Frédéric Ketterer

What factors determine Belgian general practitioners' approaches to detecting and managing substance abuse? A qualitative study based on the I-Change Model.

BackgroundGeneral practitioners (GPs) are considered to play a major role in detecting and managing substance abuse. However, little is known about how or why they decide to manage it. This study investigated the factors that influence GP behaviours with regard to the abuse of alcohol, illegal drugs, hypnotics, and tranquilisers among working Belgians.MethodsTwenty Belgian GPs were interviewed. De Vries’ Integrated Change Model was used to guide the interviews and qualitative data analyses.ResultsGPs perceived higher levels of substance abuse in urban locations and among lower socioeconomic groups. Guidelines, if they existed, were primarily used in Flanders. Specific training was unevenly applied but considered useful. GPs who accepted abuse management cited strong interpersonal skills and available multidisciplinary networks as facilitators.GPs relied on their clinical common sense to detect abuse or initiate management. Specific patients’ situations and their social, psychological, or professional dysfunctions were cited as cues to action.GPs were strongly influenced by their personal representations of abuse, which included the balance between their professional responsibilities toward their patients and the patients’ responsibilities in managing their own health as well the GPs’ abilities to cope with unsatisfying patient outcomes without reaching professional exhaustion. GPs perceived substance abuse along a continuum ranging from a chronic disease (whose management was part of their responsibility) to a moral failing of untrustworthy people. Alcohol and cannabis were more socially acceptable than other drugs. Personal experiences of emotional burdens (including those regarding substance abuse) increased feelings of empathy or rejection toward patients.Multidisciplinary practices and professional experiences were cited as important factors with regard to engaging GPs in substance abuse management. Time constraints and personal investments were cited as important barriers.Satisfaction with treatment was rare.ConclusionsMotivational factors, including subjective beliefs not supported by the literature, were central in deciding whether to manage cases of substance abuse. A lack of theoretical knowledge and training were secondary to personal attitudes and motivation. Personal development, emotional health, self-awareness, and self-care should be taught to and fostered among GPs to help them maintain a patient-centred focus. Health authorities should support collaborative care.

The approach taken to substance abuse by occupational physicians : a qualitative study on influencing factors

Objective: Aiming to enhance occupational physicians’ (OPs) practice when dealing with employee substance abuse, this study analyzes the experiences of OPs to gain insight into the factors influencing their behavior. Methods: Semi-structured interviews were conducted and analyzed using Interpretative Phenomenological Analysis. Results: OPs act differently depending on the type of drug. Their approach was mainly determined by contextual factors and by their attitudes and skills. Many OPs want to invest in health promotion. Barriers such as lack of time and focus on periodic examinations often hamper both adequate prevention and the management of workers with substance abuse. Conclusions: The approach to substance abuse by OPs could be supported by initiatives both at the individual and the collective level. A facilitating work context seems to be particularly important in their commitment to alcohol- and drug-related issues at work.

GP’s engagement in detecting and managing abuse of alcohol, illegal drugs, hypnotics and tranquilizers in the Belgian adult population

European General Practice Research Network (EGPRN) Abstracts from the EGPRN meeting in Kudasi, Turkey, 16th – 19 st May, 2013.s from the EGPRN meeting in Kudasi, Turkey, 16th – 19 st May, 2013. THEME: ‘ RISKY BEHAVIOURS AND HEALTHY OUTCOMES IN PRIMARY HEALTH CARE ’ Risk taking is an important component of development for the human condition; it is how we learn about our environment, relationships and opportunities in life. But risk involves the chance of danger and potential harm, which may impact on the health and wellbeing of patients, their families and their communities. The challenge to clinicians is to be able to recognise challenges and to promote healthier outcomes. The excessive use of substances harmful to health is extensive and varied across Europe and the diff ering characteristics are poorly understood. Substance use and misuse in the community is a multi-factorial problem, which needs to be understood in terms of physical, psychological and social dependency. These issues go beyond the consultation room and require a concerted approach by many diff ering sectors of society. Until recently little has been done in general practice. This presentation is focussed directly at the consulting room and the doctor patient interaction. There has been a steady shift across Europe that recognises the pivotal role of primary care in achieving good health outcomes. This is well documented in Starfield ’ s work, but considerable barriers and challenges remain. The general practitioner ’ s role in society has been largely reactive to the problems presented by its population but there is an increasing emphasis on prevention, multi-morbidity, chronic disease management and enhancing the wellbeing of the individual, families and communities. The numerous factors that affect a patient ’ s wellbeing must be seen in totality and hence a greater understanding of a person ’ s lifestyle is vital to place any risk taking behaviour into context. Initial assessment is important to establish the level of risk and context of the behaviour: ” What does it mean for the individual? ” Young people try substances from curiosity and only once ‘ hooked ’ peer pressure continues to encourage a person ’ s ‘ membership ’ . Others may have tried substances to solve a problem: abuse, deprivation, or pain (psychological and physical). Dependency is then established once an individual life revolves around the use of this substance; this may be socially acceptable (smoking, alcohol), illicit (heroin, cocaine, amphetamine) or iatrogenic (over the counter medicines, opiates, benzodiazepines). Each addiction generates a subculture of language, conduct and behaviour that should be understood to facilitate any challenge. European Journal of General Practice, 2013; 19: 162–184 ISSN 1381-4788 print/ISSN 1751-1402 online

La littératie en santé, un levier pour des systèmes de soins plus équitables ? Des outils pour armer les professionnels et impliquer les institutions

This article briefly recalls why low levels of health literacy should be considered to constitute a public health issue. It then proposes the concept of health literacy as a possible lever to help health care systems to more effectively take social health inequalities into account. Finally, it provides concrete tools for field workers, both clinicians and quality of care managers, and emphasises the importance of an organizational approach to health literacy.

Why Collaborative Care for Depressed Patients is so Difficult: A Belgian Qualitative Study

Although current guidelines recommend collaborative care for severely depressed patients, few patients get adequate treatment. In this study we aimed to identify the thresholds for interdisciplinary collaboration amongst practitioners when treating severely depressed patients. In addition, we aimed to identify specific and feasible steps that may add to improved collaboration amongst first and second level Belgian health care providers when treating depressed patients. In two standard focus groups (n = 8; n = 12), general practitioners and psychiatrists first outlined current practice and its shortcomings. In a next phase, the same participants were gathered in nominal groups to identify and prioritise steps that could give rise to improved collaboration. Thematic analyses were performed. Though some barriers for interdisciplinary collaboration may seem easy to overcome, participants stressed the importance of certain boundary conditions on a macro- (e.g., financing of care, secure communication technology) and meso-level (e.g., support for first level practitioner). Findings are discussed against the background of frameworks on collaboration in healthcare and recent developments in mental health care.

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.