Care In Flanders Research Articles

Presenting prevalence and management of psychosocial problems in primary care in Flanders.

BackgroundPsychosocial problems are widespread but reliable data about management are sparse. An overall view is missing and there is a need for a wider framework to include the data available in health care and welfare practice, databases and research output. The question under scope is: how are psychosocial problems presented and handled in primary care in Flanders?MethodsA mixed method was used. Using a ‘fishbone diagram’ (1) we obtained a basic structure to visualize the main (problem) areas and challenges. A literature study (2) and semi-structured interviews with health care and welfare professionals in primary care (3) were performed. Finally, two interdisciplinary focus groups were organized (4).ResultsIn Flanders, there is no tradition of multidisciplinary psychosocial research in primary care causing a lack of integrated data. Data only exist within disciplines without transdisciplinarity. The data are difficult to interpret due to different labeling and registration processes between disciplines and settings. However, we can find some general trends: assistance to patients with psychosocial problems is based on what can be offered, rather than on patient needs; drug treatment remains popular; referral of patients within primary care or to secondary care does not seem to be obvious. Among all disciplines, there is a great need for more collaboration and considerable advantages are to be expected from the growing emergence of multidisciplinary practices; multiculturalism appears to take an increasingly important place within primary care in Flanders and has implications for the care offered; and treatment effectiveness in psychosocial problems seems to be more related to the person of the caregiver than to a specific discipline, theory or type of treatment.ConclusionsBased on our results, we strongly advise stimulation and organization of integrated (multidisciplinary) research regarding psychosocial problems in primary care and a more consistent registration by the agencies in primary care.

Optimal administrative scale for planning public services: a social cost model applied to Flemish hospital care.

In choosing the scale of public services, such as hospitals, both economic and public administrative considerations play important roles. The scale and the corresponding spatial distribution of public institutions have consequences for social costs, defined as the institutions' operating costs and the users' travel costs (which include the money and time costs). Insight into the relationship between scale and spatial distribution and social costs provides a practical guide for the best possible administrative planning level. This article presents a purely economic model that is suitable for deriving the optimal scale for public services. The model also reveals the corresponding optimal administrative planning level from an economic perspective. We applied this model to hospital care in Flanders for three different types of care. For its application, we examined the social costs of hospital services at different levels of administrative planning. The outcomes show that the social costs of rehabilitation in Flanders with planning at the urban level (38 areas) are 11% higher than those at the provincial level (five provinces). At the regional level (18 areas), the social costs of rehabilitation are virtually equal to those at the provincial level. For radiotherapy, there is a difference of 88% in the social costs between the urban and the provincial level. For general care, there are hardly any cost differences between the three administrative levels. Thus, purely from the perspective of social costs, rehabilitation should preferably be planned at the regional level, general services at the urban level and radiotherapy at the provincial level.

A multidisciplinary and multi-method research framework for studying integrated care in Flanders (Belgium)

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.

Prevalence and management of psychosocial problems in primary care in Flanders

Purpose: To assess the prevalence, presentation and handling of psychosocial problems in primary care in Flanders. Theory: Data on prevalence and handling psychosocial problems are widespread and sparse. Thereby, there is a shortcoming of a global picture of the question-at-hand and a need for a frame that can comprehend the data available in health care and welfare practice, databases and scientific research. The question is: what happens in primary care to intercept the psycho social problems that are presented? Methods: A mixed method was used. 1. Using a ‘fishbone diagram’ we obtained a basic structure to visualise the main (problem) areas and challenges.2. A literature study and 3.long interviews with health care and welfare professionals in primary care, were performed. 4. Finally two interdisciplinary focus groups were organised. Findings: In Flanders, there is no tradition of multidisciplinary research in primary care causing a lack of integrated data. Existing data only exist within disciplines without transdisciplinarity. The data are difficult to interpret due to different labelling and registration processes between disciplines and settings. Discussion: We strongly advise the stimulation and organisation of integrated (multidisciplinary) research regarding psychosocial problems in primary care.

GPs’ views concerning spirituality and the use of the FICA tool in palliative care in Flanders: a qualitative study

According to recent recommendations, healthcare professionals in palliative care should be able to perform a spiritual history-taking. Previous findings suggest that the FICA tool is feasible for the clinical assessment of spirituality. However, little is known about the views of GPs on the use of this tool. To provide a solid overview of the views of Flemish GPs concerning spirituality and the use of the FICA tool for spiritual history-taking in palliative care. Qualitative interview study in Flanders, Belgium. Twenty-three GPs participated in a semi-structured interview. The interviews were analysed by thematic analysis, which includes line-by-line coding and the generation of descriptive and analytical themes. The interviewees stated that they would keep in mind the questions of the FICA tool while having a spiritual conversation, but not use them as a checklist. The content of the tool was generally appreciated as relevant, however, many GPs found the tool too structured and prescribed, and that it limited their spontaneity. They suggested rephrasing the questions into spoken language. The perceived barriers during spiritual conversations included feelings of discomfort and fear, and the lack of time and specific training. Factors that facilitated spiritual conversations included the patients' acceptance of their diagnosis, a trusting relationship, and respect for the patients' beliefs. A palliative care process with attention focused on the patient's spirituality was generally perceived as a tough but rewarding experience. The study concludes that the FICA tool could be a feasible instrument for the clinical assessment of spirituality, provided that certain substantive and linguistic adjustments are made. Additional research is needed to find the most suitable model for spiritual history-taking, in response to the specific needs of GPs.

Flemish palliative-care nurses’ attitudes to palliative sedation

Palliative sedation is an option of last resort to control refractory suffering. In order to better understand palliative-care nurses' attitudes to palliative sedation, an anonymous questionnaire was sent to all nurses (589) employed in palliative care in Flanders (Belgium). In all, 70.5% of the nurses (n = 415) responded. A large majority did not agree that euthanasia is preferable to palliative sedation, were against non-voluntary euthanasia in the case of a deeply and continuously sedated patient and considered it generally better not to administer artificial floods or fluids to such a patient. Two clusters were found: 58.5% belonged to the cluster of advocates of deep and continuous sedation and 41.5% belonged to the cluster of nurses restricting the application of deep and continuous sedation. These differences notwithstanding, overall the attitudes of the nurses are in accordance with the practice and policy of palliative sedation in Flemish palliative-care units.

Commercial, non‐profit and governmental residential elderly care in Flanders: Differences in client selection and efficiency?

Verschuere B, Moray N, Decramer A. Commercial, non‐profit and governmental residential elderly care in Flanders: differences in client selection and efficiency?Inspired by New Public Management, governments have stimulated competition, outsourcing and privatisation in the public sector. Also, in care of the elderly, there has been a substantial increase in commercial provision. The present study explored the presumed differences in the performance of public (governmental), private non‐profit and private commercial elderly care organisations. We used quantitative indicators on the population of residential elderly care organisations in Flanders (Belgium). Although we found that commercial elderly care facilities tended to be more input‐efficient while non‐profit and public elderly care facilities tended to be more attentive to recruiting and housing residents with high care needs, these results need to be interpreted in light of the regulatory framework in which the different types of elderly care facilities operate.

The landscape of postgraduate education in palliative care for general practitioners: results of a nationwide survey in Flanders, Belgium

ObjectiveTo describe the offer of continuing medical education (CME) in palliative care in Flanders, Belgium and to explore the way providers of CME address the preferences of general practitioners (GP's) towards CME. MethodsQuestionnaire-survey among official providers of formal CME. ResultsThe response rate was 43%, equally distributed over all 5 provinces of Flanders. Data show large content gaps, an under usage of appropriate educational techniques and an absence of evaluation of the impact of CME on clinical practice. Providers of CME explain how they take the preferences of GP's concerning education in palliative care into account. ConclusionsThe present offer of CME is insufficient to educate GP's in palliative care. The absence of quality criteria and the lack of coordination between different providers results in an unattractive labyrinth of courses leaving GP's and their patients in the cold. Practice implicationsA comprehensive offer of CME sessions should be installed in a coordination between all providers. This could render the use of means (logistics and speakers) more efficient. Further research could look into other ways of acquiring palliative care competences such as evaluating the learning effect of GP's working together with specialized palliative home care teams.

Religion, world view and the nurse: results of a quantitative survey among Flemish palliative care nurses

To study the religious or ideological views and practices of palliative care nurses. An anonymous questionnaire was sent to all nurses (n=589) employed in palliative care in Flanders, Belgium. A total of 70.5% of the nurses (n=415) responded. Four meaningful factors were found: the ideological dimension, the intellectual dimension, the ritualistic dimension, and the experiential dimension. Five religious or ideological clusters were found: atheists/agnostics (n=66, 18.3%), 'doubters' (n=64, 17.8%), church-going respondents (n=106, 29.4%), religious but not church-going respondents (n=64, 17.8%), and devout church-going respondents (n=60, 16.7%). Older nurses were more committed to the teachings and practices of the Roman Catholic Church. Many nurses take the freedom to compose their own religious or ideological identity. A large majority of the nurses are interested in religious issues. Yet, their attitude toward religion and world view is noncommittal.

Flemish palliative care nurses’ attitudes toward euthanasia: a quantitative study

To adequately measure the attitudes of Flemish palliative care nurses toward euthanasia, and assess the relationship between these attitudes and demographic factors and the (perceived) influence of experience in palliative care on death anxiety. An anonymous questionnaire was sent to all nurses (n=589) employed in palliative care in Flanders, Belgium: 70.5% of the nurses (n=415) responded. A majority of the nurses supported the Belgian law regulating euthanasia but also believed that most euthanasia requests disappear as soon as a patient experiences the benefits of good palliative care. Three clusters were discovered: staunch advocates of euthanasia (150 nurses, 41.1%); moderate advocates of euthanasia (135 nurses, 37%); and (moderate) opponents of euthanasia (80 nurses, 21.9%). An absolute opposition between advocates and opponents of euthanasia was not observed. A statistically significant relationship was found between the euthanasia clusters and years of experience in palliative care, and (perceived) influence of experience in palliative care on anxiety when a patient dies. Flemish palliative care nurses' attitudes toward euthanasia are nuanced and contextual. By indicating that most euthanasia requests disappear as soon as a patient experiences the benefits of good palliative care, the nurses applied a 'palliative filter' a standard procedure in the case of a euthanasia request.

Socio-demographic determinants of informal caregiving: co-resident versus extra-resident care

This article adds to the literature on the 'supply side' of informal care, by examining the socio-demographic determinants of co-resident and extra-resident informal caregiving. Results from the population survey "Care in Flanders" (N=2826), provide evidence for a different relationship between socio-demographic characteristics and informal caregiving, according to the location of care. Women, persons living without children and married (vs. unmarried) persons are more likely to be involved in extra-resident care. Involvement in co-resident care on the other hand, is more common among persons in less good health and sharing a household with someone other than a spouse or child, mostly a parent. The relationship between socio-demographic factors and care intensity is not uniform as well: while younger age and having no paid work are related to more intensive caregiving within the household, this is not the case among extra-resident caregivers. Results may be explained by the fact of some groups having more/less access to "legitimate excuses" for providing less extra-resident care, unequal risks of being confronted with (higher) care needs, as well as selection effects. Overall, our results were weak, pointing to the weakness of a strictly supply based approach in order to predict evolutions in informal care. Future studies should be aware of the differences between co-resident and extra-resident caregiving, taking into account factors from a supply as well as a demand perspective.

Closing the knowledge–performance gap: An audit of medical management for severe paediatric trauma in Flanders (Belgium)

Considerable variability in (paediatric) trauma care has been reported. We wanted to audit current practice in Flanders (Belgium). The PENTA network prospectively collected data on paediatric trauma patients in a representative sample of Flemish hospitals during 2005. All cases with an ISS>or=13 and sufficient data availability were withheld for panel evaluation (n=92). Two trained experts reviewed the medical care provided in the first hours after trauma, based on available evidence and existing universal guidelines. 'Defaults' were only withheld as such if there was 100% consensus. At random, about 25% of cases were also reviewed by two other experts in order to assess interobserver variability. In the 92 cases, 264 defaults were recognised. 25.4% of all defaults were thought to have a direct impact on the individual patient's outcome. Specific difficulties were observed with, e.g. cervical spine management (18/82 relevant cases), pCO2 and global respiratory management (38/92), fluid management (29/92) and analgesia (27/89). The agreement between the two panels was good for defaults identified (crude agreement 74.8%), yet only fair for the presumed impact on outcome (crude agreement 58.3%). We audited paediatric trauma care in Flanders and identified several problem areas (often in basic areas of paediatric life support). The inherent degree of interobserver variability does not diminish the importance of these findings. More performance-based teaching and timely recertification may have a positive impact on the quality of the care delivered.

Hoe zwaar weegt de mantel?: determinanten van de ervaren zorgbelasting bij Vlaamse mantelzorgers

Providing informal care may be perceived as a considerable burden by the caregiver and result in mental and physical health problems. This article focuses on the perceived care burden of informal carers (N = 1816) of a severely disabled person, making use of data of the postal survey “Informal care in Flanders”. Based on the stress-appraisal model of Yates, Tennstedt & Chang (1999) and role theory, 4 types of determinants are being discerned: the intensity of caregiving, resources and other roles of the informal carer, and background- and contextvariables. Results show that women and carers of a spouse or child feel more burdened, as well as carers providing more intensive care and persons who report a lower relationship quality with the care receiver. Help received with caregiving and other roles of the informal carers have only a minor influence and show mixed results.

Organisationele rollen en posities in netwerken van welzijnsorganisaties

In this contribution, a sociological study of networks of human service organizations, using social network analysis, is presented. Data from nine networks of human service organizations involved in the care for children and youngsters in Flanders are analysed. The analyses aim to sketch the prevailing pattern of client referral between types of organizations. It is speculated that the referral of clients between human service organizations is based on the role expectations that derive from the statute of the organization. Using blockmodelling techniques, it is investigated to what degree the relations of referral and the network position of an organization are directed by the statute of the organization. Results indicate that the relations of referral and the position of the organization in the network are – to a large extent – determined by the bylaws of the organization. From the data from nine networks, an average blockmodel is derived that represents the pattern of relationships between types of organizations in the average network of freely accessible youth care in Flanders.

Paediatric trauma and trauma care in Flanders (Belgium). Methodology and first descriptive results of the PENTA registry

Paediatric injury surveillance and prevention are definite priorities for the European, Belgian, and Flemish authorities. Current available data for Flanders (Belgium) are fragmentary and out-of-date. The PENTA registry (PaEdiatric Network around TraumA) was therefore set up to obtain recent population-based data on trauma and trauma care in children and youngsters in Flanders. Data were collected prospectively in a representative sample (n = 18) of Flemish emergency departments (ED). All children (age 0-17 years) who presented at the ED in 2005 or died prehospital due to trauma were included. The registry was split into two levels. The basic A registry ('all' trauma) consisted of 30 variables, and the more exhaustive B registry ('severe trauma', defined as length of hospitalisation >48 hours, including all nonsurvivors) collected data on 291 variables. The incidence for paediatric trauma presenting at Flemish ED was approximately 119/1000/year. Further data were collected in a random sample of 7,879 cases (21.9% of 35,900 eligible patients). Of all cases, 0.8% were considered 'severe' and included in the B registry. In conclusion, the 'burden' of injury in Flanders is still enormous. PENTA provides the first population-based data about the circumstances and the extent of injury in children and youngsters for the Flemish region. In this article we present in detail the surplus value of the methods used, the difficulties encountered, and the most relevant epidemiological findings from the registry.

Enquête naar kennis, gebruik en perceptie van richtlijnen betreffende cerebrovasculair accident (CVA) bij Vlaamse SP-diensten en CVA-revalidatie-eenheden

Abstract Enquiry towards knowledge on, use ofand perception of guidelines for strokein the various categories of care practitionersin Flemish (Belgian) specialized servicesfor stroke care The need for quality within medical and paramed-ical acts has actually become more determinate andurgent. This search for quality of care canbe found in „evidence-based medecine” (EBM). Oneway to implement this in practice is to develop instru-ments such as (clinical) guidelines.Since the rehabilitative care for patients after strokeis complex as well as multidisciplinary, the rele-vance of paramedical guidelines for this group ofpatients is obviously considerable. Guidelines leadindeed to a more uniform and transparent care.Through an enquiry in specialized services forstroke care in Flanders (Belgium), the authors havetried to detect the existing knowledge as well as theuse and perception of guidelines for stroke patientsof diverse categories of care practitioners.This enquiry by letter of 49 Flemish hospitals withspecialised services (SP neurological / SP locomo-torical) or with RIZIV-rehabilitation convention(National institute for health insurance) revealed thatin the respondents’ group (n = 83), physicians andnurses are most familiar with guidelines. Moreover,their knowledge increases with ascending age andexperience in stroke care. Still a lot of other practi-tioners do not know what guidelines exactly repre-sent. Thus the need for information and educationremains substantial.From all disciplines questioned, physicians useguidelines most frequently.None of the interrogated caretakers was dismissivetowards guidelines; the better their knowledge andthe more frequent their use of guidelines, the moreopen and compliant they are towards this care struc-ture.Literatuur

The adherence of type 2 diabetes patients to their therapeutic regimens: a qualitative study from the patient's perspective

AbstractIn chronic diseases such as type 2 diabetes, adherence to treatment is a major public health problem, seriously undercutting the benefits of medical care. Many studies have assessed factors associated with compliance, but the patient perspective is remarkably absent. From these studies, it seems that the patient's role in the process of adhering was to be passive and since the prescriber's view was rational and based on scientific research, it may have been assumed to be superior to the patient's beliefs and wishes. This paper reports on type 2 diabetes patients' health beliefs in relation to their illness, their communication with caregivers and the problems encountered in adhering to treatment regimens.Seven focus groups were held for type 2 diabetes patients recruited by pharmacists in primary care in Flanders, Belgium. These groups focussed on participants' experience of their treatment. Possible explanatory models were generated by qualitative content analysis of the focus group discussions.Forty‐six patients recruited from primary care participated in six semi‐structured group discussions. The data demonstrate that health beliefs, the quality of doctor/patient communication, and the quality of the information patients receive are important factors for patient adherence to treatment. Possible explanatory models for adherence emerged, relating to knowledge of the illness, body awareness and the doctor/patient relationship.This qualitative research identified explanatory models for adhering to medical treatment from the patient's perspective. Interventions designed to enhance adherence should address the patient perspective using these models in order to maximise effectiveness. Copyright © 2003 John Wiley & Sons, Ltd.

Relationship of bacterial vaginosis and mycoplasmas to the risk of spontaneous abortion

Objective: This study was undertaken to investigate a possible link between first-trimester diagnosis of bacterial vaginosis and cessation of pregnancy at ≤20 weeks' gestation. Study Design: Women (n = 228) who received routine prenatal care in Flanders, Belgium, during the first trimester (14 weeks' gestation) and had a living singleton fetus were examined for microbiologic flora of the vagina. Bacterial vaginosis was assessed either clinically (Amsel et al criteria), microscopically (clue cells), or by culture of bacterial vaginosis–associated bacteria. Data were analyzed univariately (relative risk) and multivariately. Results: The presence of bacterial vaginosis at the first prenatal visit was strongly associated with subsequent early pregnancy loss (relative risk, 5.4; 95% confidence interval, 2.5-11). After multivariate analysis bacterial vaginosis, Mycoplasma hominis, and Ureaplasma urealyticum but not other microorganisms remained associated with an increased risk of miscarriage. Conclusion: Bacterial vaginosis and mycoplasmas may play causative roles in spontaneous abortion and early pregnancy loss. (Am J Obstet Gynecol 2000;183:431-7.)