2003 - belgian geriatrics: a "swot" analysis (nl)
TRANSCRIPT
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College for Geriatrics
1. State of the Art2. Project ’s results3. SWOT analysis
2003
Thierry Pepersack on behalf of the college for geriatrics
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J.P.Baeyens et al. BVGG 2000
1. State of the art
• Peer review 2000: 103/160 geriatric units– 13 admissions/bed/year (median)– 50% admissions from private home– 46% home discharge– Median age = 82 yrs– Length of stay 22 days– median occupation rate 90%– multidisciplinary team
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State of the art
• 21 formation centers
• 37 fellows places available
http://www.health.fgov.be/AGP/fr/professions/medecins/maitre_de_stage/specialites/geria.htm
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2. College ’s projects
• 2000: Peer review
• 2001: Nutrition
• 2002: Continence
• Collaborations with the colleges for:– radiotherapy,– nephrology,– and emergency medicine
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2001 Nutrition programme
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Nutrition program 2001
OUTCOMES OF CONTINUOUS PROCESS
IMPROVEMENT OF NUTRITIONAL CARE PROGRAM
AMONG GERIATRIC UNITS IN BELGIUM
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Nutrition program 2001
Methodology: 2 phases
Observation• Comprehensive
geriatric assessment and MNA
• Routine nutrition
Intervention• Comprehensive
geriatric assessment and MNA
• « Flow Chart»• « Meals on Wheels »
approach
0 3 6 months
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Nutrition program 2001
Outcomes
• to assess the quality of care concerning nutrition among Belgian geriatric units descriptive statistics of nutritional status during phase 1
• to include more routinely nutritional assessments and interventions into comprehensive geriatric assessment sensitize the teams to nutritional aspect of the comprehensive
geriatric assessment
• to assess the impact of nutritional recommendations on nutritional status an on the length of hospitalisation comparison of nutritional parameters and hospitalisation
stays between phase 1 and phase 2
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±Std. Dev.
±Std. Err.
Mean
Phase 1 Phase 2
STA
Y (
da
ys
)
0
10
20
30
40
50
60
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Nutrition program 2001
Conclusions
• High prevalence of malnutrition among geriatric hospitalized patients
• Significant decreased hospitalization stay during 2nd phase (Confounding factor?)
• Significant increased PAB concentrations during 2nd phase
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2002 Continence programme
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DRIP
Detect, Reduce, Incontinence, Programme
Thierry Pepersack on behalf of the College of Geriatrics
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Continence 2002
Introduction
• 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
Two phases project
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Continence 2002
Part 1: Outcomes
Prevalence of urinary incontinence among
geriatric units
Classification of incontinence
Characterisation of the geriatric teams and of the
professionals implicated in the management of
incontinence
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Continence 2002
Part 1: Methodology
• Survey design: transversal
• Questionnaire by mail, web site
• Data collect of the characteristics of– hospitals– teams– patients
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Continence 2002
ResultsPrevalence of incontinence
(N=834 patients)
26% A cute
5 7 % fu n c tion a l 1 5 % u rg e 1 4 % overflow 6 % D H IC 2 % re flex
74% C hronic
45% of incontinent pa tients
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Continence 2002
Types of chronic incontinence
overflow14%
stress6%
urge15%
reflex2%
functional57%
DHIC6%
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Characteristics of the teams/patientsFactors associated with the absence of incontinence management
0% 10% 20% 30% 40% 50% 60%
severe cognitiveimpairment
severe functionalimpairment
burnout of the team
lack of profesionalformation/interest
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functional impairment
17%
diuresis control17%
decubitus ulcer(s)
24%
palliative approach
17%
retention25%
Characteristics of the patients13% under continued catheterization, why?
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Continence 2002
Characteristics of the patients13% under intermittent catheterization, why?
diuresis control50%
decubitus ulcer(s)
8%
residu42%
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Continence 2002
Relationship between % of incontinent patientsand patients’ and teams’ characteristics
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Continence 2002
Discussion (1)
• 45% of incontinent patients in geriatric units
• 26% of transient incontinence
• Functional incontinence represents more than the half of the chronic situations
• Incontinence is associated with:– High length of stay– High proportion of demented patients
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Discussion (2)
• A interventional proposition will complete this survey based on valided guidelines
Part 2: 2004?
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Continence 2004
Part 2: Objectives
• enhance quality of care among geriatric unit providing suggestions about topics which are considered important for the majority of the patients.
• improve not only the quality of life of our patients but also the quality of life of the geriatric team’s professionals.
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2003 AGGIR-PATHOS-SOCIOS
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Geriatrics 2003
3. SWOT analysis
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Strength
EBM, Comprehensive Geriatric AssessmentNew medical culture, multidisciplinary,comprehensivepsychosocial > biomedical modelCGA associated with low dependence, low
institionalization realistic approach in view of care situationNational Scientific Society associated with the CollegeMotivation, EAMAdemographic data
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Weakness
• lack of geriatricians, formation services, academic• lack of attractivity, ‘ faire savoir ’• disproportion between allowed ressources and the
burden– caregivers, staff
– geriatricians
• lack of financial incentive• lack of alternative services
– day hospitals, day centers, familial caregivers,
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Opportunities
• Education & Formation– GP, caregivers, specialists
• Geriatric programme for impatients• European, governmental research• GP partnership (CGA)
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Threats
• « Everybody practice geriatrics » (lack of professionalism)
• « Wrong » geriatrics (Fountain of Youth)
• lack of defence and promotion
• appropriation by lobbies
• Burn-out
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Priorities
• Geriatric programme• Beds programmation• Adapted financial ressources• Alternative services
– day hospital– inpatients geriatric consultation service
(multidisciplinary)– for geriatric problems (confusion, denutrition, falls,
incontinence, etc.)
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College ’s role
Objectives• Quality• Partnership• « Education »,
awareness campaign, • promotion of a
broader concept of health
Ressources advisory board Scientific Society Surveys (Nutrition,
continence) Comprehensive
geriatrics focused on:• maintenance of function and
comfort• presence of satisfactory
support systems