Research team

Primary and interdisciplinary care Antwerp (ELIZA)

Expertise

Translational and interdisciplinary research of infectious diseases and antibiotic use in primary care, with particular focus on the management of respiratory tract infections in primary care in the context of antimicrobial resistance, and the etiology, diagnosis, prognosis and treatment of bacterial and viral infections. Qualitative and quantitative research methods in health care.

Celluloepidemiology: generating and modeling SARS-COV-2 specific T-cell responses on a population level for more accurate interventions in public health. 01/11/2020 - 31/10/2021

Abstract

Mathematical simulation models have become indispensable tools for forecasting and studying the effectiveness of intervention strategies such as lockdowns and screening during the SARS-CoV-2 pandemic. Estimation of key modeling quantities uses the serological footprint of an infection on the host. However, although depending on the type of assay, SARS-CoV-2 antibody titers were frequently not found in young and/or asymptomatic individuals and were shown to wane after a relatively short period, especially in asymptomatic individuals. In contrast, T-cells have been found in different situations – also without antibodies being present - ranging from convalescent asymptomatic to mild SARS-CoV-2 patients and their household members, thereby indicating that T-cells offer more sensitivity to detect past exposure to SARS-CoV-2 than the detection of antibodies can. In this project, we will gather on a population level T-cell and antibody SARS-CoV-2 specific data from different well-described cohorts including 300 individuals (and 200 household members) who have had proven covid-19 infection > 3 months earlier, 100 general practitioners, 100 hospital workers, 500 randomly selected individuals and 75 pre-covid-era PBMC/sera. This data will be used in comparative simulation models and will lead to a reassessment of several key epidemiological estimates such as herd immunity and the reproduction number R that will significantly inform covid-19 related public health interventions.

Researcher(s)

Research team(s)

The effectiveness of the preventive measures in primary care against SARS-CoV-2 using validated, non-invasive highly sensitive serological testing 01/06/2020 - 31/05/2021

Abstract

Primary health care providers (PHCPs) like general practitioners (GPs) and their co-workers manage the vast majority of COVID-19 and other patients and keep off the pressure from hospitals. Safeguarding PHCPs' capacity during outbreaks is vital, but currently evidence is lacking on 1. how many PHCPs get infected/diseased in our country, 2. the rate at which this happens, 3. their clinical spectrum, 4. their risk factors and 5. the effectiveness of the measures to prevent this from happening. These questions need answers soon to inform policy makers. We also need more accurate (sensitive!) tests of the immune response. For this, we will evaluate a novel microfluidic dried blood spot (DBS) sampling method and digital ELISA. DBS by fingerpricking is a promising, minimally invasive and transmission safe option for blood (self-)sampling, and already applicable in a multitude of areas. In a subgroup of participants, we will compare test accuracy using the easy-to-use novel DBS method, which further minimises the potential risks of contamination and more precisely meters the required blood volume, to standard DBS.

Researcher(s)

Research team(s)

Bronchodilators for wheeze in young children presenting to primary care: a randomized, placebo-controlled, multicentre, parallel group trial. 06/05/2019 - 31/10/2022

Abstract

The main aim of this study is to establish the assumed superiority of salbutamol over no treatment and the (cost-)effectiveness of salbutamol inhalations versus placebo in children aged 6-24 months presenting to their primary care physician with wheezing. 10% of infants are prescribed short-acting bronchodilators for wheezing per year, yet evidence to support this treatment in children younger than two years old is scarce. With around 30% of all 180,000 Belgian children and 260,000 Dutch children aged 6-24 months having a period of wheeze annually, and salbutamol being prescribed in 30% of cases, 40,000 salbutamol prescriptions can potentially be prevented per year. Eligible children are otherwise healthy in this study, aged 6-24 months, and present with physician-diagnosed wheeze and a baseline respiratory symptom score of at least 7 out of 18. Recruitment will last for two consecutive years, in 40 practices in Belgium. UA will recruit 6 practices. The results of our study could impact guidelines and health care costs. If our trial demonstrates salbutamol has no or only a negligible beneficial effect in infants and young children with wheeze in primary care this will have an impact on national and international guidelines, and as a result on clinical practice. Salbutamol prescriptions may reduce substantially.

Researcher(s)

Research team(s)

The value of diagnostics to combat antimicrobial resistance by optimising antibiotic use (VALUE-Dx). 01/04/2019 - 31/03/2023

Abstract

Antimicrobial resistance (AMR) is of great public health concern, causing numerous losses of lives worldwide and threatening to reverse many of the considerable strides modern medicine has made over the last century. There is a need to stratify antibiotic and alternative treatments in terms of the actual benefit for the patient, improving patient outcome and limit the impact on AMR. High quality, effective and appropriate diagnostic tests to steer appropriate use of antibiotics are available. However, implementation of these tests into daily healthcare practice is hampered due to lack of insight in the medical, technological and health economical value and limited knowledge about psychosocial, ethical, regulatory and organisational barriers to their implementation into clinical practice. VALUE-Dx will define and understand these value indicators and barriers to adoption of diagnostics of Community-Acquired Acute Respiratory Tract Infections (CA-ARTI) in order to develop and improve health economic models to generate insight in the whole value of diagnostics and develop policy and regulatory recommendations. In addition, efficient clinical algorithms and user requirement specifications of tests will be developed fuelling the medical and technological value of CA-ARTI diagnostics. The value of diagnostics will be tested and demonstrated in a unique pan-European clinical and laboratory research infrastructure allowing for innovative adaptive trial designs to evaluate novel CA-ARTI diagnostics. Close and continuous interaction with the VALUE-Dx multi-stakeholder platform provides for optimal alignment of VALUE-Dx activities with stakeholder opinions, expert knowledge and interests. A variety of dissemination and advocacy measures will promote wide-spread adoption of clinical and cost-effective innovative diagnostics to achieve more personalized, evidence-based antibiotic prescription in order to transform clinical practice, improve patient outcomes and combat AMR.

Researcher(s)

Research team(s)

European Clinical Research Alliance on Infectious Diseases (ECRAID) - Business Plan (ECRAID-Plan). 01/01/2019 - 30/06/2021

Abstract

ECRAID will develop a business plan in line with European-funded networks to create a clinical research infrastructure that will operate from 2021. This business plan is called ECRAID-Plan. It is working with the network partners and Monitor Deloitte to develop a business plan. The business plan will outline ECRAID services, operations, governance structure, and financial sustainability plans. ECRAID is seeking to strengthen alliances with the private sector and international organisations involved in infectious disease interventions to boost investments into protecting European public health.

Researcher(s)

Research team(s)

Respiratory Syncytial virus consortiem in Europe (RESCEU). 01/01/2017 - 31/12/2021

Abstract

Respiratory syncytial virus (RSV) is not well known outside medical circles, yet most people have probably suffered from it in childhood, as it is the most common cause of severe respiratory illness in infants and children worldwide. The elderly and people with weakened immune systems are also vulnerable to RSV infection. While most people's symptoms are mild, it can result in pneumonia and 3.4 million cases annually require hospitalisation. There is no specific treatment or vaccine for RSV. The goal of the RESCEU project is to gather information on the scale of RSV infection in Europe and its economic impacts. It will then use this information to design best practice guidelines to improve the way RSV cases are monitored in Europe, and to shape future vaccination programmes. The team will also gather and analyse patient samples to identify biological markers associated with severe RSV infection. This information could aid in diagnosis and facilitate the development of new treatments and vaccines.

Researcher(s)

Research team(s)

Community acquired acute respiratory tract infection (CA-ARTI) in community care in Europe: point prevalence audit study (PPAS) of presentation and management. 05/11/2019 - 31/12/2020

Abstract

Background: This PPAS study is part of a larger project called Value-Dx -the value of diagnostics to combat antimicrobial resistance by optimising antibiotic use- and makes up part of the clinical Work Package Four (WP4). The aim of Value-Dx is to transform clinical practice, improve patient outcomes, and combat antimicrobial resistance (AMR), through the widespread use of clinical and cost-effective innovative diagnostics strategies to achieve more personalised, evidence-based antibiotic prescription and use in community care settings. Study Design: This anonymous cross sectional clinical audit study will run over a 2 to 8-week period from January to March 2020 in approximately 20 European countries. Researchers will collect information from a range of health care settings where antibiotics are prescribed for patients who have respiratory infections Study Participants: People over the age of one-year consulting with community acquired acute respiratory tract infection (CA-ARTI) in community care with participating clinicians in participating countries. Objective: To generate a description of the presentation and management of patients with CA-ARTI by community based care prescribers (CBCP), by benchmarking current practice in approximately 20 European Countries.

Researcher(s)

Research team(s)

A study of the feasibility and risks of the integration of triage and regulation of acue medical care. general practitioners, emergency departments and the 112 help centre. 01/04/2016 - 31/03/2018

Abstract

In Belgium, emergency departments and GPs take care of urgent medical care during office and out-of-hours (OOH). Patients have access to the care provider of their choice. Over the last years protocols for triage of unplanned care have been developed by working groups in Belgium. The central aim of the present project is to establish if telephonic triage (using the phone number "1733") with professional call takers using these protocols is feasible, reliable and effective. A pilot project is established in the region Leuven-Tienen, in close collaboration with the emergency departments, the general practice OOH services and the regional emergency call centre which operate in that region. The overall research questions are 1. What is the safety and efficiency of newly developed protocols when used by call takers? 2. What is the epidemiology of unplanned medical care both during office and out-of-hours? 3. What is the influence of telephone triage on the workload and cost of care for unplanned medical problems? Other activities during the project will help to inform the public and the health professionals in the Leuven region. The two year project started May 1, 2016. Results of this study will inform stakeholders about future organisation of OOH care in Belgium. The OOH care research group is part of the General Practice group of the Department of Primary and Interdisciplinary Care Principal investigator: Hilde Philips Co-supervisor Veronique Verhoeven Junior researcher: Hanne Claessen Junior researcher: Annelies Colliers Team member: Roy Remmen

Researcher(s)

Research team(s)

Alic4e-antivirals for influenza like illness? An rct of clinical and cost effectiveness in primary care. 21/01/2016 - 31/12/2016

Abstract

Antivirals for influenza like illness? An adaptive RCT of clinical and cost effectiveness in primary care. Epidemic and pandemic preparedness systems are needed to protect health and socio-economics in the European Union. Much progress has been made in developing structures for adequate public health responses. The clinical research response, however, is often delayed and fragmented, and has therefore too little impact on improving patient outcomes and on developing evidence to inform clinical management strategies. The overall mission of PREPARE (Platform foR European Prepardness Against (Re-)emerging Epidemics; www.prepare-europe.eu) therefore is to establish a European clinical research framework for harmonised, large-scale clinical research studies on infectious diseases. This will enable a rapid response to any severe infectious disease outbreak and proper treatment, by providing real-time evidence for clinical management of patients. The ALIC4E trial, a large multicentre study in primary care patients with influenza-like-illness (ILI), is part of PREPARE and aims to investigate the (cost) effectiveness of antiviral treatments for ILI in primary care, to establish a European primary care research network for clinical research during epidemics or pandemics, and to define recommendations for effective research in European primary care during an epidemic or pandemic.

Researcher(s)

Research team(s)

    Editorship EBMPracticeNet including the ultimate responsibility for the development of the online knowledge database 01/08/2015 - 31/12/2015

    Abstract

    The knowledge database of EBMPracticeNet includes all National Belgian EBM-information products, including the adapted Duodecim guidelines and all Belgian updated monodisciplinary and multidisciplinary guidelines. Within this project the researcher has the ultimate responsibility for the development of the online knowledge base. He/she is responsible for the actualization, coherence and integration of all guidelines and the other Belgian EBM products. There is a strong collaboration with the working group for the development of primary care guidelines, the project leader and the responsible for the clinical decision support system

    Researcher(s)

    Research team(s)

    EARL Focus Group Study. 01/04/2015 - 31/03/2016

    Abstract

    This project represents a formal research agreement between UA and on the other hand the client. UA provides the client research results mentioned in the title of the project under the conditions as stipulated in this contract.

    Researcher(s)

    Research team(s)

      Improving Care and Research Electronic Data Trust Antwerp (ICAREDATA). 01/09/2014 - 31/12/2018

      Abstract

      This project represents a formal research agreement between UA and on the other hand the Flemish Public Service. UA provides the Flemish Public Service research results mentioned in the title of the project under the conditions as stipulated in this contract.

      Researcher(s)

      Research team(s)

      The effect of independent doctor visits on the prescription of analgesics in primary care: a randomized controlled trial with process analysis. 01/07/2013 - 31/12/2016

      Abstract

      The primary objective of the project is to estimate the effect of Farmaka's academic detailing service in practices visited before by Farmaka on general practioners appropriate prescribing of anagesics. The study is essential to unequivocally inform policymakers, Farmaka and the scientific community on how to most effectively improve the quality of pharmaceutical care (in Belgium).

      Researcher(s)

      Research team(s)

      Research and services in the framework of the project GRACE (Genomics to combat Resistance against Antibiotics in Community-acquired LRTI in Europe). 01/07/2013 - 31/03/2015

      Abstract

      This project represents a formal research agreement between UA and on the other hand Cardiff University. UA provides Cardiff University research results mentioned in the title of the project under the conditions as stipulated in this contract.

      Researcher(s)

      Research team(s)

        Study on the effect of the Belgian antibiotics campaigns on antibiotic use in outpatient practice. 01/03/2013 - 31/08/2013

        Abstract

        This project represents a formal research agreement between UA and on the other BAPCOC. UA provides BAPCOC research results mentioned in the title of the project under the conditions as stipulated in this contract.

        Researcher(s)

        Research team(s)

          Translational research on antimicrobial resistance and community-acquired infections in Europe (TRACE). 16/06/2011 - 31/12/2018

          Abstract

          This project represents a formal research agreement between UA and on the other hand ESF. UA provides ESF research results mentioned in the title of the project under the conditions as stipulated in this contract.

          Researcher(s)

          Research team(s)

            The appropriateness of prescribing antibiotics in primary health care in Europe with respect to antibiotic resistance (APRES). 01/10/2009 - 31/03/2014

            Abstract

            The APRES project aims at providing information and recommendations on the appropriateness of prescribing antibiotics in primary care throughout Europe by collecting information on the antibiotic resistance pattern of bacteria circulating in the community and by combining this information with antibiotic prescribing patterns retrieve from primary care practices. The appropriateness of prescribing antibiotics is defined as the extent to which the pattern of prescribed antibiotics are congruent with the antibiotic resistance pattern of bacteria.

            Researcher(s)

            Research team(s)

              Improving the management of lower respiratory tract infections in general practice by means of etiological, prognostic and interventional studies. 01/01/2008 - 31/12/2011

              Abstract

              General objectives: To participate with a Flemisch primary care Network in GRACE. Specific objectives: 1. To determine the proportion of bacterial LRTI. 2. To describe the most important bacterial species in LRTI and to determine to what extent they are resistant to antibiotics. 3. To validate the CRB-65 prediction rule to assess the risk on complications in general practice. 4. To review national and international guidelines on lower respiratory tract infections. 5. To assess whether an evidence-based intervention package reduces antibiotic prescribing for community-acquired LRTI.

              Researcher(s)

              Research team(s)

                Health Economics Research and Mathematical Modelling of Infectious Diseases. 01/12/2007 - 31/12/2014

                Abstract

                The research plan over the next years involves four main research themes: 1.1.Modelling infectious diseases; 1.2.Data collection and analysis for burden of (infectious) disease estimates; 1.3.Program evaluations of infectious disease interventions; 1.4.Health economics and program evaluations in general. Each of these research themes departs from the observation that the current methodological approach can be substantially improved by using more sophisticated methods. Since these research themes are each multidisciplinary and interconnected, these improvements are expected to occur within each theme and over all themes combined.

                Researcher(s)

                Research team(s)

                  Changing behaviour of Health care professionals and the general public towards a More Prudent use of anti-microbial agents. (CHAMP) 01/04/2007 - 31/03/2011

                  Abstract

                  The aim of CHAMP (Changing behaviour of Health care professionals And the general public towards a More Prudent use of anti-microbial agents) is to promote the appropriate use of antibiotics by developing effective tools to change behaviour of health care professionals, patients in primary care, and the general public on the prescription and use of antibiotics. Effective interventions in this field should take into account cultural differences between countries and be based on knowledge of perceptions and behaviour of medical professionals, patients and the general public within the European Union. Therefore the first stage of the project will explore current prevention and management of respiratory tract infections in European primary care and perception, expectations and illness behaviour of primary care patients with respiratory tract infections. Then an up-to-date inventory of both published and unpublished public campaigns and behavioural programs will be made and qualitative information from key-players and stake-holders in this field will be gathered. Cost-effectiveness of the different interventions used until now will be modelled. In addition, information will be gathered systematically on educational programs from medical schools on prevention and management of common respiratory tract infections. The information thus gathered will be analysed and priorities chosen. Consensus will be aimed for among experts and stakeholders on tools to improve the behaviour of medical professionals and the public concerning prevention and management of infectious diseases and antibiotic use. In addition, standard procedures will be developed to measure the effects of educational activities, behavioural programs and public campaigns in this field. Finally, the implementation of the behavioural program that is thus developed will be tried out and evaluated in six GP networks in six different countries. This will be done in close collaboration with the GRACE project.

                  Researcher(s)

                  Research team(s)

                    Lower respiratory tract infections in general practice: qualitative research into factors contributing to variation in antibiotic use and resistance. 01/01/2007 - 31/12/2008

                    Abstract

                    The prescription of antibiotics for LRTI accounts for a major proportion of antibiotics used in the community and contributes to the rising prevalence of resistance. This qualitative study will explore the factors that contribute to variation in antibiotic use in general medical care in Utrecht and Antwerp. Interviews will be conducted to study the current attitudes and beliefs of both clinicians and patients to antibiotic use and resistance.

                    Researcher(s)

                    Research team(s)

                    Evidence-based management in primary care : the case for respiratory tract infections. 01/10/2006 - 30/09/2009

                    Abstract

                    For many problems encountered in primary care strong evidence to support management is lacking. In addition there is a problem of implementing evidence-based management in everyday practice. Both lead to sub-optimal patient care and misuse of available resources. Respiratory tract infections are a good example of this (Coenen S. Antibiotics for coughing in general practice [Dissertation]. University of Anwerp 2003). For lower respiratory tract infections (LRTIs) the evidence for the effectiveness of antibiotics is conflicting. Furthermore, the evidence does not allow to identify those patients who would (not) benefit from antibiotic treatment. For otitis media with effusion (OME) antibiotics are of very limited benefit. On the other hand the relevant evidence base on the overall effectiveness of surgery is provided in OME. Here however poor selectivity for referrals by GPs to ENT was documented. The current research project aims to inform the development of interventions to improve the predictive validity of OM referrals and to improve pragmatic choices about the use of antibiotics for all patients with LRTI and for important clinical subgroups of patients with LRTI.

                    Researcher(s)

                    Research team(s)

                      Genomics to Combat Resistance against Antibiotics in Community-acquired LRTI in Europe. (GRACE) 01/03/2006 - 31/08/2011

                      Abstract

                      GRACE is a Network of Excellence focusing on the complex and controversial field of community-acquired lower respiratory tract infections (LRTI), which is one of the leading reasons for seeking medical care-The promiscuous use of antibiotics to treatment of LRTI accounts for a major part of the community burden of antibiotic use and contributes dramatically to the rising prevalence of resistance among major human pathogens. The overall objective of GRACE is to combat antimicrobial resistance through integrating centres of research excellence and exploiting genomics in the investigation of community-acquired LRTI. Microbial and human genomics will be integrated with health sciences research consisting of clinical observational and intervention studies, health economics and health education to specifically change practice in managing community-acquired LRTI. GRACE is exceptional as it brings together investigators from basic laboratory sciences, clinical medicine, and health economics. In the jointly executed research programme, 17 academic groups, spread widely across 9 EU Member States and 5 SMEs will participate. GRACE will organise professional education, including web-based teaching and practical courses, through two leading European scientific societies (European Society of Clinical Microbiology and Infectious Diseases and European Respiratory Society) to disseminate the excellence of the programme. A high level of co-ordination will be obtained through a professionally IT-supported and rigorous management structure, so as to achieve optimal synergy of the components of GRACE. We aim to develop a genomic laboratory network in 8 European countries and a primary care research network in 11 European countries during the first 18 months of the project, and then to build on the infrastructure to create the jointly executed research programme. The consortium will become a virtual "European LRTI Research Centre" potentially leading to a forum promoting research and good practice in the field of community-acquired LRTI.

                      Researcher(s)

                      Research team(s)

                        Towards rational prescribing of antibiotics for acute rhinosinusitis : evaluation of the impact and costs of implementation strategies based on a multidisciplinary evidence-based guideline. 01/07/2004 - 30/06/2005

                        Abstract

                        Researcher(s)

                        Research team(s)

                        Evidence-based management in primary care : the case for respiratory tract infections. 01/10/2003 - 30/09/2006

                        Abstract

                        For many problems encountered in primary care strong evidence to support management is lacking. In addition there is a problem of implementing evidence-based management in everyday practice. Both lead to sub-optimal patient care and misuse of available resources. Respiratory tract infections are a good example of this (Coenen S. Antibiotics for coughing in general practice [Dissertation]. University of Anwerp 2003). For lower respiratory tract infections (LRTIs) the evidence for the effectiveness of antibiotics is conflicting. Furthermore, the evidence does not allow to identify those patients who would (not) benefit from antibiotic treatment. For otitis media with effusion (OME) antibiotics are of very limited benefit. On the other hand the relevant evidence base on the overall effectiveness of surgery is provided in OME. Here however poor selectivity for referrals by GPs to ENT was documented. The current research project aims to inform the development of interventions to improve the predictive validity of OM referrals and to improve pragmatic choices about the use of antibiotics for all patients with LRTI and for important clinical subgroups of patients with LRTI.

                        Researcher(s)

                        Research team(s)

                        The management of 'coughing' as a result of respiratory tract infections in general practica. A medical decision analysis study . 01/10/1999 - 28/02/2002

                        Abstract

                        Acute respiratory tract infections represent a medically, epidemiologically and socio-economically relevant problem. The diagnostic policy in primary health care, following 'coughing' as the reason for encounter, is very specific for this setting: confirm and rule out in a diagnostic landscape with low pretest probability. Which are the arguments used to conduct this policy? How streng are they and which should be used? These research questions will be answered in a partly qualitative (focus-groups) and partly quantitative research design (registration, OSCE test).

                        Researcher(s)

                        Research team(s)

                          The management of 'coughing' as a result of respiratory tract infections in general practica. A medical decision analysis study . 01/10/1997 - 30/09/1999

                          Abstract

                          Acute respiratory tract infections represent a medically, epidemiologically and socio-economically relevant problem. The diagnostic policy in primary health care, following 'coughing' as the reason for encounter, is very specific for this setting: confirm and rule out in a diagnostic landscape with low pretest probability. Which are the arguments used to conduct this policy? How streng are they and which should be used? These research questions will be answered in a partly qualitative (focus-groups) and partly quantitative research design (registration, OSCE test).

                          Researcher(s)

                          Research team(s)