General practice patients treated for substance use problems: a cross-national observational study in Belgium.

BACKGROUND: General Practitioners (GPs) are well placed to care for patients with (chronic) substance use problems. This pilot was carried out to study the feasibility and usefulness of a continuous surveillance of substance use problems among general practice patients. The objectives were (i) to describe variables with missing values exceeding 1% and whether patients were reported without substance-related problems; (ii) the profile and the magnitude of the patient population that is treated for substance use problems. METHODS: Observational study by the Belgian Network of Sentinel General Practices (SGP) in 2013. Baseline (at the first encounter) and 7-month follow-up data were reported of all patients treated for substance use problems. Two main measurements were type of substance use and patient status at follow-up. Multiple logistic regression analysis was used to examine patient status at follow-up. RESULTS: Of 479 patients, 47.2% had problems with alcohol alone, 20.3% with prescription drugs, 16.7% with illicit drugs other than heroin or methadone and 15.9% with heroin or methadone. Problems with alcohol alone were more prevalent in Flanders (53.0%; 95% confidence interval (CI) 46.8-59.1%) than in Wallonia-Brussels (39.8%; 95% CI 33.1-46.8%), while problems with heroin or methadone were more prevalent in Wallonia-Brussels (27.0%; 95% CI 21.1-33.5%) than in Flanders (7.1%; 95% CI 4.3-10.9%). At follow-up, 32.8% of the patients had dropped out, 29.0% had discontinued GP treatment and 38.2% had continued GP treatment. Overall, 32.4% of 479 patients had continued GP treatment for substance use problems during the study period. In Wallonia-Brussels, this proportion was higher (42.7%; 95% CI 35.9-49.6%) than in Flanders (24.3%; 95% CI 19.2-29.8%). CONCLUSIONS: A continuous surveillance of the general practice population treated for substance use problems seems to be feasible and useful. The latter is suggested by the specific profile and the relative magnitude of the population. Inter-regional health system differences should be taken into account to estimate the epidemiology of substance use problems among general practice patients.

Clinical action measures improve the reliability of feedback on quality of care in diabetes centres: a retrospective cohort study.

BACKGROUND: Assessment of quality of care using classical threshold measures (TM) is open to debate. Measures that take into account the clinician's actions and the longitudinal nature of chronic care are more reliable, although their major limitation is that they require more sophisticated electronic health records. We created a clinical action measure (CAM) for the control of LDL and non-HDL cholesterol from low-complexity data, and investigated how quality of care in individual diabetes centres based on the CAM is related to that based on the classical TM. METHODS: Data was used from 3421 diabetes patients treated in 95 centres, collected in two consecutive retrospective data collections. Patients met the TM when their index value was below target. Patients met the CAM when their index value was below target or above target but for whom treatment initiation or intensification, or possible contraindication, was indicated. RESULTS: Based on the TM, 60-70 % of the patients received good care. This percentage increased significantly using the CAM (+5 %, p < 0.001). At the centre level, the CAM was associated with a higher median score, and a change in position among centres ('poor', 'good' or 'excellent' performer) for 5-10 % of the centres. CONCLUSIONS: Judging quality of diabetes care of a centre based on a TM may be misleading. Low-complexity data available from a quality improvement initiative can be used to construct a more fair and feasible measure of quality of care.

Implementation of a quality improvement initiative in Belgian diabetic foot clinics: feasibility and initial results.

BACKGROUND: This article aims to describe the implementation and initial results of an audit-feedback quality improvement initiative in Belgian diabetic foot clinics. METHODS: Using self-developed software and questionnaires, diabetic foot clinics collected data in 2005, 2008 and 2011, covering characteristics, history and ulcer severity, management and outcome of the first 52 patients presenting with a Wagner grade ≥ 2 diabetic foot ulcer or acute neuropathic osteoarthropathy that year. Quality improvement was encouraged by meetings and by anonymous benchmarking of diabetic foot clinics. RESULTS: The first audit-feedback cycle was a pilot study. Subsequent audits, with a modified methodology, had increasing rates of participation and data completeness. Over 85% of diabetic foot clinics participated and 3372 unique patients were sampled between 2005 and 2011 (3312 with a diabetic foot ulcer and 111 with acute neuropathic osteoarthropathy). Median age was 70 years, median diabetes duration was 14 years and 64% were men. Of all diabetic foot ulcers, 51% were plantar and 29% were both ischaemic and deeply infected. Ulcer healing rate at 6 months significantly increased from 49% to 54% between 2008 and 2011. Management of diabetic foot ulcers varied between diabetic foot clinics: 88% of plantar mid-foot ulcers were off-loaded (P10-P90: 64-100%), and 42% of ischaemic limbs were revascularized (P10-P90: 22-69%) in 2011. CONCLUSIONS: A unique, nationwide quality improvement initiative was established among diabetic foot clinics, covering ulcer healing, lower limb amputation and many other aspects of diabetic foot care. Data completeness increased, thanks in part to questionnaire revision. Benchmarking remains challenging, given the many possible indicators and limited sample size. The optimized questionnaire allows future quality of care monitoring in diabetic foot clinics.

Falls among older general practice patients: a 2-year nationwide surveillance study.

BACKGROUND: Falling among older persons is a multifactorial health condition needing multifactorial care. Several targeted preventive interventions and their coordination are considered to be general practitioner (GP)-specific tasks. OBJECTIVES: To estimate the incidence of falls among older non-institutionalized general practice patients in Belgium (2009-10) and to describe the main characteristics of falls, fallers and fall risks; factors associated with multiple fall risks and the co-occurrence of fall risks; patient status 3 months later and care delivery. METHODS: A 2-year nationwide cross-sectional study based on data collected by the Belgian network of Sentinel General Practices on all non-institutionalized persons aged ≥65 years consulting their GP for new fall-related injuries. RESULTS: Baseline data were collected on 1503 persons and valid follow-up data were available on 715 persons (79%). The yearly incidence of older persons with fall-related injuries was estimated at 2.5% of the older general practice population; 39% of patients had also received hospital care, physician-specialist or nursing home care. A multifactorial risk profile was observed in 59% and associated with increasing age, recurrent falling, falling at home and during lower level activity. The clustering of frailty-specific fall risks was higher than expected by chance. At follow-up, 46% of at-risk patients had received physical therapy, 47% were using assistive devices, and medication had been reviewed in 28% of patients taking psychopharmacy and 17% of patients with polypharmacy. CONCLUSIONS: Our study shows a high burden of care for fall-related injuries in older general practice patients and provides baseline data for its future monitoring.

Availability of informal caregivers in surviving stroke patients in Belgium.

OBJECTIVE: To quantify the availability of informal caregivers in surviving stroke patients residing at home in Belgium. METHODS: National estimates on the availability of informal caregivers were made using data from a nationwide observational registration of family physicians working in sentinel practices and a nationwide administrative database for reimbursement of hospitals in Belgium. RESULTS: A total of 189 Belgian family physicians (FPs) from 141 practices participated in the study and recorded 326 patients (144 men and 182 women) with stroke. These FPs reach 1.5% of the Belgian population. After 1 month, 71% of the male and 75% of the female stroke survivors received support from family caregivers (p = 0.547). After 6 months, the percentage of male patients who received support from family caregivers decreased to 60% compared with 75% in female (p = 0.038). Of all patients with stroke admitted to Belgian hospitals during the reference year 2009 (n = 16.437), 8.997 returned home. Based on the findings from the sentinel practices, it is estimated that a mean of 73% (n = 6.568) and 67.5% (n = 6.073) of surviving patients with stroke can rely on informal caregivers in their home setting after one and 6 months, respectively. CONCLUSIONS: A vast majority of surviving stroke patients in Belgium can rely on informal caregivers in their home setting, but their availability rapidly decreases 6 months after the event. These findings underline the importance of proactive health policy making in stroke care taking into account the potentially decreasing number of available informal caregivers in the decades to come.

Nationwide continuous monitoring of end-of-life care via representative networks of general practitioners in Europe.

BACKGROUND: Although end-of-life care has become an issue of great clinical and public health concern in Europe and beyond, we lack population-based nationwide data that monitor and compare the circumstances of dying and care received in the final months of life in different countries. The European Sentinel GP Networks Monitoring End of Life Care (EURO SENTIMELC) study was designed to describe and compare the last months of life of patients dying in different European countries. We aim to describe how representative GP networks in the EURO SENTIMELC study operate to monitor end of life care in a country, to describe used methodology, research procedures, representativity and characteristics of the population reached using this methodology. METHODS: Nationwide representative Networks of General Practitioners (GPs)--ie epidemiological surveillance systems representative of all GPs in a country or large region of a country--in Belgium, The Netherlands, Italy and Spain continuously registered every deceased patient (>18 year) in their practice, using weekly standardized registration forms, during two consecutive years (2009-2010). RESULTS: A total of 6858 deaths were registered of which two thirds died non-suddenly (from 62% in The Netherlands to 69% in Spain), representative for the GP populations in the participating countries. Of all non-sudden deaths, between 32% and 44% of deaths were aged 85 or older; between 46% and 54% were female, and between 23% and 49% died at home. Cancer was cause of death in 37% to 53% of non-sudden death cases in the four participating countries. CONCLUSION: Via the EURO SENTI-MELC methodology, we can build a descriptive epidemiological database on end-of-life care provision in several EU countries, measuring across setting and diseases. The data can serve as baseline measurement to compare and monitor end-of-life care over time. The use of representative GP networks for end-of-life care monitoring has huge potential in Europe where several of these networks are operational.

Global quality indicators for primary care Electronic Patient Records.

Electronic Patient Records can be interfaced with medical decision support systems and quality of care assessment tools. An easy way of measuring the quality of EPR data is therefore essential. This study identified a number of global quality indicators (tracers) that could be easily calculated and validated them by correlating them with the Sensitivity and Positive Predictive Value (PPV) of data extracted from the EPR. Sensitivity and PPV of automatically extracted data were calculated using a gold standard constructed using answers to questions GPs were asked at the end of each contact with a patient. These properties were measured for extracted diagnoses, drug prescriptions, and certain parameters. Tracers were defined as drug-disease pairs (e.g. insulin-diabetes) with the assumption that if the patient is taking the drug, then the patient is suffering from the disease. Four tracers were identified that could be used for the ResoPrim primary care research database, which includes data from 43 practices, 10,307 patients, and 13,372 contacts. Moderately positive correlations were found between the 4 tracers and between the tracers and the sensitivity of automatically extracted diagnoses. For some purposes, these results may support the potential use of tracers for monitoring the quality of information systems such as EPRs.

Incidence, patient characteristics and treatment initiated for GP-diagnosed depression in general practice: results of a 1-year nationwide surveillance study.

BACKGROUND: Despite its public health significance, data about depression in general practice are often unavailable. OBJECTIVE: To study (i) the incidence of GP-diagnosed depression during 2008, (ii) associations between patient characteristics, appraised severity and initiated treatment, (iii) GPs' usual care compared to diagnostic criteria from Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition guidelines and the newly developed practice guideline of the Society of Flemish GPs (2008) and (iv) GPs' initiated treatments compared to the Flemish Guideline. METHODS: General practice-based data were collected on all patients of ≥18 years who were diagnosed by their GP with a new episode of depression in Belgian sentinel general practices (SGP) during 2008. RESULTS: Data on 1739 persons were recorded by 172 sentinel general practices. Incidence rates for GP-diagnosed depression were estimated at 719/100 000 men and 1440/100 000 women. Thirty-one per cent of patients had mild, 50% had moderate and 19% had severe GP-diagnosed depression. Although only 43% of the patients at risk for suicide were considered to have severe depression, having thoughts of death or suicide was the main factor associated with increased severity of depression. Seventy-five per cent of patients received a prescription for an antidepressive agent; 29% received a prescription for another psychoactive agent; in 36%, non-pharmaceutical support was initiated by the GP and 25% received a referral. In contrast with the Flemish GP guideline criteria: (i) 69% of patients with a new episode of mild or a first episode of moderate depression were prescribed an antidepressive agent and (ii) only 39% of the patients with severe depression were both prescribed an antidepressive agent and referred to a mental health service. CONCLUSIONS: This study has yielded original data on the incidence and management of depression in Belgian general practice. Our findings show that efforts are needed to improve depression management in Belgian general practice.

Short-term follow-up of patients diagnosed by their GP with mild depression or first-time moderate depression. Results of a 1-year nationwide surveillance study.

BACKGROUND: Despite its public health significance, data about depression in general practice are often unavailable or incomplete. OBJECTIVE: To study half-year follow-up data on patients diagnosed by their GP with a new episode of mild or a first episode of moderate depression, specifically: (i) treatment continuation, (ii) remission and, in ongoing episodes, suicidal behaviour and inability to work and (iii) the match between treatments initiated and delivered as well as the determinants of actual delivery of non-pharmacological support initiated by the GP for patients with ongoing depression. METHODS: General practice-based data were collected on all patients aged ≥18 years who were diagnosed by their GP with a new episode of depression in Belgian sentinel general practices during 2008. RESULTS: Follow-up data were available for 900 of 1048 patients. Complete treatment dropout was found in 9%, treatment discontinuation in 40% and a GP visit ≤8 weeks preceding the follow-up in 51%. Of the latter 457 patients, 60% were still depressed. Among these, one suicide attempt was reported and 24% were unable to work for ≥1 month. While 91% of the patients who received psychoactive agents at diagnosis had actually taken them, and 62% of the referred patients actually received treatment from another caregiver, non-pharmacological support by the GP was delivered in only 43% of patients for whom it was initiated. CONCLUSIONS: Half a year after diagnosis, half of patients continue to visit their GP and 60% of those patients remain depressed. The delivery of non-pharmacological GP support takes place for less than half of the patients for whom that intervention is initiated. Our follow-up findings reinforce the policy recommendations made by stakeholders, i.e. the introduction and reimbursement of a mental health consultation in family practice and integration of primary care psychologists. Quality improvement interventions may be a strategy to overcome premature discontinuation of non-pharmacological support by GPs.

Older people dying with dementia: a nationwide study.

BACKGROUND: Large-scale nationwide data describing the end-of-life characteristics of older people with dementia are lacking. This paper describes the dying process and end-of-life care provided to elderly people with mild or severe dementia in Belgium. It compares with elderly people dying without dementia. METHODS: A nationwide retrospective mortality study was conducted, via representative network of general practitioners (GPs) in 2008 in Belgium, with weekly registration of all deaths (aged ≥ 65) using a standardized form. GPs reported on diagnosis and severity of dementia, aspects of end-of-life care and communication, and on the last week of life in terms of symptoms that caused distress as judged by the GP, and the patients' physical and cognitive abilities. RESULTS: Thirty-one percent of our sample (1,108 deaths) had dementia (43% mildly, 57% severely). Of those, 26% died suddenly, 59% in care home, and 74% received palliative treatment, versus 37%, 19%, and 55% in people without dementia. GP-patient conversations were less frequent among those with (45%) than those without (73%) dementia, and 11% of both groups had a proxy decision-maker. During the last week of life, physical and psychological distress was common in both groups. Of older people with dementia, 83% were incapable of decision-making and 83% were bedridden; both significantly higher percentages than found in the group without dementia (24% and 52%). CONCLUSIONS: Several areas of end-of-life care provision could be improved. Early communication and exploration of wishes and appointment of proxy decision-makers are important components of an early palliative care approach which appears to be initiated too infrequently.

Quality assessment of automatically extracted data from GPs' EPR.

There are many secondary benefits to collecting routine primary care data, but we first need to understand some of the properties of this data. In this paper we describe the method used to assess the PPV and sensitivity of data extracted from Belgian GPs' EPR (diagnoses, drug prescriptions, referrals, and certain parameters), using data collected through an electronic questionnaire as a gold standard. We describe the results of the ResoPrim phase 2 project, which involved 4 software systems and 43 practices (10,307 patients). This method of assessment could also be applied to other research networks.

Nation-wide primary healthcare research network: a privacy protection assessment.

Efficiency and privacy protection are essential when setting up nationwide research networks. This paper investigates the extent to which basic services developed to support the provision of care can be re-used, whilst preserving an acceptable privacy protection level, within a large Belgian primary care research network. The generic sustainable confidentiality management model used to assess the privacy protection level of the selected network architecture is described. A short analysis of the current architecture is provided. Our generic model could also be used in other countries.

Excess of mortality in patients with chest pain peaks in the first 3 days period after the incident and normalizes after 1 month.

BACKGROUND: patients presenting with chest pain have a 5% chance of experiencing a coronary event. These patients are at risk of mortality and should be recognized and referred to secondary care. Aim. To determine the relationship between referral type and mortality in patients with chest pain. METHODS: the design of the study is an observational study. The setting of the study is a sentinel network of general practices in Belgium, covering 1.6% of the total population. The subjects are 1558 consecutive patients consulting with chest pain in 2003. Descriptive analyses report the standardized mortality ratios. We used the Belgian population of 1999 as the reference population and as the standard population. RESULTS: the standardized mortality ratios of 3 days were 151.0 [95% confidence interval (CI): 82.3-250.3] for the urgent referred group, 45.5 (95% CI: 12.4-116.0) for non-urgent and 13.6 (95% CI: 1.7-49.4) for the non-referred group. The standardized ratios of 1 month were, respectively, 27.6 (95% CI: 18.0-40.4), 6.7 (95% CI: 2.5-14.6) and 4.7 (95% CI: 1.9-9.7). The standardized ratios of 2-12 months were normal for the urgent referral group (1.3; 95% CI: 0.7-2.2) and for the non-urgent referral group (1.0; 95% CI: 0.5-1.9) and even less in the non-referred group (0.4; 95% CI: 0.2-0.9). CONCLUSIONS: mortality in the first 3 days and first month after consulting for chest pain is very high. There is a marked trend in mortality according to the referral type-urgently referred, non-urgently referred and not referred-suggesting risk stratification by the GP. After 1 month, mortality normalizes for all groups, suggesting that the surviving patients are well treated and the condition causing the chest pain no longer influences survival compared to the general population.

Readiness of the Belgian network of sentinel general practitioners to deliver electronic health record data for surveillance purposes: results of survey study.

BACKGROUND: In order to proceed from a paper based registration to a surveillance system that is based on extraction of electronic health records (EHR), knowledge is needed on the number and representativeness of sentinel GPs using a government-certified EHR system and the quality of EHR data for research, expressed in the compliance rate with three criteria: recording of home visits, use of prescription module and diagnostic subject headings. METHODS: Data were collected by annual postal surveys between 2005 and 2009 among all sentinel GPs. We tested relations between four key GP characteristics (age, gender, language community, practice organisation) and use of a certified EHR system by multivariable logistic regression. The relation between EHR software package, GP characteristics and compliance with three quality criteria was equally measured by multivariable logistic regression. RESULTS: A response rate of 99% was obtained. Of 221 sentinel GPs, 55% participated in the surveillance without interruption from 2005 onwards, i.e. all five years, and 78% were participants in 2009. Sixteen certified EHR systems were used among 91% of the Dutch and 63% of the French speaking sentinel GPs. The EHR software package was strongly related to the community and only one EHR system was used by a comparable number of sentinel GPs in both communities. Overall, the prescription module was always used and home visits were usually recorded. Uniform subject headings were only sometimes used and the compliance with this quality criterion was almost exclusively related to the EHR software package in use. CONCLUSIONS: The challenge is to progress towards a sentinel network of GPs delivering care-based data that are (partly) extracted from well performing EHR systems and still representative for Belgian general practice.

Symptoms and clinical signs associated with hospital admission and mortality for heart failure.

Little information is available on the predicting factors for hospitalisation and mortality in heart failure. The aim of this study was to determine the symptoms and clinical signs at the time of the diagnosis of heart failure that predict hospitalisation within the first month after diagnosis and mortality within the first six months after diagnosis. Data were prospectively collected during a two-year period by a nationwide network of sentinel family practices. All adult patients for whom the first time the diagnosis of heart failure was clinically suspected were registered. One, six and twelve months after the initial diagnosis, the family physicians completed a follow-up form with questions about the final diagnosis, evolution and outcome. In total 557 patients with confirmed heart failure were recorded (median age = 78 years). Hospitalisation within the first month after the diagnosis was best predicted by peripheral oedema (p = 0.001), nocturnal dyspnoea (p = 0.022) and pleural effusion (p = 0.032) at the time of the diagnosis. Six months after the initial diagnosis the mortality was 19% and after 12 months it was 26%. Mortality within the first six months after the diagnosis was best predicted by age (p < 0.001) and pulmonary rales (p = 0.001). Peripheral oedema appeared more among the survivors (p = 0.035). Peripheral oedema, nocturnal dyspnoea and pleural effusion are highly associated with hospitalisation within the first month after diagnosis.

The process of definitive institutionalization of community dwelling demented vs non demented elderly: data obtained from a network of sentinel general practitioners.

OBJECTIVE: The aim of the present study was to investigate the differences between characteristics of community dwelling demented and non demented elderly and their caregivers at the moment of definitive institutionalization. METHODS: The study is a cross-sectional analysis performed on data obtained from a Network of Sentinel General Practitioners. RESULTS: Older demented patients with several concomitant diseases were mainly placed because of unmanageable behavioral disturbances. Strikingly, these dementia patients were more often confronted with a time delay in definitive institutionalization due to their high care dependence. Although burden in the dementia family caregivers was an important motivation for definitive institutionalization, it did not seem to be a motive in the final institutionalization circumstances. CONCLUSIONS: Behavioral disturbances are independently of caregiver burden, professional support, or a spousal relationship the main direct reason for institutionalization of community dwelling demented elderly. The way caregivers feel supported might play the key role in the final placement decision.

Euthanasia and other end-of-life decisions: a mortality follow-back study in Belgium.

BACKGROUND: This study compares prevalence and types of medical end-of-life decisions between the Dutch-speaking and French-speaking communities of Belgium. This is the first nationwide study that can make these comparisons and the first measurement after implementation of the euthanasia law (2002). METHODS: We performed a mortality follow-back study in 2005-2006. Data were collected via the nationwide Sentinel Network of General Practitioners, an epidemiological surveillance system representative of all Belgian GPs.Weekly, all GPs reported the medical end-of-life decisions among all non-sudden deaths of patients in their practice. We compared the northern Dutch-speaking (60%) and southern French-speaking communities (40%) controlling for population differences. RESULTS: We analysed 1690 non-sudden deaths. An end-of-life decision with possible life-shortening effect was made in 50% of patients in the Dutch-speaking community and 41% of patients in the French-speaking community (OR 1.4; 95%CI, 1.2 to 1.8). Continuous deep sedation until death occurred in 8% and 15% respectively (OR 0.5; 95%CI, 0.4 to 0.7). Community differences regarding the prevalence of euthanasia or physician-assisted suicide were not significant.Community differences were more present among home/care home than among hospital deaths: non-treatment decisions with explicit life-shortening intention were made more often in the Dutch-speaking than in the French-speaking community settings (OR 2.2; 95%CI, 1.2 to 3.9); while continuous deep sedation occurred less often in the Dutch-speaking community settings (OR 0.5; 95%CI, 0.3 to 0.9). CONCLUSION: Even though legal and general healthcare systems are the same for the whole country, there are considerable variations between the communities in type and prevalence of certain end-of-life decisions, even after controlling for population differences.

Why does the general practitioner refer patients with chest pain not-urgently to the specialist or urgently to the emergency department? Influence of the certainty of the initial diagnosis.

BACKGROUND: Chest pain is an initial symptom for several minor diseases but acute myocardial infarction (AMI) should not be missed. AIM: To assess the influence of initial diagnosis and degree of certainty of this initial diagnosis on the referral decision and the referral method (urgent-non-urgent) in patients contacting their GP with chest pain. STUDY DESIGN: Observational study. SETTING: The study was performed in a sentinel network of general practices in Belgium, covering almost 1.6% of the population. SUBJECTS: All patients attending their GP and complaining of chest pain during 2003. METHOD: The relationships were reported as proportions and in odds ratios (OR) with their 95% confidence intervals. RESULTS: 1996 patients were included (men 52%). Men were referred more often (OR = 1.44; 95% CI: 1.13-1.82). Age shows no relation to referral (OR = 1.06; 95% CI: 0.83-1.35) but predicts urgent referral (OR = 1.46; 95% CI: 1.02-2.08). Odds ratios in case of serious heart disease were high with 11.58 (95% CI: 5.72-23.44) when the GP was certain of his diagnosis and 2.96 (95% CI: 1.59-5.51) if not. If the GP was uncertain, in all disease categories 54% (95% CI: 48-59) of the patients were referred non-urgently. CONCLUSION: Referral rates for patients with chest pain were influenced by the initial diagnosis and the degree of certainty of this initial diagnosis.

Primary healthcare research network: the Belgian ResoPrim recommendations.

Dedicated primary care research networks aim to gather and analyse data collected from general practioners' (GPs) electronic health records (EHRs). ResoPrim (2003-2008) was a Belgian multidisciplinary research project which was set up to provide recommendations for facilitating the organisation and management of these primary care research networks, assessing and improving opportunities for researchers working with available data from EHRs, and stimulating the involvement of GPs in such networks. This paper provides a short description of Resoprim's global methodology (which included 2 pilot phases involving 64 GPs and 6 different software systems), followed by the project's final recommendations.

Care of general practice patients preceding and following a suicide attempt: observational study in Flemish general practices.

OBJECTIVES: First, to examine general practitioner (GP) knowledge about the care (needs) of their patients; second, to examine the quality of GP follow-up care; third, to examine the transmission of patient care information from hospitals/emergency services (ES) to GPs. SETTING: 105 general practices from the representative Belgian Network of Sentinel General Practices (SGP) in Flanders, the largest region of Belgium, during 2013-2016. PARTICIPANTS: 245 suicide attempts by regular patients. OUTCOMES MEASURES: Ten care-related measures, including three indicators of quality of follow-up care, were based on data reported by the SGP on structured forms at baseline and at two follow-up points in time. RESULTS: As for GP knowledge, 10.5% of SGP failed to report whether suicidal risk was noticed in patients seen in the month preceding the attempt; 9.0% whether there were previous attempts; 22.5% whether the patient was receiving mental health treatment at follow-up and 22.0% whether suicidal behaviour was repeated at follow-up. Relatively more patients≥65 years had no suicide risk evaluation (OR 3.54; 95% CI 1.11 to 11.26). As for quality of follow-up care, there was a GP-patient contact following 90.5% of the attempts, follow-up appointments were planned following 43.4% of the attempts and there was a GP contact with patient proxies following 62.8% of the attempts. Patient age ≥65 years (OR 4.09; 95% CI 1.79 to 9.33), a recent GP-patient contact preceding the attempt (OR 1.97; 95% CI 1.13 to 3.43), depression of patient (OR 1.96; 95% CI 1.14 to 3.37) and a suburban SGP area (OR 2.34; 95% CI 1.13 to 4.82) were determinants of an increased quality of care sum. GPs received patient care information from a hospital (ES) for 67.8% of eligible attempts, with SGP practice location being a determinant. CONCLUSIONS: GPs are highly involved in the care of suicide attempters but there is room for improvement, also in informational continuity from hospital (ES) to GPs.