[Should clinicians care about health literacy ? A stimulating framework for reflection on the effectiveness of care]. / En quoi la «littératie¼ en santé intéresse-t-elle le clinicien de terrain ? Un cadre stimulant pour réfléchir à l'efficacité pratique des soins.

«Health literacy¼ refers to the ability to find, understand and use health information. It is a relatively new concept, which is becoming increasingly important but remains little known by clinicians. Still, insufficient levels of health literacy in our patients are common, underestimated and negatively associated with numerous health indicators. A set of practical tools are already available to the clinician. The aim of this article is to present the concept to clinicians and emphasize how it could revitalize reflection on the effectiveness of our interventions in the field. Physicians could take a leadership role in putting the concept of health literacy on the agenda for health care quality improvement.

La «littératie en santé¼ désigne la capacité à trouver, comprendre et utiliser les informations dans le domaine de la santé. C'est un concept relativement neuf, en pleine expansion, encore peu connu des cliniciens de terrain. Des niveaux de littératie en santé insuffisants chez les patients sont fréquents, sous-estimés et péjorativement associés à de nombreux indicateurs de santé. Cet article se propose d'adopter le point de vue du clinicien de terrain pour montrer en quoi la littératie en santé pourrait redynamiser la réflexion sur l'efficacité pratique des interventions médicales. Il fournit, ensuite, des outils pour transposer ce concept dans la pratique et conclut que les médecins ont certainement un rôle moteur à prendre pour inscrire la littératie en santé à l'agenda des processus d'amélioration de la qualité des soins.

[Multidisciplinary team meetings : experiences and difficulties of ambulatory care professionals. A qualitative study.] / Concertation multidisciplinaire: l'expérience et les difficultés des professionnels du secteur ambulatoire. Une étude qualitative.

Multidisciplinary work is gaining importance with the ageing of the population, an increase in the number of chronically ill patients, and patients' preference for homebased healthcare. Multidisciplinary team meetings (MDTMs) were designed to foster dialogue between care providers of patients with decreasing autonomy. Despite being financed by the Health Insurance, few professionals use it. This study aimed at an exploration of the professionals' reasons for this lack of MDTM. Semi-structured interviews with health and social care providers who had participated in an MDTM were analysed thematically by two researchers working independently. All of the professionals recognised the importance of MDTMs in improving support for patients and their relatives. Each person's presence at the MDTM helped participants to define their scope of action, to become acquainted with one another, and to coordinate their work. Administrative and logistical limitations were cited as obstacles, as was the absence of a multidisciplinary working culture. MDTMs place the patient at the forefront, and allow professionals to meet and agree on a treatment plan. A range of different working practices and cultures challenges the method.

Le vieillissement de la population, l'augmentation des maladies chroniques, et la préférence des patients pour les soins à domicile demandent plus de travail d'équipe. La Concertation Multidisciplinaire (CM) est une modalité favorisant le dialogue entre différents prestataires de soins au bénéfice des patients en perte d'autonomie. Bien que financée par l'assurance-maladie, elle est peu utilisée. Cette étude qualitative visait à explorer les raisons de ce manque d'utilisation de la CM par les professionnels de santé. Des entretiens semi-structurés individuels ont été menés avec des prestataires d'aide et de soins ayant déjà participé à une CM. Une analyse thématique a été menée par deux chercheurs de façon indépendante. Pour les répondants, la CM est importante pour améliorer le soutien aux patients et à leur famille. Elle permet de définir leur champ d'action, de se rencontrer et de se coordonner. Par contre, les tâches administratives, les contraintes logistiques et l'absence de culture de travail multidisciplinaire sont mentionnées comme des obstacles. La CM place le patient au centre, et permet aux professionnels de se rencontrer et de définir ensemble un plan de traitement. La variété des pratiques et des cultures de travail limite l'intérêt de la méthode.

A review of guidelines for collaboration in substance misuse management.

BACKGROUND: Substance misuse among the working population results in increasing economic costs. General practitioners (GPs) and occupational physicians (OPs) can play a central role in detecting and managing substance misuse in the working population. Their collaboration could be critical in coordinating care, in facilitating rehabilitation and in reducing sickness absence. AIMS: To search guidelines for evidence on collaboration between GPs and OPs in substance misuse detection and management in the working population. METHODS: International guidelines regarding collaborative care for alcohol, illicit drug, hypnotic and tranquillizer misuse were identified by a systematic search in the Guidelines International Network and US National Guidelines Clearinghouse databases. RESULTS: In total, 20 guidelines were considered of sufficient methodological quality, based on the criteria of the Appraisal of Guidelines for Research and Education II instrument. Only two guidelines reported on the OP's role in screening and intervention for alcohol misuse. CONCLUSIONS: There is a lack of guidance on the OP's role and on collaboration between GPs and OPs in this field. Further study is required on their respective roles in substance misuse management, the effectiveness of workplace interventions and the benefits of collaboration.

[Reticence to vaccination: an approach to the phenomenon through a literature review]. / Les réticences à la vaccination: approche du phénomène à travers les données de la littérature.

Although it exists since vaccination appeared, reticence towards vaccination seems to be increasing. Through a literature review, this article first analyses the reasons for this reticence. The decline of infectious diseases leads to greater attention to side effects of vaccines; on the other hand, the social evolution leads patients to search for zero risk in different aspects of life. Suspiciousness towards the State and the influence of media emphasizing potential deleterious effects of each vaccine are additional phenomena explaining people's hesitations. Anti-vaccination movements using Internet to disseminate their ideas are also responsible. Secondly, the article aims at assessing the public opinion about vaccination. It is still predominantly positive, even if questions remain. A typology of four patients' profiles based on statistical results is proposed. Finally, after having examined the medical doctors' opinion concerning vaccination, this article ends with some pieces of advice on how to deal with vaccination in the patient-doctor relationship.

[Patient-physician electronic communication]. / La communication médecin-patient par voie électronique.

There is a patient demand for online services provided by their doctor, but at the present, in Belgium, there are very few physicians offering such services. This article examines the different types of services and the practical, technical, legal and economic aspects of an interface for electronic doctor-patient communication in the ambulatory sector in the Belgian context. The inventory of pilot projects carried out in other countries shows high patient satisfaction rates and a low impact on doctors' workload. However, the lack of funding hinders the implementation. Given the confidential nature of data exchanged, both high level of security and development of guidelines adapted to the local Belgian context are required. Electronic communication should remain one of the modalities in a therapeutic relationship. At a technical level, using the Belgian electronic identity card and the opportunity to create a digital signature with legal value would provide a solution to most of the security requirements.

[Family practitioner and carbon monoxide poisoning]. / Médecin de famille et intoxication au monoxyde de carbone.

Carbon monoxide poisoning is not easily identifiable. It is the first cause of death by accidental poisoning in Europe. The family practitioner, who has not been made aware of this problem, incurs the risk of diagnostic indecision or of involuntary personal poisoning. Since symptomatology is non specific, the general practitioner answering housecalls is sometimes confronted with an urgent medical problem linked to the complications of this intoxication (coronary, neurological problems...), without having ways of documenting its origin of the poisoning or any means to protect himself. Through direct contact with his patients' environment, the family practitioner, being made sensitive to this problem, can certainly contribute to care and aftercare of the patient suffering from carbon monoxide poisoning, but also to the prevention of this public health problem often called "the silent killer".

[PPI very long-term treatment: is the problem only economic?]. / Les IPP au très long cours: le problème est-il uniquement economique?

Proton pump inhibitors are among the most prescribed drugs in Belgium, due to the high prevalence of gastrooesophageal reflux disease and significant impairment of health-related well-being. Short-term and long-term efficacy is superior to that of H2-receptor antagonists. Long-term safety is established. Empirical short-term treatment of symptomatic patients under 50 years of age without alarm signs is acceptable, but endoscopic investigation should always be performed before starting a long-term treatment. Doses for management of low-grade oesophagitis may be tailored to the patient's response. Continuous maintenance of full-dose is recommended for high grade oesophagitis. Surgical alternative is to be discussed with patients. Efficacy and mean cost for insurance plans are comparable. Endoscopic procedures are not yet sufficiently evaluated to be considered. Simple lifestyle advice is still useful. The burden of proton pump inhibitors cost is acceptable if they are prescribed at adequate doses. Cost-effective drugs should be chosen first.

[Some Websites frequently used in general practice]. / Dix sites Internet d'usage fréquent en médecine générale.

Internet use is booming worldwide. The general practitioner can find on the Web a significant help for his research of information, as well as for his medical practice and the administrative management of his office. The proportion of general practitioners who make use of Internet in their professional life is constantly increasing, but their major difficulty remains to know where to quickly find the reliable information. The purpose of this paper is to describe ten Websites of particular interest in general practice.