Communicable disease control--still a core public health function.
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Communicable Disease Control↗
Biomedical subjects
Viviane Van Casteren
Publications and source records attributed to Viviane Van Casteren.
Research networks: can we use data from GPs' electronic health records?
As widely discussed in the literature, there are many potential scientific usages of data extracted from the primary care Electronic Health Records (EHR), such as quality of care, epidemiological or socio-economical studies. Yet, can we use the current available data in the EHR for such purposes? In this paper, our objective is to report on the preliminary findings of the Belgian ResoPrim project (2003-2005) to answer the question. We set up a semi-anonymous network involving 26 current practices (28 volunteer GPs), 3 different EHR software systems and two Trusted Third Parties. Based on a literature overview we identified 27 research questions to be answered using 50 indicators. The study design includes retrospective (2002-2004) and prospective (6 weeks) data collection processes around the theme of "Hypertension and cardiovascular risk factors". For some data sets, the data extraction was a full automatic procedure, for some others, the data extraction was related to an input from the GPs allowing some comparisons between both procedures. At this stage, we performed an extended descriptive analysis of our data. Retrospectively we collected data related to 42,217 patients and 203,128 contacts. Prospectively we collected data for 9,236 patients and 15,234 contacts. Our main findings are briefly presented and discussed in this paper. The most promising fields seem to be the Health Research Information Systems assessment and the quality of care studies. It is quite too soon to reach the expected theoretical benefits for epidemiologic and socio-economic studies, yet some progresses could be made in relation with the denominator issue. Based on our preliminary findings and hypotheses, further analyses are foreseen during the second phase of the project (2006-2007).
Belgium↗
An 8 year nationwide prospective registration of non-consented HIV testing in Belgium.
BACKGROUND: Little information is available on the number of HIV tests that are carried out without the patient's consent. The aim of this study was to find out about the number of HIV tests for which the specific consent of the patient was not obtained and to describe the circumstances in which these tests were carried out. METHODS: Since 1993 a representative network of sentinel general practitioners (GPs) has recorded data about requests for HIV tests, risk behaviour and the patient's awareness about the test. RESULTS: In total 11,660 HIV tests were recorded and for 3628 tests the question about patient awareness was completed. Although non-consensual HIV testing (NHT) is against European guidelines on informed consent, 453 tests were performed without informed consent. Of the 292 participating GPs, 17.5 per cent never completed the question about the patient's awareness and 35.6 per cent performed at least one non-consensual HIV test. For 28.9 per cent of NHT, no risk behaviour for HIV infection was identified and for 43.4 per cent the risk behaviour was unknown. NHT was recurrent for patients with suggestive symptoms (22.7 per cent), patients consulting for a check-up (21.1 per cent) and women consulting for antenatal care (12.8 per cent). CONCLUSION: Never before have figures been available about NHT forthcoming from a prospective registration including such a large number of tested subjects. Physicians should be reminded once more about the unacceptability of NHT. Instead of performing a non-consensual HIV test, physicians should invest more time in pre-test counselling, especially in those patients with a higher risk or with suggestive symptoms for HIV.
AIDS Serodiagnosis↗
Quality of care assessment using GPs' electronic patient records: do we need data from home visits?
The paper tackles the topic of collecting data from home visits using the electronic patient record (EPR) of general practitioners (GPs), in a context with a high proportion of home visits in primary care. Since data from home visits, representing about 40% of GPs' consultations in Belgium, are rather scarcely recorded in the EPR, we wanted to study the impact of not taking into account home visits for quality assessment in primary care. Five quality indicators, which measured the accordance of the delivered care with guidelines on the management of osteoarthritis, were compared between a pooled database (consultations and home visits) and a restricted database (after removal of home visits). Our findings suggest that removing home visits from a database collected from primary care may provide a slight modification of the estimate of the quality of care, whereas conclusions on quality improvement remain relatively stable. Quality of care assessment with the EPR of GPs seems not to be dramatically hampered by the poor recording rate of home visits in the EPR.
Belgium↗
Non-consented HIV testing by Belgian general practitioners.
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AIDS Serodiagnosis↗
Registration of stroke through the Belgian sentinel network and factors influencing stroke mortality.
INTRODUCTION: Stroke is one of the leading causes of death. Belgian stroke mortality rates are only available from the death certificates notification. OBJECTIVES: To estimate stroke incidence, mortality and case fatality, to compare our figures with those available from the death certificates notification and from neighboring countries, and identifying factors influencing survival. METHODS: A nationwide prospective registration by 178 Belgian general practitioners recording all cerebrovascular events in 1998-1999. All events, including those for which medical care was immediately found in hospital, were included. RESULTS: The yearly age-and-gender-adjusted stroke attack rates were estimated at 185 cases per 100,000 inhabitants (95% CI = 169-202). After 12 months, 47% of the patients died, resulting in an estimated yearly stroke mortality rate of 88 per 100,000 inhabitants (95% CI = 73-105). The case fatality rate among men (39%; 95% CI = 29-51) was lower than among women (50%; 95% CI = 39-63) (p < 0.05). In a forward stepwise logistic regression diabetes, stroke history, hemorrhagic stroke, coma, swallow deficit and urinary incontinence had a negative influence on stroke survival. Treated hypertension had a beneficial effect on survival. CONCLUSIONS: Stroke mortality rates estimated by the sentinel practices are fairly comparable with those based on the death certificates notification. The stroke attack rates correspond with those of neighboring countries. The role of treated hypertension on the outcome of strokes remains controversial in this registration.
Age Distribution↗
The diagnostic value of macroscopic haematuria for the diagnosis of urological cancer in general practice.
BACKGROUND: The diagnostic value and the impact of some signs and symptoms in most diseases in primary care have only been studied incompletely. AIM: To assess the diagnostic value of macroscopic haematuria for the idagnosis of urological cancer (bladder, kidney) in a general practice setting, as well the influence of age, sex, and some additional signs and symptoms. DESIGN OF STUDY: Diagnostic study. SETTING: The study was performed in a sentinel station network of general practices in Belgium, covering almost 1% of the population. SUBJECTS: All patients attending their general practitioner and complaining of haematuria during 1993 and 1994 were included for the prospective part of the study. Every patient diagnosed with a urological cancer in this period was registered for the retrospective part. METHOD: Mean outcome measures of sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratio were used to assess diagnostic value. RESULTS: Within the registration year 1993-1994, patient-doctor encounters, related to 83,890 patient-years, were registered. The positive predictive value (PPV) for urological cancer was 10.3% (95% CI = 7.6% to 13.7%). Sensitivity was 59.5% (95% CI = 50.4% to 60.1%). The PPV of patients aged over 60 years was 22.1% (95% CI = 15.8% to 30.1%) for men and 8.3% (95% CI = 3.4% to 17.9%) for women. In the age group 40 to 59 years, the PPV was 3.6% (95% CI = 0.6% to 13.4%) for men and 6.4% (95% CI = 1.7% to 18.6%) for women. In the prospective part of the study, no urological cancer was found in the age group under 40 years. CONCLUSION: Men older than 60 years of age with macroscopic haematuria have a high positive predictive value for urological cancer. In these patients, a thorough investigation is indicated. In patients over 40 years of age of either sex, referral or watchful waiting can be justified.
Adult↗
How are patients informed about their HIV test results?
BACKGROUND: AIDS and HIV are hot topics in public health nowadays, but little information is available about the way in which HIV test results are communicated to patients. OBJECTIVE: Our aim was to find out about the way in which patients are informed about their HIV test results and the delay they experience. METHOD: Since 1996, a representative network of sentinel GPs has recorded data about requests for HIV tests, risk factors and the way in which and the delay with which patients are informed about their HIV test results. RESULTS: Between 1996 and 1999, 4807 requests for an HIV test were recorded. Test results were given mostly by phone (41.9%). Patients at risk were informed more often during a planned follow-up. Anxious patients were informed more often about the results by phone, and in 61.2% test results were communicated during the first week following the test. Results were given earlier if patients were anxious or had themselves asked for the test. Although non-consensual HIV testing is against the European guidelines on informed consent, 102 tests (2.2%) were performed without informed consent. CONCLUSIONS: Even though notification by phone decreases the delay, physicians should be encouraged to make follow-up appointments to inform the patient about the test results. A face-to-face conversation is the only way in which physicians can offer valuable post-test counselling. Physicians should be informed about the unlawfulness of non-consensual HIV testing.
Belgium↗
Newly diagnosed type 2 diabetic population in Belgium.
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Adult↗
The added value of the registration of home accidents in general practice.
OBJECTIVES: To determine the number, the nature and the circumstances of home accidents managed in general practices, and to compare the results with the European Home and Leisure Accidents Surveillance System (EHLASS) data. DESIGN: A prospective population survey of all domestic accidents managed in 138 sentinel general practices during 1995/96. SETTING: Primary health care. SUBJECTS: In total, 4481 patients were included, of which 58% were female. MAIN OUTCOME MEASURES: The incidence of domestic accidents managed in general practices; the nature and place of the accident; the nature of the injury; the predisposing factors and related products. RESULTS: The highest incidence of home accidents was measured among children and the elderly. The median age was significantly lower for men (36 years) than for women (54 years). Among women, 74% of all home accidents were the result of a fall. The lesion is often a contusion or wound. Fractures were recorded in 20% of all home accidents. Three-quarters of all fractures involved women, especially older women. Most accidents among women (80%) occurred during motion and housework. Among men, 65% of all home injuries occurred during motion and do-it-yourself jobs. CONCLUSION: Because of the close relation with most patients and a knowledge of their living conditions, the GP is able to provide more reliable information on the circumstances of accidents than are health care providers in hospitals. The prevention of home accidents should at least partly be based on the results provided by general practitioners.
Accidents, Home↗
The incidence of stroke and transient ischaemic attacks is falling: a report from the Belgian sentinel stations.
BACKGROUND: Increasing as well as decreasing trends in stroke incidence have been described. AIM: To examine time trends associated with the incidence of stroke and transient ischaemic attacks (TIAs) within an ongoing registration network. DESIGN OF STUDY: Analysis of data from a network of sentinel practices. SETTING: Sentinel practice population (approximately 1.4% of the total Belgian population. METHOD: Attack incidence rates of both stroke and TIA were studied at four one-year registration periods between 1984 and 1999. RESULTS: The number of events identified as stroke was 1097 (513 in males and 584 in females). The percentage of first-ever stroke was 69%, 64%, and 70% in 1989, 1998, and 1999 respectively. The number of events identified as TIAs was 382 (165 in males and 217 in females). The percentage of first-ever TIA was 65%, 69%, and 75% in 1989, 1998, and 1999 respectively. Yearly age-standardised attack rates of stroke significantly decreased during the registration period from 2.86 per 1000 in 1984, to 1.62 per 1000 in 1999 (chi2 for trend, P = 0.04) in males and from 2.97 per 1000 to 1.96 per 1000 (P = 0.007) for females. The decrease was restricted to subjects aged over 60 years. For TIA, a significant decrease (P = 0.014) was identified in females, but not in males (P = 0.61). Crude attack rates of stroke also significantly decreased, with an overall decrease between 1984 and 1999 of 37% in males and 26% in females. No such trend was found for TIA (P = 0. 63 for males and P = 0.35 for females). CONCLUSION: Both crude and age-standardised attack rates of stroke show a clear and significant decrease between 1984 and 1999. For TIA, a weaker trend was identified.
Aged↗