Christiane Duchesnes

Advantages, disadvantages and feasibility of Pay-for-Quality programs in Belgium

Quality of care, as currently measured, shows unintended and avoidable variability in health care, and the existence of under use, overuse and misuse of health care, as compared to best practice. One possible part of the solution is to introduce Pay- for-Quality (P4Q) by aligning the payment system with quality of care. However, there is a lack of comprehensive conceptual guidance on P4Q use in health care. Reviews of empirical results on P4Q effects concluded that effects are mixed and highly context dependent. The level of acceptance and support by stakeholders in Belgium was unknown. Finally, practical feasibility of P4Q implementation in Belgium was unclear. This study explored the advantages, disadvantages and feasibility of P4Q implementation in Belgium. A consortium of four universities gathered data from literature, international experts and Belgian stakeholders to assess (1) what can be learned from international P4Q models on design, implementation and evaluation; and (2) what conditions are needed to apply international P4Q models in Belgium; i.e., start from scratch, or enlarge the Belgian quality-improvement programs. The focus of this study was restricted to medical care in primary and acute hospital settings.

The ecology of health care in a Belgian area

Abstract Introduction: Focusing on the monthly prevalence of health problems and recourse to different levels of care of the population is an interesting approach to demonstrate the respective roles of different levels of health care. In the present study, the ecology of health care was studied in the region of Liège, Belgium. Method: A survey questioning people about their health problems was conducted in 2009 in two communes of the province of Liège. For each health problem, ‘health care’ was defined as contact with any qualified care provider. For each consultation, three elements were recorded: the profession of the health care provider; the place where the care was provided and the kind of health care received. Results: A total of 537 people were interviewed. The monthly prevalence of people who experienced a health problem during the previous month was 85·1%. The monthly prevalence of people who turned to a health care provider at least once during the month was 62·2%. The proportion of people turning to doctors, primarily local doctors, for a simple consultation was important (49·2%). Discussion: Our results are highly comparable with those of other studies. Recourse to a doctor is high (49%), which probably reflects the broad accessibility of health care in Belgium and maybe its overuse. Additional questions on the current and future organisation of the Belgian health care system are debated.

Retrospective analysis of a suburban out-of-hours clinic in Belgium

Abstract Introduction: In many countries, out-of-hours medical care is under scrutiny. The aim of this article is to study the activities recorded by the first out-of-hours clinic that has been opened, as a pilot study, in two Walloon communes. Material and method: A retrospective analysis of anonymized data was conducted for 2009. Coding of diagnoses was conducted using the International Classification of Primary Care (ICPC-2). Results: A total of 3949 contacts were recorded in 2009 with the out-of-hours clinic, 3294 related to inhabitants of the two communes covered, which was equivalent to 13% of the total population in question. Compared to 7·2% of contacts between midnight and 8 a.m., 82·9% of contacts took place between 8 a.m. and 9 p.m., and 91·6% of contacts were handled locally, with only 8·4% resulting in hospitalization. In addition, 52% of contacts were with patients aged between 25 and 65; 29·9% of contacts were with paediatric patients (<15 years). Patients over the age of 65 made up 18% of contacts. The most common pathologies were respiratory (R). Analysis of flu diagnoses identified two epidemic peaks. Discussion: The suburban out-of-hours clinic studied fulfilled an important role in managing the demand for health care. The large majority of health problems were resolved locally, and the inhabitants did not need to go to hospital. Appointments between midnight and 8 a.m. were in the minority, which points towards adjusting the organization of the out-of-hours service during the night. The geriatric population is not highly over-represented contrary to what might be expected considering its largest number of pathologies. The on-call doctor’s skills profile should take account of the populations and morbidities encountered. Out-of-hours clinics could possibly play a sentinel role in terms of flu epidemics. Conclusion: This study describes a pilot suburban out-of-hours clinic which met three of recommendations set by the KCE in its report on out-of-hours care in general medicine: the organization of an out-of-hours clinic with logistical support, the use of a single telephone number and merging out-of-hours areas. While debate exists on the management of out-of-hours care, this study provides evidence on the role of the physician during these hours.

790 Predicting long-term sickness absence and supporting return-to work processes using questionnaires

Introduction Promoting good health and attendance, instead of penalising absence, has become a growing policy issue, since long-term sickness absence is increasing in 27 European member states and Norway. As most employees will return to work spontaneously, resources for return to work projects should be dedicated to the high-risk group for long-term sickness absence. Methods In this project, a questionnaire was developed to predict the risk of long-term sickness absence. By combining a literature review of the predictive factors for long-term sickness absence, with a review of existing questionnaires that question long-term sickness absence, a new questionnaire was developed. A study has been set up including 10 000 participants, to assess the predictive value of the questionnaire and the model to predict the risk of long-term sickness absence. Results The literature study revealed 16 predictors for long-term sickness absence. The most predictive factor is the patient’s expectancy regarding their return to work. As the other predictive value of the other factors was ambiguously, the pilot study will explore the value of the complete model and each separate parameter. The developed questionnaire is not specific for a certain illness, nor for use in a specific country. Discussion The questionnaire developed in this research aims to support physicians to assess the risk of long-term sickness absence, wherefore an earlier start of return-to work support becomes possible. We aim to guide more employees successfully and sustainably back to work.

Is langdurig ziekteverzuim voorspelbaar en meetbaar

SamenvattingLangdurig verzuim blijft toenemen en zieke werknemers worden onvoldoende ondersteund bij hun terugkeer! In dit artikel geven we een overzicht van de voorspellende factoren voor een succesvolle terugkeer naar het werk en een overzicht van vragenlijsten die in dit verband kunnen gebruikt worden.

0120 Predicting long-term sickness absence and supporting return-to work processes, a quantitative research

Long-term sickness absence is increasing in 27 European member states and Norway. Promoting good health and attendance, instead of penalising absence, has become a growing policy issue (Edwards & Greasley, 2010). As most employees will return to work spontaneously, resources for return to work projects should be focused on the high-risk group for long-term sickness absence. In this project a questionnaire was developed to predict the risk of long-term sickness absence. The development of the questionnaire started with a literature review of the predictive factors for long-term sickness absence, and with a review of existing questionnaires that question long-term sickness absence. The questionnaire will be validated in a pilot study of 10 000 participants. These data will be used to calculate its predictive value and to build a model to predict the risk of long-term sickness absence. The literature study revealed 16 predictors for long-term sickness absence. The most predictive factor is, according to existing research, the patient‘s expectancy regarding their return to work. As the other factors are not unambiguously strong predictors, the pilot study will explore the predictive value of the complete model and each separate parameter. A new questionnaire was developed based on both reviews and the 16 predictors they revealed. The questionnaire is not specific for a certain illness, nor for use in a specific country. The questionnaire developed in this research will support physicians to assess the risk of long-term sickness absence, and to guide more employees successfully and sustainably back to work.

Experiences of hospital-based multidisciplinary team meetings in oncology: An interview study among participating general practitioners

Abstract Background: Cancer care has become complex, requiring healthcare professionals to collaborate to provide high-quality care. Multidisciplinary oncological team (MDT) meetings in the hospital have been implemented to coordinate individual cancer patients’ care. General practitioners (GPs) are invited to join, but their participation is minimal. Objectives: Aim of this study is to explore participating GPs’ perceptions of their current role and to understand their preferences towards effective role execution during MDT meetings. Methods: In May to June 2014, semi-structured interviews (n = 16) were conducted involving GPs with MDT experience in Belgium. The analysis was done according to qualitative content analysis principles. Results: Attendance of an MDT meeting is perceived as part of the GP’s work, especially for complex patient care situations. Interprofessional collaborative relationships and the GP’s perceived benefit to the MDT meeting discussions are important motivators to participate. Enhanced continuity of information flow and optimized organizational time management were practical aspects triggering the GP’s intention to participate. GPs valued the communication with the patient before and after the meeting as an integral part of the MDT dynamics. Conclusion: GPs perceive attendance of the MDT meeting as an integral part of their job. Suggestions are made to enhance the efficiency of the meetings.

Young general practitioners' professional activities: a survey in the French-speaking part of Belgium.

Introduction: This study described the professional activities of graduates of the Advanced Master of General Practice of the Belgian French-speaking universities from 1999 to 2013 and identified factors influencing their situation. Methods: Between November 2014 and June 2015, all graduates were asked to complete a questionnaire concerning their professional activities. The first part of the analysis described the respondent’s socio-demographic and professional characteristics. The second part aimed at detecting possible factors influencing GPs’ professional situation. Results: The main results of the study showed that 78.5% of graduates still worked as GPs and 21.5% left and had another activity. The way graduates worked in General Practice was also highly diverse in terms of both working time and types of activities. Only a minority of them were exclusively performing General Practice (8.5%). 45.8% of GPs worked part-time, and were more commonly women and GPs in group practice. This survey confirmed feminisation of the profession and increasing work in associations. Among factors influencing retention in General Practice, preference for specialising in General Practice at time of graduation in medicine and duration of practice influence retention in practice. Conclusion: Our survey put the emphasis on the evolution of practice: job and vocational training planning should not be performed based only on previous generations. There is no one predefined way to practise; the blurred boundaries of General Practice activities do not allow for the drafting of a reference frame that could help workforce planning.