A multidisciplinary network for the care of abnormal fatigue and CFS [in parts of Belgium]

[Dolphin]

http://www.ncbi.nlm.nih.gov/pubmed/25056488
http://www.maneyonline.com/doi/abs/10.1179/2295333714Y.0000000056

A multidisciplinary network for the care of abnormal fatigue and chronic fatigue syndrome in the provinces of East and West Flanders in Belgium.

Acta Clin Belg. 2014 Jul 24:0. [Epub ahead of print]

Tobback E, Mariman A, Heytens S, Declercq T, Bouwen A, Spooren D, Snoeck P, Van Dessel K, D'Hooghe S, Rimbaut S, Vogelaers D.


Abstract


The organization of care for patients with the chronic fatigue syndrome (CFS) in tertiary care referral centres from 2002 onwards, was negatively evaluated by the Belgian Health Care Knowledge Centre on the endpoint of socio-professional reintegration [Dolphin: These were based on rehabilitation using CBT and GET].

Subsequently, the federal health authorities asked for the elaboration of a new and innovative model of stepped care, aiming at improved integration of diagnosis and treatment into primary care and between levels of health care for patients with CFS.

The reference centre of the University Hospital Ghent took the initiative of recruiting partners in the Belgian provinces of East and West Flanders to guarantee the care for patients with medically unexplained symptoms, in particular abnormal fatigue and CFS. [Dolphin: medically unexplained symptoms is a term invariably used by those who think the symptoms likely don't have much of a physical basis/are unlikely to be medically explained in the future].

A new and innovative care model, in which general practitioners play a central role, emphasizes the importance of early recognition of the patient 'at risk', correct diagnosis and timely referral.

Early detection and intervention is essential in order to avoid or minimize illness progression towards chronicity, to safeguard opportunities for significant health improvement as well as to enhance successful socio-professional reintegration.

This approach covers both the large sample of patients developing somatic complaints without obvious disease in an early phase as well as the more limited group of patients with chronic illness, including CFS.

Cognitive behavioural therapy and graded exposure/exercise therapy are the evidence based main components of therapy in the latter.

A biopsychosocial model underlies the proposed path of care.


KEYWORDS:


Abnormal fatigue,; Care path,; Chronic fatigue syndrome,; General practitioner; Network,


PMID: 25056488 [PubMed - as supplied by publisher]

So CBT and GET didn't work last time, but that's still what they're getting this time.

 

[Dolphin]

One can read information on the audit of the previous Belgian clinics here: http://forums.phoenixrising.me/inde...lgian-cbt-get-rehab-clinics-large-sample.6072

 

[Valentijn]

So CBT and GET didn't work last time, but that's still what they're getting this time.

 

[A.B.]

Early detection and intervention is essential in order to avoid or minimize illness progression towards chronicity

Even more essential is actually knowing whether your intervention does anything at all. I skimmed the audit and they seem to have no good data on natural illness progression or effectiveness of the intervention, but who cares, psychologists need not be concerned with reality.

 

[Dolphin]

If anyone feels inclined, they do accept letters to the editor:

• Letters to the Editor should not exceed 300 words, 3 authors, 5 references and should contain a maximum of 4 tables/figures.

  http://www.maneyonline.com/ifa/acb

 

[lansbergen]

They will never learn

 

[Bob]

The abstract starts off so promisingly!

(At last, they've finally admitted that CBT and GET are ineffective, and even harmful!)

And then, of course, I read the final line.

A biopsychosocial model underlies the proposed path of care.

 

[Bob]

Cognitive behavioural therapy and graded exposure/exercise therapy are the evidence based main components of therapy in the latter.

erm...

The organization of care for patients with the chronic fatigue syndrome (CFS) in tertiary care referral centres from 2002 onwards, was negatively evaluated...

 

[A.B.]

erm...

Maybe they're hoping that by starting "treatment" early, they can prevent the faulty thoughts from becoming chronic? Surely that will prevent CFS, won't it not?

 

[Valentijn]

Maybe they're hoping that by starting "treatment" early, they can prevent the faulty thoughts from becoming chronic? Surely that will prevent CFS, won't it not?

 

[Little Bluestem]

Someone needs to introduce them to KDM.

 

[Valentijn]

Someone needs to introduce them to KDM.

Yes, I imagine outcomes regarding health, activity, and patient satisfaction are all MUCH higher at his clinic then they are at the Belgian fatigue centers.

 

[Little Bluestem]

There is no point in reinventing the wheel (particularly when you seen to think it should be square). They can just follow his model.

 

[Dolphin]

Johan blogged about this issue:
http://www.pugilator.com/awareness/the-new-multidisciplinary-diagnostic-centres-for-cfs-in-belgium/

 

[Dolphin]

Frank Twisk replied.
Here's a link to the full text of the authors' reply:

Invited Letter to the Editor
Care for chronic fatigue syndrome (CFS)/ myalgic encephalomyelitis (ME) patients in Belgium: time for a paradigm shift – Reply to letter to the editor E. Tobback, A. Mariman, D. Vogelaers
http://search.proquest.com/openview...e7d047a/1.pdf?pq-origsite=gscholar&cbl=836352