Background Demand for unplanned care in Belgium is high, placing pressure on both out-of-hours primary care facilities (OOHPCF) and emergency departments (ED). Understanding patient trajectories may help optimise care pathways and resource planning for planned and unplanned care.Objective To describe patient presentations and trajectories at OOHPCF and EDs in a region of Flanders, Belgium.Methods Data were collected in six EDs and three OOHPCF in the greater {redacted} region. All consultations were recorded during three randomly selected days in EDs and one full week in OOHPCF in 2024.Results A total of 1,469 ED and 857 OOHPCF consultations were analysed. In EDs, trauma was the most common presentation (32%), followed by ear, nose and throat (ENT) and dermatology conditions (22%). In OOHPCF, trauma and orthopaedic problems accounted for 20% of consultations, followed by ENT (17%) and dermatology (14%). Most ED patients (71%) were discharged home. Self-referral accounted for 65% of ED visits; these patients were generally younger and presented with lower-acuity conditions. One in five patients had consulted another healthcare provider within the previous week. Pain and worry were the main drivers for attendance. Attending clinicians in both settings considered up to one-third of consultations manageable in planned care.Conclusion Rather than restricting access or apportioning blame to patients, our findings indicate the need to reassess measures throughout planned and unplanned care pathways for timely access to the most appropriate care setting while maintaining patient safety and equitable access to services.
Background Advance care planning for people (ACP) with intellectual disabilities requires timely and carefully communication between family caregivers and general practitioners.Objectives Despite its recognised importance, little is known about how these stakeholders experience advance care planning and decision-making processes, particularly regarding goals of care and do not resuscitate (DNR) orders, highlighting a critical gap in ensuring person-centred palliative care for this population.Methods A qualitative design was used to investigate how Belgian general practitioners and family caregivers of adults (≥18 years) with moderate to profound intellectual disabilities (IQ ≤ 50) approach and experience decision-making about treatment goals and DNR directives. The data were analysed thematically.Findings Interviews with six family caregivers and five general practitioners identified six themes: limited preparedness for ACP, the need for open discussion, communication challenges, involvement of key stakeholders, timing, and positive outcomes. Participants reported limited ACP knowledge and a need for earlier, broader conversations that extend beyond DNR decisions. Emotional barriers, uncertainty, and concerns about discussing end-of-life care too early often delayed ACP. Family caregivers generally expected GPs to initiate discussions, while both groups emphasised multidisciplinary involvement and timely, proactive conversations. Despite challenges, ACP discussions were often experienced as reassuring and helpful.Conclusions ACP for adults with moderate to profound intellectual disabilities is shaped by knowledge gaps, communication barriers, and uncertainty about timing. Early, proactive, and multidisciplinary approaches that address personal values alongside treatment preferences may support person-centred decision-making and improve experiences of end-of-life planning.
Background Language barriers cause miscommunication in healthcare, thereby threatening care quality and patient safety, including for official language minorities. Various technological solutions exist to minimise these barriers.Aim To map and summarise technological translation tools used in patient-provider communication in primary and/or emergency care.Method A rapid scoping review using adapted Joanna Briggs Institute (JBI) methodology combined with an environmental scan. MEDLINE, Web of Science, and grey literature via ProQuest, ClinicalTrials.gov were searched. The environmental scan included a structured Google search, documents from the DOcKTEuR project steering committee and relevant Belgian organisations’ websites. Sources describing technological translation tools used during clinical encounters with patients experiencing language barriers in primary or emergency care, published in English, French, or Dutch from 2019 onward were included. Qualitative content analysis was conducted following PRISMA-ScR guidance.Results Twenty sources were included. Five categories were identified: video interpreter, telephone interpreter, translation application (AI), fixed-phrase healthcare translation application, and portable general translation device. Three domains of characteristics emerged: patient–provider interaction, operational feasibility, and ethical considerations. Video interpreter support provided high-quality interpretation and non-verbal communication however faced scheduling and technical challenges. Telephone interpreter support provided broad language coverage but lacked visual cues. AI-based applications enabled rapid multilingual support but raised concerns about accuracy. Fixed-phrase applications facilitated predefined healthcare communication, whereas portable devices offered flexible support but raised concerns about contextual appropriateness.Conclusion Technological translation tools vary in interaction quality, feasibility and ethical considerations. Evidence remains limited and heterogeneous, highlighting the need for robust evaluation of effectiveness, safety, and implementation in routine practice.
Background Spiritual health is a vital aspect of holistic health linked to improved outcomes, yet little is known about approaches used in primary care to support this dimension of wellbeing.Objectives To identify which interventions have been used to improve patients’ spiritual health in primary care, and what works, for whom, and in which contexts.Methods A qualitative realist review was registered with PROSPERO and conducted in line with RAMESES standards. Systematic database searches were completed in May 2024 and June 2025. Iterative analysis and synthesis were informed by discussions with professionals to situate findings within real-world practice contexts.Results Five European interventions were identified, each offering person-centred, listening-based support to address spiritual or existential concerns. These services operated in small, motivated pockets of practice rather than as routine provision. Validated outcome measures showed improvements in emotional wellbeing, but none directly assessed spiritual health. Most interventions followed a chaplaincy model adapted from hospital care and faced barriers to wider implementation: limited funding, workforce pressures, and inconsistent referral pathways.Conclusion Spiritual health interventions can provide valuable holistic support within primary care, but current provision is fragmented, locally driven, and often unsustainable. Improving timely referrals, increasing practitioner confidence, and reducing stigma surrounding spiritual health are priorities. A social asset-based approach may complement existing practice by equipping primary care staff to recognise spiritual need and connect patients with community organisations. Further research is required to determine the acceptability, effectiveness, and scalability of chaplaincy and alternative asset-based models of spiritual care within primary care.
Background Low-value practices are interventions that do not provide health benefits due to lack of effectiveness or associated risks that outweigh the potential benefits.Objectives The purpose of this study is to demonstrate discrepancies across various cardiovascular prevention guidelines published by numerous institutions and organisations, and establish an objective overview of the current state of the art and formulate recommendations for general practitioners.Methods A narrative review of clinical practice guidelines for CVD prevention published in English between January 2017 and December 2025 was conducted. Searches focused on major European, British, North American, and Australian scientific societies; only guidelines containing explicit recommendations on low-value or unnecessary practices were included. We identified the scientific evidence supporting these recommendations and searched for ongoing clinical trials - specifically in cases where recommendations were based on a single randomised trial, large non-randomised studies, retrospective data, or expert opinion.Results Guidelines show significant discrepancies regarding recommendations for low-value practices. These primarily relate to the evaluation of the coronary artery calcium (CAC) score, determination of lipoprotein(a) (Lp(a)), screening for abdominal aortic aneurysm (AAA), and the initiation of lipid-lowering treatment in older adults. Controversy and uncertainty were most evident when recommendations were based on non-randomised clinical trials or expert opinion.Conclusions While some guidelines align, others exhibit clear discrepancies, illustrating the uncertainty of the scientific evidence and differing interpretations. Until robust evidence from high-quality clinical trials becomes available, clinicians should exercise caution regarding certain screening procedures and therapeutic interventions in CVD prevention within general practice.
