How do patients with uncontrolled diabetes in the Brussels-Capital Region seek and use information sources for their diet?

OBJECTIVE: The aim of this study was to obtain qualitative data to understand how type 2 diabetic patients with unregulated blood glucose levels (HbA1c >140 mg/dL) seek and use information sources for their diet. METHODS: A descriptive, explorative study design was used with focus group interviews in the Brussels-Capital Region. Each interview was recorded, transcribed literally, and analysed thematically using a grounded theory approach. RESULTS: GPs were the most important information source in this study. GPs and other professionals were considered to be reliable sources of information by the patients. All patients received information passively at diagnosis. Patients that actively sought information differed in their search behaviour and reported they were not sufficiently informed. Some information sources remained unknown to the diabetic patients in this study. CONCLUSION: Diabetic patients of the Brussels-Capital Region are not well informed about their diet. The main problem is how patients perceived the accessibility of information. Practice implications Public health strategies are required to promote well-informed, proactive patients supported by healthcare teams.

The impact of care pathways for patients with proximal femur fracture: rationale and design of a cluster-randomized controlled trial.

BACKGROUND: Proximal femur fracture (PFF) is associated with considerable morbidity and mortality. The European Quality of Care Pathway (EQCP) study on PFF (NCT00962910) was designed to determine how care pathways (CP) for hospital treatment of PFF affect consistency of care, adherence to evidence-based key interventions, and clinical outcome. METHODS/DESIGN: An international cluster-randomized controlled trial (cRCT) will be performed in Belgium, Ireland, Italy and Portugal. Based on power analyses, a sample of 44 hospital teams and 437 patients per arm will be included in the study. In the control arm, usual care will be provided. Experimental teams will implement a care pathway which will include three active components: a formative evaluation of quality and organization of the care setting, a set of evidence-based key interventions, and support of the development and implementation of the CP. Main outcome will be the six-month mortality rate. DISCUSSION: The EQCP study constitutes the first international cRCT on care pathways. The EQCP project was designed as both a research and a quality improvement project and will provide a real-world framework for process evaluation to improve our understanding of why and when CP can really work. TRIAL REGISTRATION NUMBER: NCT00962910.

The impact of care pathways for exacerbation of Chronic Obstructive Pulmonary Disease: rationale and design of a cluster randomized controlled trial.

BACKGROUND: Hospital treatment of chronic obstructive pulmonary disease (COPD) frequently does not follow published evidences. This lack of adherence can contribute to the high morbidity, mortality and readmissions rates. The European Quality of Care Pathway (EQCP) study on acute exacerbations of COPD (NTC00962468) is undertaken to determine how care pathways (CP) as complex intervention for hospital treatment of COPD affects care variability, adherence to evidence based key interventions and clinical outcomes. METHODS: An international cluster Randomized Controlled Trial (cRCT) will be performed in Belgium, Italy, Ireland and Portugal. Based on the power analysis, a sample of 40 hospital teams and 398 patients will be included in the study. In the control arm of the study, usual care will be provided. The experimental teams will implement a CP as complex intervention which will include three active components: a formative evaluation of the quality and organization of care, a set of evidence based key interventions, and support on the development and implementation of the CP. The main outcome will be six-month readmission rate. As a secondary endpoint a set of clinical outcome and performance indicators (including care process evaluation and team functioning indicators) will be measured in both groups. DISCUSSION: The EQCP study is the first international cRCT on care pathways. The design of the EQCP project is both a research study and a quality improvement project and will include a realistic evaluation framework including process analysis to further understand why and when CP can really work. TRIAL REGISTRATION NUMBER: NCT00962468.

Atherosclerotic cardiovascular diseases in Belgium: a cost-of-illness analysis.

PURPOSE: This study aims to quantify costs of atherosclerotic cardiovascular diseases in Belgium in 2004. METHODS: Costs were estimated using data on prevalence, healthcare resource utilization and unit costs. Healthcare costs included expenditure on ambulatory care, hospital inpatient care, emergency care, and medications. Costs of prevention campaigns and costs of productivity loss were also included. RESULTS: Costs amounted to 3.5 billion euros in Belgium in 2004. Total costs consisted of 80 million euros related to prevention and screening, 1.3 billion euros related to pre-clinical disease, and 2.2 billion euros related to established disease. These costs were incurred by the Belgian third-party payer (58% of costs), patients (10%) and third parties (i.e. employers and supplementary health insurance) (32%). CONCLUSIONS: Atherosclerotic cardiovascular diseases impose a significant economic burden on Belgian society.