- Paul Van Royen, MD, PhD, is Professor Family Medicine within the Department of Primary and Interdisciplinary Care and... morePaul Van Royen, MD, PhD, is Professor Family Medicine within the Department of Primary and Interdisciplinary Care and Dean of the Faculty of Medicine and Health Sciences. He has more than 30 years academic expertise in clinical general practice and research. His academic work is directed at teaching and research in primary care. He is co-ordinator of several teaching modules and programs, at undergraduate levels as well as graduate and postgraduate levels. He was/is involved in several research projects, including several EU-funded projects, within primary care, on respiratory infections and antibiotic prescribing, medical decision making, medical education, health care organization and data handling. He is author of more than 150 articles in peer-reviewed journals and reviewer of different scientific journals. At his department, he has developed a research centre with a strong expertise in qualitative research and systematic reviews. He is also co-ordinator of the Clinical Guidelines project for primary care in Belgium.edit
Over recent decades, the number of available clinical practice guidelines has enormously grown. Guidelines should meet specific quality criteria to ensure good quality. There is a growing need for the developement of a set of criteria to... more
Over recent decades, the number of available clinical practice guidelines has enormously grown. Guidelines should meet specific quality criteria to ensure good quality. There is a growing need for the developement of a set of criteria to ensure that potential biases inherent in guideline development have been properly addressed and that the recommendations for practice are valid and reliable. The AGREE-collaboration is an international network that developed an instrument to critically appraise the methodological quality of guidelines. AGREE promotes a clear strategy to produce, disseminate and evaluate guidelines of high quality. In the first phase of the international project the AGREE-instrument was tested in 11 different countries. Based on this experience the instrument was refined and optimised. In the second phase it was disseminated, promoted and evaluated in 18 participating countries. Belgium was one of them. The Belgian partner in the AGREE-project developed 3 workshops a...
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Health promotion is part of GPs' commitments. Some waiting rooms have therefore been implemented with audiovisual aids (posters, pamphlets or screens) for health promotion purposes. Few studies have assessed the effect of audiovisual... more
Health promotion is part of GPs' commitments. Some waiting rooms have therefore been implemented with audiovisual aids (posters, pamphlets or screens) for health promotion purposes. Few studies have assessed the effect of audiovisual aids in primary care. To identify, describe and appraise studies that have investigated the effects of audiovisual aids on health promotion in primary healthcare waiting rooms. To determine which factors influence this impact through literature review. Systematic review. Two independent researchers using predefined keywords searched databases. Additional publications were extracted from the reference lists of the selected articles. The selection of the articles was performed on the title and abstract, followed by complete reading and assessment. Bias and level of evidence were analysed. A total of 909 articles were collected. Most of them were not in primary care settings. Fourteen peer-reviewed articles fully meeting inclusion criteria were include...
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The role of gut feelings in diagnostic reasoning is recognized by most GPs throughout Europe, and probably throughout the world. Studies on this topic have emerged from different countries but there is the risk that authors will use... more
The role of gut feelings in diagnostic reasoning is recognized by most GPs throughout Europe, and probably throughout the world. Studies on this topic have emerged from different countries but there is the risk that authors will use different terms for similar concepts. The European Expert Group on Cognitive and Interactive Processes in Diagnosis and Management in General Practice, COGITA for short, was founded in 2008 to conduct cross-border research in the area of non-analytical diagnostic reasoning. Academic GPs, PhD students, psychologists, linguists and students meet once a year to share their experiences, exchange results and initiate new studies on the topic. A milestone in their research is this publication of a short glossary of diagnostic reasoning terms relating to the gut feelings research topic. It was constructed by the COGITA group members following a literature review, which aimed to define salient terms used in their publications. They described the terms, cross-rev...
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Research Interests: Addiction, Focus Groups, Qualitative Research, Global Positioning System, Medicine, and 14 moreBelgium, Humans, Female, Male, Focus Group, Buprenorphine, Middle Aged, Adult, Public health systems and services research, General Practitioners, Cooperative Behavior, HUMAN MEDICINE, Interviews as topic, and Opiate substitution treatment
The Learning Health System (LHS) describes linking routine healthcare systems directly with both research translation and knowledge translation as an extension of the evidence-based medicine paradigm, taking advantage of the ubiquitous... more
The Learning Health System (LHS) describes linking routine healthcare systems directly with both research translation and knowledge translation as an extension of the evidence-based medicine paradigm, taking advantage of the ubiquitous use of electronic health record (EHR) systems. TRANSFoRm is an EU FP7 project that seeks to develop an infrastructure for the LHS in European primary care.Methods. The project is based on three clinical use cases, a genotype-phenotype study in diabetes, a randomised controlled trial with gastroesophageal reflux disease, and a diagnostic decision support system for chest pain, abdominal pain, and shortness of breath.Results. Four models were developed (clinical research, clinical data, provenance, and diagnosis) that form the basis of the projects approach to interoperability. These models are maintained as ontologies with binding of terms to define precise data elements. CDISC ODM and SDM standards are extended using an archetype approach to enable a ...
Research Interests: Computer Science, Ontology, Patient Safety, Biology, Electronic Health Records, and 13 moreTranslational Research, Medicine, Interoperability, Semantic Interoperability, Humans, Europe, Biomed, Theoretical Models, Archetype, Clinical Decision Support Systems, HUMAN MEDICINE, Translational Medical Research, and Modern Sciences and Engineering Technology
To support the opinion that doctors should not advise adolescents to abstain from sex a qualitative research study was conducted with focus groups of 17-year-old girls in Antwerp to determine their needs and expectations as well as their... more
To support the opinion that doctors should not advise adolescents to abstain from sex a qualitative research study was conducted with focus groups of 17-year-old girls in Antwerp to determine their needs and expectations as well as their attitudes toward health care providers. Results indicate that although health care providers play an important part in giving certain information to adolescents they should not directly advise them to abstain from sex. They can only encourage the girls to talk to their parents. Findings note that almost 50% of the girls preferred to talk to their mothers about contraceptives and sexual health citing them as the main source of information. Related studies recognized female friends sisters and doctors as other important sources of information. In this perspective an open approach and better communication of health care providers and parents is recommended.
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Dyspnoea and chest pain are signs shared with multiple pathologies ranging from the benign to life-threatening diseases. Gut feelings such as the sense of alarm and the sense of reassurance are known to play a substantial role in the... more
Dyspnoea and chest pain are signs shared with multiple pathologies ranging from the benign to life-threatening diseases. Gut feelings such as the sense of alarm and the sense of reassurance are known to play a substantial role in the diagnostic reasoning of general practitioners (GPs). A Gut Feelings Questionnaire (GFQ) has been validated to measure the GP's sense of alarm. A French version of the GFQ is available following a linguistic validation procedure. The aim of the study is to calculate the diagnostic test accuracy of a GP's sense of alarm when confronted with dyspnoea and chest pain. Prospective observational study. Patients aged between 18 and 80 years, consulting their GP for dyspnoea and/or thoracic pain will be considered for enrolment in the study. These GPs will have to complete the questionnaire immediately after the consultation for dyspnoea and/or thoracic pain. The follow-up and the final diagnosis will be collected 4 weeks later by phone contact with the ...
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The theme 'patient-centred interprofessional collaboration' of the EGPRN conference in October 2012, captures in just three words important challenges for European primary care and its research agenda. Challenges for future... more
The theme 'patient-centred interprofessional collaboration' of the EGPRN conference in October 2012, captures in just three words important challenges for European primary care and its research agenda. Challenges for future research are formulated, in three domains: clinical, educational and health services research. Transferability of research, based upon advanced computational infrastructure, will facilitate a rapid learning health care system. In educational research, this includes the use of observational and reflexivity methods. Outcomes should be defined in terms of improvement of functional status and social participation rather than in terms of disease-specific outcomes. Partnership with all stakeholders, patients, GPs and their health care colleagues and students, can help in reducing avoidable waste in the production and reporting of research evidence.
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The objective of this descriptive study is to investigate the incidence of type 2 diabetes in sentinel general practices in three regions in Belgium and to describe the patient characteristics and the start of the medical management after... more
The objective of this descriptive study is to investigate the incidence of type 2 diabetes in sentinel general practices in three regions in Belgium and to describe the patient characteristics and the start of the medical management after diagnosis. For two successive years all patients who were newly diagnosed with type 2 diabetes were registered. Two weeks after inclusion, the registering physician completed an extensive questionnaire. This questionnaire dealt with risk factors, biochemical parameters, existing complications and treatment. According to this study, the yearly incidence of type 2 diabetes in Belgium is 231 per 100,000 inhabitants. Though the biochemical parameters (BMI, HbA1c, serum cholesterol and triglycerides) do not differ in the three regions of the country being investigated, there are considerable differences in the treatment prescribed for diabetes and its co-morbidity. In Flanders, treatment is usually started with sulphonylurea, in the Walloon provinces with biguanides. Hypolipaemic treatment is also started more frequently in the latter region. In Flanders, hypertension is registered in 51.4% of the newly diagnosed patients with diabetes, which is higher than in the other regions. However, no difference is noted between the different regions in the number of patients with diabetes who are treated for hypertension. A network of sentinel physicians, taking part in voluntary registration, can be helpful in calculating the incidence of a health problem, in particular type 2 diabetes in general practice. The sentinel net can also serve as an instrument for describing patient characteristics and showing how physicians deal with health problems. The regional differences in medical approach that are described require further investigation, mainly with respect to their impact on the patients' outcome.
Research Interests: General Practice, Epidemiology, Incidence Geometry, Family Practice, Medicine, and 15 moreBelgium, Humans, Internal Medicine, Diabetes mellitus, Female, Male, Incidence, European, Middle Aged, Questionnaires, Health Problems, Public health systems and services research, Chi Square Distribution, Risk Factors, and Regional Difference
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Diagnostic reasoning is considered to be based on the interaction between analytical and non-analytical cognitive processes. Gut feelings, a specific form of non-analytical reasoning, play a substantial role in diagnostic reasoning by... more
Diagnostic reasoning is considered to be based on the interaction between analytical and non-analytical cognitive processes. Gut feelings, a specific form of non-analytical reasoning, play a substantial role in diagnostic reasoning by general practitioners (GPs) and may activate analytical reasoning. In GP traineeships in the Netherlands, trainees mostly see patients alone but regularly consult with their supervisors to discuss patients and problems, receive feedback, and improve their competencies. In the present study, we examined the discussions of supervisors and their trainees about diagnostic reasoning in these so-called tutorial dialogues and how gut feelings feature in these discussions. 17 tutorial dialogues focussing on diagnostic reasoning were video-recorded and transcribed and the protocols were analysed using a detailed bottom-up and iterative content analysis and coding procedure. The dialogues were segmented into quotes. Each quote received a content code and a parti...
Research Interests: Psychology, Computer Science, Communication, Medicine, Emotions, and 15 moreClinical Decision Making, Educational Sciences, Humans, Female, Male, Netherlands, Feeling, Medical Diagnosis, Curriculum and Pedagogy, Health Sciences Education, Clinical Competence, General Practitioners, HUMAN MEDICINE, analytic reasoning, and internship and residency
ABSTRACT In 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... more
ABSTRACT In 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.
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To determine the needs and expectations of adolescent girls concerning contraceptive use as well as their attitude to health care providers, a qualitative research was performed with four focus groups of 17-year-old girls of different... more
To determine the needs and expectations of adolescent girls concerning contraceptive use as well as their attitude to health care providers, a qualitative research was performed with four focus groups of 17-year-old girls of different education levels. All 26 girls except one were of Belgian origin. There was a fixed scenario for each group. The discussions were tape-recorded, transcribed and analysed via content analysis. Knowledge concerning the daily use and side-effects of contraceptives was insufficient. A school physician is not the person they want to talk to. The influence of the peer in the group is very important. The general practitioner is the most frequently consulted health care provider for the first pill prescription, but for a gynaecological examination they thought they had to visit a gynaecologist. The girls expected confidentiality from their general practitioner and wanted sufficient consultation time. Factors inhibiting the visits for obtaining contraceptives were the cost, waiting time and fear of the gynaecological examination. Adolescents intended to visit their general practitioner for contraceptives, but the family practice had to be easily accessible. It is a challenge for general practitioners to provide good contraceptives to adolescents and to promote compliance.
Research Interests: Health Promotion, Contraception, Focus Groups, Family Medicine, Content Analysis, and 15 moreHealth Education, Adolescent, Family Practice, Medicine, Humans, Female, Focus Group, Child and Adolescent Psychology, Confidentiality, Family Planning, General practitioner, Health Care Provider, attitude to health, Medical and Health Sciences, and Medical prescription
To investigate specific information needs of people who search for information about the human papillomavirus (HPV) on the Internet. We performed a qualitative analysis of the e-mail questions asked by the visitors of a website with... more
To investigate specific information needs of people who search for information about the human papillomavirus (HPV) on the Internet. We performed a qualitative analysis of the e-mail questions asked by the visitors of a website with evidence-based information about HPV. The website, hosted by Antwerp University, provided basic information on epidemiology and natural history of HPV in women and men, diagnostic and treatment options, screening, and vaccination. If visitors did not find an answer to their questions, they could mail their question to an e-mail address associated with the website. We received 713 questions posed by 527 e-mail correspondents. The following themes emerged as most important: transmission of HPV, the HPV vaccine, the natural history of the virus, the vicious circle (re-infection between partners), HPV detection in men and women, treatment of men and women, incubation time, pregnancy/fertility, genital warts (in)fidelity, and symptoms of HPV infection. Both men and women are seeking health information on HPV on the Internet, often after being counseled by a health care provider. Practitioners should be prepared for questions on the themes that concern people most. Practitioners may play a role in guidance towards reliable sources of information.
Research Interests: Family Medicine, Natural History, Consumer Health Information, Medicine, Counseling, and 15 moreBelgium, HUMAN PAPILLOMAVIRUS, Humans, Needs Assessment, Female, Male, Health information, Netherlands, Electronic mail, Information Need, Health Care Provider, HUMAN MEDICINE, Papillomavirus Infections, mass Screening, and Medical and Health Sciences
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Research Interests: General Practice, Communication, Decision Making, Global Positioning System, Medicine, and 13 moreFrance, Humans, Female, Male, Aged, Middle Aged, Adult, Public health systems and services research, Patient Participation, HUMAN MEDICINE, Colorectal Neoplasms, mass Screening, and Physician-Patient Relations
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Vaginal self-sampling may be valuable as an alternative method of cervical cancer screening in areas of poor resources, to enroll women who, otherwise, would not participate in population-based cervical cancer screening and in... more
Vaginal self-sampling may be valuable as an alternative method of cervical cancer screening in areas of poor resources, to enroll women who, otherwise, would not participate in population-based cervical cancer screening and in epidemiological follow-up studies. We assessed the reliability of mailed vaginal samples by evaluating the quantity and quality of genomic DNA in the samples. Mailed swabs (n = 201) were compared with freshly collected samples (n = 200) for DNA concentration (45.1 versus 50.9 ng/microl, respectively) and purity (mean optical density [OD] 260/280 ratio 1.88 versus 1.78, respectively). A small, non-significant, decrease in DNA yield with longer transport time was noted. The DNA yield of mailed samples was significantly lower compared to fresh samples (P < 0.002), but this lower yield had little effect on polymerase chain reaction (PCR) amplification. In conclusion, the large majority of mailed self-sampled vaginal swabs resulted in DNA of adequate purity and concentration for further research.
Research Interests: Adolescent, Medicine, Belgium, Biological Sciences, Humans, and 15 moreFemale, Feasibility Studies, Polymerase Chain Reaction, European, Vagina, Cervical Cancer Screening, Genomic DNA, Breast Self Examination, Postal Service, HUMAN MEDICINE, Optical Density, Self examination, Papillomavirus Infections, mass Screening, and Medical and Health Sciences
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Research Interests: Psychology, Qualitative Research, Chronic illness, Chronic, Medicine, and 15 moreFeasibility Study, Humans, Chronic Disease, Female, Feasibility Studies, Male, Interpersonal Relations, Clinical Sciences, Aged, Middle Aged, Adult, Public health systems and services research, Emergent Properties, Health Outcome, and Interviews as topic
Research Interests: General Practice, Focus Groups, Medical Education, Grounded Theory, Family Practice, and 15 moreMedicine, Emotions, Humans, Female, Diagnosis, Male, Physicians, Focus Group, Feeling, Middle Aged, Adult, Public health systems and services research, General practitioner, Focus Group Discussion, and HUMAN MEDICINE
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We describe the use of emergency contraception (EC) and its association with sociodemographic, contraceptive and behavioural characteristics in a sample of family practice attendants in Belgium. The study was part of a large Chlamydia... more
We describe the use of emergency contraception (EC) and its association with sociodemographic, contraceptive and behavioural characteristics in a sample of family practice attendants in Belgium. The study was part of a large Chlamydia trachomatis (CT) prevalence study in general practice. Sexually active women under 40 who consulted their general practitioner for routine gynaecological care were enrolled in the study. Participants completed a questionnaire on sociodemographic variables, urogenital symptoms, sexual history and sexual behaviour, and delivered a sample for CT testing. Logistic regression analysis was performed to identify determinants of a history of EC use in women in this sample. Of 815 questioned women, 23.5% had ever used EC. EC users were a heterogeneous group with respect to educational level, age and ethnicity. The use of emergency contraception was associated with the level of urbanisation, condom use, not having children yet, young age of first sexual intercourse, having had multiple partners in the past year, a history of unintended pregnancy, and current or previous STI. Information on availability and correct use of EC, and on the need for additional testing for STI, are necessary to help primary care attendees to preserve their future reproductive health.
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Problem statement Little is known about how interprofessional healthcare providers in nursing homes work together. We know that interprofessional teamwork evolves from trial and error learning and so interprofessional collaboration has to... more
Problem statement Little is known about how interprofessional healthcare providers in nursing homes work together. We know that interprofessional teamwork evolves from trial and error learning and so interprofessional collaboration has to be actively taught. This study aims to gain insights in the perception of professionals towards interprofessional collaboration in nursing homes and the factors that have an impact on interprofessional collaboration. Approach A qualitative descriptive methodology using focus group interviews and additional semi-structured interviews was performed. In total three focus group sessions with healthcare providers from different disciplines were held and additionally nine semi-structured interviews were executed. A thematic analysis was performed. The transcripts were read to immerse in the data and initial ideas were noted. Both open coding (identification of primary themes) and axial coding (analysis of relationships among themes) were conducted and re...
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Physicians' clinical decision-making may be influenced by non-analytical thinking, especially when perceiving uncertainty. Incidental gut feelings in general practice have been described, namely, as "a sense of alarm" and... more
Physicians' clinical decision-making may be influenced by non-analytical thinking, especially when perceiving uncertainty. Incidental gut feelings in general practice have been described, namely, as "a sense of alarm" and "a sense of reassurance". A Dutch Gut Feelings Questionnaire (GFQ) was developed, validated and afterwards translated into English following a linguistic validation procedure. The aims were to translate the GFQ from English into French, German and Polish; to describe uniform elements as well as differences and difficulties in the linguistic validation processes; to propose a procedural scheme for future GFQ translations into other languages. We followed a structured, similar and equivalent procedure. Forward and backward-translations, repeated consensus procedures and cultural validations performed in six steps. Exchanges between the several research teams, the authors of the Dutch GFQ, and the translators involved continued throughout the p...
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INTRODUCTION: Multimorbidity is a health issue with growing importance. During the last few decades the populations of most countries in the world have been ageing rapidly. Bulgaria is affected by the issue because of the high prevalence... more
INTRODUCTION: Multimorbidity is a health issue with growing importance. During the last few decades the populations of most countries in the world have been ageing rapidly. Bulgaria is affected by the issue because of the high prevalence of ageing population in the country with multiple chronic conditions. The AIM of the present study was to validate the translated definition of multimorbidity from English into the Bulgarian language. MATERIALS AND METHODS: The present study is part of an international project involving 8 national groups. We performed a forward and backward translation of the original English definition of multimorbidity using a Delphi consensus procedure. RESULTS: The physicians involved accepted the definition with a high percentage of agreement in the first round. The backward translation was accepted by the scientific committee using the Nominal group technique. DISCUSSION: Some of the GPs provided comments on the linguistic expressions which arose in order to i...
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In this study the performance of the guidelines produced by the British Chief Medical Officer's expert advisory group for selective screening for Chlamydia trachomatis was evaluated. The guidelines were applied to a sample of 777... more
In this study the performance of the guidelines produced by the British Chief Medical Officer's expert advisory group for selective screening for Chlamydia trachomatis was evaluated. The guidelines were applied to a sample of 777 women in general practice in Antwerp, Belgium. The accuracy of the screening/testing recommendations was suboptimal. The model detected 90% of infections but failed to identify a high-risk population; the population to be screened was reduced by only 21%. The focus on young age as the most important determinant for screening was not appropriate. More attention should be paid to risky sexual behaviour.
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The problem of poor compliance/adherence to prescribed treatments is very complex. Health professionals are rarely being asked how they handle the patient's (poor) therapy compliance/adherence. In this study, we examine explicitly the... more
The problem of poor compliance/adherence to prescribed treatments is very complex. Health professionals are rarely being asked how they handle the patient's (poor) therapy compliance/adherence. In this study, we examine explicitly the physicians' expectations of their diabetes patients' compliance/adherence. The objectives of our study were: (1) to elicit problems physicians encounter with type 2 diabetes patients' adherence to treatment recommendations; (2) to search for solutions and (3) to discover escape mechanisms in case of frustration. In a descriptive qualitative study, we explored the thoughts and feelings of general practitioners (GPs) on patients' compliance/adherence. Forty interested GPs could be recruited for focus group participation. Five open ended questions were derived on the one hand from a similar qualitative study on compliance/adherence in patients living with type 2 diabetes and on the other hand from the results of a comprehensive review ...
Research Interests: Communication, Health Behavior, Evidence Based Medicine, Focus Groups, Content Analysis, and 15 moreLife Style, Medicine, Belgium, Humans, Female, Male, Communication Skill, Focus Group, Health Professionals, Feeling, Middle Aged, Adult, General practitioner, Multidisciplinary Teams, and Metabolic control
Research Interests: General Practice, Medical Microbiology, Adolescent, Family Practice, Medicine, and 15 moreLogistic Regression, Chlamydia trachomatis, Belgium, Multivariate Analysis, Humans, Female, Communication Skill, Logistic Regression Analysis, Clinical Sciences, Chlamydia, Adult, General practitioner, Ligase Chain Reaction, Pap smear, and mass Screening
This paper evaluates the performance of an algorithm developed for opportunistic, selective screening of women for chlamydial infection in general practice in Antwerp, Belgium. Its performance was examined in 2 independent sets of... more
This paper evaluates the performance of an algorithm developed for opportunistic, selective screening of women for chlamydial infection in general practice in Antwerp, Belgium. Its performance was examined in 2 independent sets of patients: A) a cohort of 326 women participating in a pilot screening study, and B) a sample of 25 Chlamydia positive women, identified from the records of a laboratory of clinical microbiology. For group A, positive and negative predictive values were calculated and the accuracy of the algorithm was assessed. For group B, we examined the proportion of patients complying with the algorithm. In group A, the screening algorithm would have detected 73% of the cases in 35.6% of the population. The positive and negative predictive values were 7.7% and 98.4%, respectively. In group B, 84% of patients complied with the algorithm. The screening algorithm worked reasonably well in 2 datasets from a similar population studied 2 y later, but needs further validation.
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Research Interests: Primary Care, Primary Health Care, Family Practice, Medicine, Belgium, and 15 moreHumans, Female, Male, Cluster Analysis, Middle Aged, Adult, Public health systems and services research, Curriculum and Pedagogy, Medicine and Health Sciences, Medical Audit, GuideLine, Acute Disease, Guideline Adherence, Drug utilization review, and Medical prescription
Aims: People with diabetes have a pivotal role in the management of their illness and should be supported to adopt that role. In amainly curative, symptomdriven health care system, managing a chronic disease with the patient as empowered... more
Aims: People with diabetes have a pivotal role in the management of their illness and should be supported to adopt that role. In amainly curative, symptomdriven health care system, managing a chronic disease with the patient as empowered caretaker is challenging. Recently, the Belgian government commissioned a feasibility study aimed to create and evaluate a regional structured education programme for primary care type 2 diabetes patients within a comprehensive shared care intervention at community level. Methods:Two trained diabetes nurseswere engaged at community level (region of 76.852 inhabitants). An empowerment based education package (individual, group, support in insulin initiation) was developed and offered to all patients in the study area. GP referral was obligatory. A detailed analysis of participants’ characteristics was made. Outcome measures were HbA1c and BMI. Qualitative evaluation (interviews) of GPs’ and patients’ experiences was undertaken. Results: During 32 months 69% (N=55) of all GPs referred 340 patients, representing 20% of the target group. One in three participants was newly diagnosed. Mean age of participants was 65 (±10), 48% were male. Mean duration of diabetes was 6 years (±6), mean Hba1c 7.96% (±1,7) and mean BMI 29.5 (±5) kg/m2. On average people had 4.1 (±3.5) individual sessions per year. First results show an improvement of the mean HbA1c (−0.64%). Patients and GPs feel supported by the programme. Conclusion: The implementation of an empowerment based education programme at community level is feasible in a very liberal, symptom driven health care system. Barriers for nonparticipation.
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Research Interests: Primary Care, Primary Health Care, Preventive medicine, Family Practice, Medicine, and 15 moreHUMAN PAPILLOMAVIRUS, Humans, Female, Male, Awareness, Cervical Cancer, Aged, Middle Aged, Questionnaires, Cervical Cancer Screening, Adult, Public health systems and services research, Curriculum and Pedagogy, Preventive, and Papillomavirus Infections
Research Interests: Algorithms, General Practice, Communication, Belgium, Decision Trees, and 15 moreContinuing Medical Education, Humans, Female, Male, Communication Skill, Cluster Analysis, Group Intervention, Chlamydia, Adult, Analysis of Variance, General practitioner, Chi Square Distribution, Clinical Competence, mass Screening, and Medical and Health Sciences
Research Interests: General Practice, Primary Health Care, Long Term Care, Internationalization, Health Services Research, and 14 moreResearch, Family Practice, Medicine, Comorbidity, German, Humans, Biomedical Research, Europe, Female, Male, Multimorbidity, Clinical Sciences, Aged, and Public health systems and services research
Research Interests: Communication, Perception, Health Care, Qualitative Research, Chronic illness, and 15 moreMedicine, Memory, Humans, Clinical, Psychological Intervention, Patient Compliance, Gold Standard, Concordance, Health Problems, Health Beliefs, Doctor patient relationship, Decision Maker, Database System, attitude to health, and Pharmacology and pharmaceutical sciences
To determine whether opportunistic screening for Chlamydia trachomatis, based on a selective screening, algorithm, is possible in general practice in Belgium; to assess feasibility of the screening strategy with respect to workload,... more
To determine whether opportunistic screening for Chlamydia trachomatis, based on a selective screening, algorithm, is possible in general practice in Belgium; to assess feasibility of the screening strategy with respect to workload, acceptability, and organisational aspects. Implementation of a pilot screening programme by 37 GPs for a period of 15 weeks. GPs' screening practices were registered and compared with the guidelines they had received. Outcome measures were: the number of patients included in the risk assessment, uptake of screening by eligible patients, prevalence of previously unidentified infection, and uptake of treatment. After the study period GPs evaluated a number of feasibility issues on a scoring form. 326 women underwent the risk assessment and 214 were tested by an amplification assay on a urine sample. Prevalence in woman at risk was 6.4%. Overall effective screening rate was 77.6%; 9 of 11 positives took up treatment. Participating GPs found the strategy feasible and perceived that it was well accepted by their patients. The screening strategy was easily implemented by most GPs but some of them dropped out. The guidelines were followed relatively well and there were no major logistic problems. The uptake of treatment wat suboptimal. Efforts must be made to stimulate and educate more GPs to perform screening; laboratory and storage conditions should be optimised; refunding criteria should be revised; and overscreening must be avoided.
Research Interests: Algorithms, General Practice, Risk assessment, Family Practice, Medicine, and 15 moreChlamydia trachomatis, Belgium, Humans, Female, Feasibility Studies, Male, Middle Aged, Adult, Public health systems and services research, Risk Assessment, Azithromycin, Medicine and Health Sciences, Pilot Projects, mass Screening, and chlamydial infection
Background Multimorbidity, according to the World Health Organization, exists when there are two or more chronic conditions in one patient. This definition seems inaccurate for the holistic approach to Family Medicine (FM) and long-term... more
Background
Multimorbidity, according to the World Health Organization, exists when there are two or
more chronic conditions in one patient. This definition seems inaccurate for the holistic
approach to Family Medicine (FM) and long-term care. To avoid this pitfall the European
General Practitioners Research Network (EGPRN) designed a comprehensive definition of
multimorbidity using a systematic literature review.
Objective
To translate that English definition into European languages and to validate the semantic,
conceptual and cultural homogeneity of the translations for further research.
Method
Forward translation of the EGPRN’s definition of multimorbidity followed by a Delphi consensus
procedure assessment, a backward translation and a cultural check with all teams to ensure the homogeneity of the translations in their national context. Consensus was defined
as 70% of the scores being higher than 6. Delphi rounds were repeated in each country
until a consensus was reached
Results
229 European medical expert FPs participated in the study. Ten consensual translations of
the EGPRN comprehensive definition of multimorbidity were achieved.
Conclusion
A comprehensive definition of multimorbidity is now available in English and ten European
languages for further collaborative research in FM and long-term care.
Multimorbidity, according to the World Health Organization, exists when there are two or
more chronic conditions in one patient. This definition seems inaccurate for the holistic
approach to Family Medicine (FM) and long-term care. To avoid this pitfall the European
General Practitioners Research Network (EGPRN) designed a comprehensive definition of
multimorbidity using a systematic literature review.
Objective
To translate that English definition into European languages and to validate the semantic,
conceptual and cultural homogeneity of the translations for further research.
Method
Forward translation of the EGPRN’s definition of multimorbidity followed by a Delphi consensus
procedure assessment, a backward translation and a cultural check with all teams to ensure the homogeneity of the translations in their national context. Consensus was defined
as 70% of the scores being higher than 6. Delphi rounds were repeated in each country
until a consensus was reached
Results
229 European medical expert FPs participated in the study. Ten consensual translations of
the EGPRN comprehensive definition of multimorbidity were achieved.
Conclusion
A comprehensive definition of multimorbidity is now available in English and ten European
languages for further collaborative research in FM and long-term care.