出版社：Utrecht University, Maastricht University, Groningen University
摘要：Introduction : The current increase in chronic illnesses poses new challenges for European countries in terms of integrated care. In Belgium, a reform of the healthcare system has been launched through a joint plan entitled “Integrated Care for Better Health” in support of chronic patients. This exploratory study investigates how this reform impacts on the different levels of the care production chain, from policy makers to practitioners and patients, thanks to the collaboration of 3 research units. More specifically, we decided to consider patient empowerment, often defined as a key issue in the field of healthcare, and to study how it could influence each level of care management in the Belgian healthcare system. Methods : Each research unit investigated a particular dimension of the main topic, and combined different data collection methods in order to achieve a multidisciplinary point of view. The methods used were interviews about the reform process (n=21), focus groups (n=7) and direct field observations (n=38), qualitative interviews with health professionals, caregivers and chronic patients in triads (n=23), and thematic literature reviews (n=3) concerning all these aspects, but also focusing on the significant personal traits of chronic patients. Our common background were the local pilot projects launched in the context of the reform. Results : Our preliminary results demonstrate that patient empowerment does not always encompass the same scientific reality. At an institutional level, this concept is linked to the authorities’ wish to support at-home care for chronic patients. At a therapeutic level, the role of the caregivers in maintaining the patient’s autonomy, but also the social conditions of his/her life, is a salient component of empowerment. Eventually, results from the literature reviews describe how individual and personal features such as identity, and specifically survivor identity, can influence patient empowerment and his/her behaviour in the healthcare system. Discussion : This multidisciplinary research suggests that patient empowerment is not sufficiently clearly defined at each level of the care production chain. Therefore, this limitation could impede the implementation of the healthcare reform by creating misunderstandings, as it doesn’t seem to always allow the ideal management of chronic conditions. Conclusions and lessons learned : Our research illustrates the importance of determining a common meaning in terms of the main healthcare concepts, and the need to shed light on the importance of multidisciplinary points of view. Limitations : A limitation of the study was the coordination of three research projects with different objectives, and the various conceptions that depend on the specific epistemology of each team. Suggestions for future research : The long-term monitoring of the empowerment actions with regard to each pilot project at different level of the reform appears to be crucial. A second phase will allow us to extend this knowledge, but also to develop training efforts to improve the degree of collaboration between health professionals and caregivers, and to create a tool to assess more precisely the identity of chronic patients.
关键词：patient empowerment ; chronic illness ; integrated care ; care management ; multidisciplinary approach
