The Vienna self-assessment questionnaire: a usable tool towards more health-literate hospitals? Explorative case studies in three hospitals in Belgium.

Background: Strengthening the capacity of hospitals to take into account the level of health literacy of their public is a necessity to improve the quality of care. One way to develop adequate health literacy responsive policy and strategies in hospitals is the use of self-assessment tools to raise awareness, help prioritise action and mobilise stakeholders. The Vienna Health Literate Organisation (V-HLO) questionnaire, recently translated and adapted into French, is designed to meet this objective.

Effectiveness of a blended care programme for the discontinuation of benzodiazepine use for sleeping problems in primary care: study protocol of a cluster randomised trial, the Big Bird trial.

Introduction: Problematic benzodiazepine use is a global health issue. Although the adverse side effects of long-term use of benzodiazepines are well known, it remains difficult to implement interventions for discontinuation in primary care. Considering the success of blended care for the treatment of sleeping disorders and the support of substance use disorders, evidence suggests that a blended care approach, combining face-to-face consultations with the general practitioner with web-based self-learning by the patient, is beneficial for the discontinuation of chronic benzodiazepine use for primary insomnia in general practice.

Considering Patients' Empowerment in Chronic Care Management: A Cross-Level Approach.

This paper consists of an analysis of the concept of empowerment-which is often defined as a key issue in health care-at the macro, meso, and micro levels by focusing on health care reform in Belgium. Three research teams collected data and combined them in an inductive secondary analysis. Our preliminary results demonstrate that patient empowerment does not always encompass the same scientific reality.

Dealing with health literacy at the organisational level, French translation and adaptation of the Vienna health literate organisation self-assessment tool.

Background: Efforts to address health literacy should favour a system-based approach with the dual aim both of fostering the material conditions and creating a work culture inside health care organisations that makes it easier for people to use information. The Vienna Health Literate Organisation (V-HLO) self-assessment tool is a German-speaking questionnaire for quality managers of health care organisations. Its objective is to provide a diagnostic of the strengths and weaknesses of the organisation in terms of health literacy.

[Health literacy, a lever to make health care systems more equitable? Tools to support professionals and involve institutions].

This article briefly recalls why low levels of health literacy should be considered to constitute a public health issue. It then proposes the concept of health literacy as a possible lever to help health care systems to more effectively take social health inequalities into account. Finally, it provides concrete tools for field workers, both clinicians and quality of care managers, and emphasises the importance of an organizational approach to health literacy.

Development, dissemination, and applications of a new terminological resource, the Q-Code taxonomy for professional aspects of general practice/family medicine.

Background: While documentation of clinical aspects of General Practice/Family Medicine (GP/FM) is assured by the International Classification of Primary Care (ICPC), there is no taxonomy for the professional aspects (context and management) of GP/FM.

Objectives: To present the development, dissemination, applications, and resulting face validity of the Q-Codes taxonomy specifically designed to describe contextual features of GP/FM, proposed as an extension to the ICPC.

Development: The Q-Codes taxonomy was developed from Lamberts' seminal idea for indexing contextual content (1987) by a multi-disciplinary team of knowledge engineers, linguists and general practitioners, through a qualitative and iterative analysis of 1702 abstracts from six GP/FM conferences using Atlas.

Analysis of definitions of general practice, family medicine, and primary health care: a terminological analysis.

Background: There are numerous definitions of general practice/family medicine (GP/FM) and primary health care (PHC), but the distinction between the two concepts is unclear.

Aim: To conduct a terminological analysis of a set of definitions of GP/FM and of PHC, to clarify the commonalities and differences between these two concepts.

Design: Sets of 20 definitions were collected in two 'bags of words' (one for GP/FM and one for PHC terms).

Why Collaborative Care for Depressed Patients is so Difficult: A Belgian Qualitative Study.

Although current guidelines recommend collaborative care for severely depressed patients, few patients get adequate treatment. In this study we aimed to identify the thresholds for interdisciplinary collaboration amongst practitioners when treating severely depressed patients. In addition, we aimed to identify specific and feasible steps that may add to improved collaboration amongst first and second level Belgian health care providers when treating depressed patients.

A Terminology in General Practice/Family Medicine to Represent Non-Clinical Aspects for Various Usages: The Q-Codes.

The hereby proposed terminology called "Q-Codes" can be defined as an extension of the International Classification of Primary Care (ICPC-2). It deals with non-clinical concepts that are relevant in General Practice/Family Medicine (GP/FM). This terminology is a good way to put an emphasis on underestimated topics such as Teaching, Patient issues or Ethics.

General practice patients treated for substance use problems: a cross-national observational study in Belgium.

Background: General Practitioners (GPs) are well placed to care for patients with (chronic) substance use problems. This pilot was carried out to study the feasibility and usefulness of a continuous surveillance of substance use problems among general practice patients. The objectives were (i) to describe variables with missing values exceeding 1% and whether patients were reported without substance-related problems; (ii) the profile and the magnitude of the patient population that is treated for substance use problems.

[Cross-border evaluation of needs for training in therapeutic education of the patient for the management in type 2 diabetes and obesity: Survey by method of nominal group with healthcare professionals].

Introduction: The design of continuous training programs in therapeutic patient education (ETP) should be inspired by needs shown by the professionals concerned in terms of mobilization or acquisition of skills in this domain. The objective of this study is to analyze needs expressed by healthcare professionals (HP) involved in patients' management presenting a type 2 diabetes (T2D) and/or obesity and to compare them with the existing recommendations.

Methods: One hundred and five PS (general practitioners, dietitians and nurses) of 3 frontier regions of French-speaking European countries (France, Belgium and Grand duchy of Luxembourg) were questioned in 12 monodisciplinary groups according to the technique of the nominal group.

[Hospital and general therapeutic patient education practices: example of diabetes and obesity in Belgium].

Introduction/Objectives: Therapeutic Patient Education (TPE) is now part of the new medical landscape, including for the prevention and treatment of diabetes and obesity. While some countries, such as France, have decided to give priority to TPE in public health policy by means of legal recognition, no such framework has been developed in Belgium. The purpose of this article is to describe the actual TPE practices of health professionals (HP) in this environment.

Collaborative care regarding major depressed patients: A review of guidelines and current practices.

Major Depressive Disorder (MDD) is a severe and common mental disorder. A growing body of evidence suggests that stepped and/or collaborative care treatment models have several advantages for severely depressed patients and caretakers. However, despite the availability of these treatment strategies and guidance initiatives, many depressive patients are solely treated by the general practitioner (GP), and collaborative care is not common.

Searching for consensus among physicians involved in the management of sick-listed workers in the Belgian health care sector: a qualitative study among practitioners and stakeholders.

Background: In Belgium, the management of sick leave involves general practitioners (GPs), occupational health physicians (OPs) and social insurance physicians (SIPs). A dysfunctional relationship among these physicians can impede a patient's ability to return to work. The objective of this study was to identify ways to improve these physicians' mutual collaboration.

The Approach Taken to Substance Abuse by Occupational Physicians: A Qualitative Study on Influencing Factors.

Objective: Aiming to enhance occupational physicians' (OPs) practice when dealing with employee substance abuse, this study analyzes the experiences of OPs to gain insight into the factors influencing their behavior.

Methods: Semi-structured interviews were conducted and analyzed using Interpretative Phenomenological Analysis.

Results: OPs act differently depending on the type of drug.

[From chronic disease to multimorbidity: Which impact on organization of health care].

Healthcare systems are concerned with the growing prevalence of chronic diseases. Single disease approach, based on the Chronic Care Model, is known to improve specific indicators for the targeted disease. However, the co-existence of several chronic disease, or multimorbidity, within a same patient is the most frequent situation.

[Preventive health care and health promotion: Which models for supporting the evolution of clinical practice in primary health care?].

Objectives: Published operating models about preventive health care and health promotion in primary care were sought with the aim of (1) compiling a functional inventory; and (2) to formulate working hypotheses for the improvement of clinical practice towards more efficiency and more equity.

Methods: Narrative literature review, using keywords related to the various prevention classes, health promotion, primary care, practice models and health care delivery. The diversity of models led to a multi-criteria analysis.

What factors determine Belgian general practitioners' approaches to detecting and managing substance abuse? A qualitative study based on the I-Change Model.

Background: General practitioners (GPs) are considered to play a major role in detecting and managing substance abuse. However, little is known about how or why they decide to manage it. This study investigated the factors that influence GP behaviours with regard to the abuse of alcohol, illegal drugs, hypnotics, and tranquilisers among working Belgians.

[General practice has to contribute to the continuous improvement of quality of care and integrate health promotion].

Quality of care in general practice is mainly based on effectiveness of clinical and inter-personal care, and access to care. Assessment has to focus on structures and processes, more than on outcomes. The sets of clinical indicators used in some european countries, though good starting points are still incomplete to encompass the complexity of activity.

[Neglected children: birth, life and survival].

Child neglect leads to numerous and serious consequences. The physical and neurophysiological development can be altered by the lack of stimulation or via a chronic stress which increases the production of cortisol. Gradually, psychomotor and cognitive deficits can appear.

[Four years of application of the law that decriminalizes euthanasia in Belgium].

Legislation decriminalizing euthanasia came into effect in Belgium in 2002. Its application is monitored by a federal Commission, which submitted 2 reports to the Parliament, one covering the first 15 months of application and the other the years 2004 and 2005. This article analyzes and comments on the contents of these 2 documents, which provide interesting information on the medical practice of euthanasia in Belgium.

[Gifted children and the family physician].

Gifted children account for about 2% of the population but are not always identified. Nonsynchronous intellectual, biological and affective development may cause problems and disrupt relationships at home and in school. GP's are consulted for mood or behavior disorders or somatization.

Exploitation of electronic medical records data in primary health care. Resistances and solutions. Study in eight Walloon health care centres.

Introduction: The Electronic Medical Records (EMR), used every day for primary health care may constitute an instrument for gathering locally usable data to improve the quality of care and, on a larger scale, be a basis of epidemiological data. In spite of a policy of promotion of the EMR made by the Federation of French-speaking Belgian "Medical Houses", its use remains very marginal.

Methods: Eight Medical Houses, motivated by computerization of medical records have been met.