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De Man J, Remmen R, Philips H. Differences in antibiotic prescribing quality in Belgian out-of-hours primary care services. Acta Clin Belg 2023; 78:122-127. [PMID: 35635493 DOI: 10.1080/17843286.2022.2081772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study aims to compare trends in antibiotic prescribing behaviour for lower urinary tract infections among different out-of-hours primary care services. METHODS Cross-sectional study using routine prescription data extracted from electronic health records from six out-of-hours services. The study population included 5888 cases diagnosed with an uncomplicated lower urinary tract infection from 2016 to 2020. Prescriptions were assessed based on the national guidelines. RESULTS Considering the total study period, an antibiotic was prescribed in 98.9% of cases. Among these cases, 55.0% was prescribed a guideline recommended antibiotic, 21.0% was prescribed fosfomycin, 17.4% was prescribed a quinolone and 1.8% was prescribed more than one antibiotic. Guideline recommended prescribing improved substantially over time. However, there were significant differences among out-of-hours services in terms of proportion over the total study period (between 49.0% and 66.7%) as well as in terms of time-trend pattern. CONCLUSION Substantial differences among out-of-hours services suggest a potential for further improvement in the quality of antibiotic prescribing. Monitoring prescribing behaviour per out-of-hours primary care service can guide focused interventions.
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Affiliation(s)
- Jeroen De Man
- Centre for General Practice, Department of Family Practice and Community Health, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Roy Remmen
- Centre for General Practice, Department of Family Practice and Community Health, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Hilde Philips
- Centre for General Practice, Department of Family Practice and Community Health, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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Cost effects of nurse led triage at an emergency department with the advice to consult the adjacent general practice cooperative for low-risk patients, a cluster randomised trial. Health Policy 2022; 126:980-987. [DOI: 10.1016/j.healthpol.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 06/20/2022] [Accepted: 08/02/2022] [Indexed: 11/19/2022]
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Van den Bulck S, Crèvecoeur J, Aertgeerts B, Delvaux N, Neyens T, Van Pottelbergh G, Coursier P, Vaes B. The impact of the Covid-19 pandemic on the incidence of diseases and the provision of primary care: A registry-based study. PLoS One 2022; 17:e0271049. [PMID: 35793324 PMCID: PMC9258821 DOI: 10.1371/journal.pone.0271049] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 06/22/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
The Covid-19 pandemic had a tremendous impact on healthcare but uncertainty remains about the extent to which primary care provision was affected. Therefore, this paper aims to assess the impact on primary care provision and the evolution of the incidence of disease during the first year of the Covid-19 pandemic in Flanders (Belgium).
Methods
Care provision was defined as the number of new entries added to a patient’s medical history. Pre-pandemic care provision (February 1, 2018–January 31, 2020) was compared with care provision during the pandemic (February 1, 2020-January 31, 2021). A large morbidity registry (Intego) was used. Regression models compared the effect of demographic characteristics on care provision and on acute and chronic diagnoses incidence both prior and during the pandemic.
Results
During the first year of the Covid-19 pandemic, overall care provision increased with 9.1% (95%CI 8.5%;9.6%). There was an increase in acute diagnoses of 5.1% (95%CI 4.2%;6.0%) and a decrease in the selected chronic diagnoses of 12.8% (95% CI 7.0%;18.4%). Obesity was an exception with an overall incidence increase. The pandemic led to strong fluctuations in care provision that were not the same for all types of care and all demographic groups in Flanders. Relative to other groups in the population, the pandemic caused a reduction in care provision for children aged 0–17 year and patients from a lower socio-economic situation.
Conclusion
This paper strengthened the claim that Covid-19 should be considered as a syndemic instead of a pandemic. During the first Covid-19 year, overall care provision and the incidence of acute diagnoses increased, whereas chronic diseases’ incidence decreased, except for obesity diagnoses which increased. More granular, care provision and chronic diseases’ incidence decreased during the lockdowns, especially for people with a lower socio-economic status. After the lockdowns they both returned to baseline.
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Affiliation(s)
- Steve Van den Bulck
- Department of Public Health and Primary Care, Academic Center for General Practice, KU Leuven, Leuven, Belgium
- * E-mail: (SVdB); (JC)
| | - Jonas Crèvecoeur
- I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium
- Department of Public Health and Primary Care, I-BioStat, Faculty of Medicine, KU Leuven, Leuven, Belgium
- * E-mail: (SVdB); (JC)
| | - Bert Aertgeerts
- Department of Public Health and Primary Care, Academic Center for General Practice, KU Leuven, Leuven, Belgium
| | - Nicolas Delvaux
- Department of Public Health and Primary Care, Academic Center for General Practice, KU Leuven, Leuven, Belgium
| | - Thomas Neyens
- I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium
- Department of Public Health and Primary Care, I-BioStat, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Gijs Van Pottelbergh
- Department of Public Health and Primary Care, Academic Center for General Practice, KU Leuven, Leuven, Belgium
| | - Patrick Coursier
- Department of Public Health and Primary Care, Academic Center for General Practice, KU Leuven, Leuven, Belgium
| | - Bert Vaes
- Department of Public Health and Primary Care, Academic Center for General Practice, KU Leuven, Leuven, Belgium
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Morreel S, Verhoeven V, Philips H, Meysman J, Homburg I, De Graeve D, Monsieurs KG. Differences in emergency nurse triage between a simulated setting and the real world, post hoc analysis of a cluster randomised trial. BMJ Open 2022; 12:e059173. [PMID: 35777880 PMCID: PMC9252194 DOI: 10.1136/bmjopen-2021-059173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES In the TRIAGE trial, a cluster randomised trial about diverting emergency department (ED) patients to a general practice cooperative (GPC) using a new extension to the Manchester Triage System, the difference in the proportion of patients assigned to the GPC was striking: 13.3% in the intervention group (patients were encouraged to comply to an ED or GPC assignment, real-world setting) and 24.7% in the control group (the assignment was not communicated, all remained at the ED, simulated setting). In this secondary analysis, we assess the differences in the use of the triage tool between intervention and control group and differences in costs and hospitalisations for patients assigned to the GPC. SETTING ED of a general hospital and the adjacent GPC. PARTICIPANTS 8038 patients (6294 intervention and 1744 control).Primary and secondary outcome measures proportion of patients with triage parameters (reason for encounter, discriminator and urgency category) leading to an assignment to the ED, proportion of patients for which the computer-generated GPC assignment was overruled, motivations for choosing certain parameters, costs (invoices) and hospitalisations. RESULTS An additional 3.1% (p<0.01) of the patients in the intervention group were classified as urgent. Discriminators leading to the ED were registered for an additional 16.2% (p<0.01), mainly because of a perceived need for imaging. Nurses equally chose flow charts leading to the ED (p=0.41) and equally overruled the protocol (p=0.91). In the intervention group, the mean cost for patients assigned to the GPC was €23 (p<0.01) lower and less patients with an assignment to the GPC were hospitalised (1.0% vs 1.6%, p<0.01). CONCLUSION Nurses used a triage tool more risk averse when it was used to divert patients to primary care as compared with a theoretical assignment to primary care. Outcomes from a simulated setting should not be extrapolated to real patients. TRIAL REGISTRATION NUMBER NCT03793972.
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Affiliation(s)
- Stefan Morreel
- Department of Family and Population Health, University of Antwerp Faculty of Medicine and Health Sciences, Antwerpen, Belgium
| | - Veronique Verhoeven
- Department of Family and Population Health, University of Antwerp Faculty of Medicine and Health Sciences, Antwerpen, Belgium
| | - Hilde Philips
- Department of Family and Population Health, University of Antwerp Faculty of Medicine and Health Sciences, Antwerpen, Belgium
| | - Jasmine Meysman
- Department of Economics, University of Antwerp, Antwerpen, Belgium
| | - Ines Homburg
- Department of Economics, University of Antwerp, Antwerpen, Belgium
| | - Diana De Graeve
- Department of Economics, University of Antwerp, Antwerpen, Belgium
| | - K G Monsieurs
- Emergency Department, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
- ASTARC, University of Antwerp, Antwerpen, Belgium
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Homburg I, Morreel S, Verhoeven V, Monsieurs KG, Meysman J, Philips H, De Graeve D. Non-compliance with a nurse's advice to visit the primary care provider: an exploratory secondary analysis of the TRIAGE-trial. BMC Health Serv Res 2022; 22:463. [PMID: 35395840 PMCID: PMC8994354 DOI: 10.1186/s12913-022-07904-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 03/28/2022] [Indexed: 12/02/2022] Open
Abstract
Background During the cluster randomised TRIAGE-trial, a nurse advised 13% of low-risk patients presenting at an emergency department in Belgium to visit the adjacent general practitioner cooperative. Patients had the right to refuse this advice. This exploratory study examines the characteristics of refusers by uncovering the determinants of non-compliance and its impact on costs, as charged on the patient’s invoice. Methods Bivariate analyses with logistic regressions and T-tests were used to test the differences in patient characteristics, patient status, timing characteristics, and costs between refusers and non-refusers. A chi-square automatic interaction detection analysis was used to find the predictors of non-compliance. Results 23.50% of the patients refused the advice to visit the general practitioner cooperative. This proportion was mainly influenced by the nurse on duty (non-compliance rates per nurse ranging from 2.9% to 52.8%) and the patients’ socio-economic status (receiving increased reimbursement versus not OR 1.37, 95%CI: 0.96 to 1.95). Additionally, non-compliance was associated (at the 0.10 significance level) with being male, not living nearby and certain reasons for encounter. Fewer patients refused when the nurse perceived crowding level as quiet relative to normal, and more patients refused during the evening. The mean cost was significantly higher for patients who refused, which was a result of more extensive examination and higher out-of-pocket expenses at the ED. Conclusions The nurse providing the advice to visit the general practitioner cooperative has a central role in the likelihood of patients’ refusal. Interventions to reduce non-compliance should aim at improving nurse-patient communication. Special attention may be required when managing patients with a lower socio-economic status. The overall mean cost was higher for refusers, illustrating the importance of compliance. Trial registration The trial was registered on registration number NCT03793972 on 04/01/2019.
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Affiliation(s)
- Ines Homburg
- Department of Economics, University of Antwerp, Antwerp, Belgium.
| | - Stefan Morreel
- Department of Family and Population Health, University of Antwerp, Antwerp, Belgium
| | - Veronique Verhoeven
- Department of Family and Population Health, University of Antwerp, Antwerp, Belgium
| | - Koenraad G Monsieurs
- Department ASTARC, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Jasmine Meysman
- Department of Economics, University of Antwerp, Antwerp, Belgium
| | - Hilde Philips
- Department of Family and Population Health, University of Antwerp, Antwerp, Belgium
| | - Diana De Graeve
- Department of Economics, University of Antwerp, Antwerp, Belgium
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Opioid prescribing in out-of-hours primary care in Flanders and the Netherlands: A retrospective cross-sectional study. PLoS One 2022; 17:e0265283. [PMID: 35390027 PMCID: PMC8989290 DOI: 10.1371/journal.pone.0265283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/27/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Increased opioid prescribing has raised concern, as the benefits of pain relief not always outweigh the risks. Acute and chronic pain is often treated in a primary care out-of-hours (OOH) setting. This setting may be a driver of opioid use but the extent to which opioids are prescribed OOH is unknown. We aimed to investigate weak and strong opioid prescribing at OOH primary care services (PCS) in Flanders (Northern, Dutch-speaking part of Belgium) and the Netherlands between 2015 and 2019.
Methods
We performed a retrospective cross sectional study using data from routine electronic health records of OOH-PCSs in Flanders and the Netherlands (2015–2019). Our primary outcome was the opioid prescribing rate per 1000 OOH-contacts per year, in total and for strong (morphine, hydromorphone, oxycodone, oxycodone and naloxone, fentanyl, tapentadol, and buprenorphine and weak opioids (codeine combinations and tramadol and combinations) and type of opioids separately.
Results
Opioids were prescriped in approximately 2.5% of OOH-contacts in both Flanders and the Netherlands. In Flanders, OOH opioid prescribing went from 2.4% in 2015 to 2.1% in 2017 and then increased to 2.3% in 2019. In the Netherlands, opioid prescribing increased from 1.9% of OOH-contacts in 2015 to 2.4% in 2017 and slightly decreased thereafter to 2.1% of OOH-contacts. In 2019, in Flanders, strong opioids were prescribed in 8% of the OOH-contacts with an opioid prescription. In the Netherlands a strong opioid was prescribed in 57% of these OOH-contacts. Two thirds of strong opioids prescriptions in Flanders OOH were issued for patients over 75, in the Netherlands one third was prescribed to this age group.
Conclusion
We observed large differences in strong opioid prescribing at OOH-PCSs between Flanders and the Netherlands that are likely to be caused by differences in accessibility of secondary care, and possibly existing opioid prescribing habits. Measures to ensure judicious and evidence-based opioid prescribing need to be tailored to the organisation of the healthcare system.
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Van Olmen J, Van Nooten J, Philips H, Sollie A, Daelemans W. Predicting COVID symptoms from free text in medical records using Artificial Intelligence: a feasibility study (Preprint). JMIR Med Inform 2022; 10:e37771. [PMID: 35442903 PMCID: PMC9049643 DOI: 10.2196/37771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/31/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Josefien Van Olmen
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Jens Van Nooten
- Computational Linguistics, Psycholinguistics and Sociolinguistics Research Centre, University of Antwerp, Antwerp, Belgium
| | - Hilde Philips
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Annet Sollie
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Walter Daelemans
- Computational Linguistics, Psycholinguistics and Sociolinguistics Research Centre, University of Antwerp, Antwerp, Belgium
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Colliers A, De Man J, Adriaenssens N, Verhoeven V, Anthierens S, De Loof H, Philips H, Coenen S, Morreel S. Antibiotic Prescribing Trends in Belgian Out-of-Hours Primary Care during the COVID-19 Pandemic: Observational Study Using Routinely Collected Health Data. Antibiotics (Basel) 2021; 10:antibiotics10121488. [PMID: 34943701 PMCID: PMC8698421 DOI: 10.3390/antibiotics10121488] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/20/2021] [Accepted: 12/01/2021] [Indexed: 12/27/2022] Open
Abstract
Antibiotic overprescribing is one of the main drivers of the global and growing problem of antibiotic resistance, especially in primary care and for respiratory tract infections (RTIs). RTIs are the most common reason for patients to consult out-of-hours (OOH) primary care. The COVID-19 pandemic has changed the way general practitioners (GPs) work, both during office hours and OOH. In Belgian OOH primary care, remote consultations with the possibility of issuing prescriptions and telephone triage were implemented. We aimed to describe the impact of COVID-19 on GPs’ antibiotic prescribing during OOH primary care. In an observational study, using routinely collected health data from GP cooperatives (GPCs) in Flanders, we analyzed GPs’ antibiotic prescriptions in 2019 (10 GPCs) and 2020 (20 GPCs) during OOH consultations (telephone and face-to-face). We used autoregressive integrated moving average (ARIMA) modeling to identify any changes after lockdowns were implemented. In total, 388,293 contacts and 268,430 prescriptions were analyzed in detail. The number of antibiotic prescriptions per weekend, per 100,000 population was 11.47 (95% CI: 9.08–13.87) or 42.9% lower after compared to before the implementation of lockdown among all contacts. For antibiotic prescribing per contact, we found a decrease of 12.2 percentage points (95% CI: 10.6–13.7) or 56.5% among all contacts and of 5.3 percentage points (95% CI: 3.7–6.9) or 23.2% for face-to-face contacts only. The decrease in the number of prescriptions was more pronounced for cases with respiratory symptoms that corresponded with symptoms of COVID-19 and for antibiotics that are frequently prescribed for RTIs, such as amoxicillin (a decrease of 64.9%) and amoxicillin/clavulanate (a decrease of 38.1%) but did not appear for others such as nitrofurantoin. The implementation of COVID-19 lockdown measures coincided with an unprecedented drop in the number of antibiotic prescriptions, which can be explained by a decrease in face-to-face patient contacts, as well as a lower number of antibiotics prescriptions per face-to-face patient contact. The decrease was seen for antibiotics used for RTIs but not for nitrofurantoin, the first-choice antibiotic for urinary tract infections.
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Affiliation(s)
- Annelies Colliers
- Department of Family Medicine & Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium; (J.D.M.); (N.A.); (V.V.); (S.A.); (H.P.); (S.C.); (S.M.)
- Correspondence: ; Tel.: +32-(0)3-265-18-32
| | - Jeroen De Man
- Department of Family Medicine & Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium; (J.D.M.); (N.A.); (V.V.); (S.A.); (H.P.); (S.C.); (S.M.)
| | - Niels Adriaenssens
- Department of Family Medicine & Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium; (J.D.M.); (N.A.); (V.V.); (S.A.); (H.P.); (S.C.); (S.M.)
| | - Veronique Verhoeven
- Department of Family Medicine & Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium; (J.D.M.); (N.A.); (V.V.); (S.A.); (H.P.); (S.C.); (S.M.)
| | - Sibyl Anthierens
- Department of Family Medicine & Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium; (J.D.M.); (N.A.); (V.V.); (S.A.); (H.P.); (S.C.); (S.M.)
| | - Hans De Loof
- Laboratory of Physiopharmacology, Department of Pharmaceutical Sciences, Faculty of Pharmaceutical, Biomedical and Veterinary Sciences, University of Antwerp, 2610 Antwerp, Belgium;
| | - Hilde Philips
- Department of Family Medicine & Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium; (J.D.M.); (N.A.); (V.V.); (S.A.); (H.P.); (S.C.); (S.M.)
| | - Samuel Coenen
- Department of Family Medicine & Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium; (J.D.M.); (N.A.); (V.V.); (S.A.); (H.P.); (S.C.); (S.M.)
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
| | - Stefan Morreel
- Department of Family Medicine & Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium; (J.D.M.); (N.A.); (V.V.); (S.A.); (H.P.); (S.C.); (S.M.)
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De Loof H, De Win E, Moens N, Verhoeven V, Van Royen P, Kreps EO, Philips H. Overprescribing of Topical Ocular Corticosteroids and Antibiotics in Out-of-Hours Primary Care in Belgium. Drug Healthc Patient Saf 2021; 13:229-232. [PMID: 34849033 PMCID: PMC8627259 DOI: 10.2147/dhps.s339141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/03/2021] [Indexed: 11/23/2022] Open
Abstract
Prescribing patterns by primary care physicians concerning ophthalmic problems were studied using the iCAREdata, a database containing information from the out-of-hours care setting in the Flanders region of Belgium. A very high percentage of prescribed ophthalmic medication was topical antibiotics (89.4%) with tobramycin as the most prevalent substance and in clear conflict with the prevailing guidelines. In addition, a very substantial fraction of prescribed medication contained corticosteroids (30.4%). This is a potentially unsafe option within the technical infrastructure of this setting, which limits the diagnostic possibilities concerning viral infections or preexisting glaucoma risk. We conclude that more efforts are required to limit unnecessary and inappropriate prescribing behavior to further promote patient safety.
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Affiliation(s)
- Hans De Loof
- Laboratory of Physiopharmacology, Department of Pharmaceutical Sciences, University of Antwerp, Antwerp, Belgium
| | - Ellen De Win
- Laboratory of Physiopharmacology, Department of Pharmaceutical Sciences, University of Antwerp, Antwerp, Belgium
| | - Nathalie Moens
- Laboratory of Physiopharmacology, Department of Pharmaceutical Sciences, University of Antwerp, Antwerp, Belgium
| | - Veronique Verhoeven
- Research Group, Primary and Interdisciplinary Care (ELIZA), Department Family Medicine and Population Health (FAMPOP) University of Antwerp, Antwerp, Belgium
| | - Paul Van Royen
- Research Group, Primary and Interdisciplinary Care (ELIZA), Department Family Medicine and Population Health (FAMPOP) University of Antwerp, Antwerp, Belgium
| | - Elke O Kreps
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium
| | - Hilde Philips
- Research Group, Primary and Interdisciplinary Care (ELIZA), Department Family Medicine and Population Health (FAMPOP) University of Antwerp, Antwerp, Belgium
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Morreel S, Philips H, De Graeve D, Monsieurs KG, Kampen JK, Meysman J, Lefevre E, Verhoeven V. Triaging and referring in adjacent general and emergency departments (the TRIAGE trial): A cluster randomised controlled trial. PLoS One 2021; 16:e0258561. [PMID: 34731198 PMCID: PMC8565772 DOI: 10.1371/journal.pone.0258561] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/13/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To determine whether a new triage system safely diverts a proportion of emergency department (ED) patients to a general practitioner cooperative (GPC). METHODS Unblinded randomised controlled trial with weekends serving as clusters (three intervention clusters for each control). The intervention was triage by a nurse using a new extension to the Manchester Triage System assigning low-risk patients to the GPC. During intervention weekends, patients were encouraged to follow this assignment; it was not communicated during control weekends (all patients remained at the ED). The primary outcome was the proportion of patients assigned to and handled by the GPC during intervention weekends. The trial was randomised for the secondary outcome: the proportion of patients assigned to the GPC. Additional outcomes were association of these outcomes with possible confounders (study tool parameters, nurse, and patient characteristics), proportion of patients referred back to the ED by the GPC, hospitalisations, and performance of the study tool to detect primary care patients (the opinion of the treating physician was the gold standard). RESULTS In the intervention group, 838/6294 patients (13.3%, 95% CI 12.5 to 14.2) were assigned to the GPC, in the control group this was 431/1744 (24.7%, 95% CI 22.7 to 26.8). In total, 599/6294 patients (9.5%, 95% CI 8.8 to 10.3) experienced the primary outcome which was influenced by the reason for encounter, age, and the nurse. 24/599 patients (4.0%, 95% CI 2.7 to 5.9) were referred back to the ED, three were hospitalised. Positive and negative predictive values of the studied tool during intervention weekends were 0.96 (95%CI 0.94 to 0.97) and 0.60 (95% CI 0.58 to 0.62). Out of the patients assigned to the GPC, 2.4% (95% CI 1.7 to 3.4) were hospitalised. CONCLUSIONS ED nurses using a new tool safely diverted 9.5% of the included patients to primary care. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03793972.
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Affiliation(s)
- Stefan Morreel
- Department of Family and Population Health, University of Antwerp, Antwerp, Belgium
- * E-mail:
| | - Hilde Philips
- Department of Family and Population Health, University of Antwerp, Antwerp, Belgium
| | - Diana De Graeve
- Department of Economics, University of Antwerp, Antwerp, Belgium
| | - Koenraad G. Monsieurs
- Department ASTARC, University of Antwerp, Antwerp, Belgium
- Emergency Department, Antwerp University Hospital, Antwerp, Belgium
| | - Jarl K. Kampen
- Department of Epidemiology and Medical Statistics, Antwerp University Hospital, Antwerp, Belgium
| | - Jasmine Meysman
- Department of Economics, University of Antwerp, Antwerp, Belgium
| | - Eva Lefevre
- Department of Economics, University of Antwerp, Antwerp, Belgium
| | - Veronique Verhoeven
- Department of Family and Population Health, University of Antwerp, Antwerp, Belgium
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Rens E, Michielsen J, Dom G, Remmen R, Van den Broeck K. iPSYcare: the development of a linked electronic medical records database to study and optimize psychiatric care in Antwerp. BMC Res Notes 2021; 14:377. [PMID: 34565465 PMCID: PMC8474849 DOI: 10.1186/s13104-021-05791-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022] Open
Abstract
Objective The study of care trajectories of psychiatric patients across hospitals was previously not possible in Belgium as each hospital stores its data autonomously, and government-related registrations do not contain a unique identifier or are incomplete. A new longitudinal database called iPSYcare (Improved Psychiatric Care and Research) was therefore constructed in 2021, and links the electronic medical records of patients in psychiatric units of eight hospitals in the Antwerp Province, Belgium. The database provides a wide range of information on patients, care trajectories and delivered care in the region. In a first phase, the database will only contain information about adult patients who were admitted to a hospital or treated by an outreach team and who gave explicit consent. In the future, the database may be expanded to other regions and additional data on outpatient care may be added. Results IPSYcare is a close collaboration between the University of Antwerp and hospitals in the province of Antwerp. This paper describes the development of the database, how privacy and ethical issues will be handled, and how the governance of the database will be organized.
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Affiliation(s)
- Eva Rens
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium. .,Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium.
| | | | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Roy Remmen
- Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
| | - Kris Van den Broeck
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium.,Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
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12
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Vermeulen H, Coenen S, Hens N, Bruyndonckx R. Impact of changing reimbursement criteria on the use of fluoroquinolones in Belgium. J Antimicrob Chemother 2021; 76:2725-2732. [PMID: 34374778 PMCID: PMC8446932 DOI: 10.1093/jac/dkab255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/22/2021] [Indexed: 11/14/2022] Open
Abstract
Objectives The criteria for the reimbursement of fluoroquinolones changed in Belgium on 1 May 2018. This study aims to quantify the difference in fluoroquinolone use after this change, and to assess the timing and persistence of this effect, both in terms of total reimbursed fluoroquinolone use and its relative proportion. Methods Longitudinal reimbursement data on fluoroquinolone use in the Belgian community from January 2017 to November 2018 were analysed to identify a change in reimbursed fluoroquinolone use expressed in DDD per 1000 inhabitants per day (DID), using a set of non-linear mixed models including change-points. In addition, longitudinal data on the relative proportion of prescribed fluoroquinolones from January 2017 to December 2018 were analysed to identify a change in the relative proportion of prescribed fluoroquinolones using generalized estimation equations including change-points. Results Fluoroquinolone use dropped significantly immediately after the change in reimbursement criteria, from 2.21 DID (95% CI: 2.03–2.38) to 0.52 DID (95% CI: 0.48–0.56) and from 9.14% (95% CI: 8.75%–9.56%) to 6.52% (95% CI: 6.04%–7.04%). The observed decrease in fluoroquinolone use persisted over time. Conclusions While fluoroquinolone use was still above the target of 5% after the change in reimbursement criteria, its implementation helped to lower fluoroquinolone use in Belgium.
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Affiliation(s)
- Helene Vermeulen
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT), Data Science Institute (DSI), Hasselt University, Hasselt, Belgium
| | - Samuel Coenen
- Laboratory of Medical Microbiology (LMM), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.,Department of Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
| | - Niel Hens
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT), Data Science Institute (DSI), Hasselt University, Hasselt, Belgium.,Department of Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium.,Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Robin Bruyndonckx
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT), Data Science Institute (DSI), Hasselt University, Hasselt, Belgium.,Laboratory of Medical Microbiology (LMM), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
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13
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Van den Broeck K, Morreel S, Glazemakers I, Verhoeven V, Rens E, Philips H. Increase in Anxiety-Related Out-of-Hours Primary Care Consultations Since COVID-19: An Observational Study Using Routine Data in Flanders. FRONTIERS IN HEALTH SERVICES 2021; 1:763739. [PMID: 36926475 PMCID: PMC10012658 DOI: 10.3389/frhs.2021.763739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022]
Abstract
Background: Survey studies suggest that COVID-19 has had a negative impact on the population's mental well-being. Routine registration data allow a more objective way for investigating such associations, complementary to self-report measures. This study investigates the level of out of hours (OOH) consultations for psychological problems since the start of the COVID-19 pandemic in Flanders, Belgium. Methods: The iCAREdata database is a clinical research database with routine data of OOH care, covering a large area in Flanders, Belgium. After defining the first wave and the second wave of COVID-19 in Flanders in time, we compared the number of consultations regarding psychological problems (in general, anxiety-related, depression-related, and sleep-related) between those periods, the period in between these waves, and the period before the start of COVID-19. Results: A significant rise in OOH consultations due to psychological-and more specifically, anxiety-related-problems is observed since the start of the COVID-19 pandemic in Flanders. Elevated levels are observed until the second wave. This finding is in sharp contrast with the general pattern of lower demand for primary healthcare during this period. The majority of these supplementary consultations happened by phone. Consultations regarding depression-related problems did not change over time. Sleep disturbances in the OOH setting were more common after the first wave. Conclusion: Despite some limitations, a large Flemish database with routine data on OOH care shows an increase in the number of consultations regarding psychological problems in general and anxiety-related problems since the start of the COVID-19-pandemic until the second wave.
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Affiliation(s)
- Kris Van den Broeck
- Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium.,Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Stefan Morreel
- Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
| | - Inge Glazemakers
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Veronique Verhoeven
- Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
| | - Eva Rens
- Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium.,Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Hilde Philips
- Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
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14
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Smits M, Colliers A, Jansen T, Remmen R, Bartholomeeusen S, Verheij R. Examining differences in out-of-hours primary care use in Belgium and the Netherlands: a cross-sectional study. Eur J Public Health 2020; 29:1018-1024. [PMID: 31086964 PMCID: PMC6896980 DOI: 10.1093/eurpub/ckz083] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background The organizational model of out-of-hours primary care is likely to affect healthcare use. We aimed to examine differences in the use of general practitioner cooperatives for out-of-hours care in the Netherlands and Belgium (Flanders) and explore if these are related to organizational differences. Methods A cross-sectional observational study using routine electronic health record data of the year 2016 from 77 general practitioner cooperatives in the Netherlands and 5 general practitioner cooperatives in Belgium (Flanders). Patient age, gender and health problem were analyzed using descriptive statistics. Results The number of consultations per 1000 residents was 2.3 times higher in the Netherlands than in Belgium. Excluding telephone consultations, which are not possible in Belgium, the number of consultations was 1.4 times higher. In Belgium, the top 10 of health problems was mainly related to infections, while in the Netherlands there were a larger variety of health problems. In addition, the health problem codes in the Dutch top 10 were more often symptoms, while the codes in the Belgian top 10 were more often diagnoses. In both countries, a relatively large percentage of GPC patients were young children and female patients. Conclusion Differences in the use of general practitioner cooperatives seem to be related to the gatekeeping role of general practitioners in the Netherlands and to organizational differences such as telephone triage, medical advice by telephone, financial thresholds and number of years of experience with the system. The information can benefit policy decisions about the organization of out-of-hours primary care.
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Affiliation(s)
- Marleen Smits
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands.,Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Annelies Colliers
- Department of Primary and Interdisciplinary Care (ELIZA), Centre for General Practice, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Tessa Jansen
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| | - Roy Remmen
- Department of Primary and Interdisciplinary Care (ELIZA), Centre for General Practice, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Stephaan Bartholomeeusen
- Department of Primary and Interdisciplinary Care (ELIZA), Centre for General Practice, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Robert Verheij
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
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15
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Morreel S, Philips H, Verhoeven V. Organisation and characteristics of out-of-hours primary care during a COVID-19 outbreak: A real-time observational study. PLoS One 2020; 15:e0237629. [PMID: 32790804 PMCID: PMC7425859 DOI: 10.1371/journal.pone.0237629] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/30/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, general practitioners worldwide re-organise care in very different ways because of the lack of evidence-based protocols. OBJECTIVE This paper describes the organisation and the characteristics of consultations in Belgian out-of-hours primary care during five weekends at the peak of a COVID-19 outbreak and compares it to a similar period in 2019. METHODS Real-time observational study using pseudonymised routine clinical data extracted out of reports from home visits, telephone- and physical consultations (iCAREdata). Nine general practice cooperatives (GPCs) participated covering a population of 1 513 523. RESULTS All GPCs rapidly re-organised care in order to handle the outbreak and provide a safe working environment. The average consultation rate was 222 per 100 000 citizens per weekend. These consultations were handled by telephone alone in 40% (N = 6293). A diagnosis at risk of COVID-19 was registered in 6692 (43%) consultations,. Out of 5311 physical consultations, 1460 were at risk of COVID-19 of which 443 (30%) did not receive prior telephone consultation to estimate this risk. Compared to 2019, the workload initially increased due to telephone consultations but afterwards declined drastically. The physical consultation rate declined by 45% with a marked decline in diagnoses unrelated to COVID-19. CONCLUSIONS General practitioners can rapidly re-organise out-of-hours care to handle patient flows during a COVID-19 outbreak. Forty percent of the out-of-hours primary care contacts are handled by telephone consultations alone. We recommend to give a telephone consultation to all patients and not to rely on call takers to differentiate between infectious and regular care. The demand for physical consultations declined drastically provoking questions about patient's safety for care unrelated to COVID-19.
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Affiliation(s)
- Stefan Morreel
- Department of ELIZA (Primary and Interdisciplinary Care), University of Antwerp, Antwerpen, Belgium
| | - Hilde Philips
- Department of ELIZA (Primary and Interdisciplinary Care), University of Antwerp, Antwerpen, Belgium
| | - Veronique Verhoeven
- Department of ELIZA (Primary and Interdisciplinary Care), University of Antwerp, Antwerpen, Belgium
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16
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Philips H, Verhoeven V, Morreel S, Colliers A, Remmen R, Coenen S, Van Royen P. Information campaigns and trained triagists may support patients in making an appropriate choice between GP and emergency department. Eur J Gen Pract 2019; 25:243-244. [PMID: 31663392 PMCID: PMC6853219 DOI: 10.1080/13814788.2019.1675630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/30/2019] [Accepted: 09/04/2019] [Indexed: 11/23/2022] Open
Affiliation(s)
- Hilde Philips
- Department of Primary and Interdisciplinary Care (ELIZA), Gouverneur Kinsbergen Centrum, University of Antwerp, Wilrijk, Belgium
| | - Veronique Verhoeven
- Department of Primary and Interdisciplinary Care (ELIZA), Gouverneur Kinsbergen Centrum, University of Antwerp, Wilrijk, Belgium
| | - Stefan Morreel
- Department of Primary and Interdisciplinary Care (ELIZA), Gouverneur Kinsbergen Centrum, University of Antwerp, Wilrijk, Belgium
| | - Annelies Colliers
- Department of Primary and Interdisciplinary Care (ELIZA), Gouverneur Kinsbergen Centrum, University of Antwerp, Wilrijk, Belgium
| | - Roy Remmen
- Department of Primary and Interdisciplinary Care (ELIZA), Gouverneur Kinsbergen Centrum, University of Antwerp, Wilrijk, Belgium
| | - Samuel Coenen
- Department of Primary and Interdisciplinary Care (ELIZA), Gouverneur Kinsbergen Centrum, University of Antwerp, Wilrijk, Belgium
| | - Paul Van Royen
- Department of Primary and Interdisciplinary Care (ELIZA), Gouverneur Kinsbergen Centrum, University of Antwerp, Wilrijk, Belgium
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17
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Colliers A, Adriaenssens N, Anthierens S, Bartholomeeusen S, Philips H, Remmen R, Coenen S. Antibiotic Prescribing Quality in Out-of-Hours Primary Care and Critical Appraisal of Disease-Specific Quality Indicators. Antibiotics (Basel) 2019; 8:antibiotics8020079. [PMID: 31212871 PMCID: PMC6628021 DOI: 10.3390/antibiotics8020079] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/05/2019] [Accepted: 06/07/2019] [Indexed: 12/25/2022] Open
Abstract
Outpatient antibiotic use in Belgium is among the highest in Europe. The most common reason for an encounter in out-of-hours (OOH) primary care is an infection. In this study, we assessed all consultations from July 2016 to June 2018 at five OOH services. We described antibiotic prescribing by diagnosis, calculated disease-specific antibiotic prescribing quality indicators’ (APQI) values and critically appraised these APQI. We determined that 111,600 encounters resulted in 26,436 (23.7%) antibiotic prescriptions. The APQI diagnoses (i.e., bronchitis, upper respiratory infection, cystitis, tonsillitis, sinusitis, otitis media, and pneumonia) covered 14,927 (56.7%) antibiotic prescriptions. Erysipelas (1344 (5.1%)) and teeth/gum disease (982 (3.7%)) covered more prescriptions than sinusitis or pneumonia. Over 75% of patients with tonsillitis and over 50% with bronchitis, sinusitis, and otitis media were prescribed an antibiotic. Only for otitis media the choice of antibiotic was near the acceptable range. Over 10% of patients with bronchitis or pneumonia and over 25% of female patients with an acute cystitis received quinolones. The APQI cover the diagnoses for only 57% of all antibiotic prescriptions. As 5.1% and 3.7% of antibiotic prescriptions are made for erysipelas and teeth/gum disease, respectively, we propose to add these indications when assessing antibiotic prescribing quality in OOH primary care.
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Affiliation(s)
- Annelies Colliers
- Department of Primary and Interdisciplinary Care (ELIZA)-Centre for General Practice, University of Antwerp, Faculty of Medicine and Health Sciences, Doornstraat 331, B-2610 Antwerp, Belgium.
| | - Niels Adriaenssens
- Department of Primary and Interdisciplinary Care (ELIZA)-Centre for General Practice, University of Antwerp, Faculty of Medicine and Health Sciences, Doornstraat 331, B-2610 Antwerp, Belgium.
| | - Sibyl Anthierens
- Department of Primary and Interdisciplinary Care (ELIZA)-Centre for General Practice, University of Antwerp, Faculty of Medicine and Health Sciences, Doornstraat 331, B-2610 Antwerp, Belgium.
| | - Stephaan Bartholomeeusen
- Department of Primary and Interdisciplinary Care (ELIZA)-Centre for General Practice, University of Antwerp, Faculty of Medicine and Health Sciences, Doornstraat 331, B-2610 Antwerp, Belgium.
| | - Hilde Philips
- Department of Primary and Interdisciplinary Care (ELIZA)-Centre for General Practice, University of Antwerp, Faculty of Medicine and Health Sciences, Doornstraat 331, B-2610 Antwerp, Belgium.
| | - Roy Remmen
- Department of Primary and Interdisciplinary Care (ELIZA)-Centre for General Practice, University of Antwerp, Faculty of Medicine and Health Sciences, Doornstraat 331, B-2610 Antwerp, Belgium.
| | - Samuel Coenen
- Department of Primary and Interdisciplinary Care (ELIZA)-Centre for General Practice, University of Antwerp, Faculty of Medicine and Health Sciences, Doornstraat 331, B-2610 Antwerp, Belgium.
- Department of Epidemiology and Social Medicine (ESOC), University of Antwerp, Faculty of Medicine and Health Sciences, Universiteitsplein 1, B-2610 Antwerp, Belgium.
- Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Faculty of Medicine and Health Sciences, Universiteitsplein 1, B-2610 Antwerp, Belgium.
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18
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Krug B, Colliers A, Matthys J, Anthierens S, Philips H, Damen J, Coenen S, Remmen R. Video-recording consultations for educational purposes in out-of-hours primary care: patients and physicians are willing to participate. Acta Clin Belg 2019; 74:65-69. [PMID: 29609529 DOI: 10.1080/17843286.2018.1459231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background Video-recordings of consultations are used by general practitioner (GP) trainees to enable reflection on aspects of knowledge, skills and attitudes. Typically, these recordings are made during office hours in general practice, but little is known about using video-recording during out of hours (OOH) care, which is an important and distinct part of a GP's work. To be able to record consultations during OOH care (i.e. at the emergency department (ED) and at the General Practitioner Cooperative (GPC)), patients must be willing to cooperate and give informed consent. Therefore, it was of interest to investigate potential barriers in these OOH settings. Methods A questionnaire on demographics and attitudes regarding consent was administered to patients and physicians at the ED and at the GPC in Sint-Niklaas, Belgium. Results A total of 346 questionnaires were completed, 23 by physicians and 323 by patients. A majority of the patients (225/286 (79%)) would consent to video-recording the consultation, without physical examination. Almost all physicians (21/23) would agree to participate. Overall, 85% (260/323) of the patients agree when only the doctor was being recorded. Patients were neutral in recording in 79% (88/224) at the GPC and 57% (56/99) at the ED. Shyness or embarrassment was present in 32% (71/224), and 28% (28/99) at the GPC and ED, respectively. We did not find any significant differences in giving consent or feelings between patients at the GPC and ED. Conclusion A vast majority of both patients and physicians would consent to video-recording their consultation in OOH primary care settings (GPC and ED), with possible concerns about privacy, shame and discomfort.
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Affiliation(s)
- Bertwin Krug
- Faculty of Medicine and Health Sciences, Department of Primary and Interdisciplinary Care (ELIZA) – Centre for General Practice (CHA), University of Antwerp – Campus Drie Eiken, Antwerp, Belgium
| | - Annelies Colliers
- Faculty of Medicine and Health Sciences, Department of Primary and Interdisciplinary Care (ELIZA) – Centre for General Practice (CHA), University of Antwerp – Campus Drie Eiken, Antwerp, Belgium
| | - Jan Matthys
- Department of Family Medicine and Primary Healthcare, University of Ghent – UZ Gent, Ghent, Belgium
| | - Sibyl Anthierens
- Faculty of Medicine and Health Sciences, Department of Primary and Interdisciplinary Care (ELIZA) – Centre for General Practice (CHA), University of Antwerp – Campus Drie Eiken, Antwerp, Belgium
| | - Hilde Philips
- Faculty of Medicine and Health Sciences, Department of Primary and Interdisciplinary Care (ELIZA) – Centre for General Practice (CHA), University of Antwerp – Campus Drie Eiken, Antwerp, Belgium
| | - Jorn Damen
- Emergency Department, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Samuel Coenen
- Faculty of Medicine and Health Sciences, Department of Primary and Interdisciplinary Care (ELIZA) – Centre for General Practice (CHA), University of Antwerp – Campus Drie Eiken, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, Department of Epidemiology and Social Medicine (ESOC), University of Antwerp – Campus Drie Eiken, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp – Campus Drie Eiken, Antwerp, Belgium
| | - Roy Remmen
- Faculty of Medicine and Health Sciences, Department of Primary and Interdisciplinary Care (ELIZA) – Centre for General Practice (CHA), University of Antwerp – Campus Drie Eiken, Antwerp, Belgium
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Coenen S, Bartholomeeusen S, Remmen R, Van Royen P, Morreel S, Philips H. Comment on: The 'morning dip' in antimicrobial appropriateness: circumstances determining appropriateness of antimicrobial prescribing. J Antimicrob Chemother 2019; 74:277-278. [PMID: 30169647 DOI: 10.1093/jac/dky355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Samuel Coenen
- Centre for General Practice, Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium.,Department of Epidemiology and Social Medicine (ESOC), University of Antwerp, Antwerp, Belgium.,Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Stephaan Bartholomeeusen
- Centre for General Practice, Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium
| | - Roy Remmen
- Centre for General Practice, Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium
| | - Paul Van Royen
- Centre for General Practice, Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium
| | - Stefan Morreel
- Centre for General Practice, Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium
| | - Hilde Philips
- Centre for General Practice, Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium
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20
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Characterising patient complaints in out-of-hours general practice: a retrospective cohort study in Ireland. Br J Gen Pract 2018; 68:e860-e868. [PMID: 30455221 DOI: 10.3399/bjgp18x699965] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/14/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Patient complaints can provide valuable insights into the quality and safety of clinical care. Studies examining the epidemiology of complaints in out-of-hours general practice internationally are limited. AIM To characterise patient complaints in an out-of-hours general practice setting. DESIGN AND SETTING Retrospective cohort study of patient complaints to an out-of-hours service provider in Dublin, Ireland, over a 5-year period (2011-2016). This comprises nurse-led telephone triage and GP consultations for patients with urgent problems. METHOD A modified version of the UK Healthcare Complaints Analysis Tool (HCAT) was utilised to code complaints, which were reviewed independently in duplicate by two academic GPs. RESULTS Of 445 598 telephone contacts, 303 085 resulted in face-to-face GP consultations. Of 234 patients who made 298 complaints, 185 (79%) related to GP care. The remainder related to nurse triage, other staff, and management issues. A total of 109 (46%) related to children aged ≤18 years, and 134 (58%) of complainants were female. There were 0.61 complaints per 1000 GP consultations. Most complaints (n = 126, 42%) were in relation to clinical care problems, largely diagnosis and prescribing. Common themes included unmet management expectations and clinical examination dissatisfaction. Inter-rater reliability was 90% (κ statistic 0.84, 95% confidence interval = 0.80 to 0.88). Following internal investigation, 158 (85%) of GP-related complaints were managed effectively by the out-of-hours service. CONCLUSION The majority of complaints related to clinical care problems and were successfully managed locally. Expectation management may be an important way to mitigate the risk of complaints.
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21
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Colliers A, Coenen S, Remmen R, Philips H, Anthierens S. How do general practitioners and pharmacists experience antibiotic use in out-of-hours primary care? An exploratory qualitative interview study to inform a participatory action research project. BMJ Open 2018; 8:e023154. [PMID: 30269072 PMCID: PMC6169767 DOI: 10.1136/bmjopen-2018-023154] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
RATIONALE Antibiotics (ABs) are one of the most prescribed medications in out-of-hours (OOH) care in Belgium. Developing a better understanding of why ABs are prescribed in this setting is essential to improve prescribing habits. OBJECTIVES To assess AB prescribing and dispensing challenges for general practitioners (GPs) and pharmacists in OOH primary care, and to identify context-specific elements that can help the implementation of behaviour change interventions to improve AB prescribing in this setting. DESIGN This is an exploratory qualitative study using semistructured interviews. This study is part of a participatory action research project. SETTING AND PARTICIPANTS Participants include 17 GPs and 1 manager, who work in a Belgian OOH general practitioners cooperative (GPC), and 5 pharmacists of the area covered by the GPC. The GPC serves a population of more than 187 000 people. RESULTS GPs feel the threshold to prescribe AB in OOH care is lower in comparion to office hours. GPs and pharmacists talk about the difference in their professional identity in OOH (they define their task differently, they feel more isolated, insecure, have the need to please and so on), type of patients (unknown patients, vulnerable patients, other ethnicities, demanding patients and so on), workload (they feel time-pressured) and lack of diagnostic tools or follow-up. They are aware of the problem of AB overprescribing, but they do not feel ownership of the problem. CONCLUSION The implementation of behaviour change interventions to improve AB prescribing in OOH primary care has to take these context specifics into account and could involve interprofessional collaboration between GPs and pharmacists. TRIAL REGISTRATION NUMBER NCT03082521; Pre-results.
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Affiliation(s)
- Annelies Colliers
- Department of General Practice - Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Samuel Coenen
- Department of General Practice - Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Vaccine and Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Department of Epidemiology and Social Medicine (ESOC), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Roy Remmen
- Department of General Practice - Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Hilde Philips
- Department of General Practice - Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Sibyl Anthierens
- Department of General Practice - Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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22
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Colliers A, Coenen S, Philips H, Remmen R, Anthierens S. Optimising the quality of antibiotic prescribing in out-of-hours primary care in Belgium: a study protocol for an action research project. BMJ Open 2017; 7:e017522. [PMID: 29038184 PMCID: PMC5652575 DOI: 10.1136/bmjopen-2017-017522] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Antimicrobial 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) antibiotic prescribing is low. To improve antibiotic use, we need a better understanding of this quality problem and corresponding interventions. A general practitioners cooperative (GPC) for out-of-hours (OOH) care presents a unique opportunity to reach a large group of GPs and work on quality improvement. Participatory action research (PAR) is a bottom-up approach that focuses on implementing change into daily practice and has the potential to empower practitioners to produce their own solutions to optimise their antibiotic prescribing. METHODS This PAR study to improve antibiotic prescribing quality in OOH care uses a mixed methods approach. In a first exploratory phase, we will develop a partnership with a GPC and map the existing barriers and opportunities. In a second phase, we will focus on facilitating change and implementing interventions through PDSA (Plan-Do-Study-Act) cycles. In a third phase, antibiotic prescribing quality outside and antibiotic use during office hours will be evaluated. Equally important are the process evaluation and theory building on improving antibiotic prescribing. ETHICS The study protocol was approved by the Ethics Committee of the Antwerp University Hospital/University of Antwerp. PAR unfolds in response to the needs and issues of the stakeholders, therefore new ethics approval will be obtained at each new stage of the research. DISSEMINATION Interventions to improve antibiotic prescribing are needed now more than ever and outcomes will be highly relevant for GPCs, GPs in daily practice, national policymakers and the international scientific community. TRIAL REGISTRATION NUMBER NCT03082521; Pre-results.
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Affiliation(s)
- Annelies Colliers
- Department of Primary and Interdisciplinary Care (ELIZA) – Centre for General Practice, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, B-2610 Antwerp, Belgium
| | - Samuel Coenen
- Department of Primary and Interdisciplinary Care (ELIZA) – Centre for General Practice, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, B-2610 Antwerp, Belgium
- Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, B-2610 Antwerp, Belgium
- Department of Epidemiology and Social Medicine (ESOC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, B-2610 Antwerp, Belgium
| | - Hilde Philips
- Department of Primary and Interdisciplinary Care (ELIZA) – Centre for General Practice, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, B-2610 Antwerp, Belgium
| | - Roy Remmen
- Department of Primary and Interdisciplinary Care (ELIZA) – Centre for General Practice, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, B-2610 Antwerp, Belgium
| | - Sibyl Anthierens
- Department of Primary and Interdisciplinary Care (ELIZA) – Centre for General Practice, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, B-2610 Antwerp, Belgium
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23
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Karam M, Tricas-Sauras S, Darras E, Macq J. Interprofessional Collaboration between General Physicians and Emergency Department Teams in Belgium: A Qualitative Study. Int J Integr Care 2017; 17:9. [PMID: 29588632 PMCID: PMC5853879 DOI: 10.5334/ijic.2520] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 08/23/2017] [Indexed: 11/28/2022] Open
Abstract
This study aimed to assess interprofessional collaboration between general physicians and emergency departments in the French speaking regions of Belgium. Eight group interviews were conducted both in rural and urban areas, including in Brussels. Findings showed that the relational components of collaboration, which are highly valued by individuals involved, comprise mutual acquaintanceship and trust, shared power and objectives. The organizational components of collaboration included out-of-hours services, role clarification, leadership and overall environment. Communication and patient's role were also found to be key elements in enhancing or hindering collaboration across these two levels of care. Relationships between general physicians and emergency departments' teams were tightly linked to organizational factors and the general macro-environment. Health system regulation did not appear to play a significant role in promoting collaboration between actors. A better role clarification is needed in order to foster multidisciplinary team coordination for a more efficient patient management. Finally, economic power and private practice impeded interprofessional collaboration between the care teams. In conclusion, many challenges need to be addressed for achievement of a better collaboration and more efficient integration. Not only should integration policies aim at reinforcing the role of general physicians as gatekeepers, also they should target patients' awareness and empowerment.
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Michiels B, Nguyen VK, Coenen S, Ryckebosch P, Bossuyt N, Hens N. Influenza epidemic surveillance and prediction based on electronic health record data from an out-of-hours general practitioner cooperative: model development and validation on 2003-2015 data. BMC Infect Dis 2017; 17:84. [PMID: 28100186 PMCID: PMC5241973 DOI: 10.1186/s12879-016-2175-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 12/27/2016] [Indexed: 11/10/2022] Open
Abstract
Background Annual influenza epidemics significantly burden health care. Anticipating them allows for timely preparation. The Scientific Institute of Public Health in Belgium (WIV-ISP) monitors the incidence of influenza and influenza-like illnesses (ILIs) and reports on a weekly basis. General practitioners working in out-of-hour cooperatives (OOH GPCs) register diagnoses of ILIs in an instantly accessible electronic health record (EHR) system. This article has two objectives: to explore the possibility of modelling seasonal influenza epidemics using EHR ILI data from the OOH GPC Deurne-Borgerhout, Belgium, and to attempt to develop a model accurately predicting new epidemics to complement the national influenza surveillance by WIV-ISP. Method Validity of the OOH GPC data was assessed by comparing OOH GPC ILI data with WIV-ISP ILI data for the period 2003–2012 and using Pearson’s correlation. The best fitting prediction model based on OOH GPC data was developed on 2003–2012 data and validated on 2012–2015 data. A comparison of this model with other well-established surveillance methods was performed. A 1-week and one-season ahead prediction was formulated. Results In the OOH GPC, 72,792 contacts were recorded from 2003 to 2012 and 31,844 from 2012 to 2015. The mean ILI diagnosis/week was 4.77 (IQR 3.00) and 3.44 (IQR 3.00) for the two periods respectively. Correlation between OOHs and WIV-ISP ILI incidence is high ranging from 0.83 up to 0.97. Adding a secular trend (5 year cycle) and using a first-order autoregressive modelling for the epidemic component together with the use of Poisson likelihood produced the best prediction results. The selected model had the best 1-week ahead prediction performance compared to existing surveillance methods. The prediction of the starting week was less accurate (±3 weeks) than the predicted duration of the next season. Conclusion OOH GPC data can be used to predict influenza epidemics both accurately and fast 1-week and one-season ahead. It can also be used to complement the national influenza surveillance to anticipate optimal preparation.
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Affiliation(s)
- Barbara Michiels
- Department of Primary and Interdisciplinary Care Antwerp (ELIZA) - Centre for General Practice, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Van Kinh Nguyen
- Department of Epidemiology, Faculty of Public Health, Ho Chi Minh University of Medicine and Pharmacy, Ho Chi Minh, Vietnam.,Systems Medicine of Infectious Diseases (SMID), Department of Systems Immunology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Samuel Coenen
- Department of Primary and Interdisciplinary Care Antwerp (ELIZA) - Centre for General Practice, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Vaccine & Infectious Disease Institute (VAXINFECTIO) - Laboratory of Medical Microbiology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Epidemiology and Social Medicine (ESOC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Philippe Ryckebosch
- Department of Primary and Interdisciplinary Care Antwerp (ELIZA) - Centre for General Practice, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Nathalie Bossuyt
- Unit Epidemiology of infectious diseases - Operational Directorate Public Health and Surveillance, Belgian Scientific Institute for Public Health, Brussels, Belgium
| | - Niel Hens
- Epidemiology and Social Medicine (ESOC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Interuniversity Institute of Biostatistics and statistical Bioinformatics (iBIOSTAT), Hasselt University, Hasselt, Belgium.,Vaccine & Infectious Disease Institute (VAXINFECTIO) - Centre for Health Economic Research and Modelling Infectious Diseases, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Buja A, Toffanin R, Rigon S, Sandonà P, Carrara T, Damiani G, Baldo V. Determinants of out-of-hours service users' potentially inappropriate referral or non-referral to an emergency department: a retrospective cohort study in a local health authority, Veneto Region, Italy. BMJ Open 2016; 6:e011526. [PMID: 27503862 PMCID: PMC4985918 DOI: 10.1136/bmjopen-2016-011526] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND A growing presence of inappropriate patients has been recognised as one of the main factors influencing emergency department (ED) overcrowding, which is a very widespread problem all over the world. On the other hand, out-of-hours (OOH) physicians must avoid delaying the diagnostic and therapeutic course of patients with urgent medical conditions. The aim of this study was to analyse the appropriateness of patient management by OOH services, in terms of their potentially inappropriate referral or non-referral of non-emergency cases to the ED. METHODS This was an observational retrospective cohort study based on data collected in 2011 by the local health authority No. 4 in the Veneto Region (Italy). After distinguishing between patients contacting the OOH service who were or were not referred to the ED, and checking for patients actually presenting to the ED within 24 hours thereafter, these patients' medical management was judged as potentially appropriate or inappropriate. RESULTS The analysis considered 22 662 OOH service contacts recorded in 2011. The cases of potentially inappropriate non-referral to the ED were 392 (1.7% of all contacts), as opposed to 1207 potentially inappropriate referrals (5.3% of all contacts). Age, nationality, type of disease and type of intervention by the OOH service were the main variables associated with the appropriateness of patient management. CONCLUSIONS These findings may be useful for pinpointing the factors associated with a potentially inappropriate patient management by OOH services and thus contribute to improving the deployment of healthcare and the quality of care delivered by OOH services.
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Affiliation(s)
- Alessandra Buja
- Department of Molecular Medicine, Public Health Section, Laboratory of Public Health and Population Studies, University of Padua, Padua, Italy
| | | | - S Rigon
- Epidemiological Unit, ULSS 4, Region Veneto, Thiene, Italy
| | - P Sandonà
- Out of Hour Service, ULSS 4, Region Veneto, Thiene, Italy
| | - T Carrara
- Faculty of Medicine, University of Padua, Padua, Italy
| | - G Damiani
- Department of Public Health, Catholic University of the Sacred Heart, Rome, Italy
| | - V Baldo
- Department of Molecular Medicine, Public Health Section, Laboratory of Public Health and Population Studies, University of Padua, Padua, Italy
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