Problems in continuity of medication management upon transition between primary and secondary care: patients' and professionals' experiences.

Background And Objectives: Patients often experience drug-related problems at admission or after discharge from hospital. The objective of this study was to identify the main problems in medication management at transition between settings of care, as experienced by health care professionals (HCPs) and patients.

Methods: Focus group discussions were organised between December 2009 and February 2010; nine focus groups with primary and secondary care HCPs and patients and two with stakeholders.

Evaluating fracture risk in acute ankle sprains: Any news since the Ottawa Ankle Rules? A systematic review.

Background: Ankle sprain is frequently encountered, both in primary care and in emergency departments. Since 1992, the Ottawa ankle rules (OAR) can assist clinicians in determining whether an X-ray should be performed to exclude a fracture. Several guidelines recommend the use of OAR based on a systematic review from 2003.

The view of severely burned patients and healthcare professionals on the blind spots in the aftercare process: a qualitative study.

Background: In most Western countries burn centres have been developed to provide acute and critical care for patients with severe burn injuries. Nowadays, those patients have a realistic chance of survival. However severe burn injuries do have a devastating effect on all aspects of a person's life.

Stakeholders' perception on the organization of chronic care: a SWOT analysis to draft avenues for health care reforms.

Background: Adequate care for individuals living with chronic illnesses calls for a healthcare system redesign, moving from acute, disease-centered to patient-centered models. The aim of this study was to identify Belgian stakeholders' perceptions on the strengths, weaknesses, opportunities and threats of the healthcare system for people with chronic diseases in Belgium.

Methods: Four focus groups were held with stakeholders from the micro and meso level, in addition to two interviews with stakeholders who could not attend the focus group sessions.

A systematic review and meta-analysis of acute stroke unit care: what's beyond the statistical significance?

Background: The benefits of stroke unit care in terms of reducing death, dependency and institutional care were demonstrated in a 2009 Cochrane review carried out by the Stroke Unit Trialists' Collaboration.

Methods: As requested by the Belgian health authorities, a systematic review and meta-analysis of the effect of acute stroke units was performed. Clinical trials mentioned in the original Cochrane review were included.

Drug substitution associated with a hospital stay in Belgium: a retrospective analysis of a claims database.

Objectives: This study measures the extent of drug substitution associated with a hospital stay in Belgium.

Methods: Data were extracted from the 2006-2007 dataset of the Belgian Agency of Health Insurance Funds on drug use of patients hospitalized in acute hospitals. Reimbursed drugs received in ambulatory care during the 3 months prior to hospitalization were compared with drugs received during the 3 months following hospital discharge.

Development of a national position paper for chronic care: example of Belgium.

The management of chronic diseases is a prime challenge of most 21st century health care systems. Many Western countries have invested heavily in care plans oriented towards specific conditions and diseases, such as dementia and cancer. The major downside of this narrowly focused approach is that treatment of multimorbidity is ignored.

Multidisciplinary outpatient rehabilitation following cardiac revascularization or valve surgery: patient-related factors for uptake.

Background: There are concerns in Europe regarding the service provision and accessibility of multidisciplinary cardiac rehabilitation (MDCR) in general, and particularly in ambulatory settings. This paper analyses the utilization of outpatient MDCR and its determinants after cardiac revascularization or valve surgery in Belgium.

Methods: Claims rehabilitation data for all patients discharged in 2007 after a percutaneous cardiac intervention or cardiac surgery were available from the Belgian Common Sickness Funds Agency.

Terminal patients in Belgian nursing homes: a cost analysis.

Policy makers and health care payers are concerned about the costs of treating terminal patients. This study was done to measure the costs of treating terminal patients during the final month of life in a sample of Belgian nursing homes from the health care payer perspective. Also, this study compares the costs of palliative care with those of usual care.

Participating or not in a cardiac rehabilitation programme: factors influencing a patient's decision.

Background: International research indicates that attendance of patients to a proposed cardiac rehabilitation (CR) programme varies between 21% and 75%. Addressing the reasons why cardiac patients are not participating will improve accessibility to CR. The objective of this study was to investigate patient compliance with cardiac rehabilitation and the reasons of refusing or abandoning the programme.

Review of the cost-effectiveness of interventions to improve seamless care focusing on medication.

Aim Of The Review: This review of the international literature aims to assess the evidence and its methodological quality relating to the cost-effectiveness of interventions to improve seamless care focusing on medication.

Method: Studies were identified by searching Medline, EMBASE, Centre for Reviews and Dissemination databases, Cochrane Database of Systematic Reviews, and EconLit up to March 2011 using search terms related to health economics and to seamless care. To be included, economic evaluations had to explore the costs and consequences of an intervention to improve seamless care focusing on medication as compared with usual care.

Evidence based post graduate training. A systematic review of reviews based on the WFME quality framework.

Background: A framework for high quality in post graduate training has been defined by the World Federation of Medical Education (WFME). The objective of this paper is to perform a systematic review of reviews to find current evidence regarding aspects of quality of post graduate training and to organise the results following the 9 areas of the WFME framework.

Methods: The systematic literature review was conducted in 2009 in Medline Ovid, EMBASE, ERIC and RDRB databases from 1995 onward.

Higher incidence of common diagnoses in patients with low back pain in primary care.

Most studies on comorbidity in low back pain (LBP) have been conducted in specialized settings with the use of self-reports. This study has an original design using data from family practices: the incidence of the most frequent diseases was compared in patients with and without LBP in 2004. The database includes data from 67 family physicians in 52 family practices in Flanders, Belgium.

Palliative inpatients in general hospitals: a one day observational study in Belgium.

Background: Hospital care plays a major role at the end-of-life. But little is known about the overall size and characteristics of the palliative inpatient population. The aim of our study was to analyse these aspects.

Costs of terminal patients who receive palliative care or usual care in different hospital wards.

Background: In addition to the effectiveness of hospital care models for terminal patients, policy makers and health care payers are concerned about their costs. This study aims to measure the hospital costs of treating terminal patients in Belgium from the health care payer perspective. Also, this study compares the costs of palliative and usual care in different types of hospital wards.

The costs of treating terminal patients.

Context: In addition to the effectiveness of terminal care, policy makers and health care payers are concerned about the costs of treating terminal patients in a context of spiraling health care costs and limited resources.

Objectives: This article aims to review the international literature on the costs of treating terminal patients.

Methods: Studies were identified by searching PubMed, Centre for Reviews and Dissemination databases, Cochrane Database, and EconLit, up to April 2009.

Can we import quality tools? a feasibility study of European practice assessment in a country with less organised general practice.

Background: Quality is on the agenda of European general practice (GP). European researchers have, in collaboration, developed tools to assess quality of GPs. In this feasibility study, we tested the European Practice Assessment (EPA) in a one-off project in Belgium, where general practice has a low level of GP organisation.

Quality indicators for type-2 diabetes care in practice guidelines: an example from six European countries.

Introduction: Diabetes mellitus patients need a multidisciplinary management and rigorous follow up. Quality indicators are important to assess and improve the quality of the health-care delivery. Less straightforward, however, is choosing which indicators to use for the assessment of the disease management.

Prolonged cough in children: a summary of the Belgian primary care clinical guideline.

Prolonged cough is a frequent problem in the community. Several studies in the school setting have found that as many as 4.8% to 10.

Cardiovascular prevention in general practice: development and validation of an algorithm.

Objective: General practice visits are a unique opportunity to identify and treat individuals with a high cardiovascular (CV) risk. However, a case-finding strategy suited to the daily general practice is not provided in the CV prevention guidelines. We wanted to create, validate and test an algorithm for global CV risk assessment and management.

Obstacles to cardiovascular prevention in general practice.

Objective: In spite of a wide diffusion of the European guidelines for prevention of cardiovascular (CV) diseases, failures in both primary and secondary CV prevention are currently acknowledged. We wanted to uncover obstacles to CV prevention related to the general practitioner's (GP) knowledge and attitudes.

Methods And Results: A postal questionnaire was sent to a random sample of GPs from two Belgian provinces.

Teenagers and their family practitioner: matching between their reasons for encounter.

Objectives: The aim of this study was to analyse the reasons for encounter of teenagers in family practice and to compare them with the reasons recorded by their family practitioner (FP).

Methods: This cross-sectional study involved 91 FPs from the Paris area and from the French-speaking part of Belgium. The teenagers (12-17 years old) filled in an auto-administered questionnaire in the waiting room of their FP during a 1-week period.

GPs working in solo practice: obstacles and motivations for working in a group? A qualitative study.

Objective: Our aim was to analyse the obstacles and eventual motivations of solo GPs for working in group practice.

Methods: A qualitative study using 12 focus groups was carried out in primary care in French-speaking Belgium. The subjects comprised four samples of GPs: 20 GP trainers, 18 GP trainees, 25 women GPs and 25 other GPs.