Academic Center for General Practice
The department's research is organized within four large programmes with significant interactions between them: development of instruments and outcome measurement, educational research, clinical epidemiology and health care organisation research. It focusses on a broad range of clinical situations, with care for the elderly and diagnostics as its corner-stones. 1. Instrument development and outcome research Together with 11 other institutes form 6 other countries, the department was a partner within the European research group on health outcomes (ERGHO), which got a BIOMED grant to select and adapt health outcome procedures for use in ambulatory care. As a result of the succes of this work, a BIOMED 2 grant was offered to a new consortium, supporting clinical outcome in primary care for the elderly (SCOPE). Within this consortium, it is our task to makt outcome concepts usefull in a European setting. Original instruments are being developed for measuring functional status (ADMP), cognitive functioning (COGNIMETER) and autonomy (ASIEL). 2. Educational research Adaptations to both the undergraduate and postgraduate curriculum are evaluated by a group consisting of GPs as well as psychologists and educationalists. At this moment, special attention goes to skills training, to the personal fuctioning of the students and to the new licencing examination. 3. Clinical epidemiology a) Research on the diagnostic value of signs, symptoms and test results is a central line in this program with a special focus on differences between settings (e.g. General Practice versus hospitalized patients). Together with research groups all over the world, we are engaged in adapting medical knowledge developed in hospitals to a specific general practice based epidemiology. Field studies involve different methods for blood pressure measurement, chest pain, key symptoms for the diagnosis of cancer problem drinking and dermal mycosis. Within a Belgian-Dutch cooperation on meta-analysis of diagnostic tests (MEDION) and within the framework of the Cochrane Collaboration methods group on diagnostic and screening tests, methods are developped for the retrieval, quality scoring and statistical pooling of diagnostic studies. Diagnostic meta-analyses are being performed on kidney function tests, cervical screening, macroscopic haematuria and the early diagnosis of problem drinking. b) Research in Belgium is confronted with a lack of basic epidemiological data. Within a network of computerized general prtices (INTEGO), such data are collected and studied. The department is also actively involved in starting a regional cancer registry. Additionally, classical epidemiological studies involve determinants of allergy, problem drinking, dementia, cardiovascular risk factors and methycillin resistant Staphylococcus Aureus in homes for the elderly. c) In the past, intervention studies especially examined the impact of desk top testing (Reflotron, QBC) on clinical practice. Recent RCTs focus on the effect of a leaflet on anxiety and compliance in women with an abnormal cervical smear result and on the treatment of heavy sweating in cancer patients. 4. Health care organisation research In a recent report, the need of GPs in Belgium was examined. We intend to continue in examining the effect of (changes in) health care organisation on clinical practice.