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.

Improving mental healthcare for the elderly in Belgium.

INTRODUCTION: The organisation of mental healthcare for the elderly (MHCE) remains suboptimal. OBJECTIVE: To identify specific organisational models that could address the mental healthcare needs of the elderly in community and primary care. METHOD: A multi-modal approach, consisting of a literature review, an online survey of Belgian professional stakeholders, and an international comparison. The outcomes of this three-step study process were aggregated. RESULTS: Two general and four operational strategies for organising MHCE were identified as well as barriers and incentives to MHCE in the community and primary care. About half of survey respondents perceived the current MHCE in Belgium not to meet quality criteria as described in the literature and proposed points of improvement. The transversal international comparison revealed interesting approaches for MHCE. Recommendations for the future were formulated. CONCLUSION: MHCE requires a specific, low-threshold, holistic, and transdisciplinary approach. Specific strategies with emphasis on collaborative care should be applied to meet the needs of older adults with mental problems. General practitioners (GPs) can play a central role in community-oriented MHCE but should be supported by specialised healthcare providers (including old-age psychiatrists and geriatricians). Stigma and wrong beliefs, regarding the elderly population, should be tackled by means of campaigns.

Proton Therapy in Children: A Systematic Review of Clinical Effectiveness in 15 Pediatric Cancers.

Because it spares many normal tissues and reduces the integral dose, proton therapy (PT) is the preferred tumor irradiation technique for treating childhood cancer. However, to the best of our knowledge, no systematic review of the clinical effectiveness of PT in children has been reported in the scientific literature. A systematic search for clinical outcome studies on PT published between 2007 and 2015 was performed in Medline (through OVID), EMBASE, and the Cochrane Library. Twenty-three primary studies were identified, including approximately 650 patients overall. The median/mean follow-up times were limited (range, 19-91 months). None of the studies were randomized, 2 were comparative, and 20 were retrospective. Most suffered from serious methodologic limitations, yielding a very low level of clinical evidence for the outcomes in all indications. For example, for retinoblastoma, very low-level evidence was found that PT might decrease the incidence of second malignancies. For chondrosarcoma, chordoma, craniopharyngioma, ependymoma, esthesioneuroblastoma, Ewing sarcoma, central nervous system germinoma, glioma, medulloblastoma, osteosarcoma, and rhabdomyosarcoma, there was insufficient evidence to either support or refute PT in children. For pelvic sarcoma (ie, nonrhabdomyosarcoma and non-Ewing sarcoma), pineal parenchymal tumor, primitive neuroectodermal tumor, and "adult-type" soft tissue sarcoma, no studies were identified that fulfilled the inclusion criteria. Although there is no doubt that PT reduces the radiation dose to normal tissues and organs, to date the critical clinical data on the long-term effectiveness and harm associated with the use of PT in the 15 pediatric cancers under investigation are lacking. High-quality clinical research in this area is needed.

The view of severely burned patients and healthcare professionals on the blind spots in the aftercare process: a qualitative study.

BACKGROUND: In most Western countries burn centres have been developed to provide acute and critical care for patients with severe burn injuries. Nowadays, those patients have a realistic chance of survival. However severe burn injuries do have a devastating effect on all aspects of a person's life. Therefore a well-organized and specialized aftercare system is needed to enable burn patients to live with a major bodily change. The aim of this study is to identify the problems and unmet care needs of patients with severe burn injuries throughout the aftercare process, both from patient and health care professional perspectives in Belgium. METHODS: By means of face-to-face interviews (n = 40) with individual patients, responsible physicians and patient organizations, current experiences with the aftercare process were explored. Additionally, allied healthcare professionals (n = 17) were interviewed in focus groups. RESULTS: Belgian burn patients indicate they would benefit from a more integrated aftercare process. Quality of care is often not structurally embedded, but depends on the good intentions of local health professionals. Most burn centres do not have a written discharge protocol including an individual patient-centred care plan, accessible to all caregivers involved. Patients reported discontinuity of care: nurses working at general wards or rehabilitation units are not specifically trained for burn injuries, which sometimes leads to mistakes or contradictory information transmission. Also professionals providing home care are often not trained for the care of burn injuries. Some have to be instructed by the patient, others go to the burn centre to learn the right skills. Finally, patients themselves underestimate the chronic character of burn injuries, especially at the beginning of the care process. CONCLUSIONS: The variability in aftercare processes and structures, as well as the failure to implement locally developed best-practices on a wider scale emphasize the need for a comprehensive network, which can initiate transversal activities such as the development of discharge protocols, common guidelines, and quality criteria.

The role of bone morphogenetic protein-7 (Osteogenic Protein-1) in the treatment of tibial fracture non-unions. An overview of the use in Belgium.

The evolution of a fracture non-union is complex; treatment strategies are therefore challenging. The use of BMP-7 could be an interesting adjunct. We present an overview of the monitored use of this product in tibial non-unions in Belgium. Our retrospective data covers 53% (62 patients) of the cases in which it was used between 2001 and 2006. Questionnaires were sent to surgeons who had been using BMP-7 (OP-1) in tibial non-unions in Belgium. Of 55 surgeons contacted, 27 who had been treating 62 patients with a non-union of a tibial fracture responded. These fractures were most commonly treated with an external fixator and 50% of them had already received some form of graft material. Non-union was diagnosed after a median of 365 days (range, 123-1212). Treatment with OP-1 resulted in a clinical healing rate of 79.6% and a radiographic healing rate of 84.9%. Union was reported after a median of 230 (32-872) days clinically and 232 (32-739) days radiographically. We documented a large number of cases of use of BMP-7 in tibial non-union in Belgium. The healing rates of around 80% are comparable to other reports on success rates with BMP-7. Many cases presented originally with open fractures, infected wounds or fractures with bone loss. This makes the reported results even more promising. Further studies are needed to analyse the socio-economical value of this relatively expensive treatment.