ABSTRACT
Background: During out-of-hours (OOH) primary care, GPs overprescribe antibiotics for respiratory tract infections (RTIs). Many interventions have been shown to improve antibiotic prescribing quality, but their implementation in practice remains difficult. Participatory action research (PAR) aims to explore, implement and evaluate change in practice with an active involvement of local stakeholders, while generating knowledge through experience. Objectives: To evaluate whether PAR improves antibiotic prescribing quality for RTIs during OOH primary care and simultaneously identify the pivotal lessons learned. Methods: A mixed-methods study with a PAR approach in three OOH GP cooperatives (GPCs). Each GPC co-created a multifaceted intervention focusing on improving antibiotic use for RTIs through plan-do-study-act cycles. We quantified antibiotic prescribing quality indicators and formulated the lessons learned from a qualitative process analysis. Results: Interventions were chosen with the GPs and adapted to be context-relevant. The willingness to work on quality and engagement of local stakeholders led to ownership of the project, but was time-consuming. In one GPC, antibiotic prescribing significantly decreased for tonsillitis, bronchitis, otitis media and acute upper RTI. In all three GPCs, use of guideline-recommended antibiotics for otitis media significantly increased. Conclusions: Implementing multifaceted interventions through PAR can lower total and increase guideline-recommended antibiotic prescribing for RTIs in OOH primary care. Co-creating interventions with GPs to suit local needs is feasible, but reaching all GPs targeted is challenging.
ABSTRACT
BACKGROUND: In Europe, IBS is commonly treated with musculotropic spasmolytics (eg, otilonium bromide, OB). In tertiary care, a low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet provides significant improvement. Yet, dietary treatment remains to be explored in primary care. We evaluated the effect of a smartphone FODMAP-lowering diet application versus OB on symptoms in primary care IBS. METHODS: IBS patients, recruited by primary care physicians, were randomised to 8 weeks of OB (40 mg three times a day) or diet and followed for 24 weeks. We compared IBS Symptom Severity Score and the proportion of responders (improvement ≥50 points) in all patients and the subgroup fulfilling Rome IV criteria (Rome+). We also evaluated treatment efficacy, quality of life, anxiety, depression, somatic symptom severity (Patient Health Questionnaire (PHQ15, PHQ9)) and treatment adherence and analysed predictors of response. RESULTS: 459 primary care IBS patients (41±15 years, 76% female, 70% Rome+) were randomised. The responder rate after 8 weeks was significantly higher with diet compared with OB (71% (155/218) vs 61% (133/217), p=0.03) and more pronounced in Rome+ (77% (118/153) vs 62% (98/158), p=0.004). Patients allocated to diet (199/212) were 94% adherent compared with 73% with OB (148/202) (p<0.001). The significantly higher response rate with diet was already observed after 4 weeks (62% (132/213) vs 51% (110/215), p=0.02) and a high symptom response persisted during follow-up. Predictors of response were female gender (OR=2.08, p=0.04) for diet and PHQ15 (OR=1.10, p=0.02) for OB. CONCLUSION: In primary care IBS patients, a FODMAP-lowering diet application was superior to a spasmolytic agent in improving IBS symptoms. A FODMAP-lowering diet should be considered the first-line treatment for IBS in primary care. TRIAL REGISTRATION NUMBER: NCT04270487.
Subject(s)
Irritable Bowel Syndrome , Academies and Institutes , Belgium , Delivery of Health Care , Diet , Disaccharides/therapeutic use , Female , Fermentation , Humans , Irritable Bowel Syndrome/therapy , Male , Monosaccharides/therapeutic use , Oligosaccharides , Parasympatholytics , Primary Health Care , Quality of Life , RomeABSTRACT
OBJECTIVES: Falls in community-dwelling older persons occur frequently. The consequences emphasize the need to screen systematically for an increased fall risk and a targeted multifactorial and multidisciplinary approach. This study describes the extent to which fall prevention strategies are applied by primary healthcare workers in Flanders. Insight in barriers is provided. METHOD: An online survey was collected by the Centre of Expertise for Falls and fracture Prevention Flanders. RESULTS: 1483 respondents are included. 93% are confronted monthly with falls. 96% believe they can make a positive contribution to fall prevention. At least once a year, respondents inquire about falls (62%) and screen for gait/balance problems (84%). A multifactorial assessment is performed in case of a recent fall (95%) or an increased fall risk (76%). Most frequently respondents give advice on safe environment/behaviour (93%), walking aid (91%), personal alarm system (89%) and footwear (85%). Unmotivated older persons (75%) who ignore their fall risk (85%), insufficient time (60%), financial compensation (54%), staff (50%), communication (31%) and knowledge (23%) are important barriers. CONCLUSIONS: Although respondents are aware of the importance of fall prevention, these results reveal a necessity of sufficient knowledge, structured multidisciplinary cooperation and a clear policy. Raising awareness of older persons remains crucial.
