Parc de l’All iance June 17, 2010

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Symposium

Healthcare, from the hospital to home

Parc de l’All iance June 17, 2010

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Healthcare, from the hospital to home

In a constantly-changing world, healthcare professionals and political decision-makers are faced with major challenges: we have an aging population and we are seeing a significant rise in chronic health conditions; in addition, there are increasing pressures on healthcare budgets, resulting in pressure on hospitals to reduce the number of days of hospitalization. As for patients, they demand, and are entitled to, safe and effective treatment which will improve their quality of life. These factors are encouraging those involved in the healthcare system, the private sector and political decision-makers to take an in-depth look at how medical treatment should be organised, from the hospital to the home. These issues are currently being discussed in a number of European countries, and the debate will involve some important choices for society that will have to take into account the ever-changing demographic, epidemiological and sociological realities.

Saving and sustaining lives worldwideProf. Norbert RiedelChief Scientific Officer, Baxter International Inc.

Renal replacement treatment at homeProf. Dr. Michel JadoulHead of Nephrology department, Cliniques Universitaires Saint-Luc

Barriers and solutions for transferring care from the hospital to the homeDr Jan Van EmelenResearch & Innovation Director, Mutualités Libres

Economic aspects to transferring care from the hospital to the homeProf. Dr. apr. Ludo WillemsHead of Pharmacy, UZ Leuven

We need to get out of the hospital !Prof. Dr. Francis ColardynManaging Director, UZ Gent

Moderator of the symposiumProf. Dr. Jean-Louis VincentHead of the Intensive Care unit, Hôpital Universitaire Erasme

All presentations of the symposium are available on the websitewww.baxteralliancepark.be

Baxter SymposiumJune 17, 2010 – Braine-l’Alleud

Parc de l’All iance June 17, 2010

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Renal replacement treatment at home

Saving and sustaining lives worldwide

The gold standard renal replacement therapy (RRT) is undoubtedly a successful kidney transplantation (TP), in terms of survival, quality of life and cost for society. Unfortunately, many patients , especially with the growing elderly population, have contra-indications to TP and many others will require a modality of dialysis, awaiting a kidney TP. At the “Cliniques Universitaires Saint Luc, the choice of modality of dialysis is made by the patient after exposure to a pre-dialysis educational programme. This programme gives medical staff and nurses the chance to explain the different options to patients: hemodialysis in hospital, in a local unit or at home (either self or assisted), peritoneal dialysis (either self made or assisted). The decision takes into account factors such as the patient’s profile (age, comorbidities, context). Absolute or relative strong contra-indications for renal replacement therapies at home however concern only 10-20% of patients . Our multidisciplinary team thus takes great care to identify the patients’ preference(s) regarding RRT modalities. Ultimately, in our hands around 45% will choose one or another self-care modality, as a result of preferences related to better autonomy, dietary aspects, less travels to hospital, implications for their job or activities etc….. We strongly believe that taking great care of patients’ preferences will improve their adherence to the chosen RRT modality, a critical feature as any RRT modality significantly impacts on daily life. As far as the type of treatment (either HD or PD) is concerned, recent data from literature and our experience in Saint-Luc suggest that peritoneal dialysis and haemodialysis are not in competition with each other, but rather represent complementary approaches, with potential shift between modalities at some time if necessary. In the absence of large sized randomized trials , there is no scientific demonstration that renal replacement therapy at home is associated with an improved prognosis, but large observational studies suggest it is at least as good as in-center HD. The only concern would be safety. However, in our hands , this is no problem as long as the decision to opt for renal replacement treatment at home is carefully considered and the team in charge of the treatment is experienced. Indeed, it is very important that everybody’s role is clearly defined (nephrologist, general practitioner, nursing staff etc.). It is also important to educate the patients regarding the steps to be followed and contacts available in case of any medical or “technical” complications (fever in HD, abdominal pain in PD etc.). Renal replacement treatment at home does not at all mean a break of links with the hospital. Ultimately, renal replacement treatment at home can be of interest in terms of the economics of healthcare.

Baxter International Inc., founded in 1931, is a highly diversified global healthcare company which focuses on developing and commercializing life-saving and life-sustaining therapies for acute and chronic conditions. Baxter therapies are administered in the hospital as well as in the home of patients, with an increasing emphasis on home therapy. Baxter’s therapy portfolio encompasses the treatment of chronic bleeding disorders, immune deficiencies and end-stage renal disease, with a strong focus on improving clinical outcomes and patient quality of life; the prevention of disease through modern vaccines and the repair and restoration of tissue function; using biological or cellular therapies and the reduction of medical errors and hospital- or therapy-acquired infections. Baxter operates in more than 100 countries around the world and has a very strong R&D and manufacturing presence at Alliance Park and in Lessines, Belgium.

Prof. Dr.  Michel Jadoul, Head of Nephrology department, Cliniques Universitaires Saint-Luc, born in 1958, is married and has 3 children aged 23,20 and 17. He received his MD degree in 1983 at the Université catholique de Louvain, Brussels, Belgium. He trained in internal medicine and nephrology with Professor Charles van Ypersele de Strihou as mentor and spent a year in the Academic Hospital in Utrecht, The Netherlands (Prof.Dorhout Mees and Koomans). He is the head of the Department of Nephrology of the Cliniques Universitaires Saint Luc since 2003 and Clinical Professor at the Université catholique de Louvain. His past and current clinical activities include the follow-up of chronic and acute hemodialysis , as well as CKD patients. His main clinical research interests have included over the years beta2 microglobulin amyloidosis, hepatitis C and other complications in hemodialysis patients , including falls, bone fractures and sudden death as well as cardiovascular complications in kidney transplant recipients. He has been the (co)-author of over 120 scientific papers, many of them published in major nephrology journals. He is an associate editor of the American Journal of Kidney Diseases and of Néphrologie et Thérapeutique and a member of the Editorial Board of Nephrology Dialysis Transplantation and Clinical Nephrology. He is country co-investigator for the Dialysis Outcomes Practice Patterns Study(DOPPS) in Belgium since 2001 and has cochaired the KDIGO Hepatitis C Workgroup. He has received in 2008 the International Distinguished medal of the National Kidney Foundation (USA) and is a member of the KDIGO Board of Directors (2009-…).

Prof.  Norbert Riedel, Chief Scientific Officer, Baxter International Inc., is corporate vice president and chief scientific officer of Baxter International Inc., having served in that capacity since March 2001. Before assuming this role, Dr. Riedel served as president of the recombinant proteins business unit and vice president of research and development within Baxter’s BioScience business. Prior to joining Baxter in 1998, he was head of worldwide biotechnology and worldwide core research functions at Hoechst Marion Roussel, now Sanofi-Aventis. Dr. Riedel serves on the board of directors Medigene AG. He is a member of the Advisory Board of Northwestern University’s Kellogg School of Management Center for Biotechnology, the McCormick School of Engineering and the University of Vienna. He is also a member of the board of trustees of the Chicago Symphony Orchestra. Dr. Riedel received his Ph.D. in biochemistry from the University of Frankfurt in 1983. He was a postdoctoral fellow at Harvard University from 1984 to 1987, assistant professor and associate professor of medicine and biochemistry at Boston University School of Medicine from 1987 to 1991, and a visiting professor at Massachusetts Institute of Technology in 1992. He remains affiliated with Boston University as an adjunct professor and also serves as an adjunct professor of medicine at Northwestern University’s Feinberg School of Medicine. In 2009, Dr. Riedel was elected into the Austrian Academy of Sciences.

Prof. Dr. Michel JaDoul Head of Nephrology department, Cliniques Universitaires Saint-Luc

Prof. Norbert rieDel Chief Scientific Officer , Baxter International Inc.

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Economic aspects to transferring care from the hospital to the home

Barriers and solutions for transferring care from the hospital to the home

Everybody knows about the high costs associated with hospitalisation. These costs not only cover staff, procedures and drugs, but also the complications fostered by a stay in a hospital environment, such as nosocomial infections etc. Transferring care from the hospital to the home helps reduce these costs and in most cases, fits in with the expectations and preferences of the patient. It does however require flawless organisation, particularly in terms of the administration of treatments and the monitoring of patients. The role of each individual (patient, nursing staff, general practitioner, specialist doctor etc.) must be clearly defined. It is also advisable to incorporate regular assessments of how the system is organised. UZ Leuven has developed particular expertise in the field of parenteral administration at home. This expertise covers both the organisational aspects (preparation of the product in the hospital, administration at home, provision of a personalised folder for each patient, containing all relevant information etc.) and the financial implications. The comparison of the spending associated with parenteral administration in hospital and at home requires a comprehensive approach, taking all costs into account. Thanks to the organisational structure established at UZ Leuven, parenteral administration at home is become less costly for the patient than parenteral administration in hospital. Ultimately, hospital treatment at home relies on an active relationship between the patient and the hospital. The Internet can be an incredibly useful tool in this respect, particularly by enabling the patient, the nurse or the general practitioner to enter the necessary data and in return, get the information needed to adjust the treatment. Other measures need to be put in place to consolidate the links between the home and the hospital, and the patient’s involvement and motivation are crucial for the success of the system.

There are a number of barriers blocking the transfer of care from the hospital to the home. They are financial, legal and organisational. From a financial point of view, it is currently more attractive for the patient to be treated in the hospital, as this provides an all-inclusive solution. This situation is however more costly for the social security system. In the system currently in force, the transfer of care from the hospital to the home penalises the patients who has to pay for the equipment, the travel of specialist nurses etc. themselves, without any refunds. No compensation is offered to family and friends when they are brought in to play an active part in the organisation of the treatment. It is therefore a good idea not only to change the care model, but also the administrative/financial and organizational model. A number of experiments have been conducted looking at treating complex cases at home, such as the one started in Brussels and Bruges in 2003 (RIZIV/INAMI article 56 – project B080110 – 15.05.2003). Added to this financial obstacle is a legal one. It is important that it is clear who is accountable for processes which are perfectly ordinary when conducted in a hospital environment when they take place in the home. To sum it up, the structure and organisation of the healthcare system need to be reviewed. The vertical approach in which patients, doctors and pharmacists are involved in a relatively compartmentalised way, needs to be replaced with a horizontal, transmural approach based on the concept of “disease management”. “Disease management” is a process whereby the different individuals involved (patients, carers and those paying the bill) come to an agreement on the standards to apply in terms of prevention, diagnosis and treatment of a condition as well as the financial means to be used to comply with these standards. “Disease management” is already well established in many countries. We are lagging behind on this issue. A consortium has been put together to develop this concept of “disease management” in our country. It includes the APB, the Absym, the SSMG, Domus Medica, a number of IT companies and an advisory board, all motivated by the same project: to prepare the environment and structures needed to establish “disease management”. One of the key elements to the success of the project is for a consensus to be arrived at by the healthcare service providers and those who are paying the bill.

Prof. Dr. apr. Ludo Willems, Head of Pharmacy, UZ Leuven, has been affiliated to UZ Leuven as a hospital pharmacist since 1978 and is now head of UZ Leuven’s pharmacy department. He is also a part-time lecturer at the KU Leuven. In recent years, his work has been primarily focused on developing clinical pharmacy at UZ Leuven and throughout Belgium as a whole. His area of research is pharmacotherapy in exceptional patient populations such as critically ill patients, the quality of pharmaceutical service provision and the importance of clinical pharmacy in this regard. He is also chairman of the Belgian Association of Hospital Pharmacists and member of the board of the Flemish Association of Hospital Pharmacists. He also acts as the representative of hospital pharmacists in various bodies of the NIHDI, the Belgian Federal Public Health Service and the Federal Agency for Medicines and Health Products.

Dr. Jan Van Emelen, Research & Innovation Director, Mutualités Libres, Director Innovation of the Independent Health Insurance Funds. President working Group Disease Management AIM. Graduated in 1975 as a general practitioner at the KULeuven, and ever since never stopped educating himself in various aspects of health care, such as tropical diseases, nutrition, statistics and epidemiology, decision making in health care and occupational medicine. He started his career working as a physician in Congo and Ecuador working for ABOS (the Belgian administration for development cooperation), WHO and Development Assistance, a research unit on development studies. From 1900 till 1999 he was involved in occupational health within the Belgian labor administration. From 1999 on, he has been assigned as governmental advisor and expert in health care and social protection. Since 2003, Jan Van Emelen is Director Innovation of the Independent Health Insurance Funds, where he coordinates innovative pilot projects, in collaboration with other parties on health care and health care systems. Specifically Disease Management is his main occupation, at the national Belgian level, but also as president of the international working group on disease management hosted by AIM (Association Internationale de la Mutualité).

Prof. Dr. aPr. luDo WilleMsHead of Pharmacy, UZ Leuven

Dr. JaN VaN eMeleN Research & Innovation Director, Mutualités Libres

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We need to get out of the hospital ! Forecasts for the next 10 to 20 years show that if the healthcare system currently in place in Belgium is maintained, our society will no longer be able to financially support it. The same goes for Europe. Both advances in technology and in pharmaceuticals, and a progressively ageing population, cause a constant rise of costs. European data (OECD) show that a change in the system is absolutely crucial. An element of this change requires a.o. the transfer of care from the hospital to the patient’s home. A number of European countries are in the process of realising this. This is particularly true for the Netherlands, where many chronic conditions are no longer treated in hospitals or nursing homes or care homes, but rather at home. An example is granted by our nearest Dutch neighbours (Zeeland), where a tertiary care centre for around 110,000 people is linked to a number of satellite day hospitals. General practitioners are closely involved in the process through HAPs (“Huisartsenwachtposten”), located next to the hospital, and home care is supported by different means. This particular organisation of the healthcare process holds that, on the one hand, the number of hospital beds can be reduced, and on the other, patients can be discharged earlier. This is in contrast with the situation in Belgium, where there is a more clear distinction between general practitioners and specialist doctors, as well as between different hospitals (private, public, university hospitals etc.). All of these parties have a tendency to work in a rather isolated way. In the Netherlands, the way care is distributed is paramount. The general practitioner plays a very important part in the organisation: he or she acts as a guardian, a first post, restricting access to the hospital. The baton is passed from the general practitioner, to the specialist doctor, to the second-line hospital to the third-line hospital. The medical staff in turn delegates a number of actions to the nursing staff, without compromising quality of care: in Europe, the Netherlands is near the top of the list in terms of the performance of its healthcare system, and life expectancy is as high as it is in Belgium. The Dutch model is cited as an example by many experts. Conclusion: over the next 20 years, we will see a move from Hospital to Hospital at Home. This trend already started, e.g. with dialysis, chronic IV AB, parenteral nutrition, ... But also the care and the diagnosis will move from residential to home or home replacement settings.

Prof. Dr.  Francis Colardyn, Managing Director, UZ Gent, born 3 December 1944 in Kortrijk, Belgium. Doctor in Medicine. State University Gent, Belgium since July 1970. Board certified specialist in Internal Medicine since March 1975. Certified specialist in the Internal Medicine and Intensive Care Medicine (1996). Head of the department of Intensive Care from the University Hospital of Gent, Belgium since 1981 until August 2004. Professor in Intensive Care Medicine since 1986. Senior Lecturer – Intensive Care Medicine since 1991. Full Professor in Intensive Care Medicine since October 1997. Professor – Faculty Medicine and Health Sciences, University Gent, Belgium since 2003. Head physician from the University Hospital of Gent, Belgium since 1999 until June 2004. Chief Executive Officer of the University Hospital of Gent, Belgium since March 2004. Memberships of several scientific and professional organisations. Contributor of 24 books. Author or co-author of more than 170 A1-publications, published in international journals with referee. Field of interests, Infections in Intensive Care Medicine, Hospital Management.

Prof. Dr. Jean-Louis Vincent, Head of the Intensive Care unit, Hôpital Universitaire Erasme, is Professor of intensive care at the Université Libre de Bruxelles and Head of the Department of Intensive Care at the Erasme University Hospital in Brussels. He has authored or co-authored more than 690 per-reviewed publications, more than 86 books and more than 870 chapters, letters and abstracts. He is the editor-in-chief of “Critical Care”, “Current Opinion in Critical Care”, and “ICU Management”, and member of more than 30 Editorial Boards, including “Critical Care Medicine” (senior editor), “PLoS Medicine”, “Lancet Infectious Diseases”, “Intensive Care Medicine”, “Chest”, “Shock”, and “Journal of Critical Care”. Dr. Vincent is presently Secretary General of the World Federation of Societies of Intensive and Critical Care Medicine; he is a Past-President of the European Society of Intensive Care Medicine and the European Shock Society, and the Past-Chairman of the International Sepsis Forum.

Prof. Dr. fraNcis colarDyN Managing Director, UZ Gent

Moderator of the symposium

Prof. Dr. JeaN-louis ViNceNtHead of the Intensive Care unit, Hôpital Universitaire Erasme

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Notes

Boulevard d’Angleterre, 2-41420 Braine-l’AlleudBelgium

www.baxter.com

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