Belgian Setting Research Articles

Using digital technologies and applications in midwifery practice in Belgium: A descriptive cross-sectional study

IntroductionOver the past two decades, there has been a dramatic increase in the use of digital technologies within healthcare and also in midwifery. However, scarce literature exist on the use of digital technologies and applications in midwifery practice particularly in the Belgian setting. AimTo map the use of digital technologies and applications by midwives in various settings, encompassing hospitals, primary care, and educational institutions in Belgium. MethodsA descriptive cross-sectional design was used to collect data via an online questionnaire targeting at midwives working in the Flemish region, Walloon region, or Brussels-Capital region. Midwives were either Dutch-speaking or French-speaking (n = 212). The semi-structured questionnaire addressed three domains: (1) socio-demographics, (2) employment information (3) the use of digital technology, including the level of comfort with technology. Qualtrics© program was used for managing data and SPSS v28.0© for data analysis using descriptive statistics, Chi² analysis, and independent sample t-test. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology reporting guidelines. ResultsAmong respondents, 58% reported the use of digital technologies and applications, with electronic health records (89.6%), electronic prescriptions (65.6%), and remote patient monitoring (51.2%) commonly utilized. Sensor technology (7.2%), mixed care (3.8%), care robots (2.5%), and wearable devices (1.9%) were very rarely used. The target groups for these digital technologies and applications generally encompass all stages of the perinatal period. Midwives felt overall highly confident with these technologies. Younger participants and those with a Master's or PhD degree exhibited greater comfort scores in digital technology use. No significant relationships were observed between socio-demographic characteristics and the adoption of digital technology. ConclusionThe results highlight the potential for incorporating digital technologies and applications into various midwifery care settings. Addressing barriers and enhancing usability can optimize technology integration, contributing to personalized high-quality care, ultimately improving perinatal health outcomes.

Supreme Court Reverses First Belgian Set Aside Decision of an Investment Treaty Arbitral Award Confirmation of (Belgian) international public policy test

In a 2022 decision, the Brussels first instance court set aside an UNCITRAL award ordering Poland to pay damages to an investor. The first instance court decided that the arbitral tribunal had wrongly held that the investor’s due process rights had been violated by the Polish courts. The first instance court viewed this to be a breach of Belgium’s international public policy rules. In 2024, the Belgian Supreme Court reversed this set aside decision. The Supreme Court specified that an award can only be set aside if the effect of the award violates the international public policy rules, without re-assessing the merits of the dispute that was resolved by the award.

Deprescribing benzodiazepine receptor agonists in older adults: a mixed-methods study to adapt the Canadian D-PRESCRIBE intervention to the Belgian community setting

ObjectiveGuidelines recommend deprescribing benzodiazepine receptor agonists (BZRA) in older adults, yet implementation in clinical practice remains limited. Adapting effective, evidence-based interventions to a new context is a resource-saving strategy. In...

TREAT TRIAL: MULTI-CENTER CROSS-SECTIONAL TREATMENT EVALUATION OF APPARENT RESISTANT HYPERTENSION IN BELGIUM

Objective: The goal of the TREAT study is to evaluate the prevalence of apparent treatment-resistant hypertension (aRHT) in a Belgian setting and to evaluate which determining factor of pseudo-resistant hypertension contributes the most to this prevalence: white coat hypertension (WCH), underdosing of adequate drugs or poor adherence to prescribed medicines. Design and method: TREAT is a single-visit, multicentric, non-interventional, cross-sectional survey. Inclusion criteria were the following: patients over 18 years old receiving 3 or more antihypertensive molecules and referred to specialized hospital centres for aRHT. The data were collected according to the patient’s medical records. Self-reported adherence to antihypertensive treatment was collected and a Hill-bone medication adherence scale was also proposed. Results: A total of 232 patients were included. Mean anti-hypertensive treatment duration was 10.6(±9.1) years. Patients were treated with a mean of 3.8(±1.1) antihypertensive molecules and 2.8(±1.1) antihypertensive pills. Only 48.5% of the aRHT patients were treated with the triple therapy recommended by the 2023 ESH hypertension guidelines (i.e. renin-angiotensin-aldosterone system inhibitor (RAASi), calcium channel blocker (CCB) and diuretic), and only 29.1% of patients were treated with the maximal recommended dose. Inadequate dosing was mostly present with diuretics, only 60% of patients was treated with at least half the maximum dose of a diuretic. WCH was present in 11% of patients in whose ambulatory BP measurements were available in records (n=136). Therapeutic adherence was self-reported as poor or moderate in 17.6% of patients (n=41). The Hill-bone medication adherence scale (n=140, 60.4%) showed a mean score of 12(±4.2) (good adherence). In this cohort, 31.8% of patients seemed to have true resistant hypertension. Conclusions: Among patients referred to specialized centres for aRHT, about 2/3 of patients have in reality pseudo-resistant hypertension. Whereas WCH and poor adherence seems to be limited in our dataset, many patients were polymedicated with non-recommended combinations of antihypertensive molecules in 1 out of 2 patients, with inadequate dosing in 2 out of 3 patients. Pseudo-resistant hypertension seems in our cohort to be mainly related to under-use of triple combination therapy and most likely also due to underdosing.

P335 Development and validation of a Belgian set of quality indicators for inflammatory bowel diseases

Abstract Background Quality indicators are standardized, evidence-based measures of health care quality, categorised as structure (to assess the care setting), process (to assess high-quality care actions by healthcare professionals) or outcome indicators (results of actions undertaken by healthcare professionals). Several quality indicator sets have been developed to standardise, measure and optimise IBD care. Our aim was to develop and validate a set to assess IBD care in Belgium and to select a subset of indicators with room for improvement that can be used to implement and improve care in clinical practice. Methods The importance of 221 quality indicators (49 structure, 135 process and 37 outcome) identified through literature was scored on a 10-point Likert scale in a two-round modified Delphi exercise by IBD experts. In a third round, the experts indicated and ranked their top 10 indicators with most room for improvement benefitting the patient in the Belgian healthcare system to agree on an improvement subset. In parallel, patient perspectives were collected through two linguistic patient focus groups, one in Flemish (6 participants) and one in French (4 participants). A final consensus meeting was organised to discuss 1) the patient perspectives gained through the focus groups, 2) the results of two Delphi scoring rounds and 3) the results of the additional ranking round. Indicators scoring ≥7 by ≥80% of the participants during the second scoring round, or based on agreement during the consensus meeting, were included in the final set. Results Thirty-two experts (11 IBD nurses and 21 clinicians including 2 paediatricians) participated in all three voting rounds, of which 19 also participated in the consensus meeting (6 IBD nurses and 13 IBD clinicians including 2 IBD paediatricians). In total, 199 quality indicators were agreed upon to assess IBD care in Belgium (41 structure, 123 process and 35 outcome). Eighteen (3 structure, 14 process and 1 outcome; Table) were retained in the improvement subset, related to patient characteristics, endoscopy guidelines, infection prevention, steroid use, the IBD care team, services provided in the IBD clinic, the documentation of patient characteristics, the care pathway and the monitoring of disease activity. The decision to include the latter five themes was driven by the importance to patients, which was evident from the patient focus groups. Conclusion An evidence and consensus based set of quality indicators was developed and validated - including an improvement subset - allowing Belgian IBD centres to evaluate quality of provided care, set up quality improvement projects and potentially launch a benchmarking study.

Predicting Crime Across Cities and Regions: A Comparative Analysis of Predictive Modelling in Three Belgian Settings

Predicting Crime Across Cities and Regions: A Comparative Analysis of Predictive Modelling in Three Belgian Settings

Thrombectomy is a cost-saving procedure up to 24h after onset.

The treatment of ischemic stroke due to large-vessel occlusion has been revolutionized by mechanical thrombectomy (MT), as multiple trials have consistently shown improved functional outcomes compared to standard medical management both in the early and late time windows after symptom onset. However, MT is an interventional procedure that is more costly than best supportive care (BSC). We set out to study the cost-utility and budget impact of MT + BSC versus BSC alone for large-vessel occlusion using a combined decision tree and Markov model. The analysis was conducted from a Belgian payer perspective over a lifetime horizon, and health states were defined by the modified Rankin Scale (mRS). The treatment effect of MT + BSC combined clinical outcomes from all published early and late treatment window studies showing improved mRS after 90days. Resource use and utilities were informed by an observational Belgian study of 569 stroke patients. Long-term mRS transitions were sourced from the Oxford Vascular study. MT + BSC generated 1.31 additional quality-adjusted life years and resulted in cost savings of €10,216 per patient over lifetime. Deterministic sensitivity analyses demonstrated dominance of MT over a wide range of parameter inputs. In a Belgian setting, adding MT to BSC within an early time window for 1575 eligible stroke patients every year produced cost savings between €6.3 million (year 1) and €14.6 million (year 5), or a total cost saving of €56.2 million over 5years. Mechanical thrombectomy is a highly cost-effective treatment for ischemic stroke patients, providing quality-adjusted survival at lower health care cost, both when given in an early time window, as well as in a late time window.

Influence of outpatient total knee arthroplasty compared to inpatient surgery on medical and economic outcomes

Firstly, this study compared the rate of readmission after a total knee arthroplasty between selected out- patients (no hospitalization, directly sent home after surgery) and inpatients (3 days hospitalization) at 6 weeks. Secondly, it examined the mobility and the complications in the two groups after the same period of time. The rate of readmission, complications and knee mobility of 32 outpatients (M-age : 61 years ± 10 ; 10 females), were compared against those of 32 birth- matched inpatients (M-age : 64 years ± 8.6 ; 10 females). No patient was re-admitted in either group. Post- surgical complications included one hematoma resorbed at 6 weeks in the outpatient group and three joint effusions in the inpatient group. There were no instances of deep venous thrombosis, failure of primary fixation, infection, or wound dehiscence. Knee mobility was identical between the two groups. This is the first study to compare inpatient and outpatient total knee arthroplasty in a Belgian setting. Our study suggests that day-care total knee arthroplasty in selected patients is possible without increasing the rate of re-admission and complications, and without affecting the mobility at 6 weeks. However, the Belgian financial incentives do not seem to currently promote this surgical approach. These results should be confirmed with a larger sample to define the adequate length of stay after a total knee arthroplasty.

Est-ce que les implants sur mesure par impression 3D ont une valeur suffisante pour justifier leur surcoût ? Étude médico-économique comparant un implant poreux obtenu par impression 3D et son alternative proche pour le traitement des pertes de substances acétabulaires Paprosky 3B

Total hip arthroplasty (THA) is a common operation for patients suffering from hip arthrosis. It has been proven effective in improving quality of life while being cost-effective. Meanwhile, the number of revision hip arthroplasties is growing and those may require bone reconstruction and are potential indications for 3D custom implants. In these specific indications, medical 3D-printing has grown over the years and the use of 3D-printed implants has become more frequent. To date, the cost-effectiveness of 3D-printed implants for acetabular revision THA has not been evaluated. Therefore we performed a health economic analysis to: 1) analyse the cost-effectiveness of the aMace implant compared to its closest alternative on the market; 2) have a better insight into Belgian costs of revision hip arthroplasties and 3) estimate the budget impact in Belgium. 3D-printed acetabular implants provide good value-for-health in Paprosky type 3B defects in a Belgian setting. Custom Three-flanged Acetabular Components (CTAC) were compared to a 3D-printed implant (aMace) by means of a Markov model with four states (successful, re-revision, resection and dead). The cycle length was set at 6 months with a 10-year time horizon. Data was obtained through systematic literature search and provided by a large social security agency. The analysis was performed from a societal perspective. All amounts are displayed in 2019 euros. Discount rates were applied for future cost (3 %) and QALY (1.5 %) estimates. Revision hip arthroplasty has an average societal cost of €9950 without implant. Based on the outcomes of our model, aMace provides an excellent value for money compared to CTAC. The Incremental Cost-Effectiveness Ratio (ICER) was negative for all age groups. The base case of a 65-year-old person, showed a QALY gain of 0.05 with a cost reduction of €1265 compared to CTAC. The advantage of using aMace was found to be greater if a patient is younger. The re-revision rates of both CTAC and aMace and the utility of successful revision have the highest impact on costs and effects. A Monte Carlo simulation showed aMace to be a cost-effective strategy in 90 % of simulations for younger patients and in 88 % of simulations for patients above 85 years old. In Belgium, it would imply a cost reduction of €20500 on an annual basis. Based on the findings of this model, the new 3D-printed aMace implant has the potential to bring an excellent value for money when used in revision arthroplasty of Paprosky type 3B acetabular defects. For all patients, aMace resulted in a dominant, cost-saving strategy in Belgium compared to CTAC. III, comparative medico economical diagnostic tool.

Use of cardiac telerehabilitation during COVID-19 pandemic in Belgium

Background The COVID-19 pandemic has forced many cardiac rehabilitation centres to focus more on the remote delivery of cardiac rehabilitation (CR) components. This increased focus and the lessons learned from this period could enhance the implementation of telerehabilitation and increase the participation in CR in Belgium. Methods We conducted a survey between April and May 2020 about the implementation of telerehabilitation services during the COVID-19 pandemic. The electronic questionnaire was sent via email to the heads of 42 Belgian CR centres. Three reminders via email were sent during the study period. Results 27 CR centres (64%) returned completed questionnaires after three mailings. 52% of the CR centres provided remote CR services during the lockdown due to the COVID-19 pandemic. All CR centres that provided remote CR services delivered exercise training. The most used medium to deliver the CR components were online videos (71%) followed by online information on the website (64%) and emails (64%). Conclusion It is interesting that the COVID-19 pandemic has encouraged many CR centres to implement remote delivery of CR components. This can help to speed up the research and implementation of telerehabilitation in daily clinical practice. The COVID-19 pandemic could be the push for a large multicentre implementation study that could prove that telerehabilitation is feasible and effective in the Belgian setting.

Do custom 3D-printed revision acetabular implants provide enough value to justify the additional costs? The health-economic comparison of a new porous 3D-printed hip implant for revision arthroplasty of Paprosky type 3B acetabular defects and its closest alternative

PurposeTotal hip arthroplasty (THA) is a common operation for patients suffering from hip arthrosis. It has been proven effective in improving quality of life while being cost-effective. Meanwhile, the number of revision hip arthroplasty is growing and those may require bone reconstruction and are potential indications for 3D custom implants. In these specific indications, medical 3D-printing has grown over the years and the use of 3D-printed implants has become more frequent. To date, the cost-effectiveness of 3D-printed implants for acetabular revision THA has not been evaluated. Therefore we performed a health economic analysis to: (1) analyse the cost-effectiveness of the aMace implant compared to its closest alternative on the market, (2) have a better insight into Belgian costs of revision hip arthroplasties and (3) estimate the budget impact in Belgium. Hypothesis3D-printed acetabular implants provide good value-for-health in Paprosky type 3B defects in a Belgian setting. Material and methodsCustom Three-flanged Acetabular Components (CTAC) were compared to a 3D-printed implant (aMace) by means of a Markov model with four states (successful, re-revision, resection and dead). The cycle length was set at 6 months with a 10-year time horizon. Data was obtained through systematic literature search and provided by a large social security agency. The analysis was performed from a societal perspective. All amounts are displayed in 2019 euros. Discount rates were applied for future cost (3%) and QALY (1.5%) estimates. ResultsRevision hip arthroplasty has an average societal cost of €9950 without implant. Based on the outcomes of our model, aMace provides an excellent value for money compared to CTAC. The Incremental Cost-Effectiveness Ratio (ICER) was negative for all age groups. The base case of a 65 year old person, showed a QALY gain of 0.05 with a cost reduction of €1265 compared to CTAC. The advantage of using aMace was found to be greater if a patient is younger. The re-revision rates of both CTAC and aMace and the utility of successful revision have the highest impact on costs and effects. A Monte Carlo simulation showed aMace to be a cost-effective strategy in 90% of simulations for younger patients and in 88% of simulations for patients above 85 years old. In Belgium it would imply a cost reduction of €20500 on an annual basis. ConclusionsBased on the findings of this model, the new 3D-printed aMace implant has the potential to bring an excellent value for money when used in revision arthroplasty of Paprosky type 3B acetabular defects. For all patients, aMace resulted in a dominant, cost-saving strategy in Belgium compared to CTAC. Level of evidenceIII, comparative medico economical diagnostic tool.

Determining security level in forensic psychiatry: a tug of war between the DUNDRUM toolkit and the HoNOS-Secure

ABSTRACT Criteria to determine in which level of security forensic patients should receive treatment are currently non-existent in Belgium. Research regarding the assessment of security level is minimal, and limited instruments are available. This study investigated the instruments that measure the need for security level: DUNDRUM-1 and the HoNOS-Secure. The psychometric properties of the DUNDRUM-1, DUNDRUM-2 and the HoNOS-Secure were investigated. A random selection was made of 100 male forensic patients in prison. The DUNDRUM-1, DUNDRUM-2 and the HoNOS-Secure were scored retrospectively. A subsample of the files was rated by four researchers (n = 38). Comparisons were made with the security level as decided by the court. The DUNDRUM-1 achieved excellent inter-rater reliability, and the HoNOS-Secure and DUNDRUM-2 got a moderate score. The internal consistency was highest for DUNDRUM-1 followed by the HoNOS-Secure and was low for the DUNDRUM-2. Both the DUNDRUM-1 and the HoNOS-Secure predicted allocations by the court to high security. The DUNDRUM-1 outperforms the HoNOS-Secure on psychometric properties and provides clear instructions with regard to the assessment of the security level. Training seems to be important for scoring the DUNDRUM-1. The current study provided more evidence for the applicability of the DUNDRUM-1 in Belgian settings with regard to determining the need for security.

The OptiLUTS trial: improving care for therapy-resistant symptoms of the pelvis in Belgium

ABSTRACT Introduction/Background The management of therapy-resistant lower urinary tract symptoms (LUTS) and symptoms resulting from pelvic organ dysfunctions are subject to a high variability in the Belgian health-care centres. Practical guidelines and standardized patient clinical care pathways are often lacking and unadapted to the Belgian healthcare system. Objectives The OptiLUTS trial aims to improve the multidisciplinary care of therapy-resistant symptoms of the pelvis in the Belgian healthcare setting. Project A aims for the improvement of knowledge of 2nd line treatments for LUTS among general practitioners. In project B a treatment algorithm for the overactive bladder syndrome and non-obstructive urinary retention will be developed specifically for Belgium. In Project C a patient customized sacral neuromodulation (SNM) care pathway will be set up. Methods Part A: Explorative study among general practitioners by distribution of a questionnaire. Part B: Review of existing guidelines and use of the Delphi method to obtain expert consensus. Part C: A single center comparative study to compare outcomes before and after implementation of the SNM care pathway. Patients scheduled for the first stage of Interstim therapy™ will be included (N=100). Primary endpoints are the sensitivity and specificity of a new pelvic symptom assessment tool, the conversion to implant and explantation rates. Conclusion There is a margin for improvement in the care process of patients with therapy-resistant symptoms of the pelvis in the Belgium healthcare system. In the OptiLUTs trial adapted guidelines and a clinical care pathway will be developed to standardize and increase the efficiency of care. Trial registration Approval for the trial by the Ethics Committee of the Ghent University hospital: EC/2018/0244.

Clinical characteristics and outcomes of patients receiving outpatient parenteral antibiotic therapy in a Belgian setting: a single-center pilot study

ABSTRACT Background Outpatient parenteral antibiotic therapy (OPAT) was not used in Belgium before 2013, except for patients with cystic fibrosis. Thus, we have performed a pilot study to evaluate clinical characteristics and outcomes of patient receiving OPAT in a Belgian setting. Methods The study was a prospective observational single-center study of patients receiving OPAT between 1 September 2013 and 31 December, 2017. Results We included 218 OPATs. The median age was 58 years and 71% were men. At the end of the treatment, 92% of the patients on OPAT were cured. Risk factors for treatment failure were obesity, diabetes and diabetic foot infections, longer duration of hospitalization before OPAT, and duration of OPAT >16 days. An average of 24 days of hospitalization per patient discharge was saved, which amounted to 5205 days saved during the project. During the OPAT and 30 days thereafter, 71 (32.6%) of patients were readmitted, but only 26 (12%) readmissions were directly related to OPAT. Risk factors for readmissions were diabetes and diabetic foot infections, endovascular infections, longer duration of hospitalization before OPAT, duration of OPAT >30 days, and history of hospitalizations in the year before OPAT. There were 2.3 intravenous catheter-related events per 1000 days of catheter use. Patients’ level of satisfaction was high (99.5%) Conclusions In this pilot study, OPAT is found to be efficacious in saving hospitalization’s days, with a low rate of readmissions and complications and a high patients’ level of satisfaction. We therefore conclude that OPAT is feasible and safe Background Outpatient parenteral antibiotic therapy (OPAT) was not used in Belgium before 2013, except for patients with cystic fibrosis. Thus, we have performed a pilot study to evaluate clinical characteristics and outcomes of patient receiving OPAT in a Belgian setting. Methods The study was a prospective observational single-center study of patients receiving OPAT between 1 September 2013 and 31 December, 2017. Results We included 218 OPATs. The median age was 58 years and 71% were men. At the end of the treatment, 92% of the patients on OPAT were cured. Risk factors for treatment failure were obesity, diabetes and diabetic foot infections, longer duration of hospitalization before OPAT, and duration of OPAT >16 days. An average of 24 days of hospitalization per patient discharge was saved, which amounted to 5205 days saved during the project. During the OPAT and 30 days thereafter, 71 (32.6%) of patients were readmitted, but only 26 (12%) readmissions were directly related to OPAT. Risk factors for readmissions were diabetes and diabetic foot infections, endovascular infections, longer duration of hospitalization before OPAT, duration of OPAT >30 days, and history of hospitalizations in the year before OPAT. There were 2.3 intravenous catheter-related events per 1000 days of catheter use. Patients’ level of satisfaction was high (99.5%) Conclusions In our study, OPAT is found to be efficacious in saving hospitalization’s days, with a low rate of readmissions and complications and a high patients’ level of satisfaction. We therefore conclude that OPAT is feasible and safe.

Educational outreach visits to improve knee osteoarthritis management in primary care

BackgroundKnee osteoarthritis is a common problem, but often underdiagnosed and undertreated in primary care as compared to evidence-based guidelines. Educational outreach visits are an effective strategy to improve guideline adherence, but its contribution to knee osteoarthritis management is largely unknown. The aim of this study was to evaluate the overall effectiveness of educational outreach visits on process quality indicators for knee osteoarthritis management, more specifically on the referral for physical therapy.MethodsAn educational intervention study, non-randomized and controlled, was designed for general practitioners (GPs) in Belgium. During four months, 426 GPs were visited by academic detailers and allocated to the intervention group. The control group was selected from GPs not visited by academic detailers during the study period. Six months post-intervention, both groups received a questionnaire with two case-vignettes to measure the effectiveness of the educational outreach. Outcomes were assessed with a Belgian set of quality indicators for knee osteoarthritis management and focused on the number of prescriptions for appropriate physical therapy (i.e. muscle strengthening, aerobic, functional or range of motion exercises) and the adherence to eight additional quality indicators related to knee osteoarthritis management. For the analysis, multivariable logistic regression models were used and Generalized Estimating Equations to handle the correlation between the multiple results per GP.ResultsThe intervention group showed a tendency to prescribe more frequently at least one appropriate physical therapy for a case (43.8%), compared to the control group (31.3%, p = 0.057). Muscle strengthening exercises were the most frequently prescribed therapy with 37.0% in the intervention versus 26.9% in the control group. The adherence to the other quality indicators showed no significant difference between the intervention and control group and varied between 8.9 and 100% in the intervention group.ConclusionsThis intervention did not alter significantly the adherence to quality indicators and in particular the probability of prescribing physical therapy. To change general practitioners’ prescription behavior, more extensive or combined interventional approaches seem warranted.

Applicability of the DUNDRUM-1 in a forensic Belgium setting

Purpose Criteria to determine in which level of security forensic patients should receive treatment are currently non-existent in Belgium. Research regarding the assessment of security level is minimal and few instruments are available. The DUNDRUM toolkit is a structured clinical judgement instrument that can be used to provide support when determining security level. The purpose of this paper is to investigate the applicability and validity of the DUNDRUM-1 in Flanders. Design/methodology/approach The DUNDRUM-1 was scored for 50 male patients admitted at the forensic units in the public psychiatric hospital Rekem. Some files were rated by three researchers who were blind to participants’ security status, resulting in 33 double measurements. Findings Almost all files (96 per cent) contained enough information to score the DUNDRUM-1. Average DUNDRUM-1 final judgement scores were concordant with a medium security profile. No difference was found between the current security levels and the DUNDRUM-1 final judgement scores. Inter-rater reliability was excellent for the DUNDRUM-1 final judgement scores. On item level, all items had excellent to good inter-rater reliability with the exception of one item institutional behaviour which had an average inter-rater reliability. Practical implications The DUNDRUM-1 can be a useful tool in Flemish forensic settings. It has good psychometric properties. More research is needed to investigate the relationship between DUNDRUM-1 scores and security level decisions by the courts. Originality/value This is the first study that investigated the applicability of the DUNDRUM-1 in a Belgian setting, also a relative large number of repeated measurements were available to investigate the inter-rater reliability of the DUNDRUM-1.

Adaptation and validation of PCNE drug-related problem classification v6.2 in French-speaking Belgian community pharmacies.

Background Many tools exist to document drug-related problems (DRP), such as the Pharmaceutical Care Network Europe (PCNE) classification. However, none have been adapted and published for French-speaking Belgian community pharmacies. Settings French-speaking Belgian Community pharmacies. Objective The objective was to translate and adapt the PCNE V6.2 classification to the Belgian pharmacy practice and legal setting and to assess the content validity, daily use and inter-rater reliability of this classification. Main Outcome Measure Validation of the French-language adapted PCNE v6.2 classification in Belgium. Method The first step translated and adapted the PCNE V6.2 classification to the Belgian setting. Thereafter academic and community pharmacists evaluated the content validity, which involved six criteria and concerned the instruction manual (clarity, helpfulness) and the registration form (representativeness, logical design, completeness and uniqueness). The next step was the DRP collection, using the PCNE tool daily. Compliance with the instructions and the time needed to solve a DRP were evaluated. Finally, the inter-rater reliability was evaluated by comparing DRP codings done by pharmacist volunteers. Results The classification was translated into French and adapted by adding 16 items. The classification showed a high content validity for the academics and the community pharmacists. A total of 109 DRP forms were coded, with an average resolution time of 5min. Regarding the inter-rater reliability, 74 tool items out of the set of 83 showed high consistency in coding. Conclusion This study showed that the tool adaptation to a French-speaking Belgian context was reliable and has adequate validity for daily use.

PSY105 - COST-UTILITY OF NINTEDANIB VERSUS PIRFENIDONE FOR THE TREATMENT OF IDIOPATHIC PULMONARY FIBROSIS: A BELGIAN PERSPECTIVE

Idiopathic Pulmonary Fibrosis (IPF) is a debilitating lung disease consisting in an irreversibly declining lung function over time. The median survival after diagnosis is 2–3 years. In Belgium, nintedanib and pirfenidone are the only available treatments for the treatment of IPF. This study aims to compare the cost-utility of nintedanib versus pirfenidone in the Belgian setting. We adapted a previously developed Markov model to the Belgian National Health System perspective, simulating a hypothetical cohort of IPF patients followed up over a lifetime span. Relative effectiveness between the products was calculated from a network meta-analysis using data from each pivotal trial. The baseline risk of each event was estimated from the control arm of nintedanib clinical trials (TOMORROW, INPULSIS-1, INPULSIS-2). Mortality, loss of lung function and acute exacerbations were used for efficacy outcomes, serious adverse events were used for toxicity while overall discontinuation was used for tolerability. An annual discount rate of 3% and 1.5% were set for costs and health benefits, respectively. Deterministic and probabilistic sensitivity analyses tested the impact of alternate efficacy and safety outcomes, costs and utility values. We used Belgian data reported in 2018 euros as cost inputs. Nintedanib yielded more quality-adjusted life years (QALY) than pirfenidone (3.9445 QALY vs. 3.8793 QALY, respectively) and lower total costs (€7,620 less) mainly due to fewer acute exacerbations and lower treatment costs, making nintedanib a dominant option over pirfenidone due to better effectiveness and lower costs. Probabilistic sensitivity analysis shows that nintedanib is more cost-effective than pirfenidone with a probability of 95.0% at a willingness to pay of €30.000/QALY. Even if pirfenidone price was decreased by 20%, nintedanib would still dominate pirfenidone. Both nintedanib and pirfenidone have demonstrated important clinical benefits for IPF patients. In the Belgian setting, nintedanib dominates pirfenidone (less costs, more QALYs).

P01.129 Cost-effectiveness of [18F] FET for therapy assessment of temozolomide for patients with glioblastoma in a Belgian healthcare setting

P01.129 Cost-effectiveness of [18F] FET for therapy assessment of temozolomide for patients with glioblastoma in a Belgian healthcare setting

Primary care nurses in a local Belgian setting: Responding to healthcare needs of people with disabilities

Background: Given the worldwide evolution to deinstitutionalize care for people with a disability (PD), the importance of having care services, for instance as offered by primary care nurses (PCN), to deliver necessary care to PD can only be emphasized. European data (from 2014) show a relatively high percentage of PD in Belgium (16.2%) using home care services provided by primary health care providers (PCN, general practitioners…). Moreover, satisfaction levels regarding these services are among the highest in Europe. The objective of this research was to gain insight into the needs of PD regarding nursing care, based on PCN’s experiences.Methods: Between September and December 2015, a questionnaire – drawn up by a multidisciplinary team (4 general practitioners and 20 PCN) – was distributed electronically to 1547 PCN working in primary care in the Belgian region Limburg. Open-ended questions of this questionnaire were analyzed using techniques developed for qualitative data analysis. PCN were asked to report about (1) mental and behavioural problems, (2) medication policy, (3) swallowing problems, (4) monitoring of nutritional status and (5) any other needs arising in the care for PD.Results: Comments of 588 PCN were generated (response rate of 38%). Besides the (routine) tasks of PCN, the impact of PD’s and informal caregivers’ behaviour on PCN’s working environment were mentioned, particularly regarding medication policy, swallowing problems and nutrional status monitoring. PCN’s collaboration with PD and their informal caregivers is often reported about in relation to respectively PD’s limited ability to communicate or to understand PCN and informal caregivers behaving in a counteracting way, not following through PCN’s advice. Additionally, PCN report about consulting and activating other healthcare professionals in the interest of PD’s. Overall, PCN mentioned tasks in all facets of PD’s lives: from the expected nursing care and far beyond.Conclusions: Besides providing nursing care, PCN are also helping with different tasks related to daily living. This “beyond standard” - care enhances the likelihood of PD to keep on living in their homes for a longer period of time. PCN seem to play a crucial role in activating other healthcare professionals to meet the healthcare needs of PD. More extensive research should be carried out to gain insight in healthcare needs of PD and the challenges PCN come across in their care for this population. Findings can be used to align pre-qualification training and education of (future) PCN with the (unmet) needs of PD.