Introduction

Care for patients with complex problems is often offered from a disease-oriented approach. However, for individuals with chronic and complex care needs, this approach tends to overlook the needs and values of the individual and often leads to fragmented care as different providers focus on different goals. Goal-oriented care implies a shift from disease- and problem-oriented care to care that starts from the patient's goals and values. Because different professionals focus on the same goals (being the goals of the patient) goal oriented care probably leads to more integrated care. However, current research highlights a knowledge gap regarding the skills and competencies that are required to effectively apply goal-oriented care into practice.

Aims

This research aims to gain insight into the beliefs, skills and strategies that support professionals, patients and informal carers in the implementation of goal-oriented care.

Method

First, the readiness and beliefs of healthcare providers to implement goal-oriented care in their daily interprofessional work environment are investigated using the Normalisation Measure Development Survey (NoMAD) and the Interprofessional Socialization and Valuing Scale (ISVS). In a second phase, through the development and implementation of a training package on goal-oriented care in primary care in flanders, care providers, patients and their informal carers are trained in goal-oriented care. In this trajectory of co creation and implementation the experiences of these three stakeholder groups are explored through focus groups, interviews and structured field observations. In this process, the skills and strategies that both healthcare providers and their patients and informal carers use to organise care and support around the patient's goals are specifically identified.

Results

This research will provide insight on how healthcare actors in Flemish primary care can work towards integrated care for people with complex care and support needs and what competences are necessary for this. In this way, the potential of goal oriented care as a catalyst for integrated care can be further explored.