Hilde Philips

EurOOHnet—the European research network for out-of-hours primary health care

Abstract Background and rationale: European countries face similar challenges in the provision of health care. Demographic factors like ageing, population growth, changing patient behaviour, and lack of work force lead to increasing demands, costs, and overcrowding of out-of-hours (OOH) care (i.e. primary care services, emergency departments (EDs), and ambulance services). These developments strain services and imply safety risks. In the last few decades, countries have been re-organizing their OOH primary health care services. Aim and scope of the network: We established a European research network for out-of-hours primary health care (EurOOHnet), which aims to transfer knowledge, share experiences, and conduct research. Combining research competencies and integrating results can generate a profound information flow to European researchers and decision makers in health policy, contributing towards feasible and high-quality OOH care. It also contributes to a more comparable performance level within European regions. Conducted research projects: The European research network aims to conduct mutual research projects. At present, three projects have been accomplished, among others concerning the diagnostic scope in OOH primary care services and guideline adherence for diagnosis and treatment of cystitis in OOH primary care. The future: Future areas of research will be organizational models for OOH care; appropriate use of the OOH services; quality of telephone triage; quality of medical care; patient safety issues; use of auxiliary personnel; collaboration with EDs and ambulance care; and the role of GPs in OOH care.

Improving Care And Research Electronic Data Trust Antwerp (iCAREdata): a research database of linked data on out-of-hours primary care

BackgroundPrimary out-of-hours care is developing throughout Europe. High-quality databases with linked data from primary health services can help to improve research and future health services.MethodsIn 2014, a central clinical research database infrastructure was established (iCAREdata: Improving Care And Research Electronic Data Trust Antwerp, www.icaredata.eu) for primary and interdisciplinary health care at the University of Antwerp, linking data from General Practice Cooperatives, Emergency Departments and Pharmacies during out-of-hours care. Medical data are pseudonymised using the services of a Trusted Third Party, which encodes private information about patients and physicians before data is sent to iCAREdata.ResultsiCAREdata provides many new research opportunities in the fields of clinical epidemiology, health care management and quality of care. A key aspect will be to ensure the quality of data registration by all health care providers.ConclusionsThis article describes the establishment of a research database and the possibilities of linking data from different primary out-of-hours care providers, with the potential to help to improve research and the quality of health care services.

Use of out-of-hours services : the patient's point of view on co-payment: a mixed methods approach

Abstract Introduction: In many countries out of hours (OOH) care is offered by different health care services. General practitioners (GP) tend to offer services in competition with emergency departments (ED). Patients behaviour depends on a number of factors. In this study, we highlight the knowledge and ideas of patients concerning the co-payment system. Methods: We used a mixed methods design, combining quantitative and qualitative research. During two weekends in January 2005, all patients using the ED or the GP OOH service, were invited for an interview with a structured questionnaire. A stratified random sample of patients participated in a semi-structured interview. Both methods add complementary data to answer the research questions. Results: Most mentioned reasons for seeking help at the ED are: accessibility (15.0%), proximity (6.4%) and competence of the staff (5.6%). Reasons for choosing the GP are: GP is easy to find, minor medical problem or anxiety and confidence in the GP. The odds of not knowing the co-payment system are significantly higher in patients visiting the ED (OR 1.783; 95% CI: 1.493-2.129). Mostly GP users recognize the problem of ED overuse. They suggested especially to provide clear information about the tasks of the different services and about the payment system, to reduce ED overuse. Conclusion and discussion: When intending to shift from ED to GP services for minor medical problems, aiming at just one measure is no option. Information campaigns aiming to address the entire population, can clarify the role of each player in out-of-hours care.

Can we improve adherence to guidelines for the treatment of lower urinary tract infection? A simple, multifaceted intervention in out-of-hours services.

OBJECTIVES To improve antimicrobial prescribing behaviour of general practitioners in large-scale out-of-hours services for uncomplicated lower urinary tract infection (LUTI) in females aged 20-80 years, which is regarded as one of the most prevalent bacterial infections in primary care. METHODS A quasi-experimental design was used in two regional large-scale out-of-hours services. A simple, multifaceted intervention was offered in a 16 week period in one region (the intervention region). During the two washout periods, at 5 and 17 months, we observed diagnoses and prescriptions. The main outcome measure was the share of appropriate and inappropriate prescriptions. RESULTS The proportion of patients with LUTI ranged from 1.0% to 2.1%. The relative proportion of appropriate prescriptions in the intervention region increased from 26.9% to 69.4%, but decreased afterwards to 40.8%. CONCLUSIONS A simple, multifaceted intervention for treatment of LUTI during out-of-hours care may improve the quality of antimicrobial prescribing, although the improvement may not be sustained in the longer term.

Correlates of safe sex behaviour among low-educated adolescents of different ethnic origin in Antwerp, Belgium

Background Several reports suggest that low educated adolescents of ethnic minority origin are at a higher risk of acquiring a sexually transmitted infection (STI) than autochthonous teens. On the other hand, focus group research with young Moroccan boys revealed a positive attitude towards condom use; they claim to use a condom even more frequently than their Belgian peers. The aim of this study is to document the behavioural, educational and social correlates that influence the use of condoms among low educated adolescents of different origin. Method Data from 378 questionnaires completed by 253 native Belgian and 125 ethnic minority adolescents, mostly Moslems, were analysed with the statistic software: SPSS. Results were interpreted according to the behavioural science ASE model (Attitude, Social influences, self-Efficacy). Results Native boys discuss sexual items more frequently with their parents and sexual partner, while boys in the other group address their questions more frequently to teachers, pharmacists and doctors. In both groups the most important correlate of safe sex intention and behaviour is the self-efficacy variable ‘both partners taking the initiative with regard to condom use’. This correlate refers to communication skills. Parental support and quality of general communication about sexuality with the parents are very important for both groups. A positive attitude of peers influences the intention of condom use in both groups. Conclusion There is no significant difference in sexual activity and safe sex behaviour between native boys and young males of ethnic minority. Self efficacy (correct condom use and taking the initiative) is the most prominent predictor of safe sex behaviour in both groups.

How does a Belgian health care provider deal with a request for emergency contraception

Objective To evaluate how Belgian health care providers deal with a request for emergency contraception. Method In 2002–2003 we conducted 12 focus groups with pharmacists, general practitioners and school physicians. A skilled moderator accompanied by an observer conducted the focus groups using a semi-structured screenplay. Results All these health care providers agree with the free access to emergency contraception (EC), but experience considerable frustration with regard to the practical aspects and the legal framework. General practitioners (GPs) claim to spend a lot of time on requests for EC and they are concerned about the quality of the counselling provided in pharmacies. Pharmacists are creative when giving counselling in the pharmacy, but there is, nevertheless, a problem with a lack of privacy. School physicians are frustrated that there is no legal possibility to respond to a request for EC when they feel they are ideally placed to advise adolescents. Conclusion The over-the-counter sale of EC offers women better access, but many barriers still interfere with optimal care. Pharmacists experience a lack of skills to communicate with adolescents and a lack of privacy to give counselling. GPs have good intentions, but are confronted with a lack of willingness on the part of the patients and also financial barriers. School physicians want more possibilities to help adolescents.

Use of emergency departments by primary care patients

Introduction In many Western countries, accident and emergency (A&E) departments are frequently attended. Apparently this phenomenon occurs in countries with less (i.e. Spain’) and more (i.e. the Netherlands*) structured healthcare systems. As a result, overcrowding of A&E departments hinders urgent healthcare delivery. In some countries (as in Belgium) general practitioners (GPs) provide continuous out-of-hours services while A&E departments have free access. In Belgium patients d o not pay direct fees a t the A&E department, whereas a t a GP surgery they do. We studied patients’ reasons for visiting an A&E department and the appropriateness of these visits. A patient’s visit was judged ‘appropriate’ if the hospital consultant was of the opinion that a GP in primary care could not have treated the patient properly.

Agreement on urgency assessment between secretaries and general practitioners: an observational study in out-of-hours general practice service in Belgium

Background: In some European countries telephone triage (TT) during out-of-hours primary care showed to be safe and effective. Other countries, such as Belgium, may not have trained auxiliary personnel while their national health services want to establish TT. Objectives: To compare urgency levels assessed by secretaries and general practitioners in one general practice cooperative in Belgium. Methods: Percentage of correct-, under-, and over-triage were calculated in total and per reason for encounter. Inter-rater agreement was investigated. Results: The secretaries correctly triaged (same urgency level) 77% of the telephone calls, under-triaged 10% and over-triaged 13%.‘Shortness of breath’, ‘skin cuts’, ‘chest pain’, ‘feeling unwell’ and ‘syncope’ were often under-triaged. Conclusion: Before introducing TT, auxiliary staff should be trained and protocols should be used.

Reducing inappropriate A&E attendances

Ismail et al clearly show that interventions in primary care do not decrease the number of inappropriate attendances at accident and emergency departments (A&E), nor increase patient self-care.1 In Belgium (Flanders), we observed a large increase in attendance of young children at primary care out-of-hours (PCOOH) services after implementation of a general practice cooperative (GPC).2,3 Recently, data from new PCOOH services in colocation …

Optimising the quality of antibiotic prescribing in out-of-hours primary care in Belgium: a study protocol for an action research project

Introduction Antimicrobial resistance is a major public health threat driven by inappropriate antibiotic use, mainly in general practice and for respiratory tract infections. In Belgium, the quality of general practitioners’ (GPs) antibiotic prescribing is low. To improve antibiotic use, we need a better understanding of this quality problem and corresponding interventions. A general practitioners cooperative (GPC) for out-of-hours (OOH) care presents a unique opportunity to reach a large group of GPs and work on quality improvement. Participatory action research (PAR) is a bottom-up approach that focuses on implementing change into daily practice and has the potential to empower practitioners to produce their own solutions to optimise their antibiotic prescribing. Methods This PAR study to improve antibiotic prescribing quality in OOH care uses a mixed methods approach. In a first exploratory phase, we will develop a partnership with a GPC and map the existing barriers and opportunities. In a second phase, we will focus on facilitating change and implementing interventions through PDSA (Plan-Do-Study-Act) cycles. In a third phase, antibiotic prescribing quality outside and antibiotic use during office hours will be evaluated. Equally important are the process evaluation and theory building on improving antibiotic prescribing. Ethics The study protocol was approved by the Ethics Committee of the Antwerp University Hospital/University of Antwerp. PAR unfolds in response to the needs and issues of the stakeholders, therefore new ethics approval will be obtained at each new stage of the research. Dissemination Interventions to improve antibiotic prescribing are needed now more than ever and outcomes will be highly relevant for GPCs, GPs in daily practice, national policymakers and the international scientific community. Trial registration number NCT03082521; Pre-results.