The emergence of multidisciplinarism

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1 The emergence of multidisciplinarism Prof. dr. Francis Colardyn CEO Brussels, 8 October University Hospital Gent

2 Why changing care? Keeping the healthcare system sustainable (expenditure) Improve patient outcome and QoL Deal with reducing number of trained staff 2

3 Health spending is growing faster than our economies 3

4 Policy Options: Long-term measures Ref: Aart De Geus, Deputy Secretary-General, OECD 4

5 Hospital at Home for Elderly Patients with Acute Decompensation of Chronic Heart Failure Conclusions: Substitutive hospital-athome care is a viable alternative to traditional hospital inpatient care for elderly patients with acutely decompensated CHF. This type of care demonstrated clinical feasibility and efficacy in comparison with its alternative. Ref: Vittoria Tibaldi, MD e.a., Arch Intern Med/Vol 169 (No. 17), Sept 28,

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7 9 Zorg in Zeeuws-Vlaanderen C E G H L 4 1 J 7 A B K 6 3 Ziekenhuiszorg 1 Locatie De Honte, Terneuzen F I D 2 Locatie Antonius, Oostburg 3 Locatie Liduina, Hulst Thuiszorg 4 Hoofdkantoor, Terneuzen 5 Rayonkantoor, Oostburg 6 Rayonkantoor, Hulst Verzorgingshuiszorg 7 Woonzorgcentrum Coensdike, Aardenburg 8 Huize Emmaus, IJzendijke 9 Woonzorgcentrum Ter Schelde, Breskens 10 Woonzorgcentrum Rozenoord, Sluis Verpleeghuiszorg 11 Verpleeghuis De Stelle, Oostburg Verzorgingshuiszorg Overige A B Zorgcentrum De Vurssche, Axel De Blaauwe Hoeve, Hulst instellingen C D E F G H I J WoonZorgCentrum Antonius, Kloosterzande De Lange Akkers, Koewacht De Burght, Oostburg De Redoute, Sas van Gent De Blide, Terneuzen Zorgcentrum Bachten-Dieke t Verlaet, Westdorpe De Molenhof, Zaamslag Verpleeghuiszorg K L De Blauwe Hoeve, Hulst Verpleeghuis Ter Schorre, Terneuzen 7

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9 Chain of care exchange of information on and about you intra- and extramural integration crucial! Ref: prof. dr. Bart Sijnave, CIO UZ Gent 9

10 Main results Sixteen trials involving 1,627 people were included. We classified the interventions into three models: multidisciplinary interventions (a holistic approach bridging the gap between hospital admission and discharge home delivered by a team); case management interventions (intense monitoring of patients following discharge often involving telephone follow up and home visits); and clinic interventions (follow up in a CHF clinic). There was considerable overlap within these categories, however the components, intensity and duration of the interventions varied. 10

11 Authors Conclusions The data from this review are insufficient for forming recommendations. Further research should include adequately powered, multicentre studies. Future studies should also investigate the effect of interventions on patients and carers quality of life, their satisfaction with the interventions and cost effectiveness. 11

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14 Authors conclusions In this updated review, we found five studies (four new studies) that met the inclusion criteria. The review suggests that practice-based IPC interventions can improve healthcare processes and outcomes, but due to the limitations in terms of the small number of studies, sample sizes, problems with conceptualising and measuring collaboration, and heterogeneity of interventions and settings, it is difficult to draw generalisable inferences about the key elements of IPC and its effectiveness. 14

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17 Conclusion Chronic disease means management not treatment ICT enables the patient taking responsibility of his own health Technology can be home-adapted The health care giver must change not only his/her mindset, but also his/her skills At this time, evidence of outcome is lacking, but cost reduction is proven 17