Background: Multi-morbidity and polypharmacy of the elderly population enhances the probability of elderly in residential long-term care facilities experiencing inappropriate medication use.Objectives: The aim is to systematically review literature to assess the prevalence of inappropriate medication use in residential long-term care facilities for the elderly.Methods: Databases (MEDLINE, EMBASE) were searched for literature from 2004 to 2016 to identify studies examining inappropriate medication use in residential long-term care facilities for the elderly. Studies were eligible when relying on Beers criteria, STOPP, START, PRISCUS list, ACOVE, BEDNURS or MAI instruments. Inappropriate medication use was defined by the criteria of these seven instruments.Results: Twenty-one studies met inclusion criteria. Seventeen studies relied on a version of Beers criteria with prevalence ranging between 18.5% and 82.6% (median 46.5%) residents experiencing inappropriate medication use. A smaller range, from 21.3% to 63.0% (median 35.1%), was reported when considering solely the 10 studies that used Beers criteria updated in 2003. Prevalence varied from 23.7% to 79.8% (median 61.1%) in seven studies relying on STOPP. START and ACOVE were relied on in respectively four (prevalence: 30.5–74.0%) and two studies (prevalence: 28.9–58.0%); PRISCUS, BEDNURS and MAI were all used in one study each.Conclusions: Beers criteria of 2003 and STOPP were most frequently used to determine inappropriate medication use in residential long-term care facilities. Prevalence of inappropriate medication use strongly varied, despite similarities in research design and assessment with identical instrument(s).

BackgroundHealth literacy (HL) is defined as necessary competencies to make well-informed decisions. As patients’ decision making is a key element of patient-centered health care, insight in patients’ HL might help healthcare professionals to organize their care accordingly. This is particularly true for people in a vulnerable situation, potentially with limited HL, who are, for instance, at greater risk of having limited access to care [1, 2].As HL correlates with education, instruments should allow inclusion of low literate people. To that end, the relatively new instrument, HLS-EU-Q47, was subjected to a comprehensibility test, its shorter version, HLS-EU-Q16, was not. Therefore, the goal of this study was to examine feasibility of HLS-EU-Q16 (in Dutch) for use in a population of people with low literacy.MethodsPurposive sampling of adults with low (yearly) income (< €16,965.47) and limited education (maximum high school), with Dutch language proficiency. Exclusion criteria were: psychiatric, neurodegenerative diseases or impairments. To determine suitability (length, comprehension and layout) participants were randomly distributed either HLS-EU-Q16 or a modified version and were interviewed directly afterwards by one researcher. To determine feasibility a qualitative approach was chosen: cognitive interviews were carried out using the verbal probing technique.ResultsThirteen participants completed HLS-EU-Q16 (n = 7) or the modified version (n = 6). Questions about ‘disease prevention’ or ‘appraisal’ of information are frequently reported to be incomprehensible. Difficulties are attributed to vocabulary, sentence structure and the decision process (abstraction, distinguishing ‘appraising’ from ‘applying’ information, indecisive on the appropriate response).ConclusionsHLS-EU-Q16 is a suitable instrument to determine HL in people with limited literacy. However, to facilitate the use and interpretation, some questions would benefit from minor adjustments: by simplifying wording or providing explanatory, contextual information.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4391-8) contains supplementary material, which is available to authorized users.

ObjectivesTo support patients in their disease management, providing information that is adjusted to patients’ knowledge and ability to process health information (ie, health literacy) is crucial. To ensure effective health communication, general practitioners (GPs) should be able to identify people with limited health literacy. To this end, (dis)agreement between patients’ health literacy and GPs’ estimations thereof was examined. Also, characteristics impacting health literacy (dis)agreement were studied.DesignCross-sectional survey of general practice patients and GPs undertaken in 2016–17.SettingForty-one general practices in two Dutch-speaking provinces in Belgium.ParticipantsPatients (18 years of age and older) visiting general practices. Patients were excluded when having severe impairments (physical, mental, sensory).Main outcome measuresPatients’ health literacy was assessed with 16-item European Health Literacy Survey Questionnaire. GPs indicated estimations on patients’ health literacy using a simple scale (inadequate; problematic; adequate). (Dis)agreement between patients’ health literacy and GPs’ estimations thereof (GPs’ estimations being equal to/higher/lower than patients’ health literacy) was measured using Kappa statistics. The impact of patient and GP characteristics, including duration of GP–patient relationships, on this (dis)agreement was examined using generalised linear logit model.ResultsHealth literacy of patients (n=1375) was inadequate (n=201; 14.6%), problematic (n=299; 21.7%), adequate (n=875; 63.6%). GPs overestimated the proportion patients with adequate health literacy: adequate (n=1241; 90.3%), problematic (n=130; 9.5%) and inadequate (n=4; 0.3%). Overall, GPs’ correct; over-/underestimations of health literacy occurred for, respectively, 60.9%; 34.2%; 4.9% patients, resulting in a slight agreement (κ=0.033). The likelihood for GPs to over-/underestimate patients’ health literacy increases with decreasing educational level of patients; and decreasing number of years patients have been consulting with their GP.ConclusionsIntuitively assessing health literacy is difficult. Patients’ education, the duration of GP–patient relationships and GPs’ gender impact GPs’ perceptions of patients’ health literacy.

BackgroundAn accurate medication overview is essential to reduce medication errors. Therefore, it is essential to keep the medication overview up-to-date and to exchange healthcare information between healthcare professionals and patients. Digitally shared information yields possibilities to improve communication. However, implementing a digitally shared medication overview is challenging. This articles describes the development process of a secured, electronic platform designed for exchanging medication information as executed in a pilot study in Belgium, called “Vitalink”.FindingsThe goal of “Vitalink” is to improve the exchange of medication information between professionals working in healthcare and patients in order to achieve a more efficient cooperation and better quality of care. Healthcare professionals of primary and secondary health care and patients of four Belgian regions participated in the project. In each region project groups coordinated implementation and reported back to the steering committee supervising the pilot study. The electronic medication overview was developed based on consensus in the project groups. The steering committee agreed to establish secured and authorized access through the use of electronic identity documents (eID) and a secured, eHealth-platform conform prior governmental regulations regarding privacy and security of healthcare information.DiscussionA successful implementation of an electronic medication overview strongly depends on the accessibility and usability of the tool for healthcare professionals. Coordinating teams of the project groups concluded, based on their own observations and on problems reported to them, that secured and quick access to medical data needed to be pursued. According to their observations, the identification process using the eHealth platform, crucial to ensure secured data, was very time consuming. Secondly, software packages should meet the needs of their users, thus be adapted to daily activities of healthcare professionals. Moreover, software should be easy to install and run properly. The project would have benefited from a cost analysis executed by the national bodies prior to implementation.

BackgroundPhysician and non-physician leadership development programs aim to improve organizational performance. Although a significant, positive relation between physicians’ leadership skills and patient outcomes, staff satisfaction and staff retention has been found, physicians are not formally trained in clinical leadership skills during their physician training. A lot of current healthcare leaders were chosen to take on leadership because of their productivity, published research, solid clinical skills, or because they were great educators, Heifetz RA. Leadership Without Easy Answers; 1994 although they often do not have the skills to build a team, resulting in dysfunctional teams and having to deal with conflicts and chaos. The first steps of a Clinical Leadership Program is to gain insight in one’s personality, one’s personal skills and one’s leadership growth potential, because this gives information on one’s natural leadership style. The aim of our research is to gain insight in the personality traits of healthcare professionals who are leading teams and to check (a) whether Belgian physicians with leadership ambition, share certain preferences, (b) whether physicians differ from other healthcare staff in terms of personality, (c) whether our sample of Belgian physicians differs from a population of physicians in the United States of America.MethodsIn-hospital physicians and non-physicians enrolled in a Clinical Leadership Program consented to participate. They explored their personal preferences across four dimensions, based on the Myers-Briggs Type Indicator (MBTI). Their most suitable MBTI profile was determined with a self-assessment and a complementary guidance of an MBTI-coach. Chi-squared tests and logistic regression were performed to check distributions across different MBTI-dimensions and to assess the relation with profession and location.ResultsAmong participating physicians significantly more preferences for ‘Thinking’ then for ‘Feeling’ were found. Non-physicians were found to be significantly more ‘Sensing’ and ‘Judging’ compared with physicians. No significant differences were found between physicians from our (Belgian) and the USA dataset.ConclusionPreferences of physicians proved to be different from those of non-physicians. ‘ISTJ’ is the most frequent personality profile both in Belgian and USA physicians.