2003 - Belgian Geriatrics: a "SWOT" analysis (NL)

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2003 - Belgian Geriatrics: a "SWOT" analysis (NL)

  1. 1. College for Geriatrics 1. State of the Art 2. Project ’s results 3. SWOT analysis 2003 Thierry Pepersack on behalf of the college for geriatrics
  2. 2. 1. State of the art <ul><li>Peer review 2000: 103/160 geriatric units </li></ul><ul><ul><li>13 admissions/bed/year (median) </li></ul></ul><ul><ul><li>50% admissions from private home </li></ul></ul><ul><ul><li>46% home discharge </li></ul></ul><ul><ul><li>Median age = 82 yrs </li></ul></ul><ul><ul><li>Length of stay 22 days </li></ul></ul><ul><ul><li>median occupation rate 90% </li></ul></ul><ul><ul><li>multidisciplinary team </li></ul></ul>
  3. 3. State of the art <ul><li>21 formation centers </li></ul><ul><li>37 fellows places available </li></ul>http://www.health.fgov.be/AGP/fr/professions/medecins/maitre_de_stage/specialites/geria.htm
  4. 4. 2. College ’s projects <ul><li>2000: Peer review </li></ul><ul><li>2001: Nutrition </li></ul><ul><li>2002: Continence </li></ul><ul><li>Collaborations with the colleges for: </li></ul><ul><ul><li>radiotherapy, </li></ul></ul><ul><ul><li>nephrology, </li></ul></ul><ul><ul><li>and emergency medicine </li></ul></ul>
  5. 5. 2001 Nutrition programme
  6. 6. OUTCOMES OF CONTINUOUS PROCESS IMPROVEMENT OF NUTRITIONAL CARE PROGRAM AMONG GERIATRIC UNITS IN BELGIUM
  7. 7. Methodology: 2 phases <ul><li>Observation </li></ul><ul><li>Comprehensive geriatric assessment and MNA </li></ul><ul><li>Routine nutrition </li></ul><ul><li>Intervention </li></ul><ul><li>Comprehensive geriatric assessment and MNA </li></ul><ul><li>« Flow Chart» </li></ul><ul><li>« Meals on Wheels » approach </li></ul>0 3 6 months
  8. 8. Outcomes <ul><li>to assess the quality of care concerning nutrition among Belgian geriatric units </li></ul><ul><ul><li>descriptive statistics of nutritional status during phase 1 </li></ul></ul><ul><li>to include more routinely nutritional assessments and interventions into comprehensive geriatric assessment </li></ul><ul><ul><li>sensitize the teams to nutritional aspect of the comprehensive geriatric assessment </li></ul></ul><ul><li>to assess the impact of nutritional recommendations on nutritional status an on the length of hospitalisation </li></ul><ul><ul><li>comparison of nutritional parameters and hospitalisation stays between phase 1 and phase 2 </li></ul></ul>
  9. 10. Conclusions <ul><li>High prevalence of malnutrition among geriatric hospitalized patients </li></ul><ul><li>Significant decreased hospitalization stay during 2 nd phase (Confounding factor?) </li></ul><ul><li>Significant increased PAB concentrations during 2 nd phase </li></ul>
  10. 11. 2002 Continence programme
  11. 12. DRIP D etect, R educe, I ncontinence, P rogramme Thierry Pepersack on behalf of the College of Geriatrics
  12. 13. Introduction <ul><li>urinary incontinence is a straightforward condition, its cause easily identified and treated, treatment can have a major impact on the older person's quality of life </li></ul><ul><li>Two phases project </li></ul>
  13. 14. Part 1: Outcomes <ul><li>Prevalence of urinary incontinence among geriatric units </li></ul><ul><li>Classification of incontinence </li></ul><ul><li>Characterisation of the geriatric teams and of the professionals implicated in the management of incontinence </li></ul>
  14. 15. Part 1: Methodology <ul><li>Survey design: transversal </li></ul><ul><li>Questionnaire by mail, web site </li></ul><ul><li>Data collect of the characteristics of </li></ul><ul><ul><li>hospitals </li></ul></ul><ul><ul><li>teams </li></ul></ul><ul><ul><li>patients </li></ul></ul>
  15. 16. Results Prevalence of incontinence (N=834 patients)
  16. 17. Types of chronic incontinence
  17. 18. Characteristics of the teams/patients Factors associated with the absence of incontinence management
  18. 19. Characteristics of the patients 13% under continued catheterization, why?
  19. 20. Characteristics of the patients 13% under intermittent catheterization, why?
  20. 21. Relationship between % of incontinent patients and patients’ and teams’ characteristics
  21. 22. Discussion (1) <ul><li>45% of incontinent patients in geriatric units </li></ul><ul><li>26% of transient incontinence </li></ul><ul><li>Functional incontinence represents more than the half of the chronic situations </li></ul><ul><li>Incontinence is associated with: </li></ul><ul><ul><li>High length of stay </li></ul></ul><ul><ul><li>High proportion of demented patients </li></ul></ul>
  22. 23. Discussion (2) <ul><li>A interventional proposition will complete this survey based on valided guidelines </li></ul><ul><li>Part 2: 2004? </li></ul>
  23. 24. Part 2: Objectives <ul><li>enhance quality of care among geriatric unit providing suggestions about topics which are considered important for the majority of the patients. </li></ul><ul><li>improve not only the quality of life of our patients but also the quality of life of the geriatric team’s professionals. </li></ul>
  24. 25. 2003 AGGIR-PATHOS-SOCIOS
  25. 26. 3. SWOT analysis
  26. 27. Strength <ul><li>EBM, Comprehensive Geriatric Assessment </li></ul><ul><li>New medical culture, multidisciplinary,comprehensive </li></ul><ul><li>psychosocial > biomedical model </li></ul><ul><li>CGA associated with low dependence, low institionalization </li></ul><ul><li>realistic approach in view of care situation </li></ul><ul><li>National Scientific Society associated with the College </li></ul><ul><li>Motivation, EAMA </li></ul><ul><li>demographic data </li></ul>
  27. 28. Weakness <ul><li>lack of geriatricians, formation services, academic </li></ul><ul><li>lack of attractivity, ‘ faire savoir ’ </li></ul><ul><li>disproportion between allowed ressources and the burden </li></ul><ul><ul><li>caregivers, staff </li></ul></ul><ul><ul><li>geriatricians </li></ul></ul><ul><li>lack of financial incentive </li></ul><ul><li>lack of alternative services </li></ul><ul><ul><li>day hospitals, day centers, familial caregivers, </li></ul></ul>
  28. 29. Opportunities <ul><li>Education & Formation </li></ul><ul><ul><li>GP, caregivers, specialists </li></ul></ul><ul><li>Geriatric programme for impatients </li></ul><ul><li>European, governmental research </li></ul><ul><li>GP partnership (CGA) </li></ul>
  29. 30. Threats <ul><li>« Everybody practice geriatrics » (lack of professionalism) </li></ul><ul><li>« Wrong » geriatrics (Fountain of Youth) </li></ul><ul><li>lack of defence and promotion </li></ul><ul><li>appropriation by lobbies </li></ul><ul><li>Burn-out </li></ul>
  30. 31. Priorities <ul><li>Geriatric programme </li></ul><ul><li>Beds programmation </li></ul><ul><li>Adapted financial ressources </li></ul><ul><li>Alternative services </li></ul><ul><ul><li>day hospital </li></ul></ul><ul><ul><li>inpatients geriatric consultation service (multidisciplinary) </li></ul></ul><ul><ul><ul><ul><li>for geriatric problems (confusion, denutrition, falls, incontinence, etc.) </li></ul></ul></ul></ul>
  31. 32. College ’s role <ul><li>Objectives </li></ul><ul><li>Quality </li></ul><ul><li>Partnership </li></ul><ul><li>« Education », awareness campaign, </li></ul><ul><li>promotion of a broader concept of health </li></ul><ul><li>Ressources </li></ul><ul><li>advisory board </li></ul><ul><li>Scientific Society </li></ul><ul><li>Surveys (Nutrition, continence) </li></ul><ul><li>Comprehensive geriatrics focused on: </li></ul><ul><ul><ul><li>maintenance of function and comfort </li></ul></ul></ul><ul><ul><ul><li>presence of satisfactory support systems </li></ul></ul></ul>

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