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The
Middle East Academy for Medicine of Ageing (MEAMA) -
1.
MDS Quality Indicators and Their Use in the Quality Assurance Process 6.
Home health services at NWAFHP Improving
health of the elderly a Nordic experience From
1 through 3 September, 2004, the third session of the first MEAMA
course was organized in Bahrain in the Kingdom of Bahrain. Seventeen
participants from six Middle-East countries participated in the
session. Originally a one day symposium on aspects of quality of
life was planned at the day before the third session. For the participants
of the course this symposium would have been the first day of the
session. Unfortunately, because of an unavoidable change in the
date of the course, the symposium had to be cancelled. A disappointment
which was compensated by the presence of two highly qualified speakers,
who participated during the whole session, with excellent presentations
and fruitful discussions. It was a pleasure for both participants
and organizers to have prof. dr Miel Ribbe from Amsterdam, the Netherlands,
and prof. dr Palmi Jonsson from Reykjavik, Iceland, available for
information and advise. Dr Adel Al-offi presented the results of a community geriatric team for mental disorders in Bahrain. Consultations are offered at home, in nursing homes and in hospitals. The model was cost effective and postponed hospitalisation or admittance in a nursing home. The level of adherence to the guidelines for diabetes mellitus in older patients in Canada was discussed by Al Malik Waleed from Saudia Arabia. The use of aspirin and blood pressure control were good, however, the measurements of HbA1c and the lipid profile was measured in less than 15% of the patients. Physicians know the guidelines, but do not use them in older patients. How to select a guideline from the increasing number of guidelines? Prof. Fawzi Amin recognizes six domains for the quality of a guideline: 1. the scope and purpose; 2. the stakeholder involvement; 3.te rigour of development; 4. the clarity and presentation; 5. the applicability; 6. the editorial independence. A critical review of a guideline should be followed by a discussion how to implement the guideline. For simple problems the guidelines are usually simple, for complex problems the guidelines are mostly broad and complicated. The groups' discussions asked for guidelines for special problems in patients, but also for caregivers, rehabilitation, safety and environmental risks and lifestyle improvement. For the nursing homes attention was asked for the end of life problems and cognitive functioning. For hospital discharge guidelines were requested. Guidelines for outpatient clinics were felt to be difficult to develop, for example regarding non-verbal communication. In a second lecture prof. Miel Ribbe emphasized the subjective, dynamic, normative and comprehensive aspects of quality. And quality care includes the impact, the process and the output. Quality indicators and the minimum data set were discussed, followed by an introduction of the interRai group and instruments. Several members of the participants showed serious interest to participate in a study of the interRai, to get information end insight in the Arabic patients. It offers the possibility to compare the outcomes of the Arabic world with other countries and cultures. As an area of the world, different from the Arabic world, prof. Palmi Jonsson was invited to explain the health care system in the Nordic countries of Europe: Norway, Sweden, Finland, Denmark and Iceland. Iceland has the highest life expectancy for people over 65 years of age in Europe. The limited population of Iceland made it possible to set up a system to keep older people at home as long as possible and to offer nursing home care only when needed. The success and the problems of the system were discussed. A problem in the system is the insufficient coordination between the institutions. Another problems is that general physicians have not been accustomed to visit patients at home. Because the incidence of chronic diseases in patients roughly doubles per five years increase of age, a programme for prevention has been developed in Iceland, with preventive measures for the age group 15-40 years, the age group 40-50 years and the age group 50 to 70 years and older. As in former sessions the participants evaluated the session and made suggestions for subjects of special interest for the last session of the course. The six subjects with the highest score of interest will be included in the programme of the next session: education and training for general practitioners and team members; how to start a society for gerontology and services for older people; theories about the process of ageing; nutrition, weight loss and adipositas; falls and fall prevention; management models in health care services for older people. The course was accommodated by the Bahrain Ministry of Health in the attractive Novotel, build in accordance with the typical old Bahrain architecture. A major sponsor for the course was the Merck Institute of Aging & Health. The Ministry of Health of the government of Bahrain offered excellent support and Gulf Air offered generous and excellent travel facilities for the European speakers. The acceptance of a board position by prof. Miel Ribbe will strengthen further development of the board and will support the preparations for the second course, to be started in the autumn of 2005. Sijmen Duursma |
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