Research Josefien van Olmen

Abstract

Trial Aim. The study aims at evaluating the best PPI deprescribing strategy in patients who are chronically using PPIs without an established indication for long-term use. Trial Participants and setting. Inclusion: Eligible patients are those of either gender, above the age of 18, eligible to give informed consent. Based on indication: Patients on long-term (>12 weeks) chronic PPI use without therapy indication are eligible to participate. Based on dose: Patients on a "maintenance" PPI dose are eligible for randomization. Maintenance dose is 20 mg of omeprazole, esomeprazole or pantoprazole daily or 15 mg of lansoprazole daily or 10 mg of rabeprazole daily. Patients on "healing" PPI dose (i.e. ≥40 mg esomeprazole, esomeprazole or pantoprazole or ≥30 mg of lansoprazole or ≥20 mg or rabeprazole daily) are also eligible for the study, but need first to down-titrate their dose to "maintenance" dose before they can be considered for randomization. Intervention(s). Chronic PPI therapy is changed to on-demand therapy approach for one month. The dose PPI should be maintenance dose (the lowest dose). PPI intake should occur only when needed to reduce symptoms, followed by PPI interruption (36-40). When symptoms recur during this month, the patient restarts PPI intake until symptoms again resolve, upon which the intake of medication is again stopped. PPI therapy is stopped and replaced by alginate formulation for one month. Alginates have shown effectively reducing GERD symptoms (42-44) and have shown 38 to 40% success rate as deprescribing therapy (12-25). After one month, the use of alginates is stopped. All patients will receive lifestyle adviceand guidelines for antacid use and will be followed up for 1 year. Antacids excluded for use during the study: drugs based on magaldrate such as Riopan® and Gastricalm® and Syngel® as it also includes lidocaine and it is not considered a standard antacid. Control. The comparator for this study will be a gradually decreasing intermittent dosing scheme for one month before stopping the PPI, which is in line with the Belgian guidelines (12) and was already used in a Belgian primary care study (13,14). Also in this arm, all patients will receive lifestyle advice and guidelines for antacids use. Similar to the intervention arms, all patients will be followed for need to restart PPI therapy for one year. Objectives. Outcome measures. Primary Endpoint. To evaluate the best PPI deprescribing strategy in primary care patients who are chronically using PPIs without an established indication. The therapeutic outcome of a patient is determined by the sum of 3 key indicators: (1) No clinically relevant use of PPI (2) treatment satisfaction and (3) willingness to continue with the current treatment. A patient is defined as successful when the sum of these key points is equal to 3, or not successful otherwise. The follow up period of this study starts at visit 3 and is 12 months long. For analysis, the sum of the key indicators as reported by the patient after 12 months follow up will be considered (a.k.a last study visit 5). Secondary failures, i.e; patients who fail to stop the PPI after the initial randomized intervention phase, are not considered to represent success of the intervention even if in the course of the study these patients are able to stop the PPI.

Researcher(s)

• Promoter: van Olmen Josefien

Research team(s)

• Primary and interdisciplinary care Antwerp (ELIZA)

Project type(s)

• Research Project

Abstract

CITY-MOVE adapts and implements the WHO Global Action Plan on Physical Activity (GAPPA) in six cities across three continents and develops a cross-contextual evaluation framework for transferability and scalability. Physical activity is a key behavior to reduce the NCD burden, including protecting against cancers and type 2 diabetes. There are many evidence-based interventions for cities to promote physical activity, yet they remain under-implemented, with a whole-of-system approach particularly lacking, and often fail to target the least active or vulnerable groups. Knowledge gaps are: a) how to adapt, b) successfully implement, and c) evaluate interventions, and d) how to transfer lessons to other interventions, target groups and contexts. In partnership with the cities, we identified interventions targeting individuals across the life course, particularly vulnerable and least active groups, aligned with the GAPPA domains of active people, societies, environments and systems. CITY-MOVE will: 1) Develop a city-GAPPA Theory of Change and operationalise assessment measures; 2) Adapt city-GAPPA to six cities, engaging stakeholders in each context; 3) Support cities in successful implementation through action research in living labs; 4) Assess reach, adoption, feasibility, fidelity, and sustainability of selected interventions in each city; 5) Improve the development and utilisation of routinely collected data to support successful implementation; 6) Generate cross-contextual evidence on implementation, evaluation and scalability through multi-criteria decision assessment for 12 interventions in six cities; and 7) Generate global capacity through regional Communities of Practice. CITY-MOVE results lead to increased physical activity by target populations, contributing to reduced premature NCD mortality, and to adaptable solutions ready for take-up by implementers.

Researcher(s)

• Promoter: van Olmen Josefien
• Co-promoter: Bastiaens Hilde
• Co-promoter: Thornton Lukar
• Co-promoter: Wouters Edwin

Research team(s)

• Primary and interdisciplinary care Antwerp (ELIZA)

Project website

Project type(s)

• Research Project

Abstract

Type 2 diabetes (T2D) and depression are highly prevalent conditions and have significant impact on health outcomes worldwide. Both conditions maintain a bidirectional relationship causing T2D and depression to occur together twice as frequently as would be predicted by chance alone. Current studies on this comorbidity however employ an individualistic perspective and ignore its social drivers– necessitating sociological research on the topic. A merger between Fundamental Cause Theory and Syndemic theory will be applied to(1) assess the clustering of T2D and depression and the role of socio-economic (SE) vulnerability within this clustering; (2) look how the adverse interactions between T2D, depression and SE vulnerability amplify disease burden and complications, and (3) study the contextual forces that cause and/or exacerbate this clustering. I will use HISlink data (Health Interview Survey + Health Insurance data) to assess (1) and (2) in Belgium. Next, I will address (3) by assessing the contextual variation in the syndemic across (a) Belgian communities (using Local Health Interview Survey data) and (b) European countries (using European Health Interview Survey data), and whether this variation can be explained by spatial and health system characteristics, respectively. The resulting fundamental knowledge has the potential to help policymakers in their endeavours to improve population health by offering insight into the drivers of the co-morbidity of T2D and depression.

Researcher(s)

• Promoter: Wouters Edwin
• Co-promoter: Buffel Veerle
• Co-promoter: van Olmen Josefien
• Fellow: Bos Philippe

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

European society is becoming increasingly diverse due to high levels of migration. Persons with a migration background, especially those from non-western countries, may experience significant challenges when they seek medical care. Some of the main issues arise in the context of medical decision-making, where cultural preferences for close family involvement may be difficult to reconcile with the western model of medicine, as enshrined in health law and medical deontology. This is the first comprehensive research project on medical decision-making in patients with a migration background undertaken in the European context. It brings together state-of-the-art expertise in health sciences, medical sociology, and health law, and applies a transversal research design and a tailored socio-legal research methodology. In this way, we will gain crucial insight into the relevant preferences of patients with a migration background and into strategies and tools that may be legally acceptable to improve medical decision-making in a diversity-responsive way. More specifically, the goals of the proposed research are threefold, each corresponding to a major research gap and therefore groundbreaking. The first research goal is to examine the preferences and challenges of patient populations with a migration background regarding medical decision-making, with particular attention to the role of family members in this process, and the variations that may exist between and within these groups. The second research goal is to investigate the practical strategies and tools that general practitioners have developed to address these preferences and challenges. The third research goal is to analyze how much room Belgian health law currently leaves for responding to these preferences and whether this legal framework should be reinterpreted or amended in the light of the "human right to culturally appropriate healthcare". The overarching aim is to improve diversity-responsive, patient-oriented care for the migrant population, by identifying those strategies and tools that may be legally acceptable to accommodate patient preferences and by incorporating them in policy and legal recommendations, as well as in an educational module for physicians and information materials for patients, families, and healthcare workers. The project uses a mixed-methods design, combining desk research and quantitative (factorial survey with hypothetical vignettes) and qualitative (focus group discussions, in-depth interviews and nominal group method) research methodologies. The research team will jointly review the results from the three perspectives, by using multiperspective qualitative methods. With its aim to examine and improve diversity-responsive, patient-oriented care for the migrant population, our research project aligns closely with the vision statement of the University of Antwerp on fostering diversity and equal opportunities, as well as with current national and international political and research priorities. Supporting an inclusive society by reducing inequalities and social exclusion is a priority action point for the European Commission, the Council of Europe, the UN, and the WHO. International policy instruments highlight that inequalities in access to healthcare are growing and particularly affect vulnerable groups, including patients with a migration background. Consequently, they call for measures to guarantee that every person effectively obtains a satisfactory degree of care. In contributing to this goal, our research project addresses central policy and research priorities. The project is therefore expected to result in major opportunities to obtain European and other international funding, and to form the basis for international research collaborations, taking into account similar challenges arising in other European countries. In this way, the project will also significantly increase the international visibility of the University of Antwerp.

Researcher(s)

• Promoter: Van Assche Kristof
• Co-promoter: Van de Velde Sarah
• Co-promoter: van Olmen Josefien
• Co-promoter: Van Royen Paul
• Co-promoter: Vansweevelt Thierry

Research team(s)

• Personal Rights and Property Rights

Project type(s)

• Research Project

Abstract

Most traditional youth mental health interventions fail to achieve sustainable impact at scale because they overly rely on individualized, medical illness-focused models and treat youth as passive beneficiaries. citiesRISE, a multi-stakeholder initiative founded in 2017 to address these gaps, has worked with youth, communities, and professionals across five cities, as well as social innovators in over twenty countries, to develop a set of evidence-based, scalable youth mental health interventions and implementation models. The YiPEE project aims to provide robust evidence on the feasibility, adaptability, effectiveness, and cost-effectiveness of a multi-component intervention targeting the inner, social, and environmental dimensions that underpin mental health and broader NCD risk reduction outcomes, when implemented using a youth-informed and -activated approach. This will be achieved through a a mixed-methods approach, conducting a realist evaluation across the four sites (Chennai, India; Nairobi, Kenya; Cape Town, South Africa; Stockholm, Sweden) to study key implementation outcomes following the Practical Robust Implementation and Sustainability Model (PRISM) as well as the mechanisms underlying why the intervention works, for whom, and under what real-world conditions. In Chennai, YiPEE will conduct a randomized controlled trial for more robust evaluation of effectiveness and cost-effectiveness in achieving key mental health and other NCD related lifestyle behavioral outcomes. YiPEE focuses on the combination of a school-based multicomponent intervention targeting positive disruption in the inner, social, and environmental dimensions of adolescents' mental health and a youth-informed and -activated implementation model that puts young people at the centre of transformation, working collaboratively with a range of other stakeholders.

Researcher(s)

• Promoter: van Olmen Josefien
• Co-promoter: De Man Jeroen
• Co-promoter: Willem Lander
• Co-promoter: Wouters Edwin

Research team(s)

• Primary and interdisciplinary care Antwerp (ELIZA)

Project type(s)

• Research Project

Abstract

The Flemish government supports the development of primary care. This happens partly within the VAGZ, with the policy instruments regulation and financing. In addition, organisations providing support have been set up, such as VIVEL. VIVEL supports the development of the ELZ with a number of supporting activities and evaluations of themes such as: a) participation of people with care and support needs in care degrees (by Artevelde-Hefboom); b) indicators and identification of vulnerability for ELZ (U Gent); and c) data and dashboard for monitoring care needs and supply at ELZ level (VIVEL working group on data). The VAGZ wants to use its support efficiently and effectively. This planning benefits from knowledge (and experimental learning) about what has worked and knowledge gathering on what works well and what works less well in the first years of the ELZ. There is international comparative research evaluating the COVID-19 response and decentralisation 2,3. However, an evaluation of the functioning of ELZ in Flanders has not been done to date. The aim of the current evaluation is to know whether and how ZR used the resources and function of population managers during the COVID pandemic to strengthen the governance, collaboration and organisation of the ELZ and what process changes and health outcomes this led to.

Researcher(s)

• Promoter: van Olmen Josefien

Research team(s)

• Primary and interdisciplinary care Antwerp (ELIZA)

Project type(s)

• Research Project

Abstract

Encouraging women to give birth in health facilities is considered a key strategy to prevent women and babies from dying. However, facility-based delivery (FBD) is increasingly understood not to be enough to reduce maternal and perinatal mortality. Measuring only the coverage of FBD in a particular context does not reflect the content and quality of care women receive. To address this shortcoming, effective coverage measures – which introduce the dimension of quality of care to the measurement of intervention coverage – are proposed as the new best practice. However, the relevance and feasibility of measuring effective coverage of FBD (ECFBD) in low-resource contexts remains understudied. We have limited insight into the conceptual and practical challenges which may hamper operationalisation of this indicator. My project addresses this research gap by investigating the relevance and feasibility of measuring ECFBD across Tanzanian health system levels, from the facility-level in Newala district, up to regional, national, and international levels. By using qualitative research methods and studying experiences 'from the ground up', the project will shed light on the tensions between international measurement demands and local needs, as well as how they might be addressed. My findings will thus be able to inform future efforts to measure ECFBD, hereby contributing to promoting global health measurement that is truly helpful to improve local-level health services and outcomes.

Researcher(s)

• Promoter: van Olmen Josefien
• Fellow: Molenaar Jil

Research team(s)

• Primary and interdisciplinary care Antwerp (ELIZA)

Project type(s)

• Research Project

Abstract

Sustainable Development Goal 3 underlines the right of everyone to have timely access to primary healthcare (PHC). Despite the fact that Belgium has put various reforms in place to make PHC more affordable and accessible, inequalities in access to care are even getting bigger – creating the need for innovative measures. A new health care model should thus be designed and tested to link people who have difficulties accessing PHC (PDAP) to the existing PHC system. Such a new model requires new fundamental knowledge, as former solutions have repeatedly failed. Since the country is also confronted with increasing health demands and limited budgets, there is impetus to tap into the potential of reverse innovations from low and middleincome countries (LMICs). A review of health innovations in LMICs and a theoretical analysis on the required characteristics of such a new model resulted in a community health worker (CHW) intervention – inspired by the Family Health System in Brazil and Re-engineering PHC in South Africa. We hypothesise that an outreaching PHC model with a CHW intervention will address the access-to-care challenges in Flanders, Belgium. We will first study the interplay over time between the different barriers PDAP experience throughout the access-to-care continuum in Flanders (WP 1). Secondly, we will investigate the innovative PHC models in South Africa and Brazil to develop the CHW intervention (WP2). In WP3, we will design a new outreaching PHC model which uses CHWs to improve access to care for PDAP in Flanders. In WPs 4 and 5, we will implement and evaluate the CHW intervention in a cluster randomised controlled trial. Finally, we will also assess the cost-effectiveness of the intervention (WP6). Throughout this work, academic experts from sociology, family medicine, and economics closely collaborate with committed societal stakeholders to join scientific insights and implementation knowhow, to optimise fit to practice and societal impact.

Researcher(s)

• Promoter: Bastiaens Hilde
• Co-promoter: Masquillier Caroline
• Co-promoter: van Olmen Josefien

Research team(s)

• Primary and interdisciplinary care Antwerp (ELIZA)

Project website

Project type(s)

• Research Project

Abstract

The current state-of-the art advocates for a biopsychosocial rehabilitation approach for persistent pain after breast cancer treatment. Within this approach pain science education is combined with promotion of an active lifestyle based on self-regulation techniques. We argue for testing an innovative eHealth self-management support program for this purpose. The assumption is that this delivery mode reduces barriers to pain self-management support, through bringing timely support near to people, creating a safe environment as opposed to hospital settings, providing a multidimensional support model taking into account the biopsychosocial needs of patients, and lowering costs. This program can provide patients with the knowledge, proactive, cognitive and self-management skills to master their situation and journey towards less pain and pain-related disability and participation in normal life again. Therefore, the general aim of the proposed project is to investigate the effectiveness of an eHealth self-management support program for pain-related disability (I) in breast cancer survivors with persistent pain (P). The program makes use of an innovative chatbot format for delivering pain science education and motivating and monitoring physical activity. The eHealth program is automated and personalized using comprehensive decision-tree-based algorithms in order to promote pain self-management support. The primary scientific objective of the study is to determine the effectiveness of this eHealth self-management support program for persistent pain after breast cancer treatment compared to 1) usual care (i.e. superiority of the eHealth self-management support program) (C1) and 2) a comprehensive pain rehabilitation program delivered face-to-face in a physical therapy setting (i.e. non-inferiority of the eHealth self-management support program) (C2) on pain-related disability (O).

Researcher(s)

• Promoter: De Groef An
• Co-promoter: Meeus Mira
• Co-promoter: van Olmen Josefien
• Co-promoter: Wens Johan
• Co-promoter: Willem Lander

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project

Abstract

The increasing prevalence of Type 2 Diabetes (T2D) and the frequent concurrence of comorbidity puts a heavy strain on societies (both the patients and health system), in terms of healthcare cost, patients' quality of life and loss of productivity. Interventions such as Integrated Chronic Care (ICC) and disease specific care trajectories are introduced to better address these complex needs but there is limited evaluation of these interventions. Most existing evaluations are limited in three ways: a) They show effects on diabetes-specific clinical outcomes, but do not take into account the comorbidity dimension; b) They do not take into account the variation in implementation of ICC; and c) have limited information on health-related quality of life (HRQoL) and cost-effectiveness. This proposal will triangulate different data sources (available health insurance data, laboratory and primary health care data combined with primary HR QoL data) in Belgium to addresses those gaps by examining the cost and cost-effectiveness of ICC for people with T2D and potential comorbidities for different levels of ICC implementation in Flanders. More specifically, we aim to (1) estimate the cost of care for T2D patients with and without comorbidities for different levels of ICC implementation in Flanders; (2) assess the impact of different levels of ICC implementation on HRQoL among T2D patients with and without comorbidities; and (3) evaluate the cost-effectiveness of different levels of ICC implementation in the provision of care among T2D patients with and without comorbidities. This project responds to a strongly felt need among 22 interviewed stakeholders that the increasing prevalence of chronic patients necessitates a move towards more ICC but that financing is a major barrier. This project pushed the boundaries of knowledge by quantifying costs and benefits. The knowledge generated in this study can contribute to a more effective and efficient implementation of ICC for the management of diabetes patients (with comorbidities) in Flanders. This is extremely relevant in a society with increasing health inequity and financial barriers to healthcare utilization and self-management.

Researcher(s)

• Promoter: Wouters Edwin
• Co-promoter: Buffel Veerle
• Co-promoter: van Olmen Josefien
• Fellow: Nugraha Ryan Rachmad

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

South Africa has a high burden of severe mental disorders. The country promotes deinstitutionalisation for people living with a severe mental disorder (PSMD) – shifting the locus of care from hospitals to local communities. This push, however, has not been fit with an according care model in these communities. PSMD are discharged into households without any support – often resulting in a cyclical pattern of short-term readmissions to the hospitals that they have been discharged from, sometimes with devastating consequences. The project aims to build a research partnership between the Univ. of KwaZulu-Natal, the Univ. of Cape Town and the Univ. of Antwerp which will (1) exchange knowledge on the potential of households in health care, (2) strengthen the relationships with policy makers and (3) improve the curriculum of social work auxiliaries providing household support. The combination of these activities is aimed at enabling a research program to durably improve the well-being of PSMD using a household intervention – thereby stopping the revolving door syndrome and the devastating social/economic/health consequences it creates.

Researcher(s)

• Promoter: Wouters Edwin
• Co-promoter: Masquillier Caroline
• Co-promoter: van Olmen Josefien

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

Type 2 Diabetes (T2D) is one of the leading causes of death in the world (3.7 million deaths/year). In Belgium, 6.1% of the population is diagnosed with diabetes. Effective treatment exits and is relatively straightforward from a technical point of view, but T2D care is socially and organizationally complex. It requires lifelong follow-up and self-management along a continuum of care: patients need to be diagnosed, treated, followed-up, and supported to achieve glycaemic control. Unfortunately, people (especially vulnerable groups) are lost at each of these steps, leading to complications and avoidable hospitalizations. Knowledge is urgently needed on the determinants of these leakages in the care continuum. In accordance with the socioecological model, we aim to disentangle the determinants of drop-out at 3 levels (patient, health system & community level) through an innovative multilevel Cascade-of-Care approach. The Cascade-of-Care visualizes the drops between the steps of the care continuum while our multilevel analyses will attempt to explain each drop using determinants at the 3 levels. We will build a unique dataset combining (1) individual health insurance and medical lab data, (2) organizational data of primary care practices and (3) administrative and self-gathered data of neighborhoods. Spatial multilevel analysis will allow us to assess (1) the relative impact of and (2) interaction between the determinants at these 3 levels on each step of the continuum of care.

Researcher(s)

• Promoter: Wouters Edwin
• Co-promoter: Buffel Veerle
• Co-promoter: van Olmen Josefien

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

Chronic illnesses (CI) encompass a broad range of long-lasting conditions with uncertain trajectories and often with complicated treatment. Chronic illness management (CIM) requires mobilization of a patient's social network. Social network-based interventions have been shown to improve health outcomes for people with CI, however, most research has focused on native populations in high-income countries. The use of such interventions in the promotion of CI self-management among migrants is more complex. In this jPPP, we will adapt, pre-test, and assess the relevance and feasibility of using 2 methods (ClickDiaries and the Social Connections Mapping Tool) to collect data on social networks and their relevance in CIM among non-EU migrants in Antwerp, by means of a rapid literature review, focus group discussions, stakeholder consultations and tool administration. The output will be an adapted tool that can capture the scope, functions, and strength of local but also transnational networks relevant to CIM of migrants; information about why, when, and to what purpose networks are mobilized; and longitudinal insights on how networks can change over the course of a CI. This tool will serve to address research gaps in this area but also can contribute towards design of CIM programs and clinical consultation aids for professionals supporting migrants with CI. The adapted tool will also be used in forthcoming large EU research proposals.

Researcher(s)

• Promoter: van Olmen Josefien

Research team(s)

• Primary and interdisciplinary care Antwerp (ELIZA)

Project type(s)

• Research Project

Abstract

The city of Antwerp and the Antwerp primary care zones have organized the COVID response on their territory. Now that the COVID-19 pandemic is reaching an endemic phase, the city wants to evaluate the COVID response on its territory and draw lessons from it in function of potential new similar health crises in the future. This evaluation project responds to the evaluation questions through a systematic method and based on strong scientific research.

Researcher(s)

• Promoter: van Olmen Josefien

Research team(s)

• Primary and interdisciplinary care Antwerp (ELIZA)

Project type(s)

• Research Project

Abstract

What can we learn from COVID-19? Was a research project proposal submitted to the FWO but wasn't granted. The aim of the project was to contribute to a better understanding of the links between governance and resilience of urban health systems in superdiverse cities. The general objective was to explore and compare the factors underlying resilience of urban health systems in two selected cities, using COVID-19 as a tracer condition for a shock. We designed six sub-studies, each tackling one specific objective. This jPPP-project is a pilot project to prepare for the 'Urban health systems, shocks and resilience: what can we learn from COVID-19?' project. This is also part of the 'living lab' that the Primary Care and Public Health spearhead is developing with the City of Antwerp.

Researcher(s)

• Promoter: van Olmen Josefien

Research team(s)

• Primary and interdisciplinary care Antwerp (ELIZA)

Project type(s)

• Research Project

Abstract

The aim is to develop a multidisciplinary good clinical practice guideline on oncological post-acute care in primary care, according to the international standards for the development of an evidence-based guideline and the criteria used by the Belgian Centre for Evidence-Based Medicine (CEBAM) for the validation of guidelines.

Researcher(s)

• Promoter: van Olmen Josefien
• Co-promoter: De Groef An
• Co-promoter: Van Royen Paul
• Co-promoter: Wens Johan

Research team(s)

• Primary and interdisciplinary care Antwerp (ELIZA)

Project type(s)

• Research Project

Abstract

Given the crucial role of health promotion and disease prevention in primary care and the limited attention paid to it in current training programmes in Belgium, there is a need for capacity building for disease prevention and health promotion for primary care professionals. With this project, we formulate strategies for a better embedding of health promotion and disease prevention in primary care training, based on international standards and using a European network. The project is carried out by a multidisciplinary consortium of two academic partners from both language areas -University of Antwerp (UA) and Université Catolique de Louvain (UCL) - and the expertise centre on health promotion - Vlaams Instituut Gezond Leven (GL). The multidisciplinary research team consists of general practitioners, psychologists, educational experts and communication scientists. The research group can call upon an extensive steering committee of stakeholders with representatives of care users, educational institutes, professional organisations and policy makers from both parts of the country, both during the inventory phase and for the development of the strategy and dissemination. The inclusion of representatives of vulnerable target groups in the steering committee guarantees specific attention to the needs and input of these groups. The development of strategies is done in 3 phases, organised in 3 work packages. In WP1 we will elaborate a Belgian frame of reference for the provision and quality of education in health promotion and disease prevention through desk research. Existing international frameworks such as the core skills set for health promotion workers by the International Union for Health Promotion and Education (IUHPE) are the starting point for a cross-professional frame of reference adapted to the Belgian context. In WP2, we will make an inventory of the existing provision and of the quality of health promotion and disease prevention in primary health care training in Belgium through a survey starting from the stakeholder network. This also includes a comparative analysis with training courses in other European countries, through the research group's connections to European networks. The trainings will be analysed based on the frame of reference developed in WP1 and Clement's didactic model. WP3 will focus on the development of strategies for the envisaged embedding of health promotion and disease prevention in primary care training based on the results of WP1 and WP2. By means of co-creation work sessions, the research group together with stakeholders will develop a draft strategy in the form of an educational package, which will be tested in a Delphi procedure. The dissemination to training institutes, professional and scientific organisations, target groups and policy makers and the creation of a support base for concrete strategies will take place together with the steering committee. A final symposium and publications in professional journals will contribute to this.

Researcher(s)

• Promoter: van Olmen Josefien
• Co-promoter: Bastiaens Hilde
• Co-promoter: Michels Nele
• Co-promoter: Van Royen Kathleen
• Co-promoter: Van Royen Paul

Research team(s)

• Primary and interdisciplinary care Antwerp (ELIZA)

Project type(s)

• Research Project

Abstract

During the course of the COVID-19 outbreak, a wealth of data has been accumulated from the efforts of the health systems to overcome the pandemic. Months of patient encounters with primary to tertiary care systems are leaving an affluence of valuable information reflecting the real impact of the virus in people's health and lives. These real-world data [RWD] offer an unparalleled opportunity to understand COVID-19 but also an important analytical challenge due to the dissimilar and heterogeneous nature of this information. Using complementary data sources from primary health care and hospitals, this project aims to set up a methodological framework for data harmonization, linkage, and analytical development of a novel tool for multi-state risk prediction identifying the role of comorbidities, among other factors, in predicting COVID-19 progression into severity, and subsequent recovery or death. This research will afford a unique instrument for risk stratification and resource allocation in the face of current and future epidemics and will serve as a proof of concept of the usefulness of RWD and the feasibility of the adaptation of novel this methodological framework to other countries/settings based on local data.

Researcher(s)

• Promoter: van Olmen Josefien
• Co-promoter: Philips Hilde

Research team(s)

• Primary and interdisciplinary care Antwerp (ELIZA)

Project website

Project type(s)

• Research Project

Abstract

Introduction. Globalization, innovation, urbanization, climate change and ageing have consequences for public health and for health care systems. It has led to new health problems, to more diversity among the population, to a different societal context, and to new possibilities and threats in the health care system. Answers to these global and local challenges include intersectoral collaboration and integration. Belgium is undertaking steps to move to more integrated care, with initiatives like first line zones and decentralization of health care towards primary care level. Few initiatives are evaluated, which leaves a knowledge gap on implementation, effectiveness and cost. This proposal aims to contribute to implementation and evidence of high quality integrated care, in Belgium and in other contexts Research objectives. The objectives of the research plan are to increase quality of integrated care, by 1) respond better to diversity and new health needs in the changing society; 2) adaptation, implementation and evaluation of health and care models that strengthen links between public health and primary care and between patient, health providers and community; and 3) to contribute to sustainable change by improving institutional and health system context for integrated care, through linkage between health policy and implementation. Approach and methods. The plan builds upon the transversal themes of 1) diversity and vulnerable groups and changing health needs, in particular multi-morbidity; 2) new forms of organization and collaboration and; 3) role of data and information systems. The underlying conceptual approach takes into account health systems dynamics, meaning the study of the relations between different elements in the system and with the context. It is structured in three work packages. WP1 examines the variation and cost of multi-morbidity; implementation and effectiveness of interventions to address diversity and multi-morbidity; and the monitoring of multi-morbidity in health systems. WP2 studies network dynamics and outcomes of provider collaboration and patient health care utilization in different care models; task-shifting and intersectoral collaboration. WP3 examines digital tools support vulnerable groups; strengthening of data management systems to support collaboration and integrated care and evaluates the impact of increased sharing of health information data on patients and society. The methods will include epidemiological surveys, secondary data analyses of quantitative datasets, health expenditure and costing analyses, and stakeholder analyses using qualitative methods. The identified priority areas in this proposal provide opportunities to link existing research work of the four spearhead research groups, and collaboration with operational partners and policy makers in the local and regional context of Antwerp. Impact. After 5 years, this research strategy has led to the following results. 1) new knowledge on multi-morbidity among different population groups; 2) evidence on effects and cost of new care models in the Belgium context,; and 3) utilization of digital tools and health data for research and practice; and 4) recognition of the spearhead research of the UA on quality of integrated care.

Researcher(s)

• Promoter: van Olmen Josefien
• Fellow: van Olmen Josefien

Research team(s)

• Primary and interdisciplinary care Antwerp (ELIZA)

Project type(s)

• Research Project

Abstract

MultiMorbidity (MM), the concurrence of two or more chronic conditions, is a growing phenomenon in all countries, and more prevalent among vulnerable groups in society. Yet, research to understand and address the phenomenon has only recently taken off. In the Belgium context, the burden of multimorbidity, measured by disability, is highest for cardiovascular diseases with or without diabetes; chronic respiratory diseases and depression; neurological diseases and cancers. The prevalence of MM has risen from 8,9% in 1997 to 15,2% in 2018. How patients use health care for their different conditions is not well known, while this has implications for quality of care and cost. Best practices in health care organizations to manage multimorbidity are being documented, but implementation research on feasibility, cost and effectiveness is still patchy. The PhD aims to improve understanding the burden, management and cost of multimorbidity in the Belgium health system, from the patient and health system perspective. Two Research Questions will be examined: 1) What are patterns of health care utilisation and health care cost for people with multiple chronic conditions? 2) Which innovations to manage multimorbidity are implemented, and what is the feasibility acceptability and effectiveness and cost of implementation? Year 1 and 2 will be used to develop the research protocol, explore existing data and to do the analysis of RQ1. Year 2 and 3 will be used for RQ. At least drie peer reviewed articles will be written with the following topics: 1) health care utilization and cost for Belgium patients with multiple chronic conditions; 2) implementation analysis of pilots for integrated care for multimorbidity; and 3) cost-effectiveness of multimorbidity pilots in the Belgium health system.

Researcher(s)

• Promoter: van Olmen Josefien
• Co-promoter: Van Hal Guido
• Fellow: Tran Bich Phuong

Research team(s)

• Primary and interdisciplinary care Antwerp (ELIZA)

Project type(s)

• Research Project

Abstract

Cambodia is confronted with a growing diabetes epidemic, translated in an increase of the prevalence of deaths attributable to this chronic disease by 42.9% between 2005 and 2016. The diabetes epidemic is projected to severely hamper the country's much needed developmental progress. The country's public health system has been primarily designed to tackle acute diseases and is therefore not capable of comprehensively addressing this public health problem. The proposed project intends to address this problem by joining forces with two local actors – NIPH and MoPoTsyo – to generate context-sensitive strategies to co-create comprehensive but context-specific diabetes care. More specifically, it aims to (1) investigate where current policies and strategies differ from the optimal WHO ICCC framework, and (2) see how these differences translate in suboptimal outcomes in diabetes management, and finally (3) develop roadmaps (together with the stakeholders) to overcome the shortcomings in the current approaches.

Researcher(s)

• Promoter: Wouters Edwin
• Co-promoter: Masquillier Caroline
• Co-promoter: van Olmen Josefien

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project

Abstract

Background: Diabetes and hypertension are increasingly dominant in the global burden of disease. Effective interventions for prevention, detection, treatment and control of both conditions are available, but do not reach all people in need. Countries are struggling how to scale-up interventions sustainably and effectively. There is an urgent need to develop and document strategies on how to do so. Method: This project examines the scale-up of existing evidence-based packages for control of diabetes and/or hypertension with five components: (a) identification of people with hypertension and/or type 2 diabetes and (b) treatment in primary care services, (c) health education and (d) self-management support to patients and caregivers, and (e) collaboration among caregivers. The project develops, implements and evaluates roadmaps for the national scale-up of this package, in three different types of countries: a low-middle income country with a developing health system (Cambodia), a former socialist country with a centralised health system (Slovenia), and a Western European country with a decentralised system (Belgium). The research objectives are: 1) to analyse the organisational capacity to scale-up the integrated care package and to assess contextual barriers and facilitators; 2) to develop and implement roadmaps for a national scale-up strategy in each country; 3) to evaluate the impact of scale-up on health outcomes and costs; and 4) to generate lessons for other countries. Outcomes: The project will result in comprehensive scale-up strategies and increased diabetes and hypertension control in each country. The involvement of policy-makers, professionals and patients will ensure the local relevance and impact. The project is innovative in applying the conceptual insights from scale-up science to the field of noncommunicable diseases. The lessons on scale-up will benefit policy-makers in other countries with similar contexts.

Researcher(s)

• Promoter: Wouters Edwin
• Co-promoter: Remmen Roy
• Co-promoter: van Olmen Josefien

Research team(s)

• Centre for Population, Family and Health

Project type(s)

• Research Project