Professionals' treatment goals for long-term benzodiazepine and Z-drugs management: a qualitative study.

BACKGROUND: Benzodiazepines and Z-drugs (BZD/Z) are frequently prescribed for longer than recommended. Through their interactions with patients taking BZD/Z, primary care and mental health professionals play a key role in the management of this medication. AIM: To explore how primary care and mental health care professionals set treatment goals with users of long-term BZD/Z. DESIGN & SETTING: A qualitative study using semi-structured interviews with professionals from mental health, addiction care, and primary care practices in Belgium. METHOD: Semi-structured interviews were conducted, online and in person, with 24 professionals working in mental health and primary care. Inductive thematic content analysis was performed. RESULTS: Seven themes were identified from the analysis. Professionals tended not to use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) standard to diagnose a BZD/Z substance use disorder. They described criteria based on their experience. They identified diverse types of patients that influence their choice of treatment goals. Professionals appeared to position themselves according to their own treatment goals for their patients, either by promoting the goal of abstinence or harm reduction. Some of them reported feeling trapped into continuing to prescribe and considered BZD/Z withdrawal to be difficult. Some were afraid to engage in a conversation that might break the bond of trust with the patient. Few professionals mentioned patient participation in the treatment goal setting. They asked for targeted withdrawal recommendations, perceiving the current recommendations to be too broad. CONCLUSION: Whether primary care or mental health care professionals are more in favour of a total abstinence or a harm reduction approach to BZD/Z, professionals should be guided towards greater patient participation in setting and evaluating goals with patients taking BZD/Z.

[Functional disorders in primare care]. / Les troubles fonctionnels en Médecine générale.

General practitioners frequently encounter patients with functional disorders. The authors discuss the specific aspects of the management of this population in general practice, through the lens of the five functions that define this discipline. A classification of functional disorders and the analysis of prognostic factors are of great value in deciding on therapeutic strategies. The general practitioner can contribute to the disappearance of mild functional disorders by listening to the patient and by providing appropriate patient centered care. More severe situations are rarer and require a multidisciplinary approach to which the general practitioner should contribute.

Le médecin généraliste rencontre fréquemment des patients atteints de troubles fonctionnels. Les auteurs évoquent les aspects spécifiques de leur prise en charge en Médecine générale, sous le prisme des cinq fonctions qui définissent cette discipline. Une classification des troubles fonctionnels et l'analyse des facteurs de pronostic sont d'une grande utilité, pour décider des orientations thérapeutiques. Par une prise en charge adaptée, centrée sur le patient et sur son écoute, le médecin généraliste peut contribuer à la disparition des troubles fonctionnels légers. Les situations plus sévères sont plus rares. Elles nécessitent une prise en charge pluridisciplinaire à laquelle il est souhaitable que le médecin généraliste apporte sa contribution.

[Summary Community Health Centers in Belgium: thinking health out of the box]. / Les maisons médicales en Belgique : la santé dans tous ses états.

The federation of community health centersa includes 130 practices in French-speaking Belgium. They are organized as self-managed practices, which enables a certain equality between the workers in the team in terms of shared decision. Moreover, these care structures are organized as multidisciplinary teams and most of the time choose a capitation-fee payment for their services. This method of remuneration makes it possible to increase proactivity and improve prevention and health promotion, which are at the heart of the challenges for primary care. The center in Trooz illustrates this organization around the concept of community health. The active participation of patients in the project is at the center of the concerns to achieve patient-centered care.

La Fédération des maisons médicales (FMM) regroupe 130 pratiques en Belgique francophone. Elles sont organisées en autogestion, ce qui confère une certaine égalité entre les travailleurs de l'équipe quant aux décisions prises. Par ailleurs, ces structures de soins sont organisées en pratique multidisciplinaire et optent, la plupart du temps, pour un paiement forfaitaire de leurs prestations. Ce mode de rémunération permet d'augmenter la proactivité et d'améliorer la prévention et la promotion à la santé qui sont au cœur des défis de la première ligne. La maison médicale de Trooz illustre cette organisation autour du concept central de la santé communautaire. La participation active des patients dans le projet est au cœur des préoccupations pour réaliser une réelle approche centrée sur leurs besoins.

Interprofessional collaboration between general practitioners and primary care nurses in Belgium: a participatory action research.

Given the sociodemographic challenges facing the Belgian primary care system, it is essential to strengthen interprofessional collaboration (IPC) between healthcare providers. Therefore, our aims for this study were to assess IPC between general practitioners (GPs) and nurses; identify target priorities for improving IPC; and facilitate the planning and implementation of the proposed improvement strategies. Based on diversity criteria, six groups of GPs and nurses were chosen for a participatory action research. Participants performed a SWOT analysis of their IPC to identify strengths and weaknesses of their collaboration practice configurations. Main factors limiting IPC were related to the type of financing system which impeded or facilitated multidisciplinary team meetings, a weak functional integration, and a lack of interprofessional education. Overall, communication and task delegation were co-identified as common priorities. Actions prioritized by each group were related to these two priorities and accounted for local, specific needs. Communication could be supported through improved tools and dedicating time for multidisciplinary team meetings. Task delegation was more challenging and raised questions related to nurses' training, legislation, and payment systems. IPC seems to be easier to achieve when healthcare professionals belong to the same organization and consider themselves a team.

Mapping the current knowledge in syndemic research applied to men who have sex with men: a scoping review protocol.

INTRODUCTION: Men who have sex with men (MSM) are disproportionally affected by a number of health conditions that are associated with violence, stigma, discrimination, poverty, unemployment or poor healthcare access. In recent years, syndemic theory provided a framework to explore the interactions of these health disparities on the biological and social levels. Research in this field has been increasing for the past 10 years, but methodologies have evolved and sometimes differed from the original concept. The aim of this paper is to provide an overview of the existing literature on syndemic theory applied to MSM in order to identify knowledge gaps, inform future investigations and expand our understanding of the complex interactions between avoidable health conditions in a vulnerable population. METHODS AND ANALYSIS: The proposed scoping review will follow the methodological framework developed by Arksey and O'Malley with subsequent enhancements by Levac et al, Colquhoun et al and Peters et al as well as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review. A systematic search of MEDLINE, PsycInfo, Scopus, Cochrane Central Register of Controlled Trials and ProQuest Sociological Abstracts will be conducted. Reference lists of the included studies will be hand-searched for additional studies. Screening and data charting will be achieved using DistillerSR. Data collating, summarising and reporting will be performed using R and RStudio. Tabular and graphical summaries will be presented, alongside an evidence map and a descriptive overview of the main results. ETHICS AND DISSEMINATION: This scoping review does not require ethical approval. Data and code will be made accessible after manuscript submission. Final results will be disseminated through publication in a peer-reviewed journal and collaboration with grassroots Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual (LGBTQIA+) organisations. REGISTRATION: This protocol was registered on manuscript submission on the Open Science Framework at the following address: https://osf.io/jwxtd; DOI: 10.17605/OSF.IO/JWXTD.

[Health literacy, a lever to make health care systems more equitable? Tools to support professionals and involve institutions]. / 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.

[From chronic disease to multimorbidity: Which impact on organization of health care]. / De la maladie chronique à la multimorbidité : quel impact sur l'organisation des soins de santé ?

Healthcare systems are concerned with the growing prevalence of chronic diseases. Single disease approach, based on the Chronic Care Model, is known to improve specific indicators for the targeted disease. However, the co-existence of several chronic disease, or multimorbidity, within a same patient is the most frequent situation. The fragmentation of care, as consequence of the single disease approach, has negative impact on the patient and healthcare professionals. A person centred approach is a method addressing the combination of health issues of each patient. The coordination and synthesis role is key to ensure continuity of care for the patient within a network of healthcare professionals from several settings of care. This function is the main characteristic of an organized first level of care.

[HIV infection. A chronic disease that redefines collaboration between general practitioners and specialists. A qualitative study on opportunities and obstacles to collaboration]. / L’infection par le VIH : une maladie chronique redéfinissant la collaboration entre généralistes et spécialistes. Obstacles et opportunités.

PURPOSE: With the development of antiretroviral therapy, Human Immunodeficiency Virus [HIV) infection has become a chronic disease. In order to develop an efficient response to this new challenge, there is a need for closer collaboration between specialized units and general practitioners. This article identifies the opportunities for and the barriers to this collaboration. METHODS: Semi-structured interviews were conducted with patients living with HIV, general practitioners working in multidisciplinary group practice using the capitation system and infectiologists from one Belgian urban area. Interviews focused one xperiences and expectations in relation to diagnosis, follow-up and collaboration between general practitioners and infectiologists. RESULTS: Overall, infectiologists and general practitioners aspire to improved communication and collaboration. There are overlaps between general practitioner's and infectiologist's field of action. The general practitioner's intervention is sometimes restricted to common uncomplicated or psychosocial problems, in the context of unplanned and short contacts.Infectiologists prefer to focus on HIV problems, leaving general practitioners to take care of these patients' other health problems. The patient may be an obstacle to greater involvement of general practitioners due to fear of stigmatization from his family and social circle or lack of confidence in the general practitioner's skills. CONCLUSION: This research underlines the difficulties and gaps in the care of HIV patients and provides preliminary explanations for the lack of active cooperation between general practitioners and infectiologists. Overlaps between the areas of professional skills can result in uncovered aspects of care, which can have a negative impact on patients, but also on general practitioners and infectiologists. Collaboration between general practitioners and infectiologists should be based on a concerted decision, with clear allocation of tasks, taking into account the patient's expectations.

[Criteria of the patient's decision concerning vaccination against influenza AH1N1, in Belgium and France]. / Critères de décision du patient concernant la vaccination contre la grippe AH1N1, en Belgique et en France.

INTRODUCTION: We have analyzed the reasons evoked by the patients to decide or not to be vaccinated against AH1N1 influenza, in France and Belgium. METHODS: Semi-structured interviews were performed, recorded and transcribed for analysis. Fifty-eight interviews were performed with patient living in the region of Midi-Pyrénées, France (21 interviews) and in the province of Liège, Belgium (37 interviews). The patients were recruited by general practitioners. Within the sample, some patients were vaccinated against AH1N1 influenza and others were not. RESULTS: Five criteria influenced the decision to be vaccinated or not: how people understand the epidemic and the threats it represents; their representation about the vaccine (and its harmlessness); their beliefs and representations about vaccination; the influence of the health professionals' opinion; the discussions between the patient and his acquaintances; and how the patient seeks for information. CONCLUSION: These elements can be considered as criteria influencing the decision about any vaccination. They reflect the patient's subjectivity, the patient's perception of vaccination. Investigating these dimensions in the patient's mind can help the practitioner to positively influence the reluctant patients. Identifying threats and received ideas should allow the doctor to correct them and accept vaccination.

Effect of an audiovisual message for tetanus booster vaccination broadcast in the waiting room.

BACKGROUND: General practitioners (GPs) often lack time and resources to invest in health education; audiovisual messages broadcast in the waiting room may be a useful educational tool. This work was designed to assess the effect of a message inviting patients to ask for a tetanus booster vaccination. METHODS: A quasi experimental study was conducted in a Belgian medical practice consisting of 6 GPs and 4 waiting rooms (total: 20,000 contacts/year). A tetanus booster vaccination audiovisual message was continuously broadcast for 6 months in 2 randomly selected waiting rooms (intervention group--3 GPs) while the other 2 waiting rooms remained unequipped (control group--3 GPs). At the end of the 6-month period, the number of vaccine adult-doses delivered by local pharmacies in response to GPs' prescriptions was recorded. As a reference, the same data were also collected retrospectively for the general practice during the same 6-month period of the previous year. RESULTS: During the 6-month reference period where no audiovisual message was broadcast in the 4 waiting rooms, the number of prescriptions presented for tetanus vaccines was respectively 52 (0.44%) in the intervention group and 33 (0.38%) in the control group (p = 0.50). By contrast, during the 6-month study period, the number of prescriptions differed between the two groups (p < 0.0001), rising significantly to 91 (0.79%) in the intervention group (p = 0.0005) while remaining constant in the control group (0.38% vs 0.39%; p = 0.90). CONCLUSIONS: Broadcasting an audiovisual health education message in the GPs' waiting room was associated with a significant increase in the number of adult tetanus booster vaccination prescriptions delivered by local pharmacies.