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AIM: To describe and compare end-of-life care for people with mild or severe dementia in general practice in Belgium, Italy and Spain, in terms of place of care, place of death, treatment aims, use of specialized palliative care and communication with general practitioners (GPs). METHODS: Cross-sectional retrospective survey was carried out of nationwide networks of GPs in Belgium, Italy and Spain, including patients who died aged 65 years or older in 2009-2011 and were judged by the GP to have had dementia (n = 1623). RESULTS: GPs reported a higher proportion of older people with severe dementia in Belgium (55%) than in Spain (46 %) and Italy (45 %), and a higher proportion of patients living in care homes (57% vs 18% and 13%, respectively). A palliative treatment aim was common in the last 3 months of life in all three countries. Specialized palliative care services were provided in 14% (Italy, severe dementia) to 38% (Belgium, severe dementia) of cases. Communication between GP and patient about illness-related topics occurred in between 50% (Italy) and 72% (Belgium) of cases of mild dementia, and 10% (Italy) to 32% (Belgium) of cases of severe dementia. Patient preferences for end-of-life care were known in a minority of cases. Few people (13-15 %) were transferred between care settings in the last week of life. CONCLUSIONS: Although overall treatment aims at the end of life are often aligned with a palliative care approach and transfer rates are low, there is room for improvement in end-of-life care for people with dementia in all countries studied, especially regarding early patient-GP communication. Geriatr Gerontol Int 2017; ••: ••-••.

Background: Palliative care has traditionally focused on people with cancer, but the majority of older people will die from other causes. This research investigates differences in end-of-life care between older people who died with or without cancer in Belgium. Method: Nationwide representative mortality follow-back study among GPs, who filled in a weekly questionnaire and follow-up questionnaires regarding all their patients who died. The study included people who died non-suddenly over the age of 75 (n=1662) in 2009 and 2010. Results: Of people 75 or older, 22% died with cancer. Older people who died without cancer more often lived in a care home (38%) and more often had severe dementia (23%) than older people who died with cancer (14% and 5% respectively). Controlled for these differences, having a palliative treatment goal during the last 3 months of life was more common among older people with cancer (up to 93%) than among older people without cancer (up to 77%), whereas curative or life prolongingtreatment goals were less common among older people with cancer. The GP was more often aware of preference for a place of death (51%; OR=1.94, 95%CI=1.47-2.55), preference for medical treatment(s) at the end of life (35%; OR=2.02, 95%CI=1.52-2.67), or preference for a proxy decision maker (20%; OR=1.57, 95%CI=1.32-2.18) for people with cancer than people without cancer (34%, 18% and 13% respectively). Communication between GP and patient regarding diagnosis, possible complications and physical, psychological, social or spiritual problems was more common among older people with cancer than older people without cancer. Conclusion: Compared with older people without cancer, GPs of older people with cancer recognize different treatment goals for them and communicate more with them. These results suggest cancer is an important trigger, also for older people, to communicate about care at the end of life and to initiate palliative care. Funding: Flemish League against Cancer.

Background: The involvement of family in shared decision making and communication about medical issues at the end of life may be particularly relevant to older people, but it is unknown how often this happens in different countries. Method: Nationwide representative mortality follow-back study among general practitioners (GPs), who filled in a weekly questionnaire regarding all their patients who died. The study included people who died non-suddenly over the age of 75 and whose longest place of residence in the last year of life was home (n=1556) in Belgium, the Netherlands and Italy in 2013, 2014 or 2015. GPs indicated if they had communicated with the patient and/or family about diagnosis, prognosis, approaching end of life, pros and cons of treatments, options for end-of-life care, spiritual issues and psychological or social issues. Results: GPs communicated more often with older patients about all topics in Belgium (65%-81%) and the Netherlands (51%-87%) than in Italy (3-33%). On average, GPs in Belgium communicated with older patients about 3 out of 7 end-of-life topics, compared with 5 topics in the Netherlands and 1 topic in Italy. In all countries GPs communicated with family about an average of 4 topics, particularly diagnosis (75%-89%), prognosis (74%-90%) and the approaching end of life (71%-89%). In Belgium and Italy, all topics were more frequently discussed with family than with the patient; in the Netherlands, only options for end-of-life care were more frequently discussed with the family. Conclusion: That communication between GP and family was similar in all countries suggest that family are seen as an appropriate avenue for communicating about end-of-life issues in different cultural settings, but whether this should be in conjunction with communication with the patient differs as shown by the substantial variance across countries in communication with older patients themselves. Funding: None.

Aims: Hospital admissions towards the end of life may indicate a low quality of dying. Yet population-based data on hospital use at the end of life are scarce. We aimed to describe and compare the frequency, length and timing of acute hospital admissions in the last three months of life in Belgium (BE), the Netherlands (NL), Italy (IT) and Spain (ES). Method: Cross-national, population-based mortality followback study via nationwide representative epidemiological surveillance networks of general practitioners (GPs). Using a standardised form, GPs recorded the care in the last three months of life of every deceased adult practice patient (01/01/2009-31/12/2011). Nursing home deaths from the NL (6%) were excluded as they are not attended by GPs. Analysis involved descriptive statistics, chi-squared tests and multivariate logistic regression analysis. Results: We studied 7,209 deaths. In BE, NL, IT and ES, 53%, 48%, 51% and 52% of patients, respectively (p Conclusions: Across countries, and particularly in Belgium, hospital care in the last three months of life is highly prevalent and increases considerably in the final days of life, suggesting an institutionalised nature of dying. Differences between countries may reflect differences in healthcare policy and end-of-life care practice.

In 2009 startte het RIZIV een programma « zorgtrajecten » voor bepaalde groepen diabetes type 2 (DM2) of chronische nierinsufficiëntie (CNI) patiënten. De eerste doelstelling van het ACHIL project (Ambulatory Care Health Information Laboratory) bestaat in een evaluatie van de doeltreffendheid van de zorgtrajecten om de kwaliteit van zorgen op het terrein te verbeteren. Kwaliteit van zorgen betekent hier de overeenstemming met aanbevelingen. Andere dimensies van kwaliteit van zorgen, zoals de efficiëntie of de tevredenheid van patiënten, maken niet het onderwerp uit van deze studie. Er werd gebruik gemaakt van 4 verschillende bronnen om deze studie te realiseren, de vier “pijlers” van ACHIL : een “centrale pijler”, het Intermutualistisch Agentschap (IMA), het referentienetwerk Intego en het referentienetwerk Huisartsenpeilpraktijken (PP). Voor de centrale pijler werden gegevens verzameld via extractie uit de elektronische patiëntendossiers van huisartsen of via manuele inbreng van gegevens in een web applicatie. Zo werden er bijvoorbeeld via de centrale pijler gegevens verzameld over 18250 DM2 zorgtrajectpatiënten en over 12889 CNI zorgtrajectpatiënten (gegevens 2011). Onze resultaten zijn erg bemoedigend en tonen, op basis van resultaten uit de 4 pijlers die in dezelfde richting gaan dat het zorgtrajectprogramma doeltreffend was in de periode 2009-2011 om patiënten die het nodig hadden op te nemen in een zorgtraject en om de opvolging van deze patiënten te verbeteren (verbeteren van de kwaliteit van zorgen in termen van proces, bijvoorbeeld de frequentie van opvolging van HbA1c, eGFR, parathormoon of proteïnurie of de frequentie van inname van statines). De gegevens laten echter niet toe ons uit te spreken over een manifeste verbetering van de gezondheidstoestand van deze patiënten die zou kunnen toegeschreven worden aan de zorgtrajecten (verbetering van kwaliteit van zorgen in termen van klinische resultaten, zoals de HbA1c waarden, de bloeddruk of de snelheid van vermindering van glomerulaire filtratie). Het programma “zorgtrajecten” is een complexe interventie bestaande uit verschillende elementen, zoals de handtekening van een contract, de maatregelen van gezondheidseducatie, de terugbetaling van diverse consultaties en materiaal, het oprichten van lokale multidisciplinaire structuren. Het is niet mogelijk om aan te duiden aan welke onderdelen van deze complexe interventie de waargenomen verbeteringen van het zorgproces kunnen worden toegeschreven. Deze studie is een observationele studie (een retrospectieve cohortstudie) en geen gerandomiseerde en gecontroleerde studie, en bovendien is de observatieperiode erg kort. Ten slotte willen we ook geen globaal oordeel vellen over de kwaliteit van zorgen voor diabetes of chronische nierinsufficiëntie patiënten, noch een absolute vergelijking maken over het niveau van kwaliteit van zorg tussen verschillende groepen patiënten. Al deze bemerkingen zijn belangrijk bij het lezen van dit rapport. We bevelen momenteel, op basis van onze resultaten en rekening houdend met de hierboven geformuleerde opmerkingen, aan om onze resultaten te bevestigen en verder uit te diepen en de gevonden verbeteringen van kwaliteit van zorgen te behouden en te versterken. Om dit te realiseren zou het nuttig zijn om meer gegevens over een langere periode te verzamelen, om de extractie van gegevens uit de elektronische patiëntendossiers van huisartsen in een beveiligde en aanvaarde omgeving te veralgemenen, om deze gegevens te koppelen met deze van het IMA, om kwaliteitscirkels in te stellen op basis van feedback aan de zorgverleners en de lokale multidisciplinaire netwerken. We zijn de mening toegedaan dat de multi-pijler en multidisciplinaire dimensie van ACHIL een belangrijk pluspunt is voor de komende jaren. Het huidige rapport handelt over de globale resultaten van de evaluatie van de kwaliteit van zorgen. De aspecten van feedback aan de zorgverleners en de evaluatie van de kwaliteit van het systeem van gegevensinzameling worden in afzonderlijke documenten en publicaties behandeld.

The numerous existing primary care-based research networks currently use various data collection methods. In this paper, we compared routine data extracted from general practitioners' (GPs') electronic patient records (EPRs) and GPs' answers to an electronic questionnaire. We investigated for 10,307 Belgian patients 10 healthcare conditions using clinical and biological parameters (cholesterol, blood pressure, and body mass index), diagnoses (hypertension, diabetes, and personal past cardiovascular event(s)), and drug prescriptions (antidiabetic drugs, aspirin, statins, and antihypertensive drugs). We found a relatively fair agreement (Kappa ?0.40) between the two data collection methods for 7 healthcare conditions, but no agreement for the biological parameters. When EPR data was used and compared with the questioning method, the prevalence of diagnoses and drug prescriptions was relatively lower and the prevalence of clinical and biological parameters was relatively higher (all missing data excluded) in the EPR data than in the data collected using the questioning method. Using EPR data, we calculated an acceptable proxy for the prevalence as observed using the questioning method. The comparison of the two data collection methods was a worthwhile approach, in that it could highlight potential ways to improve both care quality and information systems.

Efficiency and privacy protection are essential when setting up nationwide research networks. This paper investigates the extent to which basic services developed to support the provision of care can be re-used, whilst preserving an acceptable privacy protection level, within a large Belgian primary care research network. The generic sustainable confidentiality management model used to assess the privacy protection level of the selected network architecture is described. A short analysis of the current architecture is provided. Our generic model could also be used in other countries. ispartof: pages:23-28 ispartof: Studies in Health Technology and Informatics vol:174 pages:23-28 ispartof: Special Topic Conference of the European-Federation-for-Medical-Informatics (EFMI) location:Moscow, RUSSIA date:18 Apr - 20 Apr 2012 status: published

ispartof: Working paper of the Scientific Research Community Historical Demography, issue:2012 pages:1-27 status: published

In the course of the nineteenth century, millions of migrants moved to and settled permanently in western European urban centers. This large influx of immigrants, originating from various regions with different demographic backgrounds, affected the level and pace of the local fertility transition. In this study the authors sampled and analyzed 747 couples consisting of natives and immigrants in the city of Antwerp during the early fertility transition. Stopping behavior of both native, immigrant and mixed couples is analyzed. The authors found that adult migrants display stopping behavior that resembles that at their origin while individuals that immigrated during childhood adapt more often to the dominant local fertility pattern. While the migratory status of the mother was more decisive than that of the father, couples consisting of both immigrants were the last to implement more efficient reproductive strategies. By focusing on individual behavioral patterns, new light is shed on the diffusion of reproductive behavior during the Western European fertility decline., Historical Social Research Vol. 37, No. 3 (2012)

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It has been argued in sociology, economics, and evolutionary anthropology that family size limitation enhances the intergenerational upward mobility chances in modernized societies. If parents have a large flock, family resources get diluted and intergenerational mobility is bound to head downwards. Yet, the empirical record supporting this resource dilution hypothesis is limited. This article investigates the empirical association between family size limitation and intergenerational mobility in an urban, late nineteenth century population in Western Europe. It uses life course data from the Belgian city of Antwerp between 1846 and 1920. Findings are consistent with the resource dilution hypothesis: after controlling for confounding factors, people with many children were more likely to end up in the lower classes. Yet, family size limitation was effective as a defensive rather than an offensive strategy: it prevented the next generation from going down rather than helping them to climb up the social ladder. Also, family size appears to have been particularly relevant for the middle classes. Implications for demographic transition theory are discussed.