Belgian Care Research Articles

Evaluating the need to reform the organisation of care for major trauma patients in Belgium: an analysis of administrative databases.

In light of the international evolutions to establish inclusive trauma systems and to concentrate the care for the most severely injured in major trauma centres, we evaluated the degree of dispersion of trauma care in Belgium. We used descriptive statistics to illustrate the dispersion of major trauma care in Belgium based on two independent administrative databases: the registry of Mobile Intensive Care Units (2009-2015) and the Belgian Hospital Discharge Dataset (2009-2014). Patients with a severe trauma (n = 3856 in 2015) were transported towards 145 different hospital sites (on a total of 198 hospital sites) resulting in a median of 17 cases per hospital site (min = 1; P25 = 4; P75 = 30; max = 165). A minority of major trauma patients is after admission transferred to another hospital (8%) with a median of 10 days after admission to the hospital (IQR 3.5-24). The dispersion of care for major trauma patients in Belgium is so high that a reorganisation of care for severe injured patients in major trauma centres concentrating professional expertise and specialised equipment is recommended to guarantee a high quality of care in a qualitative and sustainable way.

Reconstructive Tubal Surgery as an Alternative to Assisted Reproductive Technology After Tubal Sterilization: Experience in a Secondary Belgian Care Center

Abstract Objective: The goal of this research was to evaluate fertility outcomes after laparoscopic tubal anastomosis for reversal of tubal sterilization, and assess this procedure's place as an al...

Implementing integrated Care in Belgium: a nationwide mobilization

Introduction- background and problem statement. Belgium as well as other European countries are faced with an increasing prevalence of chronic diseases and an aging population, intensified by the complexity of multimorbidity. This demands changing the current health system which is primarily focused on specific disease management and acute care. The World Health Organization calls for a global movement towards integrated, people centered health services.5 Description of policy context and objective: Belgium has an accessible health care with a national, compulsory health insurance (covering 99% of the Belgian population). Health care system is highly fragmented, providers work on a ‘fee for service’ base, and there is little stimulation for multidisciplinary consultation and integration. In 2013 a national survey on health in a representative sample of the Belgian population stated that 28,5% reported one or more chronic disease.6 In October 2015 a national Plan: “Integrated Care for a better health” 7 was approved by all competent national and regional Ministers of public health. This Plan is based on the principles of Triple Aim8, and complementary principles of improving equity and job satisfaction for the care providers. The implementation of the national plan is one of the major health care reforms under the current government. A strategic choice has been made for a bottom up implementation strategy in pilot regions rather than the more classic top down regulation approach based on national negotiations with interest groups. At the same time a strong national guidance framework has been put in place. Target population: The Plan targets the whole Belgian population with a focus on people with a chronic disease. The call for pilot projects was successful with 70 applicants in regions of 100 000 to 150 000 inhabitants. Twenty candidates were selected, covering 1/3th of the Belgian population (3.672.558 inhabitants). Highlights: (innovation,impact,outcomes) These 20 pilot projects are being coached by an external consultant and receive state funding for coordination costs to develop a regional 4-year action plan. This regional action plan must be based on the needs and resources in their region (stratification of the population). Actions should cover 14 components: patient empowerment, case management, informal care, social and professional reintegration, prevention, care coordination and care continuity, incorporating the experience of the patients organizations, electronic shared/integrated patient record, multidisciplinary guidelines, testing innovative ways of financing integrated care, installing a culture of quality. All these actions should be dealt with according to the principles of change management. Those regional action plans that are approved will receive coordination funding to roll out their actions over 4 years., A scientific team will assist the pilot projects in building a culture of quality and procedures for auto-evaluation. The aim is to increase efficiency, these gains are reassigned to the project through a system of budget guarantees in health care. Comments on transferability and conclusion: The Belgian approach combines stimulation of bottom up ideas and entrepreneurship with guidance from the policymakers by setting out the framework for innovation and encouraging the collaboration between partners in the region. The co-creative process between policy makers and partners on the field seeks to establish the partnerships necessary to reach a sustainable integrated care system.

Optimising the quality of antibiotic prescribing in out-of-hours primary care in Belgium: a study protocol for an action research project

IntroductionAntimicrobial resistance is a major public health threat driven by inappropriate antibiotic use, mainly in general practice and for respiratory tract infections. In Belgium, the quality of general practitioners’ (GPs)...

Lessons learned about integrating multisectorial collaboration agreements

This contrubution wil make a cross comparative analysis of research done in innovation strategies in elderly care, mental health care and chronic care in Belgium. The aim of this analysis is to better understand which factors hamper or facilitate multisectorial collabration in order the enhance integrated care (on the organisational level). The added value of a cross comparative analysis of innovation paths in different sectors, is that it allows for identifying idiosyncratic issues in certain care domains, but more importantly, transversal barriers and facilitating or hampering factors regardless of the health or social issue that is being adressed. The contribition is grounded in empirical process evaluation research (realist eveluation) of a number of recent Belgian initiatives to enhance integrated care. Contentwise, the contribution relies on theoretical insights from health system approaches, interorganisational network literature and institutional field studies. The cross comparative analysis will lead to a number of lessons to be taken on board when trying to enhance integrated care activities. thses lessons will be discussed agans the background of exstsing theoretical debates on multisectorial collaborations and integrated care.

A qualitative study of the perspectives of Sub-Saharan African migrant women with HIV/AIDS and their caregivers on treatment and care in Belgium

AbstractHIV treatment may be less effective as a prevention option when HIV patients especially migrants encounter difficulties in accessing treatment and care even in resource-rich settings. This paper explores perspectives of HIV-infected Sub-Saharan African (SSA) migrant women and their caregivers on HIV treatment/care in Belgium. We conducted a qualitative study between April 2013 and December 2014. We included HIV-infected SSA migrant women and their caregivers providing treatment and care in a university teaching hospital in Belgium. Data was analyzed using thematic analysis. A total of 44 patients and eight HIV healthcare providers were included in the study. All participants acknowledged the availability and accessibility to free treatment that contributes to long-term survival if treatment is adhered to. Women with uncertain immigration status and unstable housing reported difficulties in obtaining treatment/care and the fear of discontinuity if deported to their country of origin. Free, availabl...

Attitudes towards reforming primary care in Belgium: social network analysis in a pluralist context.

Health care policies are influenced by many groups which in turn influence each other. Our aim was to describe a network of nominated influential stakeholders and analyze how it affects attitudes to reforming primary care. Face-to-face interviews were carried out in Belgium with 102 influential people. Each respondent was asked to score solutions for improving the role of general practice in the health care system and to nominate up to six other influential stakeholders. Social network and multivariate analyses were used to describe the nomination network and its effect on attitudes to reform. The network was highly centralized and homophilous (tendency to bond with people who are similar) for language groups. Despite Belgium having a strong pluralist tradition of decision making, policy makers were central to the network (average indegree = 10.8) compared to professional representatives (6.9). Respondents supported an enhanced role for general practitioners but did not support radically new policies. Social network analysis contributes to understanding why health care reforms may languish in pluralistic, decentralized health care systems. The central position of a stakeholder in a network is related to perceived influence but does not favour a radical policy orientation. In addition, language-group homophily in the 'perceived influence network' leads to a weak coalition that only favours small-step reform.

La atención primaria en Bélgica

Belgium is an attractive country to work in, not just for doctors but for all Spanish workers, due to it having the headquarters of European Union. The health job allure is double; on the one hand, the opportunity to find a decent job, and on the other, because it is possible to develop their professional abilities with patients of the same nationality in a health system with a different way of working.The Belgium health care system is based on security social models. Health care is financed by the government, social security contributions, and voluntary private health insurance. Primary care in Belgium is very different to that in Spain. Citizens may freely choose their doctor (general practitioner or specialist) increasing the lack of coordination between primary and specialized care. This leads to serious patient safety problems and loss of efficiency within the system. Belgium is a European country with room to improve preventive coverage.General practitioners are self-employed professionals with free choice of setting, and their salary is linked to their professional activity. Ambulatory care is subjected to co-payment, and this fact leads to great inequities on access to care. The statistics say that there is universal coverage but, in 2010, 14% of the population did not seek medical contact due to economic problems. It takes 3 years to become a General Practitioner and continuing medical education is compulsory to be revalidated.In general, Belgian and Spaniards living and working in Belgium are happy with the functioning of the health care system. However, as doctors, we should be aware that it is a health care system in which access is constrained for some people, and preventive coverage could be improved.

Missing data at follow-up: The case of the interRAI home care assessment instrument in Belgium

BackgroundIn Belgium, a web application BelRAI was developed to support the use of interRAI Home Care assessments. However, not all clients have had a follow-up assessment. ObjectivesTo examine the prevalence of incomplete assessments at 6-month follow-up and to compare the profiles of persons with and without missing data. DesignObservational study of interRAI Home Care data and data from the Belgian Intermutuality Agency. SettingHome care in Belgium. ParticipantsHealthcare professionals using BelRAI in the context of an evaluation of home care interventions to delay institutionalization of frail older people. MethodsDescriptive statistics were calculated based on demographic characteristics and outcome measures. Poisson regressions for the relative risk of institutionalization and for the relative risk of death were performed for a period of 6 and 12 months. ResultsIn a sample of 4987 persons (mean age 79.90), two groups were determined: a group without and a group with missing data at 6-month follow-up. At baseline, the group with missing data at follow-up has a worse health status than the group without missing data. Persons with missing data at 6-month follow-up had a 3.63 higher chance of dying between 6 and 12 months after baseline, a 3.43 higher chance for institutionalization at 6 months, and a 2.87 higher chance for institutionalization at 12 months. ConclusionIn this study, missing data at follow-up is not a random occurrence. The findings are important for healthcare professionals and for researchers working with longitudinal data. Further study is required to research possible solutions.

Public Health Triangulation to inform decision-making in Belgium.

We assessed the impact of a nation-wide ambulatory care complex intervention (the "care trajectory program") on quality of care in Belgium. We used the three-step public health triangulation method described in this paper and data from four different data sources: a national reimbursement database, an electronic patient record-based general practitioner network, the Belgian general practitioner sentinel network, and a new national registry for care trajectory patients. By applying our method and using the available evidence, we identified key findings that have been accepted by experts and stakeholders. We also produced timely recommendations for the decision-making process, four years after the start of the care trajectory program.

Practices and Policies of Early Childhood Education and Care in Belgium, Europe:

Practices and Policies of Early Childhood Education and Care in Belgium, Europe:

Medium- to Long-Term Impact of Rotavirus Vaccination on Hospital Care in Belgium: A 7-Year Follow-Up of the Rotavirus Belgium Impact Study (RotaBIS).

IntroductionRotavirus (RV) vaccination was introduced in Belgium in 2006. With the high uptake it had (>85%), a sharp decline in hospitalizations was observed during the first years after vaccine introduction. The objective of this study was to investigate whether this decline was maintained and to simulate projections.MethodsThe Rotavirus Belgium Impact Study allowed an analysis of the RV vaccine impact amongst children in 11 hospitals in Belgium over a 9-year period (2005–2013) with 2 years pre- and 7 years post-vaccine introduction. Results were compared by year and by subsequent birth cohort aging up to 5 years. The two different analysis methods helped dismantling the different (direct and indirect) effects of vaccine protection to simulate future hospitalization trends.ResultsDuring the whole observation period, 40,552 RV detection tests were performed of which 5832 were positive (14.4%). After RV vaccine introduction, a significant reduction in number of tests performed (−38%) was combined with a dramatic drop in numbers of positive tests (−76.6%). The decreases were spectacular during the first two years of vaccine introduction; after that period, the decrease flattened. Cross-sectional comparison with cohort data showed that the initial drop was heavily influenced by the herd effect of the vaccine. Cohort analysis demonstrated a low rate of residual disease over time, suggesting another infection source other than the child population.ConclusionThe residual disease will be maintained in the community when a same vaccination strategy is continued over time, starting vaccination of children only at 6 weeks’ time.FundingGlaxoSmithKline Biologicals SA.Trial registrationClinicalTrials.gov identifier, NCT01563146.Electronic supplementary materialThe online version of this article (doi:10.1007/s40121-015-0099-1) contains supplementary material, which is available to authorized users.

Reference centres for adults with rare and complex cancers – Policy recommendations to improve the organisation of care in Belgium

BackgroundRare and/or complex cancers call for a very specific expertise and adequate infrastructure. In Belgium, every hospital with a programme in oncology can deliver care for adults with rare and/or complex cancer types, without having demonstrated a specific know-how to adequately manage these patients. Therefore, the Minister of Health ordered a scenario for the organisation of care for adults with rare and/or complex cancers, taking into account the current Belgian situation and relevant foreign experience. MethodsCombined methods were used in this study: a literature review, the consultation of stakeholders, in depth discussions in 14 multidisciplinary groups leading to concrete proposals for several rare/complex cancers and the consultation of a panel of expert pathologists. ResultsThe core recommendation is the set-up of shared care networks around reference centres, with multidisciplinary teams of recognised expertise in specific rare/complex cancers. The definition of minimum caseloads for hospitals and medical specialists, the evaluation of the quality of care, a model of diagnostic confirmation and the set-up of a national portal website which provides information on rare and/or complex cancers and reference centres are highly recommended. ConclusionIt is no longer practicable, efficient or ethical that every hospital or every practitioner continues to offer care for every rare/complex cancer. Improving the quality of rare/complex cancer care requires to concentrate expertise and sophisticated infrastructure in reference centres. Furthermore, the formation of networks between reference centres and peripheral centres will allow a delivery of care combining expertise and proximity. The next step is the translation of the recommendations into policy decisions. It is very well realised that this will take some courage and that a certain degree of resistance will have to be surmounted, but eventually, the best interest of the patient should prevail.

Good continuum of HIV care in Belgium despite weaknesses in retention and linkage to care among migrants.

BackgroundThe Belgian HIV epidemic is largely concentrated among men who have sex with men and Sub-Saharan Africans. We studied the continuum of HIV care of those diagnosed with HIV living in Belgium and its associated factors.MethodsData on new HIV diagnoses 2007–2010 and HIV-infected patients in care in 2010–2011 were analysed. Proportions were estimated for each sequential stage of the continuum of HIV care and factors associated with attrition at each stage were studied.ResultsOf all HIV diagnosed patients living in Belgium in 2011, an estimated 98.2 % were linked to HIV care, 90.8 % were retained in care, 83.3 % received antiretroviral therapy and 69.5 % had an undetectable viral load (<50 copies/ml). After adjustment for sex, age at diagnosis, nationality and mode of transmission, we found lower entry into care in non-Belgians and after preoperative HIV diagnoses; lower retention in non-Belgians and injecting drug users; higher retention in men who have sex with men and among those on ART. Younger patients had lower antiretroviral therapy uptake and less viral suppression; those with longer time from diagnosis had higher ART uptake and more viral suppression; Sub-Saharan Africans on ART had slightly less viral suppression.ConclusionsThe continuum of HIV care in Belgium presents low attrition rates over all stages. The undiagnosed HIV-infected population, although not precisely estimated, but probably close to 20 % based on available survey and surveillance results, could be the weakest stage of the continuum of HIV care. Its identification is a priority along with improving the HIV care continuum of migrants.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-1230-3) contains supplementary material, which is available to authorized users.

Specialised teams or personal continuity across inpatient and outpatient mental healthcare? Study protocol for a natural experiment

IntroductionMental healthcare organisation can either pursue specialisation, that is, distinct clinicians and teams for inpatient and outpatient care or personal continuity of care, that is, the same primary clinician for...

Does the Belgian diabetes type 2 care trajectory improve quality of care for diabetes patients?

BackgroundThe Belgian care trajectory (CT) for diabetes mellitus type 2 (T2DM), implemented in September 2009, aims at providing integrated, evidence-based, multidisciplinary patient- centred care, based on the chronic care model.The research project ACHIL (Ambulatory Care Health Information Laboratory) studied the adherence of CT patients, in the early phases of CT programme implementation, with CT obligations, their uptake of incentives for self-management, whether the CT programme was targeting the appropriate group of patients, how care processes for these patients evolved over time and whether CT start led to better quality in the processes and outcomes of care.MethodsThis observational study took place in the period 2006–2011 and covered T2DM patients who started a CT between 01/09/2009 and 31/12/2011.Four data sources were used: outcome data, from electronic patient records (EPRs) on all CT patients, provided by general practitioners (GPs); reimbursement process data on all CT patients and clinically comparable patients; and data from a sample of CT patients and clinically comparable patients from an EPR-based regional GP network and a paper-based national GP network, respectively.Through multilevel analysis of cross-sectional and longitudinal data, the effect of CT inclusion on processes and outcome was estimated, controlling for potential confounders.ResultsBy the end of 2011, data on 18,250 CT patients had been collected. Approximately 50 % of these CT patients had received reimbursement for a glucometer and nearly 60 % had had at least one encounter with a diabetes educator. The CT programme recruited T2DM patients who had been difficult to control in the past. In the years prior to CT start, there had been a gradual improvement in the follow up of these patients. Moreover, compared to non-CT patients, the proportion of CT patients adhering to the recommended frequency for monitoring of parameters, such as HbA1c, increased significantly around CT start. Some data sources, albeit not all, suggested there had been an improvement in certain outcomes, such as HbA1c, after CT inclusion.ConclusionsAccording to this study, CT enrolment is associated with better quality of care processes compared to non-CT patients. This improvement was found in several of the data sources used in this study. However, results on outcome parameters remain inconclusive.

The Ars Moriendi Model for Spiritual Assessment: A Mixed-Methods Evaluation.

To explore nurses' and physicians' experiences with the ars moriendi model (AMM) for spiritual assessment. Convergent, parallel, mixed-methods. Palliative home care in Belgium. 17 nurses and 4 family physicians (FPs) in the quantitative phase, and 19 nurses and 5 FPs in the later qualitative phase. A survey was used to investigate first impressions after a spiritual assessment. Descriptive statistics were applied for the analysis of the survey. In a semistructured interview a few weeks later, nurses and physicians were asked to describe their experiences with using the AMM. Interviews were audio recorded, transcribed, and qualitatively analyzed. Quantitative and qualitative results were compared to see whether the findings were confirmative. The survey assessed the feasibility of the AMM for use in palliative home care, whereas the semistructured interviews collected in-depth descriptions of healthcare providers' (HCPs') experiences with the AMM. The AMM was perceived as valuable. Many patients shared their wishes and expectations about the end of life. Most HCPs said they felt that the patient-provider relationship had been strengthened as a result of the spiritual assessment. Almost all assessments raised new issues; however, many dyads had informally discussed spiritual issues before. The current study suggests that HCPs believe that the AMM is a useful spiritual assessment tool. Guided by the model, HCPs can gather information about the context, life story, and meaningful connections of patients, which enables them to facilitate person-centered care. The AMM appears to be an important tool for spiritual assessment that can offer more insight into patients' spirituality and help nurses to establish person-centered end-of-life care.

Pneumococcal lower respiratory tract infections in adults: an observational case-control study in primary care in Belgium.

BackgroundSerious lower respiratory tract infections (SLRTIs), especially Streptococcus pneumoniae (SP)-related pneumonia cause considerable morbidity and mortality. Chest imaging, sputum and blood culture are not routinely obtained by general practitioners (GPs). Antibiotic therapy is usually started empirically. The BinaxNOW® and Urine Antigen Detection (UAD) assays have been developed respectively to detect a common antigen from all pneumococcal strains and the 13 pneumococcal serotypes present in the vaccine Prevenar 13® (PCV13).MethodsOPUS-B was a multicentre, prospective, case-control, observational study of patients with SLRTI in primary care in Belgium, conducted during two winter seasons (2011–2013). A urine sample was collected at baseline for the urine assays. GPs were blinded to the results. All patients with a positive BinaxNOW® test and twice as much randomly selected BinaxNOW® negative patients were followed up. Recorded data included: socio-demographics, medical history, vaccination history, clinical symptoms, CRB-65 score, treatments, hospitalization, blood cultures, healthcare use, EQ-5D score. The objectives were to evaluate the percentage of SP SLRTI within the total number of SLRTIs, to assess the percentage of SP serotypes and to compare the burden of disease between pneumococcal and non-pneumococcal SLRTIs.ResultsThere were 26 patients with a BinaxNOW® positive test and 518 patients with a BinaxNOW® negative test. The proportion of pneumococcal SLRTI was 4.8 % (95 % CI: 3.1 %–7.2 %). Sixty-eight percent of positive cases showed serotypes represented in PCV13. In the BinaxNOW-positive patients, women were more numerous, there was less exposure to young children, seasonal influenza vaccination was less frequent, COPD was more frequent, the body temperature and the number of breaths per minute were higher, the systolic blood pressure was lower, the frequency of sputum, infiltrate, chest pain, muscle ache, confusion/disorientation, diarrhoea, pneumonia and exacerbations of COPD was more frequent, EQ-5D index and VAS scale were lower, the number of visits to the GP, of working days lost and of days patients needed assistance were higher.ConclusionsSP was responsible for approximately 5 % of SLRTIs observed in primary care in Belgium. Pneumococcal infection was associated with a significant increase in morbidity. Sixty-eight percent of serotypes causing SLRTI were potentially preventable by PCV13.

Infection due to travel-related carbapenemase-producing Enterobacteriaceae, a largely underestimated phenomenon in Belgium

Background:Carbapenemase-producing Enterobacteriaceae (CPE) are emerging worldwide, representing a major threat for public health. Early CPE detection is crucial in order to prevent infections and the development of reservoirs/outbreaks in hospitals. In 2008, most of the CPE strains reported in Belgium were imported from patients repatriated from abroad. Actually, this is no longer the case.Objectives and methods:A surveillance was set up in Belgian hospitals (2012) in order to explore the epidemiology and determinants of CPE, including the link with international travel/hospitalization. The present article describes travel-related CPE reported in Belgium. Different other potential sources for importation of CPE are discussed.Results:Only 12% of all CPE cases reported in Belgium (2012–2013) were travel related (with/without hospitalization). This is undoubtedly an underestimation (missing travel data: 36%), considering the increasing tourism, the immigration from endemic countries, the growing number of foreign patients using scheduled medical care in Belgium, and the medical repatriations from foreign hospitals. The free movement of persons and services (European Union) contributes to an increase in foreign healthcare workers (HCW) in Belgian hospitals. Residents from nursing homes located at the country borders can be another potential source of dissemination of CPE between countries. Moreover, the high population density in Belgium can increase the risk for CPE-dissemination. Urban areas in Belgium may cumulate these potential risk factors for import/dissemination of CPE.Conclusions:Ideally, travel history data should be obtained from hospital hygiene teams, not from the microbiological laboratory. Patients who received medical care abroad (whatever the country) should be screened for CPE at admission.

The ecology of health care in a Belgian area

Introduction:Focusing on the monthly prevalence of health problems and recourse to different levels of care of the population is an interesting approach to demonstrate the respective roles of different levels of health care. In the present study, the ecology of health care was studied in the region of Liège, Belgium.Method:A survey questioning people about their health problems was conducted in 2009 in two communes of the province of Liège. For each health problem, ‘health care’ was defined as contact with any qualified care provider. For each consultation, three elements were recorded: the profession of the health care provider; the place where the care was provided and the kind of health care received.Results:A total of 537 people were interviewed. The monthly prevalence of people who experienced a health problem during the previous month was 85·1%. The monthly prevalence of people who turned to a health care provider at least once during the month was 62·2%. The proportion of people turning to doctors, primarily local doctors, for a simple consultation was important (49·2%).Discussion:Our results are highly comparable with those of other studies. Recourse to a doctor is high (49%), which probably reflects the broad accessibility of health care in Belgium and maybe its overuse. Additional questions on the current and future organisation of the Belgian health care system are debated.