General practice/family medicine has a central role in health care, helping to keep the focus on ... more General practice/family medicine has a central role in health care, helping to keep the focus on the needs of the patient. Both policy experts (Starfield, 1998) and official organizations (WONCA/WHO, 2002), support this view, believing that the balance in health care should shift from supply-driven development to needs and community-driven priority setting. Given that the main challenge for health care
To determine if spirometry is essential for the early detection of COPD in general practice, comp... more To determine if spirometry is essential for the early detection of COPD in general practice, compared to the screening value of a short questionnaire. Methods: A prospective survey of the population aged 35 to 70 years visiting their general practitioner (GP) during a 12-week period, using a questionnaire on symptoms of obstructive lung disease (OLD). Spirometry was performed in all participants with positive answers and in a 10% random sample from the group without complaints. Twenty GPs were provided with a hand-held spirometer, and received training in performance and interpretation of lung function tests. All 35-to 70-year-old patients (n ؍ 3,408) were screened for current use of bronchodilators. The subgroup receiving bronchodilators (n ؍ 250, 7%) was assumed to have OLD, and was excluded.
ABSTRACT Assessment of diabetes care quality increasingly integrates measurements of patient perc... more ABSTRACT Assessment of diabetes care quality increasingly integrates measurements of patient perceptions. With escalating demand for diabetic services, it is critical to evaluate patients' experiences with patient-centred care and their association with outcome of care indicators. Global satisfaction and experiences with patient-centred care were evaluated in patients with type 2 diabetes. Patients participated in a quality improvement programme set-up as a two-arm clustered randomized trial. The Usual Quality Improvement Programme (UQIP) targeted clinical inertia in primary care physicians. The Advanced Quality Improvement Programme (AQIP) aimed to reduce the rate of clinical inertia and improve the provision of patient-centred care. Objective measures of patient-centred care, including overall satisfaction with care and measures related to health promotion, were associated with mean levels of glycosylated haemoglobin (HbA1c), low-density lipoprotein cholesterol (LDLc) and systolic blood pressure (SBP), measur
To explore views on high quality diabetes care based on an analysis of existing diversity in diab... more To explore views on high quality diabetes care based on an analysis of existing diversity in diabetes care programmes and related quality indicators. A review of systematic reviews was performed. Four databases (MEDLINE database of the National Library of Medicine, COCHRANE database of Systematic Reviews, the Cumulative Index to Nursing and Allied Health Database-CINAHL and Pre-Cinahl) were searched for English review articles published between November 1989 and December 2006. Methodological quality of the articles was assessed. A standardized extraction form was used to assess features of diabetes care programmes and diabetes quality indicators with special reference to those aspects that hinder the conceptualization of high quality diabetes care. Based on these findings the relationship between diversity in diabetes care programmes and the conceptualization of high quality diabetes care was further explored. Twenty-one systematic reviews met the inclusion criteria representing a t...
Diagnosis of dementia in primary care is both difficult and important. The recommendations by sev... more Diagnosis of dementia in primary care is both difficult and important. The recommendations by several authors to improve the diagnosis of dementia by general practitioners are important, but insufficient. It is argued that perhaps the disease concept in itself is a cause of confusion for clinicians. Primary care physicians need an adapted procedure, gradually leading to the final diagnosis of dementia. It has to be a stepwise labelling strategy, using global descriptions and non-disease specific labels in the beginning, ending up with well-defined disease criteria. In this process, there is circularity: previous diagnoses have to be kept in mind because symptoms and signs may gradually change during the progression of the disease, leading to reconsideration of previous deleted options. To frame this properly, the primary care physician needs to adopt a broad "frail elderly" geriatric concept. Implementation of this concept not only helps the diagnostic process, but also st...
To determine if spirometry is essential for the early detection of COPD in general practice, comp... more To determine if spirometry is essential for the early detection of COPD in general practice, compared to the screening value of a short questionnaire. A prospective survey of the population aged 35 to 70 years visiting their general practitioner (GP) during a 12-week period, using a questionnaire on symptoms of obstructive lung disease (OLD). Spirometry was performed in all participants with positive answers and in a 10% random sample from the group without complaints. Twenty GPs were provided with a hand-held spirometer, and received training in performance and interpretation of lung function tests. All 35- to 70-year-old patients (n = 3,408) were screened for current use of bronchodilators. The subgroup receiving bronchodilators (n = 250, 7%) was assumed to have OLD, and was excluded. Airflow obstruction was defined according to the European Respiratory Society standards. The positive predictive power of the questionnaire was low (sensitivity, 58%; specificity, 78%; likelihood rat...
Complex chronic conditions often require long-term care from various healthcare professionals. Th... more Complex chronic conditions often require long-term care from various healthcare professionals. Thus, maintaining quality care requires care coordination. Concepts for the study of care coordination require clarification to develop, study and evaluate coordination strategies. In 2007, the Agency for Healthcare Research and Quality defined care coordination and proposed five theoretical frameworks for exploring care coordination. This study aimed to update current theoretical frameworks and clarify key concepts related to care coordination. We performed a literature review to update existing theoretical frameworks. An in-depth analysis of these theoretical frameworks was conducted to formulate key concepts related to care coordination. Our literature review found seven previously unidentified theoretical frameworks for studying care coordination. The in-depth analysis identified fourteen key concepts that the theoretical frameworks addressed. These were 'external factors', ...
The aim of this paper is to provide a theoretical background for performing and reading systemati... more The aim of this paper is to provide a theoretical background for performing and reading systematic reviews of diagnostic studies. We first discuss items for assessment of methodological quality in diagnostic studies and then present methods on how to incorporate these quality measures in systematic reviews. The items of internal validity determine whether the presented results of the individual studies are unbiased and can be trusted. Items of external validity determine to what extent the results are applicable outside the population in which the study was performed. The issues concern the adequacy of the study population, the performance and interpretation of the diagnostic tests and the presentation of the results. Several methods exist for incorporation of issues of methodological quality into systematic reviews, such as subgroup analyses, meta-regression analysis, and methodological scores. Publications of diagnostic studies should provide sufficient information to enable assessment of the methodological quality. Furthermore, publication of results of subgroup analyses should be promoted. Methodological criteria lists might help to improve the quality of systematic reviews of diagnostic research. With the items of methodological quality in mind the general practitioner might be better equipped to critically read and interpret diagnostic reviews.
Social Psychiatry and Psychiatric Epidemiology, 2001
s Abstract Background: Expressed emotion (EE) is a well-established, important predictor of the r... more s Abstract Background: Expressed emotion (EE) is a well-established, important predictor of the relapse rate of patients suffering from schizophrenia and other severe psychiatric disorders. EE measures the quality of the social interaction between a patient and his most important (in)formal caregiver. The aim of this study was to investigate the quality of the relationship in the staffpatient dyad as measured by the concept of EE. Methods: EE was assessed using the Camberwell Family Interview (CFI, professionals) and the Perceived Criticism Scale (PCS,residents and professionals form) in a sample of 56 professional caregivers and their residents in nine sheltered living facilities in Flanders. Results: Depending on the instrument, high EE was found to exist in one out of six (CFI) or one out of three (PCS) relationships. There was a significant positive correlation between the resident PCS and the critical comment scale of the CFI. Conclusions: The results of this study support the hypothesis that high levels of EE exist in some staff-resident relationships, which are mainly manifest as frequent critical comments and the presence of hostility. Emotional overinvolvement appears to be exceptional. Compared with the PCS, the CFI provides the most information about the quality of the relationship.
Rationale: To assess the success rate of smoking cessation with the ''minimal intervention strate... more Rationale: To assess the success rate of smoking cessation with the ''minimal intervention strategy'' in general practice, and to determine the influence of spirometry on this success rate. Methods: Training in smoking cessation advice was given to 16 general practitioners (GPs). During 12 weeks, these GPs screened their practice population for smoking habits, the degree of dependence on nicotine, and the motivation to quit smoking. Patients willing to stop were randomised to a group that underwent a single office spirometry, or to a control group. The GPs were asked to support the attempts with the minimal intervention strategy. Success rates were compared after 6, 12 and 24 months. Results: On a population of 5590 patients, 1206 smokers were identified (22%). To the vulnerable group, identified following the Prochaska and Di Clemente scheme, the proposal was made to change smoking behaviour. Two hundred and twenty-one patients undertook an attempt of smoking cessation. Nicotine replacement therapy (NRT) or bupropion was prescribed in 51% of the attempts. Sixty-four sustained quitters were counted after 6 months (29%), 43 after 1 year (19%) and 33 after 2 years (15%). We found a small but statistically non-significant difference in success rate in favour of the group that underwent office spirometry. Conclusion: GPs can motivate almost 20% of their smoking population to quit smoking. The success rate with the minimal intervention strategy was 19% after 1 year and 15% after 2 years. We found no arguments in favour of confronting smokers with their lung function as a tool for enhancing smoking cessation.
Patient Education and Counseling, Volume 34, Issue null, Pages S73-S74, 1 May 1998, Authors:Chant... more Patient Education and Counseling, Volume 34, Issue null, Pages S73-S74, 1 May 1998, Authors:Chantal Van Audenhove; G. Van Humbeeck; I. Van Rompaey; H. Vertommen; G. Pieters; J. Peuskens; J. Heyrman.
Because many patients in usual care reach the diabetes treatment goals, it may be more efficaciou... more Because many patients in usual care reach the diabetes treatment goals, it may be more efficacious to focus quality improvement efforts on those general practice populations requiring additional support. We therefore developed a tool based on a composite end point considering blood pressure, lipids, and glycaemia. We created an aggregated z(A)-score, calculated as the average of 3 z-scores testing whether the mean practice values of hemoglobin A1c, low density lipoprotein cholesterol, and systolic blood pressure are significantly higher than the corresponding ADA-target (respectively 7%, 100 mg/dL, and 130 mm Hg). This score was used with 100 general practitioners who participated in a Quality Improvement Program. We defined the cut-off value (COV) to determine "Practices Requiring Support" (z(A) <COV) using a receiver's operating characteristics curve with the mean practice CHD risk as gold standard. To further test the z-score validity, we calculated the correlation coefficient between the z-score and the mean practice CHD risk and the improvement in the z-score after the Quality Improvement Program. The COV was -1.22 and was valid to discriminate between practices at higher risk from practices at lower CHD risk (24% +/- 4% vs. 19% +/- 4%). The correlation coefficient was -0.515 (P = 0.001). The average z-score increased from -1.21 +/- 0.97 at baseline to 0.49 +/- 1.01 after the intervention (P < 0.001). This scoring system is useful to picture practice populations with diabetes who are at high cardiovascular risk because of modifiable risk factors. Although the unadjusted z-score cannot be used to compare physicians, this technique can be used to evaluate improvement efforts over time.
To study the diagnostic parameters of a number of instruments for a diagnosis of dementia in gene... more To study the diagnostic parameters of a number of instruments for a diagnosis of dementia in general practice and the added diagnostic value of these tests.
INTERNATIONAL JOURNAL OF SYSTEMATIC AND EVOLUTIONARY MICROBIOLOGY, 2005
Study of mural painting isolates, leading to the transfer of 'Bacillus maroccanus' and 'Bacillus ... more Study of mural painting isolates, leading to the transfer of 'Bacillus maroccanus' and 'Bacillus carotarum' to Bacillus simplex, emended description of Bacillus simplex, re-examination of the strains previously attributed to 'Bacillus macroides' and description of Bacillus muralis sp. nov.
An elderly Belgian population group anno 1986 consisting of 53 men and 110 women above the age of... more An elderly Belgian population group anno 1986 consisting of 53 men and 110 women above the age of 75 years with a mean age of 80 and 81 years, respectively, is characterized by relative obesity and low diastolic blood pressure, both in men and women. The SBP/DBP ratio is 1.91 in men and 1.88 in women. HDL-cholesterol levels are relatively high in men. Women still have slightly higher HDL-cholesterol levels than men, the difference between women and men being 3.4 mg/dl. In both sexes HDL-cholesterol correlates negatively with body weight. The 24-hour urinary sodium/potassium ratio is 2.9 in men and 2.5 in women. Factors significantly related to diastolic blood pressure in a multiple regression analysis included being on a low-salt diet, the level of 24-hour urinary potassium excretion and of 24-hour urinary creatinine excretion in men, and body weight, heart rate and the level of 24-hour urinary calcium excretion in women. It may be concluded that significant differences exist between the distribution of cardiovascular risk factors in older compared to middle-aged subjects.
Objective: To evaluate the barriers and facilitators to high-quality diabetes care as experienced... more Objective: To evaluate the barriers and facilitators to high-quality diabetes care as experienced by general practitioners (GPs) who participated in an 18-month quality improvement program (QIP). This QIP was implemented to promote compliance with international guidelines.
Background: Most quality improvement programs in diabetes care incorporate aspects of clinician e... more Background: Most quality improvement programs in diabetes care incorporate aspects of clinician education, performance feedback, patient education, care management, and diabetes care teams to support primary care physicians. Few studies have applied all of these dimensions to address clinical inertia.
General practice/family medicine has a central role in health care, helping to keep the focus on ... more General practice/family medicine has a central role in health care, helping to keep the focus on the needs of the patient. Both policy experts (Starfield, 1998) and official organizations (WONCA/WHO, 2002), support this view, believing that the balance in health care should shift from supply-driven development to needs and community-driven priority setting. Given that the main challenge for health care
To determine if spirometry is essential for the early detection of COPD in general practice, comp... more To determine if spirometry is essential for the early detection of COPD in general practice, compared to the screening value of a short questionnaire. Methods: A prospective survey of the population aged 35 to 70 years visiting their general practitioner (GP) during a 12-week period, using a questionnaire on symptoms of obstructive lung disease (OLD). Spirometry was performed in all participants with positive answers and in a 10% random sample from the group without complaints. Twenty GPs were provided with a hand-held spirometer, and received training in performance and interpretation of lung function tests. All 35-to 70-year-old patients (n ؍ 3,408) were screened for current use of bronchodilators. The subgroup receiving bronchodilators (n ؍ 250, 7%) was assumed to have OLD, and was excluded.
ABSTRACT Assessment of diabetes care quality increasingly integrates measurements of patient perc... more ABSTRACT Assessment of diabetes care quality increasingly integrates measurements of patient perceptions. With escalating demand for diabetic services, it is critical to evaluate patients' experiences with patient-centred care and their association with outcome of care indicators. Global satisfaction and experiences with patient-centred care were evaluated in patients with type 2 diabetes. Patients participated in a quality improvement programme set-up as a two-arm clustered randomized trial. The Usual Quality Improvement Programme (UQIP) targeted clinical inertia in primary care physicians. The Advanced Quality Improvement Programme (AQIP) aimed to reduce the rate of clinical inertia and improve the provision of patient-centred care. Objective measures of patient-centred care, including overall satisfaction with care and measures related to health promotion, were associated with mean levels of glycosylated haemoglobin (HbA1c), low-density lipoprotein cholesterol (LDLc) and systolic blood pressure (SBP), measur
To explore views on high quality diabetes care based on an analysis of existing diversity in diab... more To explore views on high quality diabetes care based on an analysis of existing diversity in diabetes care programmes and related quality indicators. A review of systematic reviews was performed. Four databases (MEDLINE database of the National Library of Medicine, COCHRANE database of Systematic Reviews, the Cumulative Index to Nursing and Allied Health Database-CINAHL and Pre-Cinahl) were searched for English review articles published between November 1989 and December 2006. Methodological quality of the articles was assessed. A standardized extraction form was used to assess features of diabetes care programmes and diabetes quality indicators with special reference to those aspects that hinder the conceptualization of high quality diabetes care. Based on these findings the relationship between diversity in diabetes care programmes and the conceptualization of high quality diabetes care was further explored. Twenty-one systematic reviews met the inclusion criteria representing a t...
Diagnosis of dementia in primary care is both difficult and important. The recommendations by sev... more Diagnosis of dementia in primary care is both difficult and important. The recommendations by several authors to improve the diagnosis of dementia by general practitioners are important, but insufficient. It is argued that perhaps the disease concept in itself is a cause of confusion for clinicians. Primary care physicians need an adapted procedure, gradually leading to the final diagnosis of dementia. It has to be a stepwise labelling strategy, using global descriptions and non-disease specific labels in the beginning, ending up with well-defined disease criteria. In this process, there is circularity: previous diagnoses have to be kept in mind because symptoms and signs may gradually change during the progression of the disease, leading to reconsideration of previous deleted options. To frame this properly, the primary care physician needs to adopt a broad "frail elderly" geriatric concept. Implementation of this concept not only helps the diagnostic process, but also st...
To determine if spirometry is essential for the early detection of COPD in general practice, comp... more To determine if spirometry is essential for the early detection of COPD in general practice, compared to the screening value of a short questionnaire. A prospective survey of the population aged 35 to 70 years visiting their general practitioner (GP) during a 12-week period, using a questionnaire on symptoms of obstructive lung disease (OLD). Spirometry was performed in all participants with positive answers and in a 10% random sample from the group without complaints. Twenty GPs were provided with a hand-held spirometer, and received training in performance and interpretation of lung function tests. All 35- to 70-year-old patients (n = 3,408) were screened for current use of bronchodilators. The subgroup receiving bronchodilators (n = 250, 7%) was assumed to have OLD, and was excluded. Airflow obstruction was defined according to the European Respiratory Society standards. The positive predictive power of the questionnaire was low (sensitivity, 58%; specificity, 78%; likelihood rat...
Complex chronic conditions often require long-term care from various healthcare professionals. Th... more Complex chronic conditions often require long-term care from various healthcare professionals. Thus, maintaining quality care requires care coordination. Concepts for the study of care coordination require clarification to develop, study and evaluate coordination strategies. In 2007, the Agency for Healthcare Research and Quality defined care coordination and proposed five theoretical frameworks for exploring care coordination. This study aimed to update current theoretical frameworks and clarify key concepts related to care coordination. We performed a literature review to update existing theoretical frameworks. An in-depth analysis of these theoretical frameworks was conducted to formulate key concepts related to care coordination. Our literature review found seven previously unidentified theoretical frameworks for studying care coordination. The in-depth analysis identified fourteen key concepts that the theoretical frameworks addressed. These were 'external factors', ...
The aim of this paper is to provide a theoretical background for performing and reading systemati... more The aim of this paper is to provide a theoretical background for performing and reading systematic reviews of diagnostic studies. We first discuss items for assessment of methodological quality in diagnostic studies and then present methods on how to incorporate these quality measures in systematic reviews. The items of internal validity determine whether the presented results of the individual studies are unbiased and can be trusted. Items of external validity determine to what extent the results are applicable outside the population in which the study was performed. The issues concern the adequacy of the study population, the performance and interpretation of the diagnostic tests and the presentation of the results. Several methods exist for incorporation of issues of methodological quality into systematic reviews, such as subgroup analyses, meta-regression analysis, and methodological scores. Publications of diagnostic studies should provide sufficient information to enable assessment of the methodological quality. Furthermore, publication of results of subgroup analyses should be promoted. Methodological criteria lists might help to improve the quality of systematic reviews of diagnostic research. With the items of methodological quality in mind the general practitioner might be better equipped to critically read and interpret diagnostic reviews.
Social Psychiatry and Psychiatric Epidemiology, 2001
s Abstract Background: Expressed emotion (EE) is a well-established, important predictor of the r... more s Abstract Background: Expressed emotion (EE) is a well-established, important predictor of the relapse rate of patients suffering from schizophrenia and other severe psychiatric disorders. EE measures the quality of the social interaction between a patient and his most important (in)formal caregiver. The aim of this study was to investigate the quality of the relationship in the staffpatient dyad as measured by the concept of EE. Methods: EE was assessed using the Camberwell Family Interview (CFI, professionals) and the Perceived Criticism Scale (PCS,residents and professionals form) in a sample of 56 professional caregivers and their residents in nine sheltered living facilities in Flanders. Results: Depending on the instrument, high EE was found to exist in one out of six (CFI) or one out of three (PCS) relationships. There was a significant positive correlation between the resident PCS and the critical comment scale of the CFI. Conclusions: The results of this study support the hypothesis that high levels of EE exist in some staff-resident relationships, which are mainly manifest as frequent critical comments and the presence of hostility. Emotional overinvolvement appears to be exceptional. Compared with the PCS, the CFI provides the most information about the quality of the relationship.
Rationale: To assess the success rate of smoking cessation with the ''minimal intervention strate... more Rationale: To assess the success rate of smoking cessation with the ''minimal intervention strategy'' in general practice, and to determine the influence of spirometry on this success rate. Methods: Training in smoking cessation advice was given to 16 general practitioners (GPs). During 12 weeks, these GPs screened their practice population for smoking habits, the degree of dependence on nicotine, and the motivation to quit smoking. Patients willing to stop were randomised to a group that underwent a single office spirometry, or to a control group. The GPs were asked to support the attempts with the minimal intervention strategy. Success rates were compared after 6, 12 and 24 months. Results: On a population of 5590 patients, 1206 smokers were identified (22%). To the vulnerable group, identified following the Prochaska and Di Clemente scheme, the proposal was made to change smoking behaviour. Two hundred and twenty-one patients undertook an attempt of smoking cessation. Nicotine replacement therapy (NRT) or bupropion was prescribed in 51% of the attempts. Sixty-four sustained quitters were counted after 6 months (29%), 43 after 1 year (19%) and 33 after 2 years (15%). We found a small but statistically non-significant difference in success rate in favour of the group that underwent office spirometry. Conclusion: GPs can motivate almost 20% of their smoking population to quit smoking. The success rate with the minimal intervention strategy was 19% after 1 year and 15% after 2 years. We found no arguments in favour of confronting smokers with their lung function as a tool for enhancing smoking cessation.
Patient Education and Counseling, Volume 34, Issue null, Pages S73-S74, 1 May 1998, Authors:Chant... more Patient Education and Counseling, Volume 34, Issue null, Pages S73-S74, 1 May 1998, Authors:Chantal Van Audenhove; G. Van Humbeeck; I. Van Rompaey; H. Vertommen; G. Pieters; J. Peuskens; J. Heyrman.
Because many patients in usual care reach the diabetes treatment goals, it may be more efficaciou... more Because many patients in usual care reach the diabetes treatment goals, it may be more efficacious to focus quality improvement efforts on those general practice populations requiring additional support. We therefore developed a tool based on a composite end point considering blood pressure, lipids, and glycaemia. We created an aggregated z(A)-score, calculated as the average of 3 z-scores testing whether the mean practice values of hemoglobin A1c, low density lipoprotein cholesterol, and systolic blood pressure are significantly higher than the corresponding ADA-target (respectively 7%, 100 mg/dL, and 130 mm Hg). This score was used with 100 general practitioners who participated in a Quality Improvement Program. We defined the cut-off value (COV) to determine "Practices Requiring Support" (z(A) <COV) using a receiver's operating characteristics curve with the mean practice CHD risk as gold standard. To further test the z-score validity, we calculated the correlation coefficient between the z-score and the mean practice CHD risk and the improvement in the z-score after the Quality Improvement Program. The COV was -1.22 and was valid to discriminate between practices at higher risk from practices at lower CHD risk (24% +/- 4% vs. 19% +/- 4%). The correlation coefficient was -0.515 (P = 0.001). The average z-score increased from -1.21 +/- 0.97 at baseline to 0.49 +/- 1.01 after the intervention (P < 0.001). This scoring system is useful to picture practice populations with diabetes who are at high cardiovascular risk because of modifiable risk factors. Although the unadjusted z-score cannot be used to compare physicians, this technique can be used to evaluate improvement efforts over time.
To study the diagnostic parameters of a number of instruments for a diagnosis of dementia in gene... more To study the diagnostic parameters of a number of instruments for a diagnosis of dementia in general practice and the added diagnostic value of these tests.
INTERNATIONAL JOURNAL OF SYSTEMATIC AND EVOLUTIONARY MICROBIOLOGY, 2005
Study of mural painting isolates, leading to the transfer of 'Bacillus maroccanus' and 'Bacillus ... more Study of mural painting isolates, leading to the transfer of 'Bacillus maroccanus' and 'Bacillus carotarum' to Bacillus simplex, emended description of Bacillus simplex, re-examination of the strains previously attributed to 'Bacillus macroides' and description of Bacillus muralis sp. nov.
An elderly Belgian population group anno 1986 consisting of 53 men and 110 women above the age of... more An elderly Belgian population group anno 1986 consisting of 53 men and 110 women above the age of 75 years with a mean age of 80 and 81 years, respectively, is characterized by relative obesity and low diastolic blood pressure, both in men and women. The SBP/DBP ratio is 1.91 in men and 1.88 in women. HDL-cholesterol levels are relatively high in men. Women still have slightly higher HDL-cholesterol levels than men, the difference between women and men being 3.4 mg/dl. In both sexes HDL-cholesterol correlates negatively with body weight. The 24-hour urinary sodium/potassium ratio is 2.9 in men and 2.5 in women. Factors significantly related to diastolic blood pressure in a multiple regression analysis included being on a low-salt diet, the level of 24-hour urinary potassium excretion and of 24-hour urinary creatinine excretion in men, and body weight, heart rate and the level of 24-hour urinary calcium excretion in women. It may be concluded that significant differences exist between the distribution of cardiovascular risk factors in older compared to middle-aged subjects.
Objective: To evaluate the barriers and facilitators to high-quality diabetes care as experienced... more Objective: To evaluate the barriers and facilitators to high-quality diabetes care as experienced by general practitioners (GPs) who participated in an 18-month quality improvement program (QIP). This QIP was implemented to promote compliance with international guidelines.
Background: Most quality improvement programs in diabetes care incorporate aspects of clinician e... more Background: Most quality improvement programs in diabetes care incorporate aspects of clinician education, performance feedback, patient education, care management, and diabetes care teams to support primary care physicians. Few studies have applied all of these dimensions to address clinical inertia.
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Papers by Jan Heyrman