Introduction

Boost is a multifaceted integrated care pilot project in Brussels.  It is one of 12 local pilot projects launched under the national Belgian strategy for integrated care. One of the Boost interventions is creating a new function in the regional care ecosystem called “trusted front line professional” (TFLP), aimed at supporting patients with complex needs in a cross-sectorial perspective through the activation of relevant local resources.

Description

After an initial training course, any professional can act as a TFLP: nurse, GP, pharmacist, social worker, physiotherapist, occupational therapist... A monthly community of practice meeting and a toolkit including a Personalized Guided Plan, an inventory of resources and a helpdesk phone line support the function. Financing comes from shared savings.

Aim

A double mind-set change is expected from the professionals:

- adopting a focus on the patient’s goals and priorities

-  taking an asset-based approach to foster patients’ resilience by arranging support around them, with timely use of relevant resources, including in non-health sectors.

At the heart of BOOST, this function also aims to create a common ground and mutual/shared understanding amongst several professions.

Stakeholders and targeted population

BOOST is a consortium of 50 partners – care organisations and self-employed workers - from the health sector and beyond: representatives of patients and carers, primary care professionals, home care services, social workers, hospitals, mental health and community health professionals, academics, ... Most of them participated in the project design and continue in its implementation.

The target public is people with cardiovascular disorders, diabetes, COPD and/or chronic renal impairment combined with indicators of frailty (multiple comorbidity, polypharmacy, frequent hospital admissions, mental health problems, isolation, low income etc.).

The project operates in 3 districts in the centre of Brussels, covering 130 000 inhabitants.

Timeline

Boost started in January 2018 for a four-years duration. Professionals enrolled as TFLPs since early 2019.

Highlights

The TFLP function differs from a case manager considering that any professional can handle it. The TFLP serves more as a doorway towards complementary services rather than providing daily case management. S/he connects  to a community of practice where s/he can share good practices and develop additional tools and initiatives to support the function with an eye to further strengthening care integration.

Transferability

Being a function – not a new profession – designed to be easily “plugged-in” to any existing profession makes the TFLP highly transferable to  broader population and health conditions.

Findings

The demand for recognition, which at first fuelled some professionals’ motivation appeared to subsequently hamper their full commitment as it triggers the fear of losing their professional specificity when enrolling as a TFLP. To overcome this reluctance, the strategy focuses on  “function” instead of ‘profession’ and on building legitimacy for the function outside the consortium. Implementation of the function is still at an early stage.

Lessons learned

Working with highly motivated professionals at an early stage opens ways for others to step in. BOOST must find a balance  between the preservation of professional specificities and developing a common interprofessional ground.