Showing papers by "Thierry Christiaens published in 2010"

Qualitative insights into general practitioners views on polypharmacy

Abstract: Background: Polypharmacy is common among older people. The purpose of this study is to describe GPs’ views and beliefs on polypharmacy in order to identify the role of the GP in relation to improving prescribing behaviour. The awareness of these often established beliefs is key for understanding behaviour and promoting change which can guide action towards more rational prescribing. Methods: A qualitative descriptive methodology was used with semi-structured interviews. Interviews were conducted with 65 GPs from the region of Aalst, a district of a mixed urban and rural population in Belgium. The aim of the study was to describe the GPs’ perspectives on polypharmacy in primary care. Results: GPs acknowledge that polypharmacy is a problem in their older patient population, especially because of the risk of adverse drug reactions, interactions and lowered adherence. GPs mention that difficulties in keeping an overview of the exact medication intake is an important problem caused by polypharmacy. The patients’ strong belief in their medication and self-medication are seen as important barriers in reducing the number of drugs taken. Next to these patient related factors, there are some factors related to the prescriber, such as the lack of regular evaluation of the medication schedule by GPs and the involvement of several prescribers, especially in a hospital setting. According to the respondents, prevention and evidence based medicine guidelines often induce polypharmacy. Conclusions: GPs point out that polypharmacy is an important problem in their older patient population. They see an important role for themselves in optimizing drug regimens for their patients. However, they do not have a readymade solution for polypharmacy. The limited set of options for addressing polypharmacy leave GPs feeling powerless to tackle the problem. There is a need for simple GP friendly tools and access to pharmacotherapeutic advice. Future research in this area and interventions seeking to improve prescribing for the elderly will have to focus on practical tools and take into account the GPs’ sense of helplessness.

Barriers to nonpharmacologic treatments for stress, anxiety, and insomnia Family physicians’ attitudes toward benzodiazepine prescribing

Abstract: OBJECTIVE To explore the attitudes of FPs toward benzodiazepine (BZD) prescribing and the perceived barriers to nonpharmacologic approaches to managing stress, anxiety, and insomnia. DESIGN A questionnaire including 32 statements about treatment of insomnia, stress, and anxiety. SETTING Local quality groups for FPs in Belgium. PARTICIPANTS A total of 948 Belgian FPs. MAIN OUTCOME MEASURES Barriers to using nonpharmacologic approaches in family practice. RESULTS We identified 3 different groups of FPs according to their attitudes about BZD prescribing. A first relatively big group of FPs (39%) were not really concerned about the risks of BZD prescribing. Those in the second group (17%) were aware of the problems associated with BZDs, but did not perceive it to be their role to use nonpharmacologic approaches in family practice. Those in the third group (44%) were concerned about BZD prescribing and found it to be a “bad solution,” but were faced with various barriers to applying nonpharmacologic approaches. Surprisingly, we found that nearly 97% of FPs thought that most people were eligible for nonpharmacologic approaches, but experienced implementation barriers at the level of the patient, the level of the FP, and the level of the health care system. CONCLUSION Using different education and behavioural-change strategies for different FP groups seems important. A large group of FPs does not find prescribing BZDs to be problematic. Sensitizing and alerting FPs to this issue remains very important.

Barriers to nonpharmacologic treatments for stress, anxiety, and insomnia

Abstract: OBJECTIVE To explore the attitudes of FPs toward benzodiazepine (BZD) prescribing and the perceived barriers to nonpharmacologic approaches to managing stress, anxiety, and insomnia. DESIGN A questionnaire including 32 statements about treatment of insomnia, stress, and anxiety. SETTING Local quality groups for FPs in Belgium. PARTICIPANTS A total of 948 Belgian FPs. MAIN OUTCOME MEASURES Barriers to using nonpharmacologic approaches in family practice. RESULTS We identified 3 different groups of FPs according to their attitudes about BZD prescribing. A first relatively big group of FPs (39%) were not really concerned about the risks of BZD prescribing. Those in the second group (17%) were aware of the problems associated with BZDs, but did not perceive it to be their role to use nonpharmacologic approaches in family practice. Those in the third group (44%) were concerned about BZD prescribing and found it to be a “bad solution,” but were faced with various barriers to applying nonpharmacologic approaches. Surprisingly, we found that nearly 97% of FPs thought that most people were eligible for nonpharmacologic approaches, but experienced implementation barriers at the level of the patient, the level of the FP, and the level of the health care system. CONCLUSION Using different education and behavioural-change strategies for different FP groups seems important. A large group of FPs does not find prescribing BZDs to be problematic. Sensitizing and alerting FPs to this issue remains very important.

Vijf verschillende beleidsopties voor de behandeling van urineweginfecties bij vrouwen

Abstract: minerva 116 Sa m e n v a tt in g v a n d e s tu d ie Bestudeerde populatie 309 niet-zwangere vrouwen van gemiddeld 42 jaar (SD 15) met een vermoeden van ongecompliceerde urineweginfectie, gerekruteerd door 62 huisartsen en verpleegkundigen in Zuid-Engeland exclusiecriteria: onmiddellijke antibioticatherapie noodzakelijk (zwangerschap, pyelonefritis, nausea, braken of andere ernstige systemische symptomen), ouder dan 75 jaar, psychose, dementie, terminale zorg.