Pathway for inpatients with depressive episode in Flemish psychiatric hospitals: a qualitative study

<p>Abstract</p> <p>Background</p> <p>Within the context of a biopsychosocial model of the treatment of depressive episodes, a multidisciplinary approach is needed. Clinical pathways have been developed and implemented in hospitals to support multidisciplinary teamwork. The aim of this study is to explore current practice for the treatment of depressive episodes in Flemish psychiatric hospitals. Current practice in different hospitals is studied to get an idea of the similarities (outlined as a pathway) and the differences in the treatment of depressive episodes.</p> <p>Methods</p> <p>A convenience sample of 11 Flemish psychiatric hospitals participated in this qualitative study. Semi-structured interviews were conducted with different types of health care professionals (n = 43). The websites of the hospitals were searched for information on their approach to treating depressive episodes.</p> <p>Results</p> <p>A flow chart was made including the identified stages of the pathway: pre-admission, admission (observation and treatment), discharge and follow-up care. The characteristics of each stage are described. Although the stages are identified in all hospitals, differences between hospitals on various levels of the pathway exist. Hospitals emphasized the individual approach of each patient. The results point to a biopsychosocial approach to treating depressive episodes.</p> <p>Conclusion</p> <p>This study outlined current practice as a pathway for Flemish inpatients with depressive episodes. Within the context of surveillance of quality and quantity of care, this study may encourage hospitals to consider developing clinical pathways.</p

Folia en gecommentarieerd geneesmiddelenrepertorium: opinie lezers en leesgedrag bemoedigen en verrassen

The publications of the Belgian Centre for Pharmacotherapeutic Information (BCPI) aim to provide actual pharmacotherapeutic information for doctors, dentists and pharmacists. An inquiry among a representative sample of readers was set up in order to reveal possibilities for optimisation of the tools used. The frequency of reading and consulting was satisfying, at least for the Folia Pharmacotherapeutica and for the National Formulary. Information cards of newly registered drugs were less frequently consulted. The website is only known by a minority. Readers do generally not have major objections as to the formal aspects of the publications by the BCPI. A few adaptations could be taken into consideration. The publications of the BCPI are considered as disseminating reliable information. This information is mainly used to recall or to enrich knowledge. Prescription or delivery behaviour is however not strongly influenced by the information provided. In the near future complementarity between electronic and written media will be considered. Using the sources of the BCPI in continuing education and medical decision making is another important item.status: publishe

Empirical management of community-acquired pneumonia: impact of concurrent A/H1N1 influenza pandemic on guideline implementation

Background: Guideline-concordant therapies have been proven to be associated with improved health and economic outcomes in the treatment of community-acquired pneumonia (CAP). However, actual use of CAP guidelines remains poor, but using tailored interventions looks promising. Based on local observations, we assessed the impact of low-intensity interventions to improve guideline use. Methods: Pre- and post-intervention study with segmented regression analysis in a large tertiary care centre [University Hospitals Leuven (UZL)] and a smaller secondary care control hospital [Ziekenhuis Oost-Limburg (ZOL)] from October 2007 through to June 2010 in Belgium. Results: A total of 477 patients were included in UZL, with 58.5% of the patients treated according to local guidelines. Guideline adherence remained stable, but a decrease (-28.6%; P=0.021) was observed during guideline re-introduction in October 2009. Further analysis showed a high correlation with the concurrent A/H1N1 influenza pandemic (r(point-biserial)=0.683; P=0.045) and with suspected influenza infection (odds ratio=2.70; P=0.038). In ZOL, 326 patients were enrolled, with 69.3% being treated concordantly. A similar, non-significant decrease in guideline adherence was observed after October 2009. Conclusions: Our interventions did not lead to a higher proportion of CAP patients receiving guideline-compliant therapy. Instead, a compliance decrease was observed, coinciding with the peak in the A/H1N1 pandemic in the population. Similar observations could be made in ZOL. The widespread attention for this pandemic may have altered the perception of needed antibiotic therapy for pulmonary infections, bypassing our interventions and decreasing actual guideline compliance. Increased vigilance and follow-up is needed when epidemics with similar impact occur in the future