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Background: General Practitioners (GPs) are well placed to care for patients with (chronic) substance use problems. This pilot was carried out to study the feasibility and usefulness of a continuous surveillance of substance use problems among general practice patients. The objectives were (i) to describe variables with missing values exceeding 1% and whether patients were reported without substance-related problems; (ii) the profile and the magnitude of the patient population that is treated for substance use problems. Methods: Observational study by the Belgian Network of Sentinel General Practices (SGP) in 2013. Baseline (at the first encounter) and 7-month follow-up data were reported of all patients treated for substance use problems. Two main measurements were type of substance use and patient status at follow-up. Multiple logistic regression analysis was used to examine patient status at follow-up. Results: Of 479 patients, 47.2% had problems with alcohol alone, 20.3% with prescription drugs, 16.7% with illicit drugs other than heroin or methadone and 15.9% with heroin or methadone. Problems with alcohol alone were more prevalent in Flanders (53.0%; 95% confidence interval (CI) 46.8-59.1%) than in Wallonia-Brussels (39.8%; 95% CI 33.1-46.8%), while problems with heroin or methadone were more prevalent in Wallonia-Brussels (27.0%; 95% CI 21. 1-33.5%) than in Flanders (7.1%; 95% CI 4.3-10.9%). At follow-up, 32.8% of the patients had dropped out, 29.0% had discontinued GP treatment and 38.2% had continued GP treatment. Overall, 32.4% of 479 patients had continued GP treatment for substance use problems during the study period. In Wallonia-Brussels, this proportion was higher (42.7%; 95% CI 35.9-49.6%) than in Flanders (24.3%; 95% CI 19.2-29.8%). Conclusions: A continuous surveillance of the general practice population treated for substance use problems seems to be feasible and useful. The latter is suggested by the specific profile and the relative magnitude of the population. Inter-regional health system differences should be taken into account to estimate the epidemiology of substance use problems among general practice patients. [ABSTRACT FROM AUTHOR]

Aims: To analyse whether care trajectories (CT) were associated with increased prevalence of parenteral hypoglycemic treatment (PHT=insulin or GLP-1 analogues), statin therapy or RAAS-inhibition. Introduced in 2009 in Belgium, CTs target patients with type 2 diabetes mellitus (T2DM), in need for or with PHT.Methods: Retrospective study based on a registry with 97 general practitioners. The evolution in treatment since 2006 was compared between patients with vs. without a CT, using longitudinal logistic regression.Results: Comparing patients with (N=271) vs. without a CT (N=4424), we noted significant differences (p<0.05) in diabetes duration (10.1 vs. 7.3 years), HbA1c (7.5 vs. 6.9%), LDL-C (85 vs. 98mg/dl), microvascular complications (26 vs. 16%). Moreover, in 2006, parenteral treatment (OR 52.1), statins (OR 4.1) and RAAS-inhibition (OR 9.6) were significantly more prevalent (p<0.001). Between 2006 and 2011, the prevalence rose in both groups regarding all three treatments, but rose significantly faster (p<0.05) after 2009 in the CT-group.Conclusions: Patients enrolled in a CT differ from other patients even before the start of this initiative with more intense hypoglycemic and cardiovascular treatment. Yet, they presented higher HbA1c-levels and more complications. Enrolment in a CT is associated with additional treatment intensification. [ABSTRACT FROM AUTHOR]

Objective To quantify the availability of informal caregivers in surviving stroke patients residing at home in Belgium. Methods National estimates on the availability of informal caregivers were made using data from a nationwide observational registration of family physicians working in sentinel practices and a nationwide administrative database for reimbursement of hospitals in Belgium. Results A total of 189 Belgian family physicians ( FPs) from 141 practices participated in the study and recorded 326 patients (144 men and 182 women) with stroke. These FPs reach 1.5% of the Belgian population. After 1 month, 71% of the male and 75% of the female stroke survivors received support from family caregivers (p = 0.547). After 6 months, the percentage of male patients who received support from family caregivers decreased to 60% compared with 75% in female (p = 0.038). Of all patients with stroke admitted to Belgian hospitals during the reference year 2009 (n = 16.437), 8.997 returned home. Based on the findings from the sentinel practices, it is estimated that a mean of 73% (n = 6.568) and 67.5% (n = 6.073) of surviving patients with stroke can rely on informal caregivers in their home setting after one and 6 months, respectively. Conclusions A vast majority of surviving stroke patients in Belgium can rely on informal caregivers in their home setting, but their availability rapidly decreases 6 months after the event. These findings underline the importance of proactive health policy making in stroke care taking into account the potentially decreasing number of available informal caregivers in the decades to come. [ABSTRACT FROM AUTHOR]

Background: Educational level has repeatedly been identified as an important determinant of access to health care, but little is known about its influence on end-of-life care use. Objectives: To examine the relationship between individual educational attainment and end-of-life care use and to assess the importance of individual educational attainment in explaining differential end-of-life care use. Research Design: A retrospective cohort study via a nationwide sentinel network of general practitioners (GPs; SENTI-MELC Study) provided data on end-of-life care utilization. Multilevel analysis was used to model the association between educational level and health care use, adjusting for individual and contextual confounders based upon Andersen's behavioral model of health services use. Subjects: A Belgian nationwide representative sample of people who died not suddenly in 2005-2007. Results: In comparison to their less educated counterparts, higher educated people equally often had a palliative treatment goal but more often used multidisciplinary palliative care services (odds ratios [OR] for lower secondary education 1.28 [1.04-1.59] and for higher [secondary] education: 1.31 [1.02-1.68]), moved between care settings more frequently (OR: 1.68 [1.13-2.48] for lower secondary education and 1.51 [0.93-2.48] for higher [secondary] education) and had more contacts with the GP in the final 3 months of life. Conclusions: Less well-educated people appear to be disadvantaged in terms of access to specialist palliative care services, and GP contacts at the end of life, suggesting a need for empowerment of less well-educated terminally ill people regarding specialist palliative and general end-of-life care use. [ABSTRACT FROM AUTHOR]

The aim of this study was (1) to estimate the incidence of suicidal behavior, i.e., suicide and suicide attempts, among Belgian general practice patients in 2007-2008 and to estimate trends since previous surveillance periods, i.e., 1991-1993 and 2000-2001; and (2) to investigate characteristics of actors, acts, and first care delivery. Data were collected by the national network of sentinel general practitioners, recording all suicidal behavior they were confronted with in their daily practice in the three periods. In 2007-2008 incidence rates of both suicide and suicide attempts had declined compared to the previous periods while the use of violent versus non-violent suicidal methods remained unchanged. GP involvement in first care after suicidal behavior declined over time from 71% to 39% in the largest part of the population, i.e., younger and adult persons. The last surveillance of suicidal behavior by the Belgian sentinel network of GPs most likely resulted in an underestimation, probably as a result of a declining role of GPs in delivery of first care to patients following suicidal behavior. [ABSTRACT FROM AUTHOR]

Background. Patients presenting with chest pain have a 5% chance of experiencing a coronary event. These patients are at risk of mortality and should be recognized and referred to secondary care.Aim. To determine the relationship between referral type and mortality in patients with chest pain.Methods. The design of the study is an observational study. The setting of the study is a sentinel network of general practices in Belgium, covering 1.6% of the total population. The subjects are 1558 consecutive patients consulting with chest pain in 2003. Descriptive analyses report the standardized mortality ratios. We used the Belgian population of 1999 as the reference population and as the standard population.Results. The standardized mortality ratios of 3 days were 151.0 [95% confidence interval (CI): 82.3–250.3] for the urgent referred group, 45.5 (95% CI: 12.4–116.0) for non-urgent and 13.6 (95% CI: 1.7–49.4) for the non-referred group. The standardized ratios of 1 month were, respectively, 27.6 (95% CI: 18.0–40.4), 6.7 (95% CI: 2.5–14.6) and 4.7 (95% CI: 1.9–9.7). The standardized ratios of 2–12 months were normal for the urgent referral group (1.3; 95% CI: 0.7–2.2) and for the non-urgent referral group (1.0; 95% CI: 0.5–1.9) and even less in the non-referred group (0.4; 95% CI: 0.2–0.9).Conclusions. Mortality in the first 3 days and first month after consulting for chest pain is very high. There is a marked trend in mortality according to the referral type—urgently referred, non-urgently referred and not referred—suggesting risk stratification by the GP. After 1 month, mortality normalizes for all groups, suggesting that the surviving patients are well treated and the condition causing the chest pain no longer influences survival compared to the general population. [ABSTRACT FROM AUTHOR]

Background Euthanasia became legal in Belgium in 2002. Physicians must adhere to legal due care requirements when performing euthanasia; for example, consulting a second physician and reporting each euthanasia case to the Federal Review Committee. Aim To study the adherence and non-adherence of GPs to legal due care requirements for euthanasia among patients dying at home in Belgium and to explore possible reasons for non-adherence. Design of study Large scale, retrospective study. Setting General practice in Belgium. Method A retrospective mortality study was performed in 2005-2006 using the nationwide Belgian Sentinel Network of General Practitioners. Each week GPs reported medical end-of-life decisions taken in all non-sudden deaths of patients in their practice. GP interviews were conducted for each euthanasia case occurring at home. Results Interviews were conducted for nine of the 11 identified euthanasia cases. Requirements concerning the patient's medical condition were met in all cases. Procedural requirements such as consultation of a second physician were sometimes ignored. Euthanasia cases were least often reported (n = 4) when the physician did not regard the decision as euthanasia, when only opioids were used to perform euthanasia, or when no second physician was consulted. Factors that may contribute to explaining non-adherence to the euthanasia law included: being unaware of which practices are considered to be euthanasia; insufficient knowledge of the euthanasia law; and the fact that certain procedures are deemed burdensome. Conclusion Substantive legal due care requirements for euthanasia concerning the patient's request for euthanasia and medical situation were almost always met by GPs in euthanasia cases. Procedural consultation and reporting requirements were not always met. [ABSTRACT FROM AUTHOR]

Background: This study compares prevalence and types of medical end-of-life decisions between the Dutch-speaking and French-speaking communities of Belgium. This is the first nationwide study that can make these comparisons and the first measurement after implementation of the euthanasia law (2002). Methods: We performed a mortality follow-back study in 2005-2006. Data were collected via the nationwide Sentinel Network of General Practitioners, an epidemiological surveillance system representative of all Belgian GPs. Weekly, all GPs reported the medical end-of-life decisions among all non-sudden deaths of patients in their practice. We compared the northern Dutch-speaking (60%) and southern French-speaking communities (40%) controlling for population differences. Results: We analysed 1690 non-sudden deaths. An end-of-life decision with possible lifeshortening effect was made in 50% of patients in the Dutch-speaking community and 41% of patients in the French-speaking community (OR 1.4; 95%CI, 1.2 to 1.8). Continuous deep sedation until death occurred in 8% and 15% respectively (OR 0.5; 95%CI, 0.4 to 0.7). Community differences regarding the prevalence of euthanasia or physician-assisted suicide were not significant. Community differences were more present among home/care home than among hospital deaths: non-treatment decisions with explicit life-shortening intention were made more often in the Dutch-speaking than in the French-speaking community settings (OR 2.2; 95%CI, 1.2 to 3.9); while continuous deep sedation occurred less often in the Dutch-speaking community settings (OR 0.5; 95%CI, 0.3 to 0.9). Conclusion: Even though legal and general healthcare systems are the same for the whole country, there are considerable variations between the communities in type and prevalence of certain end-of-life decisions, even after controlling for population differences. [ABSTRACT FROM AUTHOR]

The article focuses on the Belgian Sentinel Network Monitoring End-of-Life Care (SENTI-MELC) study, which aims to provide a current state of affairs on end-of-life care provisions of dying persons. The final 3 months of life of nonsudden deaths are examined. The first of part of the registration form surveyed basic data about the patient while the second part focuses on the retrospective care during the final three months. Information on the treatment goal, content of care and associated characteristics is further presented.

Background: End-of-life care has become an issue of great clinical and public health concern. From analyses of official death certificates, we have societal knowledge on how many people die, at what age, where and from what causes. However, we know little about how people are dying. There is a lack of population-based and nationwide data that evaluate and monitor the circumstances of death and the care received in the final months of life. The present study was designed to describe the places of end-of-life care and care transitions, the caregivers involved in patient care and the actual treatments and care provided to dying patients in Belgium. The patient, residence and healthcare characteristics associated with these aspects of end-of-life care provision will also be studied. In this report, the protocol of the study is outlined. Methods/Design: We designed a nationwide mortality follow-back study with data collection in 2005 and 2006, via the nationwide Belgian Sentinel Network of General Practitioners (GPs) i.e. an existing epidemiological surveillance system representative of all GPs in Belgium, covering 1.75% of the total Belgian population. All GPs were asked to report weekly, on a standardized registration form, every patient (>1 year) in their practice who had died, and to identify patients who had died "non-suddenly." The last three months of these patients' lives were surveyed retrospectively. Several quality control measures were used to ensure data of high scientific quality. Discussion: In 2005 and 2006, respectively 1385 and 1305 deaths were identified of which 66% and 63% died non-suddenly. The first results are expected in 2007. Via this study, we will build a descriptive epidemiological database on end-of-life care provision in Belgium, which might serve as baseline measurement to monitor end-of-life care over time. The study will inform medical practice as well as healthcare authorities in setting up an end-of-life care policy. We publish the protocol here to inform others, in particular countries with analogue GP surveillance networks, on the possibilities of performing end-of-life care research. A preliminary analysis of the possible strengths, weaknesses and opportunities of our research is outlined. [ABSTRACT FROM AUTHOR]

Background Little information is available on the number of HIV tests that are carried out without the patient's consent. The aim of this study was to find out about the number of HIV tests for which the specific consent of the patient was not obtained and to describe the circumstances in which these tests were carried out. [ABSTRACT FROM PUBLISHER]

The article discusses a study which investigated the relationship between the care provided in the final three months of life and the prevalence and types of end of life decisions in Belgium. Data were collected by the researchers through the Sentinel Network of General Practitioners. A two year mortality retrospective study was performed in 2005 to 2006 across the country. Researchers found an association between utilization of specialist multidisciplinary palliative care services and intensified symptom alleviation, continuous deep sedation forgoing food/fluids, and the total of decisions explicitly intended to shorten life.

Abstract: Background: General Practitioners (GPs) are at the first level of contact in many European healthcare systems and they supposedly have a role in supporting cancer patients in achieving their desired place of death. A four-country (Belgium, the Netherlands, Italy and Spain) study was carried out exploring current practices. Patients and Methods: EURO SENTI-MELC adopted a retrospective study design and data for this study were collected in 2010 through representative GPs’ networks in four countries. In the current study all non-sudden cancer deaths were included with weekly GP registrations. Results: The main study sample included 930 deceased cancer patients: preference for place of death was known by GPs for only 377. GP awareness on the preferred place of death varied across countries, 27% in Italy, 36% in Spain, 45% in Belgium and 72% in the Netherlands (p <0.01). The general level of preferences met was high, from 68% (Italy) to 92% (Spain). Conclusions: Despite the importance of being able to die in a preferred location, GPs were often unaware about patient preferences, especially in Italy and Spain. If GPs were informed, the preference was often met in all countries, indicating room for improvement in end-of-life care. [Copyright &y& Elsevier]

Abstract: Context: Advance care planning (ACP) is an important part of patient-centered palliative care. There have been few nationwide studies of ACP, especially in Europe. Objectives: To investigate the prevalence and characteristics of ACP in two European countries and identify the associated factors. Methods: A mortality follow-back study was undertaken in 2007 via representative nationwide Sentinel Networks of general practitioners (GPs) in Belgium and The Netherlands using similar standardized procedures. All GPs reported on each non-suddenly deceased patient in their practice. Our main outcome measure was whether or not ACP, that is, an agreement for medical treatment and/or medical decisions in the last phase of life in the case of the patient losing competence, was present. Results: Among 1072 non-sudden deaths, ACP was done with 34% of patients and most often related to the forgoing of potential life-prolonging treatments in general (24%). In 8% of cases, ACP was made in consultation with the patient and in writing. In 23% of cases, care was planned with the patient’s family only. Multivariate analysis revealed that ACP was more often made with patients if they were capable of decision making during the last three days of life (odds ratio [OR] 3.86; 95% confidence interval [CI] 2.4–6.1), received treatment aimed at palliation in the last week (OR 2.57; 95% CI 1.6–4.2), had contact with a GP in the last week (OR 2.71; 95% CI 1.7–4.1), died of cancer (OR 1.46; 95% CI 1.1–2.0), or died at home (OR 2.16; 95% CI 1.5–3.0). Conclusion: In these countries, ACP is done with approximately one-third of the studied terminally ill patient population. Most agreements are made only verbally, and care also is often planned with family only. ACP relates strongly both to patient factors and to health care measures performed at the very end of life. [Copyright &y& Elsevier]