Merche Julie, Van Durme Thérèse, Sibille François-Xavier, Buret Laetitia, Schoevaerdts Didier, De Brauwer Isabelle, de Saint-Hubert Marie
Department of Geriatric Medicine, CHU UCL Namur, Yvoir, Belgium.
Université catholique de Louvain, Institute of Health and Society, Brussels, Belgium.
BMC Health Serv Res. 2025 Mar 19;25(1):411. doi: 10.1186/s12913-025-12484-4.
Nursing home residents (NHR) have complex health needs due to their multimorbidity and frailty, challenging interorganisational collaboration, particularly between nursing homes (NH) and hospitals. Coronavirus disease pandemic highlighted the need to strengthen the expertise of NHs care teams. Geriatric mobile teams (GMT) exist in several countries and aim to provide interdisciplinary advice to reinforce the primary care expertise. To develop GMTs in Belgium, we chose a participatory and systemic approach. The aim focuses on identifying areas of partnership between hospitals and NHs based on the geriatric needs of residents, from the perspective of the stakeholders involved in their care. Additionally, it examines the essential requirements for fostering collaboration among these stakeholders.
Qualitative study using semi-structured interviews of 20 healthcare professionals working in a Belgian academic hospital or within its affiliated NH network. Themes were extracted using thematic analysis, employing simultaneously an inductive approach for the partnership areas and a deductive approach constructed around Karam's framework of interorganizational and interprofessional collaboration.
Participants highlighted the increasing complexity of NHRs' healthcare needs and the crucial role of geriatric expertise in managing behavioural and psychological symptoms of dementia, assessing complex medical situations, and advance care planning. While all supported enhanced collaboration, key challenges included formalizing processes and facilitating care integration between providers. Balancing high-level care with the risk of over-medicalization also remains a critical issue. These findings are reflected in three main themes: empowering nursing homes with geriatric expertise; The high importance of integration and formalisation; and balancing tension between a place of residence and high skilled care.
This study provides a comprehensive overview of expected collaboration areas and practical strategies to manage constraints. By using a qualitative approach, we integrated the perspectives of all key stakeholders, ensuring that proposed initiatives align with actual needs. Strengthening collaboration between NHs and geriatric services requires formalized frameworks and co-designed protocols with frontline caregivers. Such an initiative has the potential to dismantle compartmentalized care pathways for NHRs.
由于患有多种疾病且身体虚弱，养老院居民有着复杂的健康需求，这对组织间的协作构成了挑战，尤其是养老院与医院之间的协作。冠状病毒病大流行凸显了加强养老院护理团队专业知识的必要性。老年移动团队在多个国家都有，旨在提供跨学科建议以加强初级护理专业知识。为在比利时发展老年移动团队，我们选择了一种参与式和系统性的方法。目标聚焦于从参与居民护理的利益相关者的角度，根据居民的老年护理需求确定医院与养老院之间的合作领域。此外，还研究了促进这些利益相关者之间合作的基本要求。
采用定性研究方法，对在比利时一家学术医院或其附属养老院网络工作的20名医疗保健专业人员进行半结构化访谈。使用主题分析法提取主题，同时对合作领域采用归纳法，围绕卡拉姆的组织间和跨专业合作框架构建演绎法。
参与者强调了养老院居民医疗保健需求日益复杂，以及老年护理专业知识在管理痴呆症的行为和心理症状、评估复杂医疗情况以及预先护理规划方面的关键作用。虽然所有人都支持加强合作，但关键挑战包括使流程正规化以及促进提供者之间的护理整合。在高水平护理与过度医疗化风险之间取得平衡仍然是一个关键问题。这些发现体现在三个主要主题中：用老年护理专业知识赋能养老院；整合与正规化的高度重要性；以及平衡居住场所与高技能护理之间的紧张关系。
本研究全面概述了预期的合作领域以及管理制约因素的实际策略。通过采用定性方法，我们整合了所有关键利益相关者的观点，确保所提出的举措符合实际需求。加强养老院与老年护理服务之间的合作需要正规化的框架以及与一线护理人员共同设计的协议。这样一项举措有可能消除为养老院居民设置的分散护理路径。
