving working conditions and providing psychological support for GPs.

Harley William Moon (1936-2018).

Harley William Moon,DVM, Ph.D., an outstanding American person and researcher of comparative microbiology and pathology of intestinal diseases, the former director of the USDA, ARS, National Animal Disease Center (Iowa), of Plum Island Animal Disease Center (New York) and of Veterinary Research Institute of Iowa State University, member of the National Academy of Sciences (USA) passed away after some difficult and lonely last years of his life, on October 7, 2018 at the age of 82.

Experiences of hospital-based multidisciplinary team meetings in oncology: An interview study among participating general practitioners.

BACKGROUND: Cancer care has become complex, requiring healthcare professionals to collaborate to provide high-quality care. Multidisciplinary oncological team (MDT) meetings in the hospital have been implemented to coordinate individual cancer patients' care. General practitioners (GPs) are invited to join, but their participation is minimal. OBJECTIVES: Aim of this study is to explore participating GPs' perceptions of their current role and to understand their preferences towards effective role execution during MDT meetings. METHODS: In May to June 2014, semi-structured interviews (n = 16) were conducted involving GPs with MDT experience in Belgium. The analysis was done according to qualitative content analysis principles. RESULTS: Attendance of an MDT meeting is perceived as part of the GP's work, especially for complex patient care situations. Interprofessional collaborative relationships and the GP's perceived benefit to the MDT meeting discussions are important motivators to participate. Enhanced continuity of information flow and optimized organizational time management were practical aspects triggering the GP's intention to participate. GPs valued the communication with the patient before and after the meeting as an integral part of the MDT dynamics. CONCLUSION: GPs perceive attendance of the MDT meeting as an integral part of their job. Suggestions are made to enhance the efficiency of the meetings.

Young general practitioners' professional activities: a survey in the French-speaking part of Belgium.

INTRODUCTION: This study described the professional activities of graduates of the Advanced Master of General Practice of the Belgian French-speaking universities from 1999 to 2013 and identified factors influencing their situation. METHODS: Between November 2014 and June 2015, all graduates were asked to complete a questionnaire concerning their professional activities. The first part of the analysis described the respondent's socio-demographic and professional characteristics. The second part aimed at detecting possible factors influencing GPs' professional situation. RESULTS: The main results of the study showed that 78.5% of graduates still worked as GPs and 21.5% left and had another activity. The way graduates worked in General Practice was also highly diverse in terms of both working time and types of activities. Only a minority of them were exclusively performing General Practice (8.5%). 45.8% of GPs worked part-time, and were more commonly women and GPs in group practice. This survey confirmed feminisation of the profession and increasing work in associations. Among factors influencing retention in General Practice, preference for specialising in General Practice at time of graduation in medicine and duration of practice influence retention in practice. CONCLUSION: Our survey put the emphasis on the evolution of practice: job and vocational training planning should not be performed based only on previous generations. There is no one predefined way to practise; the blurred boundaries of General Practice activities do not allow for the drafting of a reference frame that could help workforce planning.

Attracting and retaining GPs: a stakeholder survey of priorities.

BACKGROUND: Despite being a key player in the healthcare system, training and practising general practice has become less attractive in many countries and is in need of reform. AIM: To identify political priorities for improving GPs' attraction to the profession and their retention within it. DESIGN AND SETTING: Stakeholder face-to-face survey in Belgium, 2008. METHOD: A total of 102 key stakeholders were recruited from policymakers, professional groups, academia, GP leaders, and the media. All interviewees were asked to score 23 policies on four criteria: effectiveness in attracting and retaining GPs, cost to society, acceptance by other health professionals, and accessibility of care. An overall performance score was computed (from -3 to +3) for each type of policy - training, financing, work-life balance, practice organisation, and governance - and for innovative versus conservative policies. RESULTS: Practice organisation policies and training policies received the highest scores (mean score ≥ 1.11). Financing policies, governance, and work-life balance policies scored poorly (mean score ≤ 0.65) because they had negative effects, particularly in relation to cost, acceptance, and accessibility of care. Stakeholders were keen on moving GPs towards team work, improving their role as care coordinator, and helping them to offload administrative tasks (score ≥ 1.4). They also favoured moves to increase the early and integrated exposure of all medical students to general practice. Overall, conservative policies were better scored than innovative ones (beta = -0.16, 95% confidence interval = -0.28 to -0.03). CONCLUSION: The reforming of general practice is made difficult by the small-step approach, as well as the importance of decision criteria related to cost, acceptance, and access.

Geriatric day hospital: opportunity or threat? A qualitative exploratory study of the referral behaviour of Belgian general practitioners.

BACKGROUND: In order to address the challenges of an ageing population the Belgian government decided to allocate resources to the creation of geriatric day hospitals (GDHs). Although GDHs are meant to be a strategy to support general practitioners (GPs) caring for the frail elderly, few Belgian GPs seem to refer to a GDH. This study aims to explore the barriers and facilitating factors of GPs' referral to GDHs. METHODS: A qualitative study using focus group discussions (FGDs) was conducted. Fifteen FGDs were organized in the different Belgian regions (Flanders, Wallonia, Brussels). RESULTS: Contextual factors such as the unsatisfactory cooperation between hospital and GPs and organizational barriers such as the lack of communication on referral procedures between hospital and primary health care (PHC) were identified. Lack of basic knowledge about the concept or the local organization of GDH seemed to be a problem. Unclear task descriptions, responsibilities and activities of a GDH formed prominent points of discussion in all FGDs. Nevertheless a lot of possible advantages and disadvantages of GDHs for the patient and for the GP were mentioned. CONCLUSIONS: In the case of poor referral to GDHs, focusing on improving overall collaboration between primary and secondary health care is essential. This can be achieved by actively delivering adequate information, permanent communication and more involvement of PHC in the organization and functioning of GDHs. The absence of a transparent health care system with delineated role definitions, seems to hinder the integration of new initiatives like GDHs in the care process. Strategies to enhance referral to GDHs should use a comprehensive approach.