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Kool E, Schellevis FG, Jaarsma DADC, Feijen-de Jong EI. How to improve newly qualified midwives' transition-into-practice. A Delphi study. Sex Reprod Healthc 2023; 38:100921. [PMID: 37866285 DOI: 10.1016/j.srhc.2023.100921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND In the Netherlands, newly qualified midwives start work as registered midwives without any formal transition support. Research shows that newly qualified midwives do not feel sufficiently confident and competent in their work during the period following graduation. This could impact the quality of care provided by newly registered midwives. The aim of this study is to seek consensus with stakeholders concerning viable components of support for newly qualified midwives working in midwifery care in the Netherlands. METHODS A Delphi study was conducted among maternity care stakeholders in the Netherlands. During two rounds, sixteen statements derived from a theoretical framework of organizational socialization theory and previous studies were assessed (round 1, n = 56; round 2, n = 52). Stakeholders (N = 61) were invited and completed an online questionnaire that included spaces for opinions and remarks. RESULTS Stakeholders agreed about an introductory support period for newly qualified midwives, involving performance feedback and regional-level backup from fellow midwives during shifts. They further agreed on the responsibilities of established professionals that they should support newcomers in practice and provide mentoring or group coaching, although they face organizational barriers for supporting newcomers. CONCLUSIONS Stakeholders found consensus upon several components of support at the workplace. In addition, a stable work environment seemed less important in their opinion while previous research suggests otherwise. Practice organisations need to improve the employment conditions and support for newly qualified midwives to ensure the quality of midwifery care is guaranteed.
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Affiliation(s)
- Elizabeth Kool
- University of Groningen, University Medical Center Groningen, Department of Primary and Long-term Care, PO Box 196, 9700 AD Groningen, The Netherlands; Midwifery Academy Amsterdam Groningen, InHolland, Groningen, The Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, The Netherlands.
| | - Francois G Schellevis
- Amsterdam UMC location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands; NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Debbie A D C Jaarsma
- Faculty of Veterinary Medicine, Utrecht University. Wenckebach Institute for Education and Training, Center for Education Development and Research in Health Professions, LEARN, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Esther I Feijen-de Jong
- University of Groningen, University Medical Center Groningen, Department of Primary and Long-term Care, PO Box 196, 9700 AD Groningen, The Netherlands; Midwifery Academy Amsterdam Groningen, InHolland, Groningen, The Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, The Netherlands
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2
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Groot LJJ, Schers HJ, Burgers JS, Schellevis FG, Smalbrugge M, Uijen AA, van de Ven PM, van der Horst HE, Maarsingh OR. Optimising personal continuity for older patients in general practice: a study protocol for a cluster randomised stepped wedge pragmatic trial. BMC Fam Pract 2021; 22:207. [PMID: 34666678 PMCID: PMC8526277 DOI: 10.1186/s12875-021-01511-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/15/2021] [Indexed: 11/20/2022]
Abstract
Background Continuity of care, in particular personal continuity, is a core principle of general practice and is associated with many benefits such as a better patient-provider relationship and lower mortality. However, personal continuity is under pressure due to changes in society and healthcare. This affects older patients more than younger patients. As the number of older patients will double the coming decades, an intervention to optimise personal continuity for this group is highly warranted. Methods Following the UK Medical Research Council framework for complex Interventions, we will develop and evaluate an intervention to optimise personal continuity for older patients in general practice. In phase 0, we will perform a literature study to provide the theoretical basis for the intervention. In phase I we will define the components of the intervention by performing surveys and focus groups among patients, general practitioners, practice assistants and practice nurses, concluded by a Delphi study among members of our group. In phase II, we will test and finalise the intervention with input from a pilot study in two general practices. In phase III, we will perform a stepped wedge cluster randomised pragmatic trial. The primary outcome measure is continuity of care from the patients’ perspective, measured by the Nijmegen Continuity Questionnaire. Secondary outcome measures are level of implementation, barriers and facilitators for implementation, acceptability and feasibility of the intervention. In phase IV, we will establish the conditions for large-scale implementation. Discussion This is the first study to investigate an intervention for improving personal continuity for older patients in general practice. If proven effective, our intervention will enable General practitioners to improve the quality of care for their increasing population of older patients. The pragmatic design of the study will enable evaluation in real-life conditions, facilitating future implementation. Trial registration number Netherlands Trial Register, trial NL8132. Registered 2 November 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01511-y.
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Affiliation(s)
- Lex J J Groot
- Department of General Practice, Amsterdam University Medical Centre, location VU University Medical Centre, van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands.
| | - Henk J Schers
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Geert Grooteplein 21, 6525, EZ, Nijmegen, The Netherlands
| | - Jako S Burgers
- MUMC+/ Maastricht University, Department of General Practice, Care and Public Health Research Institute (CAPHRI), Universiteitssingel 40, 6229, ER, Maastricht, the Netherlands
| | - Francois G Schellevis
- Department of General Practice, Amsterdam University Medical Centre, location VU University Medical Centre, van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands
| | - Martin Smalbrugge
- Department of Medicine for Older People, Amsterdam University Medical Centre, location VU University Medical Centre, De Boelelaan 1109, 1081, HV, Amsterdam, the Netherlands
| | - Annemarie A Uijen
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Geert Grooteplein 21, 6525, EZ, Nijmegen, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, De Boelelaan 1089a, 1081, HV, Amsterdam, the Netherlands
| | - Henriëtte E van der Horst
- Department of General Practice, Amsterdam University Medical Centre, location VU University Medical Centre, van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands
| | - Otto R Maarsingh
- Department of General Practice, Amsterdam University Medical Centre, location VU University Medical Centre, van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands
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Pati S, Pati S, van den Akker M, Schellevis FG, Sahoo KC, Burgers JS. Managing diabetes mellitus with comorbidities in primary healthcare facilities in urban settings: a qualitative study among physicians in Odisha, India. BMC Fam Pract 2021; 22:99. [PMID: 34022811 PMCID: PMC8141170 DOI: 10.1186/s12875-021-01454-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/12/2021] [Indexed: 11/22/2022]
Abstract
Aim To explore the perceived barriers and facilitators in the management of the patients having diabetes with comorbidities by primary care physicians. Methods A qualitative In-Depth Interview study was conducted among the primary care physicians at seventeen urban primary health care centres at Bhubaneswar city of Odisha, India. The digitally recorded interviews were transcribed verbatim and translated into English. The data were analysed using thematic analysis. Results Barriers related to physicians, patients and health system were identified. Physicians felt lack of necessary knowledge and skills, communication skills and overburdening due to multiple responsibilities to be major barriers to quality care. Patients’ attitude and beliefs along with socio-economic status played an important role in treatment adherence and in the management of their disease conditions. Poor infrastructure, irregular medicine supply, and shortage of skilled allied health professionals were also found to be barriers to optimal care delivery, as was the lack of electronic medical records and personal treatment records. Conclusion Comprehensive guidelines with on the job training for capacity building of the physicians and creation of multidisciplinary teams at primary care level for a more holistic approach towards management of diabetes with comorbidities could be the way forward to optimal delivery of care.
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Affiliation(s)
- Sandipana Pati
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India. .,Indian Institute of Public Health Bhubaneswar (PHFI), Plot No. 267/3408, Jaydev Vihar, Mayfair Lagoon Road, Bhubaneswar-751013, Bhubaneswar, Odisha, India.
| | - Sanghamitra Pati
- Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, Odisha, India
| | - Marjan van den Akker
- Institute of General Practice, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.,Department of Family Medicine, Maastricht University, Maastricht, the Netherlands.,Academic Centre of General Practice, KU Leuven, Leuven, Belgium
| | - F G Schellevis
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers Location VUmc, Amsterdam, Netherlands.,NIVEL (Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Krushna Chandra Sahoo
- Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, Odisha, India
| | - Jako S Burgers
- Department of Family Medicine, School CAPRI, Maastricht University, Maastricht, the Netherlands.,Dutch College of General Practitioners, Utrecht, The Netherlands
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Tichelman E, Warmink-Perdijk W, Henrichs J, Peters L, Schellevis FG, Berger MY, Burger H. Intrapartum synthetic oxytocin, behavioral and emotional problems in children, and the role of postnatal depressive symptoms, postnatal anxiety and mother-to-infant bonding: A Dutch prospective cohort study. Midwifery 2021; 100:103045. [PMID: 34077815 DOI: 10.1016/j.midw.2021.103045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 02/22/2021] [Accepted: 05/13/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine the association between intrapartum synthetic oxytocin and child behavioral and emotional problems and to assess if maternal depressive or anxious symptoms or mother-to-infant bonding play a mediating role in this association. DESIGN Prospective cohort study. SETTING Population-based Pregnancy Anxiety and Depression Study. PARTICIPANTS Pregnant women in their first trimester of pregnancy visiting a total of 109 primary and nine secondary obstetric care centers in the Netherlands between 2010 and 2014 were invited to participate. Follow-up measures used for the present study were collected from May 2010 to January 2019. Women with multiple gestations and with a preterm birth were excluded. MEASUREMENTS Intrapartum synthetic oxytocin exposure status was based on medical birth records and was defined as its administration (Yes/No), either for labour induction or augmentation. Child behavioral and emotional problems were measured with the Child Behavior Checklist at up to 60 months postpartum. Maternal depressive symptoms, anxiety and mother-to infant bonding were measured with the Edinburgh Postnatal Depression Scale, State Trait Anxiety Inventory and the Mother-to-Infant Bonding Scale from 6 months postpartum. We used multivariable linear regression models to estimate standardized beta coefficients and unique variance explained. FINDINGS 1,528 women responded. In total 607 women received intrapartum synthetic oxytocin. Intrapartum synthetic oxytocin administration was not associated with child behavioral and emotional problems, mother-to-infant bonding nor with postnatal anxiety. Intrapartum synthetic oxytocin was however significantly but weakly associated with more postnatal depressive symptoms (β=0.17, 95%CI of 0.03 to 0.30) explaining 0.6% of unique variance. Maternal postnatal depressive symptoms, postnatal anxiety symptoms and suboptimal mother-to-infant bonding were positively associated with child behavioral and emotional problems. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE We found no evidence that intrapartum synthetic oxytocin is associated with child behavioral and emotional problems, mother-to-infant bonding, or with postnatal anxiety symptoms. Because there was no association between intrapartum synthetic oxytocin and behavioral and emotional problems in children no mediation analysis was carried out. However, intrapartum synthetic oxytocin was positively but weakly associated with postnatal depressive symptoms. The clinical relevance of this finding is negligible in the general population, but unknown in a population with a high risk of depression.
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Affiliation(s)
- Elke Tichelman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG, Amsterdam Public, Health research institute, Amsterdam, the Netherlands; University of Groningen, University Medical Centre Groningen, Department of General Practice and Elderly Care Medicine, the Netherlands.
| | - Willemijn Warmink-Perdijk
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG, Amsterdam Public, Health research institute, Amsterdam, the Netherlands; University of Groningen, University Medical Centre Groningen, Department of General Practice and Elderly Care Medicine, the Netherlands
| | - Jens Henrichs
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG, Amsterdam Public, Health research institute, Amsterdam, the Netherlands
| | - Lillian Peters
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG, Amsterdam Public, Health research institute, Amsterdam, the Netherlands; University of Groningen, University Medical Centre Groningen, Department of General Practice and Elderly Care Medicine, the Netherlands
| | - Francois G Schellevis
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Marjolein Y Berger
- University of Groningen, University Medical Centre Groningen, Department of General Practice and Elderly Care Medicine, the Netherlands
| | - Huibert Burger
- University of Groningen, University Medical Centre Groningen, Department of General Practice and Elderly Care Medicine, the Netherlands
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5
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Witteveen AB, Henrichs J, Walker AL, Bohlmeijer ET, Burger H, Fontein-Kuipers Y, Schellevis FG, Stramrood CAI, Olff M, Verhoeven CJ, de Jonge A. Effectiveness of a guided ACT-based self-help resilience training for depressive symptoms during pregnancy: Study protocol of a randomized controlled trial embedded in a prospective cohort. BMC Pregnancy Childbirth 2020; 20:705. [PMID: 33213400 PMCID: PMC7676420 DOI: 10.1186/s12884-020-03395-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/04/2020] [Indexed: 01/30/2023] Open
Abstract
Background During pregnancy, about 10 to 20% of women experience depressive symptoms. Subclinical depression increases the risk of peripartum depression, maternal neuro-endocrine dysregulations, and adverse birth and infant outcomes. Current treatments often comprise face-to-face psychological or pharmacological treatments that may be too intensive for women with subclinical depression leading to drop-out and moderate effectiveness. Therefore, easily accessible, resilience enhancing and less stigmatizing interventions are needed to prevent the development of clinical depression. This paper describes the protocol of a prospective cohort study with an embedded randomized controlled trial (RCT) that aims to improve mental resilience in a sample of pregnant women through a self-help program based on the principles of Acceptance and Commitment Therapy (ACT). Maternal and offspring correlates of the trajectories of peripartum depressive symptoms will also be studied. Methods Pregnant women (≥ 18 years) receiving care in Dutch midwifery practices will participate in a prospective cohort study (n ~ 3500). Between 12 and 18 weeks of pregnancy, all women will be screened for depression with the Edinburgh Postnatal Depression Scale (EPDS). Women with an EPDS score ≥ 11 will be evaluated with a structured clinical interview. Participants with subclinical depression (n = 290) will be randomized to a 9-week guided self-help ACT-training or to care as usual (CAU). Primary outcomes (depressive symptoms and resilience) and secondary outcomes (e.g. anxiety and PTSD, bonding, infant development) will be collected via online questionnaires at four prospective assessments around 20 weeks and 30 weeks gestation and at 6 weeks and 4 months postpartum. Maternal hair cortisol concentrations will be assessed in a subsample of women with a range of depressive symptoms (n = 300). The intervention’s feasibility will be assessed through qualitative interviews in a subsample of participants (n = 20). Discussion This is the first study to assess the effectiveness of an easy to administer intervention strategy to prevent adverse mental health effects through enhancing resilience in pregnant women with antepartum depressive symptomatology. This longitudinal study will provide insights into trajectories of peripartum depressive symptoms in relation to resilience, maternal cortisol, psychological outcomes, and infant developmental milestones. Trial registration Netherlands Trial Register (NTR), NL7499. Registered 5 February 2019.
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Affiliation(s)
- Anke B Witteveen
- Department of Midwifery Science, AVAG/Amsterdam Public Health Research Institute, Amsterdam UMC, location VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Jens Henrichs
- Department of Midwifery Science, AVAG/Amsterdam Public Health Research Institute, Amsterdam UMC, location VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Annika L Walker
- Department of Midwifery Science, AVAG/Amsterdam Public Health Research Institute, Amsterdam UMC, location VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Ernst T Bohlmeijer
- Department of Psychology, Health and Technology , University of Twente , Drienerlolaan 5, 7522 NB, Enschede, Netherlands
| | - Huibert Burger
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, Hanzeplein 1, Groningen, 9713GZ, Netherlands
| | - Yvonne Fontein-Kuipers
- Institute for Healthcare - School of Midwifery , Rotterdam University of Applied Sciences , Rochussenstraat 198, 3015 EK, Rotterdam, Netherlands
| | - Francois G Schellevis
- Department of General Practice , Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam Public Health Research Institute , Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands.,NIVEL Netherlands Institute for Health Services Research , Otterstraat 118, 3513 CR, Utrecht, Netherlands
| | - Claire A I Stramrood
- Department of Obstetrics and Gynaecology, OLVG, Oosterpark 9, 1091 AC, Amsterdam, Netherlands
| | - Miranda Olff
- Department of Psychiatry UMC, location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands.,ARQ National Psychotrauma Centre , Nienoord 5, 1112 XE, Diemen, Netherlands
| | - Corine J Verhoeven
- Department of Midwifery Science, AVAG/Amsterdam Public Health Research Institute, Amsterdam UMC, location VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.,Department of Obstetrics and Gynecology Maxima Medical Centre , Veldhoven, Netherlands.,Division of Midwifery School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Ank de Jonge
- Department of Midwifery Science, AVAG/Amsterdam Public Health Research Institute, Amsterdam UMC, location VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
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6
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Weesie YM, Hek K, Schermer TRJ, Schellevis FG, Leufkens HGM, Rook EJ, van Dijk L. Use of Opioids Increases With Age in Older Adults: An Observational Study (2005-2017). Front Pharmacol 2020; 11:648. [PMID: 32477127 PMCID: PMC7241279 DOI: 10.3389/fphar.2020.00648] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 04/22/2020] [Indexed: 11/13/2022] Open
Abstract
Aim Pain is increasingly treated with opioids. Potential harms of opioid therapy disproportionally affect older patients. This study aims to provide information on trends, nature and duration of opioid prescribing to older adults, in primary care and to explore differences between older patients from different ages. Methods Primary care data (2005-2017) were derived from routine electronic medical records of patients in Nivel Primary Care Database. All opioid prescriptions with Anatomical Therapeutic Chemical Classification (ATC) code N02A were selected (except for codeine). Diagnoses were recorded using the International Classification of Primary Care (ICPC). Patients were categorized in three age groups (65-74, 75-84, and ≥85 years). Descriptive analyses were used to describe the trend of opioid prescriptions for specific opioids, the duration of use and underlying diagnoses. Results 283,600 patients were included of which 32,287 had at least one opioid prescription in 2017. An increase in the number of older adults who received at least one opioid was seen between 2005 and 2017. The oldest patients were more likely to be prescribed an opioid, especially when it comes to strong opioids, the increase in the volume of prescribing was highest in this group. Moreover, over 40% of the oldest patients used strong opioids chronically. Strong opioids were mostly prescribed for musculoskeletal diagnoses. Cancer was the second most common diagnosis for strong opioids in the younger subgroups, whereas less specified diagnoses were as second in the oldest subgroup. Conclusion Opioid prescription changes with increasing age in frequency, nature, and duration, despite higher harm risks among older patients. Because of the high prevalence of chronic use, it is important to monitor the patient throughout the treatment and to critically evaluate the initiation and continuation of opioid prescriptions.
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Affiliation(s)
- Yvette M Weesie
- Pharmaceutical Care, Netherlands Institute for Health Services Research (Nivel), Utrecht, Netherlands
| | - Karin Hek
- Pharmaceutical Care, Netherlands Institute for Health Services Research (Nivel), Utrecht, Netherlands
| | - Tjard R J Schermer
- Pharmaceutical Care, Netherlands Institute for Health Services Research (Nivel), Utrecht, Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands
| | - Francois G Schellevis
- Pharmaceutical Care, Netherlands Institute for Health Services Research (Nivel), Utrecht, Netherlands.,Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers location VUmc, Amsterdam, Netherlands
| | - Hubertus G M Leufkens
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University (UU), Utrecht, Netherlands
| | | | - Liset van Dijk
- Pharmaceutical Care, Netherlands Institute for Health Services Research (Nivel), Utrecht, Netherlands.,Department of PharmacoTherapy,-Epidemiology & -Economics (PTEE), Faculty of Mathematics and Natural Sciences, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
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7
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Stol DM, Hollander M, Damman OC, Nielen MMJ, Badenbroek IF, Schellevis FG, de Wit NJ. Mismatch between self-perceived and calculated cardiometabolic disease risk among participants in a prevention program for cardiometabolic disease: a cross-sectional study. BMC Public Health 2020; 20:740. [PMID: 32434574 PMCID: PMC7238643 DOI: 10.1186/s12889-020-08906-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 05/12/2020] [Indexed: 12/11/2022] Open
Abstract
Background The rising prevalence of cardiometabolic diseases (CMD) calls for effective prevention programs. Self-assessment of CMD risk, for example through an online risk score (ORS), might induce risk reducing behavior. However, the concept of disease risk is often difficult for people to understand. Therefore, the study objective was to assess the impact of communicating an individualized CMD risk score through an ORS on perceived risk and to identify risk factors and demographic characteristics associated with risk perception among high-risk participants of a prevention program for CMD. Methods A cross-sectional analysis of baseline data from a randomized controlled trial conducted in a primary care setting. Seven thousand five hundred forty-seven individuals aged 45–70 years without recorded CMD, hypertension or hypercholesterolemia participated. The main outcome measures were: 1) differences in cognitive and affective risk perception between the intervention group - who used an ORS and received an individualized CMD risk score- and the control group who answered questions about CMD risk, but did not receive an individualized CMD risk score; 2) risk factors and demographic characteristics associated with risk perception. Results No differences were found in cognitive and affective risk perception between the intervention and control group and risk perception was on average low, even among high-risk participants. A positive family history for diabetes type 2 (β0.56, CI95% 0.39–0.73) and cardiovascular disease (β0.28, CI95% 0.13–0.43), BMI ≥25 (β0.27, CI95% 0.12–0.43), high waist circumference (β0.25, CI95% 0.02–0.48) and physical inactivity (β0.30, CI95% 0.16–0.45) were positively associated with cognitive CMD risk perception in high-risk participants. No other risk factors or demographic characteristics were associated with risk perception. Conclusions Communicating an individualized CMD risk score did not affect risk perception. A mismatch was found between calculated risk and self-perceived risk in high-risk participants. Family history and BMI seem to affect the level of CMD risk perception more than risk factors such as sex, age and smoking. A dialogue about personal CMD risk between patients and health care professionals might optimize the effect of the provided risk information. Trial registration Dutch trial Register number NTR4277, registered 26th Nov 2013.
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Affiliation(s)
- D M Stol
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, the Netherlands. .,Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands.
| | - M Hollander
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, the Netherlands
| | - O C Damman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - M M J Nielen
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands
| | - I F Badenbroek
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, the Netherlands.,Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands
| | - F G Schellevis
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands.,Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers (location VUmc), Amsterdam, The Netherlands
| | - N J de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, the Netherlands
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8
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Kool LE, Schellevis FG, Jaarsma DADC, Feijen-De Jong EI. The initiation of Dutch newly qualified hospital-based midwives in practice, a qualitative study. Midwifery 2020; 83:102648. [PMID: 32035343 DOI: 10.1016/j.midw.2020.102648] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/10/2020] [Accepted: 01/21/2020] [Indexed: 10/25/2022]
Abstract
In the Netherlands, a percentage of newly qualified midwives start work in maternity care as a hospital-based midwife, although prepared particularly for working autonomously in the community. AIM This study aimed to explore newly qualified Dutch midwives' perceptions of their job demands and resources during their initiation to hospital-based practice. DESIGN We conducted a qualitative study with semi structured interviews using the Job Demands-Resources model as theoretical framework. METHODS Twenty-one newly qualified midwives working as hospital-based midwives in the Netherlands were interviewed individually between January and July 2018. Transcripts were analyzed using thematic content analysis. FINDINGS High workload, becoming a team member, learning additional medical procedures and job insecurity were perceived demands. Participants experienced the variety of the work, the teamwork, social support, working with women, and employment conditions as job resources. Openness for new experiences, sociability, calmness and accuracy were experienced as personal resources, and perfectionism, self-criticism, and fear of failure as personal demands. CONCLUSION Initiation to hospital-based practice requires from newly qualified midwives adaptation to new tasks: working with women in medium and high-risk care, managing tasks, as well as often receiving training in additional medical skills. Sociability helps newly qualified midwives in becoming a member of a multidisciplinary team; neuroticism and perfectionism hinders them in their work. Clear expectations and a settling-in period may help newly qualified midwives to adapt to practice. The initiation phase could be better supported by preparing student midwives for working in a hospital setting and helping manage expectations about the settling-in period.
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Affiliation(s)
- Liesbeth E Kool
- Department of Midwifery Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands, Department of General Practice & Elderly Medicine, University of Groningen, University Medical Centre Groningen, the Netherlands, AVAG (Academy Midwifery Amsterdam and Groningen), Dirk Huizingastraat 3-5, 9713GL, the Netherlands.
| | - Francois G Schellevis
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers location VUmc, van de Boechorststraat 7, 1081 BT Amsterdam the Netherlands and NIVEL (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
| | - Debbie A D C Jaarsma
- Department of Medical Education, Center for Education Development and Research in Health Professions, University Medical Center Groningen, A. Deusinglaan 1, 9713 AV Groningen, the Netherlands
| | - Esther I Feijen-De Jong
- Department of Midwifery Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands, Department of General Practice & Elderly Medicine, University of Groningen, University Medical Centre Groningen, the Netherlands, AVAG (Academy Midwifery Amsterdam and Groningen), Dirk Huizingastraat 3-5, 9713GL, the Netherlands
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9
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Nielen MMJ, Spronk I, Davids R, Korevaar JC, Poos R, Hoeymans N, Opstelten W, van der Sande MAB, Biermans MCJ, Schellevis FG, Verheij RA. Estimating Morbidity Rates Based on Routine Electronic Health Records in Primary Care: Observational Study. JMIR Med Inform 2019; 7:e11929. [PMID: 31350839 PMCID: PMC6688441 DOI: 10.2196/11929] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 04/30/2019] [Accepted: 06/17/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Routinely recorded electronic health records (EHRs) from general practitioners (GPs) are increasingly available and provide valuable data for estimating incidence and prevalence rates of diseases in the population. This paper describes how we developed an algorithm to construct episodes of illness based on EHR data to calculate morbidity rates. OBJECTIVE The goal of the research was to develop a simple and uniform algorithm to construct episodes of illness based on electronic health record data and develop a method to calculate morbidity rates based on these episodes of illness. METHODS The algorithm was developed in discussion rounds with two expert groups and tested with data from the Netherlands Institute for Health Services Research Primary Care Database, which consisted of a representative sample of 219 general practices covering a total population of 867,140 listed patients in 2012. RESULTS All 685 symptoms and diseases in the International Classification of Primary Care version 1 were categorized as acute symptoms and diseases, long-lasting reversible diseases, or chronic diseases. For the nonchronic diseases, a contact-free interval (the period in which it is likely that a patient will visit the GP again if a medical complaint persists) was defined. The constructed episode of illness starts with the date of diagnosis and ends at the time of the last encounter plus half of the duration of the contact-free interval. Chronic diseases were considered irreversible and for these diseases no contact-free interval was needed. CONCLUSIONS An algorithm was developed to construct episodes of illness based on routinely recorded EHR data to estimate morbidity rates. The algorithm constitutes a simple and uniform way of using EHR data and can easily be applied in other registries.
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Affiliation(s)
- Mark M J Nielen
- Netherlands Institute for Health Services Research, Utrecht, Netherlands.,Centre for Health and Society, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Inge Spronk
- Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Rodrigo Davids
- Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Joke C Korevaar
- Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - René Poos
- Centre for Health and Society, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Nancy Hoeymans
- Centre for Health and Society, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Wim Opstelten
- Dutch College of General Practitioners, Utrecht, Netherlands
| | - Marianne A B van der Sande
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands.,Julius Center for Health Sciences and Primary Care, Julius Global Health, Utrecht, Netherlands
| | - Marion C J Biermans
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Robert A Verheij
- Netherlands Institute for Health Services Research, Utrecht, Netherlands
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10
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Jansen T, Verheij RA, Schellevis FG, Kunst AE. Use of out-of-hours primary care in affluent and deprived neighbourhoods during reforms in long-term care: an observational study from 2013 to 2016. BMJ Open 2019; 9:e026426. [PMID: 30872553 PMCID: PMC6429913 DOI: 10.1136/bmjopen-2018-026426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/11/2018] [Accepted: 01/21/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Major long-term care (LTC) reforms in the Netherlands in 2015 may specifically have disadvantaged socioeconomically deprived groups to acquire LTC, possibly impacting the use of acute care. We aimed to demonstrate whether LTC reforms coincided with changes in the use of out-of-hours (OOH) primary care services (PCSs), and to compare changes between deprived versus affluent neighbourhoods. DESIGN Ecological observational retrospective study using routinely recorded electronic health records data from 2013 to 2016 and population registry data. SETTING Data from 15 OOH PCSs participating in the Nivel Primary Care Database (covering approximately 6.5 million inhabitants) in the Netherlands. PCS utilisation data on neighbourhood level were matched with sociodemographic characteristics, including neighbourhood socioeconomic status (SES). PARTICIPANTS Electronic health records from 6 120 384 OOH PCS contacts in 2013-2016, aggregated to neighbourhood level. OUTCOME MEASURES AND ANALYSES Number of contacts per 1000 inhabitants/year (total, high/low-urgency, night/evening-weekend-holidays, telephone consultations/consultations/home visits).Multilevel linear regression models included neighbourhood (first level), nested within PCS catchment area (second level), to account for between-PCS variation, adjusted for neighbourhood characteristics (for instance: % men/women). Difference-in-difference in time-trends according to neighbourhood SES was assessed with addition of an interaction term to the analysis (year×neighbourhood SES). RESULTS Between 2013 and 2016, overall OOH PCS use increased by 6%. Significant increases were observed for high-urgency contacts and contacts during the night. The largest change was observed for the most deprived neighbourhoods (10% compared with 4%-6% in the other neighbourhoods; difference not statistically significant). The increasing trend in OOH PCS use developed practically similar for deprived and affluent neighbourhoods. A a stable gradient reflected more OOH PCS use for each lower stratum of SES. CONCLUSIONS LTC reforms coincided with an overall increase in OOH PCS use, with nearly similar trends for deprived and affluent neighbourhoods. The results suggest a generalised spill over to OOH PCS following LTC reforms.
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Affiliation(s)
- Tessa Jansen
- Department of Primary Care, Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Robert A Verheij
- Department of Primary Care, Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Francois G Schellevis
- Department of Primary Care, Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute Amsterdam University Medical Centers | Location VUmc, Amsterdam, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
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11
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Kolozsvári LR, Kónya J, Paget J, Schellevis FG, Sándor J, Szőllősi GJ, Harsányi S, Jancsó Z, Rurik I. Patient-related factors, antibiotic prescribing and antimicrobial resistance of the commensal Staphylococcus aureus and Streptococcus pneumoniae in a healthy population - Hungarian results of the APRES study. BMC Infect Dis 2019; 19:253. [PMID: 30866843 PMCID: PMC6415336 DOI: 10.1186/s12879-019-3889-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 03/07/2019] [Indexed: 11/10/2022] Open
Abstract
Background Antimicrobial resistance (AMR) is an increasing public health problem worldwide. We studied some patient-related factors that might influence the antimicrobial resistance. and whether the volume of antibiotic prescribing of the primary care physicians correlate with the antibiotic resistance rates of commensal nasal Staphylococcus aureus and Streptococcus pneumoniae. Methods The socio-demographic questionnaires, the antibiotic prescription and resistance data of commensal nasal S. aureus and S. pneumoniae were collected in the 20 participating Hungarian practices of the APRES study. Multivariate logistic regression analyses were performed on the patient-related data and the antimicrobial resistance of the S. aureus and S. pneumoniae on individual, patient level. Ecological analyses were performed with Spearman’s rank correlations at practice level, the analyses were performed in the whole sample (all practices) and in the cohorts of primary care practices taking care of adults (adult practices) or children (paediatric practices). Results According to the multivariate model, age of the patients significantly influenced the antimicrobial resistance of the S. aureus (OR = 0.42, p = 0.004) and S. pneumoniae (OR = 0.89, p < 0.001). Living with children significantly increased the AMR of the S. pneumoniae (OR = 1.23, p = 0.019). In the cohorts of adult or paediatric practices, neither the age nor other variables influenced the AMR of the S. aureus and S. pneumoniae. At practice level, the prescribed volume of penicillins significantly correlated with the resistance rates of the S. aureus isolates to penicillin (rho = 0.57, p = 0.008). The volume of prescribed macrolides, lincosamides showed positive significant correlations with the S. pneumoniae resistance rates to clarithromycin and/or clindamycin in all practices (rho = 0.76, p = 0.001) and in the adult practices (rho = 0.63, p = 0.021). Conclusions The age is an important influencing factor of antimicrobial resistance. The results also suggest that there may be an association between the antibiotic prescribing of the primary care providers and the antibiotic resistance of the commensal S. aureus and S. pneumoniae. The role of the primary care physicians in the appropriate antibiotic prescribing is very important to avoid the antibiotic resistance.
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Affiliation(s)
- László Róbert Kolozsvári
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary.
| | - József Kónya
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - John Paget
- NIVEL, The Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Francois G Schellevis
- NIVEL, The Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| | - János Sándor
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Gergő József Szőllősi
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Szilvia Harsányi
- Department of Health Systems Management, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Zoltán Jancsó
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Imre Rurik
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
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12
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Magnée T, de Beurs DP, Schellevis FG, Verhaak PF. [Developments in mental health care in Dutch general practices: an overview of recent studies]. Tijdschr Psychiatr 2019; 61:126-134. [PMID: 30793274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Dutch policy aims to strengthen mental health care in general practices, to keep health care affordable. Recently, a new function (mental health nurses) and a new referral model for patients with mental health problems were introduced.<br/> AIM: To explore to what extent the volume of mental health care in Dutch general practices has increased and to what extent the content changed in the period 2010-2015.<br/> METHOD: This study employed: 1. analyses of medical records, and 2. a case study in a primary health care centre.<br/> RESULTS: The number of general practices with at least one mental health nurse increased from 20% in 2010 to almost 90% in 2015. In the period 2010-2014, general practitioners (gps) and mental health nurses treated increasing numbers of patients with mental health problems. No task shifting from gps to mental health nurses was observed. In the period 2011-2015, the number of antidepressant prescriptions increased slightly. In 2014, gps in a well-prepared primary care centre allocated 87% of their patients with mental health problems to a treatment setting in line with the referral model.<br/> CONCLUSION: Dutch general practices have recently provided more mental health care, thereby emphasising their important role in the mental health care system.
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13
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Willeboordse F, Schellevis FG, Meulendijk MC, Hugtenburg JG, Elders PJM. Implementation fidelity of a clinical medication review intervention: process evaluation. Int J Clin Pharm 2018; 40:550-565. [PMID: 29556930 PMCID: PMC5984963 DOI: 10.1007/s11096-018-0615-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/07/2018] [Indexed: 11/28/2022]
Abstract
Background Implementation of clinical medication reviews in daily practice is scarcely evaluated. The Opti-Med intervention applied a structured approach with external expert teams (pharmacist and physician) to conduct medication reviews. The intervention was effective with respect to resolving drug related problems, but did not improve quality of life. Objective The objective of this process evaluation was to gain more insight into the implementation fidelity of the intervention. Setting Process evaluation alongside a cluster randomized trial in 22 general practices and 518 patients of 65 years and over. Method A mixed methods design using quantitative and qualitative data and the conceptual framework for implementation fidelity was used. Implementation fidelity is defined as the degree to which the various components of an intervention are delivered as intended. Main outcome measure Implementation fidelity for key components of the Opti-Med intervention. Results Patient selection and preparation of the medication analyses were carried out as planned, although mostly by the Opti-Med researchers instead of practice nurses. Medication analyses by expert teams were performed as planned, as well as patient consultations and patient involvement. 48% of the proposed changes in the medication regime were implemented. Cooperation between expert teams members and the use of an online decision-support medication evaluation facilitated implementation. Barriers for implementation were time constraints in daily practice, software difficulties with patient selection and incompleteness of medical files. The degree of embedding of the intervention was found to influence implementation fidelity. The total time investment for healthcare professionals was 94 min per patient. Conclusion Overall, the implementation fidelity was moderate to high for all key components of the Opti-Med intervention. The absence of its effectiveness with respect to quality of life could not be explained by insufficient implementation fidelity.
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Affiliation(s)
- F Willeboordse
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
| | - F G Schellevis
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - M C Meulendijk
- Department of Information and Computing Sciences, Utrecht University, Utrecht, The Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - J G Hugtenburg
- Department of Clinical Pharmacology & Pharmacy, VU University Medical Center, Amsterdam, The Netherlands
| | - P J M Elders
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
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14
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Abstract
PURPOSE The purpose of this study was to investigate developments in antidepressant prescriptions by Dutch general practitioners, alongside the national introduction of mental health nurses. Antidepressant prescriptions are very common in general practice, but are often not in line with recommendations. The recent introduction of mental health nurses may have decreased antidepressant prescriptions, as general practitioners (GPs) have greater potential to offer psychological treatment as a first choice option instead of medication. MATERIAL AND METHODS Anonymised data from the medical records of general practices participating in the NIVEL Primary Care Database in 2011-2015 were analysed in an observational study. We used multilevel logistic regression analyses to determine whether total antidepressant prescriptions and antidepressants prescribed within one week of diagnosing anxiety or depression decreased in the period 2011-2015. We analysed whether changes in antidepressant prescriptions were associated with the employment or consultation of mental health nurses. RESULTS Antidepressants were prescribed in 30.3% of all anxiety or depression episodes; about half were prescribed within the first week. Antidepressants prescriptions for anxiety or depression increased slightly in the period 2011-2015. The employment of mental health nurses was not associated with a decreased number of prescriptions of antidepressants. Patients who had at least one mental health nurse consultation had fewer immediate prescriptions of antidepressants, but not fewer antidepressants in general. CONCLUSIONS Antidepressant prescriptions are still common in general practice. So far, the introduction of mental health nurses has not decreased antidepressant prescriptions, but it may have a postponing effect.
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Affiliation(s)
- Tessa Magnée
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- CONTACT T. Magnée Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500 BN Utrecht, The Netherlands
| | - Derek P. de Beurs
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Francois G. Schellevis
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
| | - Peter F. Verhaak
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Department of General Practice, Groningen University, Groningen, The Netherlands
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15
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Spronk I, Korevaar JC, Schellevis FG, Albreht T, Burgers JS. Evidence-based recommendations on care for breast cancer survivors for primary care providers: a review of evidence-based breast cancer guidelines. BMJ Open 2017; 7:e015118. [PMID: 29237652 PMCID: PMC5728293 DOI: 10.1136/bmjopen-2016-015118] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To review evidence-based (EB) recommendations on survivorship care for primary care providers (PCPs) in EB breast cancer guidelines. DESIGN AND SETTING Guidelines were collected via experts and via literature database, guideline database and cancer agency websites searches. METHOD EB guidelines in any language published between 2012 and 2017 were collected. EB recommendations on survivorship care relevant for PCPs were extracted and grouped into three categories (recurrence detection, long-term effects and recurrence prevention). The content of the recommendations was analysed and summarised in the number and type of clinical topics addressed. The Appraisal of Guidelines for Research and Evaluation II instrument was used to evaluate the methodological quality of the guidelines. RESULTS Six guidelines, of which two were of acceptable methodological quality, were included. One was specifically made for general practitioners. Fifteen clinical topics were identified. Guidelines differed in the clinical topics addressed and for some identical topics in the content of the recommendations. Many recommendations were based on low-quality evidence. Recurrence detection received most attention, physical examination and mammography were often highlighted. Potential complications largely varied in number and type. Intimacy concerns, vaginal dryness, dyspareunia, fatigue, menopausal symptoms, peripheral neuropathy and lymphedema were reported in more than one guideline. Recurrence prevention was mentioned in four guidelines; all recommended physical activity. CONCLUSION The number of EB recommendations in guidelines is limited. Moreover, recommendations differ between guidelines and most are based on low-quality evidence. More high-quality research is needed to develop and adapt guidelines to support PCPs in providing optimal breast cancer survivorship care.
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Affiliation(s)
- Inge Spronk
- General Practice, NIVEL Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Joke C Korevaar
- General Practice, NIVEL Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Francois G Schellevis
- General Practice, NIVEL Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Tit Albreht
- Centre for Health System Analyses, National Institute of Public Health, Ljubljana, Slovenia
| | - Jako S Burgers
- Dutch College of General Practitioners, Utrecht, The Netherlands
- Department Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands
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16
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de Jonge A, Wouters MGAJ, Klinkert J, Brandenbarg J, Zwart JJ, Van Dillen J, van der Horst HE, Schellevis FG. Pitfalls in the use of register-based data for comparing adverse maternal and perinatal outcomes in different birth settings. BJOG 2017; 124:1477-1480. [DOI: 10.1111/1471-0528.14676] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2017] [Indexed: 11/30/2022]
Affiliation(s)
- A de Jonge
- Department of Midwifery Science; AVAG and the Amsterdam Public Health research institute; VU University Medical Center; Amsterdam the Netherlands
| | - MGAJ Wouters
- Department of Obstetrics and Gynaecology; VU University Medical Center; Amsterdam the Netherlands
| | - J Klinkert
- EVAA Holding BV; Amsterdam the Netherlands
| | - J Brandenbarg
- Midwifery practice Brandenbarg; Amstelveen the Netherlands
| | - JJ Zwart
- Department of Obstetrics; Deventer Hospital; Deventer the Netherlands
| | - J Van Dillen
- Department of Obstetrics; Radboud University Medical Center Nijmegen; Nijmegen the Netherlands
| | - HE van der Horst
- Department of General Practice and Elderly Care Medicine; VU University Medical Centre; Amstelveen the Netherlands
| | - FG Schellevis
- Department of Midwifery Science; AVAG and the Amsterdam Pubic Health research institute; Amsterdam the Netherlands
- NIVEL; Netherlands Insititute for Health Services Research; Utrecht the Netherlands
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17
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Sinnige J, Braspenning JC, Schellevis FG, Hek K, Stirbu I, Westert GP, Korevaar JC. [Inter-practice variation in polypharmacy prevalence amongst older patients in primary care]. Ned Tijdschr Geneeskd 2017; 161:D864. [PMID: 28181895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE Complex medication management in older people with multiple chronic conditions can introduce practice variation in polypharmacy prevalence. This study aimed to determine the inter-practice variation in polypharmacy prevalence and examine how this variation was influenced by patient and practice characteristics. METHODS This cohort study included 45,731 patients aged 55 years and older with at least one prescribed medication from 126 general practices that participated in NIVEL Primary Care Database in the Netherlands. Medication dispensing data of the year 2012 were used to determine polypharmacy. Polypharmacy was defined as the chronic and simultaneous use of at least five different medications. Multilevel logistic regression models were constructed to quantify the polypharmacy prevalence variation between practices. Patient characteristics (age, gender, socioeconomic status, number, and type of chronic conditions) and practice characteristics (practice location and practice population) were added to the models. RESULTS After accounting for differences in patient and practice characteristics, polypharmacy rates varied with a factor of 2.4 between practices (from 12.4% to 30.1%) and an overall mean of 19.8%. Age and type of conditions were highly positively associated with polypharmacy, and to a lesser extent a lower socioeconomic status. CONCLUSIONS Considerable variation in polypharmacy rates existed between general practices, even after accounting for patient and practice characteristics, which suggests that there is not much agreement concerning medication management in this complex patient group. Initiatives that could reduce inappropriate heterogeneity in medication management can add value to the care delivered to these patients.
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Affiliation(s)
- J Sinnige
- *Dit onderzoek werd eerder gepubliceerd in Pharmacoepidemiology and Drug Safety (2016;25:1033-41) met als titel 'Inter-practice variation in polypharmacy prevalence amongst older patients in primary care'. Afgedrukt met toestemming
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18
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van Oostrom SH, Gijssen R, Stirbu I, Korevaar JC, Schellevis FG, Picavet HSJ, Hoeymans N. [Time trends in prevalence of chronic diseases and multimorbidity not only due to aging: data from general practices and health surveys]. Ned Tijdschr Geneeskd 2017; 161:D1429. [PMID: 28854986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Chronic diseases and multimorbidity are common and expected to rise over the coming years. The objective of this study is to examine the time trend in the prevalence of chronic diseases and multimorbidity over the period 2001 till 2011 in the Netherlands, and the extent to which this can be ascribed to the aging of the population. METHODS Monitoring study, using two data sources: 1) medical records of patients listed in a nationally representative network of general practices over the period 2002-2011, and 2) national health interview surveys over the period 2001-2011. Regression models were used to study trends in the prevalence-rates over time, with and without standardization for age. RESULTS An increase from 34.9% to 41.8% (p<0.01) in the prevalence of chronic diseases was observed in the general practice registration over the period 2004-2011 and from 41.0% to 46.6% (p<0.01) based on self-reported diseases over the period 2001-2011. Multimorbidity increased from 12.7% to 16.2% (p<0.01) and from 14.3% to 17.5% (p<0.01), respectively. Aging of the population explained part of these trends: about one-fifth based on general practice data, and one-third for chronic diseases and half of the trend for multimorbidity based on health surveys. CONCLUSIONS The prevalence of chronic diseases and multimorbidity increased over the period 2001-2011. Aging of the population only explained part of the increase, implying that other factors such as health care and society-related developments are responsible for a substantial part of this rise.
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Affiliation(s)
- S H van Oostrom
- *Dit onderzoek werd eerder gepubliceerd in PLoS One (2016;11:e0160264) met als titel 'Time trends in prevalence of chronic diseases and multimorbidity not only due to aging: data from general practices and health surveys'. Afgedrukt met toestemming
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19
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Scaioli G, Schäfer WLA, Boerma WGW, Spreeuwenberg PMM, Groenewegen PP, Schellevis FG. Communication at the primary-secondary care interface: a cross-sectional survey in 34 countries. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw165.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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van Oostrom SH, Gijsen R, Stirbu I, Korevaar JC, Schellevis FG, Picavet HSJ, Hoeymans N. Time Trends in Prevalence of Chronic Diseases and Multimorbidity Not Only due to Aging: Data from General Practices and Health Surveys. PLoS One 2016; 11:e0160264. [PMID: 27482903 PMCID: PMC4970764 DOI: 10.1371/journal.pone.0160264] [Citation(s) in RCA: 161] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/16/2016] [Indexed: 11/26/2022] Open
Abstract
Introduction Chronic diseases and multimorbidity are common and expected to rise over the coming years. The objective of this study is to examine the time trend in the prevalence of chronic diseases and multimorbidity over the period 2001 till 2011 in the Netherlands, and the extent to which this can be ascribed to the aging of the population. Methods Monitoring study, using two data sources: 1) medical records of patients listed in a nationally representative network of general practices over the period 2002–2011, and 2) national health interview surveys over the period 2001–2011. Regression models were used to study trends in the prevalence-rates over time, with and without standardization for age. Results An increase from 34.9% to 41.8% (p<0.01) in the prevalence of chronic diseases was observed in the general practice registration over the period 2004–2011 and from 41.0% to 46.6% (p<0.01) based on self-reported diseases over the period 2001–2011. Multimorbidity increased from 12.7% to 16.2% (p<0.01) and from 14.3% to 17.5% (p<0.01), respectively. Aging of the population explained part of these trends: about one-fifth based on general practice data, and one-third for chronic diseases and half of the trend for multimorbidity based on health surveys. Conclusions The prevalence of chronic diseases and multimorbidity increased over the period 2001–2011. Aging of the population only explained part of the increase, implying that other factors such as health care and society-related developments are responsible for a substantial part of this rise.
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Affiliation(s)
- Sandra H van Oostrom
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- * E-mail:
| | - Ronald Gijsen
- Centre for Health and Society, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Irina Stirbu
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands
| | - Joke C Korevaar
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands
| | - Francois G Schellevis
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands
- Department of General Practice and Elderly Care Medicine /EMGO Institute for health and care research, VU University Medical Centre, Amsterdam, the Netherlands
| | - H. Susan J Picavet
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Nancy Hoeymans
- Centre for Health and Society, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
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Muntinga ME, Jansen APD, Schellevis FG, Nijpels G. Expanding access to pain care for frail, older people in primary care: a cross-sectional study. BMC Nurs 2016; 15:26. [PMID: 27110220 PMCID: PMC4842300 DOI: 10.1186/s12912-016-0147-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 04/16/2016] [Indexed: 12/15/2022] Open
Abstract
Background Although untreated pain has a negative impact on quality of life and health outcomes, research has shown that older people do not always have access to adequate pain care. Practice nurse-led, comprehensive geriatric assessments (CGAs) may increase access to tailored pain care for frail, older people who live at home. To explore this, we investigated whether new pain cases were identified by practice nurses during CGAs administered as part of an intervention with the Geriatric Care Model, a comprehensive care model based on the Chronic Care Model, and whether the intervention led to tailored pain action plans in care plans of frail, older people. Methods We used cross-sectional data from the older Adults: Care in Transition (ACT) study, a 2-year clinical trial carried out in two regions of the Netherlands. Practice nurses proactively visited older people at home and administered an in-home CGA that included an assessment of pain. Pain care-related agreements and actions (pain action plans) based on CGA results were described in a tailored care plan. We analyzed care plans of 781 older people who received a first-time CGA by a practice nurse for the presence of pain, pain location and cause, new pain cases, and pain action plans. We used descriptive statistics to analyze our data. Results We found that 315 (40.3 %) older people experienced any type of pain. Practice nurses identified 20 (10.6 %) new pain cases, and 188 (59.7 %) older people with pain formulated at least one therapeutic or non-therapeutic pain action plan together with a practice nurse. More than half of the older people whose pain had already been identified by a primary care physician wanted a pain action plan. Most pain action plans consisted of actions or agreements related to continuity of care. Discussion and conclusion Practice nurses in primary care can contribute to expanding older people's access to tailored pain care. Future researchers should continue to direct their focus at ways to overcome the barriers that restrict older people’s access to pain care.
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Affiliation(s)
- M E Muntinga
- Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - A P D Jansen
- Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - F G Schellevis
- Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands ; NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - G Nijpels
- Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Kasteleyn MJ, Vos RC, Rijken M, Schellevis FG, Rutten GEHM. Effectiveness of tailored support for people with Type 2 diabetes after a first acute coronary event: a multicentre randomized controlled trial (the Diacourse-ACE study). Diabet Med 2016; 33:125-33. [PMID: 26031804 DOI: 10.1111/dme.12816] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2015] [Indexed: 12/01/2022]
Abstract
AIMS To evaluate the effectiveness of a tailored, supportive intervention strategy in influencing diabetes-related distress, health status, well-being and clinical outcomes in people with Type 2 diabetes shortly after a first acute coronary event. METHODS People with Type 2 diabetes and a recent first acute coronary event (n = 201) were randomized to the intervention group (three home visits by a diabetes nurse) or the attention control group (one telephone consultation). Outcomes were measured after discharge (baseline) and at 5 months (follow-up) using validated questionnaires for diabetes-related distress (Problem Areas in Diabetes), well-being (WHO Well-Being Index) and health status (Euroqol 5 Dimensions; Euroqol Visual Analogue Scale). ancova was used to analyse change-over-time differences between groups. RESULTS Follow-up data were available for 81 participants in the intervention group (66.0 ± 9.3 years, 76% male) and 80 in the control group (65.6 ± 9.4 years, 75% male) participants. Mean diabetes-related distress was low after hospital discharge (intervention group: 8.2 ± 10.1; control group: 9.2 ± 12.4) and did not change after 5 months (intervention group: 9.2 ± 12.4; control group: 9.0 ± 11.2). Baseline well-being was less favourable but improved significantly in the intervention group (baseline: 58.5 ± 28.0; follow-up: 65.5 ± 23.7; P = 0.005), but not in the control group (baseline: 57.5 ± 25.2; follow-up: 59.6 ± 24.4; P = 0.481). Health status also improved in the intervention group (baseline: 69.9 ± 17.3; follow-up: 76.8 ± 15.6; P < 0.001) but not in the control group (baseline: 68.6 ± 15.9; follow-up: 69.9 ± 16.7; P = 0.470). A significant group effect was found for health status (F = 7.9; P = 0.006). CONCLUSIONS Although the intervention had no effect on diabetes-related distress, this might be at least partially attributable to very low levels of diabetes-related distress at baseline. Interestingly, health status scores and well-being, which were less favourable at baseline, both improved after the tailored support intervention.
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Affiliation(s)
- M J Kasteleyn
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - R C Vos
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M Rijken
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - F G Schellevis
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - G E H M Rutten
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
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Kasteleyn MJ, de Vries L, van Puffelen AL, Schellevis FG, Rijken M, Vos RC, Rutten GEHM. Diabetes-related distress over the course of illness: results from the Diacourse study. Diabet Med 2015; 32:1617-24. [PMID: 25763843 DOI: 10.1111/dme.12743] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2015] [Indexed: 11/28/2022]
Abstract
AIMS To investigate the relationship between diabetes duration and diabetes-related distress and to examine the impact of micro- and macrovascular complications and blood glucose-lowering treatment on this relationship. METHODS We conducted a cross-sectional study in people with Type 2 diabetes who participated in the Dutch Diacourse study (n = 590) and completed the Problem Areas in Diabetes questionnaire. Data on diabetes duration, micro- and macrovascular complications and blood glucose-lowering treatment were collected. Multiple linear regression analysis was used to investigate the association between diabetes duration and diabetes-related distress, and to examine whether complications and treatment could explain this association. RESULTS A significant linear and quadratic association between diabetes duration and diabetes-related distress was found (duration: β = 0.27, P = 0.005; duration(2): β = -0.21, P = 0.030). The association between duration and distress could be explained by microvascular complications and insulin treatment, which were both more often present in people with a longer diabetes duration, and were associated with higher levels of diabetes-related distress (β = 0.20, P < 0.001 and β = 0.16, P = 0.006 respectively). Duration, age, gender, complications and treatment together explained 13.1% of the variance in distress. CONCLUSIONS Diabetes duration was associated with diabetes-related distress. This association can be explained largely by the presence of diabetes-related microvascular complications and insulin treatment. Healthcare providers should focus on distress in people with Type 2 diabetes in different stages over the course of illness, especially when complications are present or when people are on insulin treatment. As well as diabetes duration, complications and blood glucose-lowering treatment, diabetes-related distress is likely to be influenced by many other factors.
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Affiliation(s)
- M J Kasteleyn
- Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands
| | - L de Vries
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - A L van Puffelen
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - F G Schellevis
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - M Rijken
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - R C Vos
- Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands
| | - G E H M Rutten
- Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands
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van der Heide I, Snoeijs S, Boerma W, Schellevis FG, Rijken PM. Innovative practices to care for people with multimorbidity in Europe. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv168.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Snoeijs S, Boerma W, Schellevis FG, Rijken PM. Improving patient-centredness of care practices for people with multimorbidity. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv168.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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26
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van den Dungen C, Hoeymans N, van den Akker M, Biermans MCJ, van Boven K, Joosten JHK, Verheij RA, de Waal MWM, Schellevis FG, van Oers JAM. Do practice characteristics explain differences in morbidity estimates between electronic health record based general practice registration networks? BMC Fam Pract 2014; 15:176. [PMID: 25358247 PMCID: PMC4231185 DOI: 10.1186/s12875-014-0176-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 10/10/2014] [Indexed: 11/13/2022]
Abstract
Background General practice based registration networks (GPRNs) provide information on population health derived from electronic health records (EHR). Morbidity estimates from different GPRNs reveal considerable, unexplained differences. Previous research showed that population characteristics could not explain this variation. In this study we investigate the influence of practice characteristics on the variation in incidence and prevalence figures between general practices and between GPRNs. Methods We analyzed the influence of eight practice characteristics, such as type of practice, percentage female general practitioners, and employment of a practice nurse, on the variation in morbidity estimates of twelve diseases between six Dutch GPRNs. We used multilevel logistic regression analysis and expressed the variation between practices and GPRNs in median odds ratios (MOR). Furthermore, we analyzed the influence of type of EHR software package and province within one large national GPRN. Results Hardly any practice characteristic showed an effect on morbidity estimates. Adjusting for the practice characteristics did also not alter the variation between practices or between GPRNs, as MORs remained stable. The EHR software package ‘Medicom’ and the province ‘Groningen’ showed significant effects on the prevalence figures of several diseases, but this hardly diminished the variation between practices. Conclusion Practice characteristics do not explain the differences in morbidity estimates between GPRNs. Electronic supplementary material The online version of this article (doi:10.1186/s12875-014-0176-7) contains supplementary material, which is available to authorized users.
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den Heijer CDJ, van Bijnen EME, Paget WJ, Pringle M, Goossens H, Bruggeman CA, Schellevis FG, Stobberingh EE. Prevalence and resistance of commensal Staphylococcus aureus, including meticillin-resistant Staphylococcus aureus: a European cross-sectional study. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku165.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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van Oostrom SH, Picavet HSJ, de Bruin SR, Stirbu I, Korevaar JC, Schellevis FG, Baan CA. Multimorbidity of chronic diseases and health care utilization in general practice. BMC Fam Pract 2014; 15:61. [PMID: 24708798 PMCID: PMC4021063 DOI: 10.1186/1471-2296-15-61] [Citation(s) in RCA: 159] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 03/25/2014] [Indexed: 11/16/2022]
Abstract
Background Multimorbidity is common among ageing populations and it affects the demand for health services. The objective of this study was to examine the relationship between multimorbidity (i.e. the number of diseases and specific combinations of diseases) and the use of general practice services in the Dutch population of 55 years and older. Methods Data on diagnosed chronic diseases, contacts (including face-to-face consultations, phone contacts, and home visits), drug prescription rates, and referral rates to specialised care were derived from the Netherlands Information Network of General Practice (LINH), limited to patients whose data were available from 2006 to 2008 (N = 32,583). Multimorbidity was defined as having two or more out of 28 chronic diseases. Multilevel analyses adjusted for age, gender, and clustering of patients in general practices were used to assess the association between multimorbidity and service utilization in 2008. Results Patients diagnosed with multiple chronic diseases had on average 18.3 contacts (95% CI 16.8 19.9) per year. This was significantly higher than patients with one chronic disease (11.7 contacts (10.8 12.6)) or without any (6.1 contacts (5.6 6.6)). A higher number of chronic diseases was associated with more contacts, more prescriptions, and more referrals to specialized care. However, the number of contacts per disease decreased with an increasing number of diseases; patients with a single disease had between 9 to 17 contacts a year and patients with five or more diseases had 5 or 6 contacts per disease per year. Contact rates for specific combinations of diseases were lower than what would be expected on the basis of contact rates of the separate diseases. Conclusion Multimorbidity is associated with increased health care utilization in general practice, yet the increase declines per additional disease. Still, with the expected rise in multimorbidity in the coming decades more extensive health resources are required.
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Affiliation(s)
- Sandra H van Oostrom
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
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Schäfer WLA, Boerma WGW, Schellevis FG, Groenewegen PP. Discrepancies between what patients’ find important and their actual experiences. Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt126.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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30
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Uijen AA, Schers HJ, Schene AH, Schellevis FG, Lucassen P, van den Bosch WJHM. Experienced continuity of care in patients at risk for depression in primary care. Eur J Gen Pract 2013; 20:161-6. [PMID: 24033228 DOI: 10.3109/13814788.2013.828201] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Existing studies about continuity of care focus on patients with a severe mental illness. OBJECTIVES Explore the level of experienced continuity of care of patients at risk for depression in primary care, and compare these to those of patients with heart failure. METHODS Explorative study comparing patients at risk for depression with chronic heart failure patients. Continuity of care was measured using a patient questionnaire and defined as ( 1 ) number of care providers contacted (personal continuity); ( 2 ) collaboration between care providers in general practice (team continuity) (six items, score 1-5); and ( 3 ) collaboration between GPs and care providers outside general practice (cross-boundary continuity) (four items, score 1-5). RESULTS Most patients at risk for depression contacted several care providers throughout the care spectrum in the past year. They experienced high team continuity and low cross-boundary continuity. In their general practice, they contacted more different care providers for their illness than heart failure patients did (P < 0.01). Patients at risk for depression experienced a slightly better collaboration between these care providers in their practice: a mean score of 4.3 per item compared to 4.0 for heart failure patients (P = 0.03). The perceived cross-boundary continuity, however, was reversed: a mean score of 3.5 per item for patients at risk for depression, compared to 4.0 for heart failure patients (P = 0.01). CONCLUSION The explorative comparison between patients at risk for depression and heart failure patients shows small differences in experienced continuity of care. This should be analysed further in a more robust study.
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Affiliation(s)
- Annemarie A Uijen
- Department of Primary and Community Care 117, Radboud University Nijmegen Medical Centre , Nijmegen , The Netherlands
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Geelen E, Krumeich A, Schellevis FG, van den Akker M. General practitioners' perceptions of their role in cancer follow-up care: a qualitative study in the Netherlands. Eur J Gen Pract 2013; 20:17-24. [PMID: 24576124 DOI: 10.3109/13814788.2013.805408] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In the last few decades there has been a considerable increase in the number of cancer survivors. Health policy makers would like to see cancer follow-up care moved from secondary to primary care. METHOD Between 2008 and 2010, a qualitative study among primary health care professionals was performed to get more insight into the way they care for cancer survivors. Analysed was whether a coordinating role in cancer survivorship care would fit in with the practical logic underlying the way the general practitioners work. RESULTS In their everyday work, general practitioners are used to provide care in a reactive way. Based on this habitus, they classify their patients into 'not special' and 'special' ones. Since general practitioners label cancer survivors as 'not special,' they expect these patients to take the initiative to ask for help and present their complaints in a clear and complete way. Their habitus as a gatekeeper implies that they are reticent about referring patients to other primary health care professionals. In regard to 'not special' patients, such as cancer survivors, general practitioners appear to build on the patients' own strengths. CONCLUSION The emphasis on a wait-and-see attitude in contemporary Dutch general practice, as well as the general practitioners' role as a gatekeeper are at odds with the proactive and holistic approach inherent to a coordinating role in cancer follow-up. Therefore, we assume that it will be difficult for general practitioners to shape a pivotal role in this care.
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Affiliation(s)
- Els Geelen
- Health Ethics and Society, Maastricht University , Maastricht , The Netherlands
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Van der Meer V, Nielen MMJ, Drenthen AJM, Van Vliet M, Assendelft WJJ, Schellevis FG. Cardiometabolic prevention consultation in the Netherlands: screening uptake and detection of cardiometabolic risk factors and diseases--a pilot study. BMC Fam Pract 2013; 14:29. [PMID: 23442805 PMCID: PMC3605095 DOI: 10.1186/1471-2296-14-29] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 02/07/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Until now, cardiometabolic risk assessment in Dutch primary health care was directed at case-finding, and structured, programmatic prevention is lacking. Therefore, the Prevention Consultation cardiometabolic risk (PC CMR), a stepwise approach to identify and manage patients with cardiometabolic risk factors, was developed. The aim of this study was 1) to evaluate uptake rates of the two steps of the PC CMR, 2) to assess the rates of newly diagnosed hypertension, hypercholesterolemia, diabetes mellitus and chronic kidney disease and 3) to explore reasons for non-participation. METHODS Sixteen general practices throughout the Netherlands were recruited to implement the PC CMR during 6 months. In eight practices eligible patients aged between 45 and 70 years without a cardiometabolic disease were actively invited by a personal letter ('active approach') and in eight other practices eligible patients were informed about the PC CMR only by posters and leaflets in the practice ('passive approach'). Participating patients completed an online risk estimation (first step). Patients estimated as having a high risk according to the online risk estimation were advised to visit their general practice to complete the risk profile with blood pressure measurements and blood tests for cholesterol and glucose and to receive recommendations about risk lowering interventions (second step). RESULTS The online risk estimation was completed by 521 (33%) and 96 (1%) of patients in the practices with an active and passive approach, respectively. Of these patients 392 (64%) were estimated to have a high risk and were referred to the practice; 142 of 392 (36%) consulted the GP. A total of 31 (22%) newly diagnosed patients were identified. Hypertension, hypercholesterolemia, diabetes and chronic kidney disease were diagnosed in 13%, 11%, 1% and 0%, respectively. Privacy risks were the most frequently mentioned reason not to participate. CONCLUSIONS One third of the patients responded to an active invitation to complete an online risk estimation. A passive invitation resulted in only a small number of participating patients. Two third of the participants of the online risk estimation had a high risk, but only one third of them attended the GP office. One in five visiting patients had a diagnosed cardiometabolic risk factor or disease.
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Affiliation(s)
- Victor Van der Meer
- Department of Public Health and Primary Care, Leiden University Medical Centre, Postzone V-0-P, PO Box 9600, 2300, Leiden, RC, The Netherlands.
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Abstract
OBJECTIVE In the field of mental health care, a major role for general practice is advocated. However, not much is known about the treatment and referral of mental health problems in general practice. This study aims at the volume and nature of treatment of mental health problems in general practice; the degree to which treatment varies according to patients' gender, age, and social economic status; and trends in treatment and referral between 2004 and 2008. DESIGN/SETTING Descriptive study with trends in time in general practice in the Netherlands. SUBJECTS 350,000 patients enlisted in general practice, whose data from the Netherlands Information Network of General Practice were routinely collected from 1 January 2004 to 31 December 2008. MAIN OUTCOME MEASURES For all episodes of mental health problems recorded by the GP, the proportion of patients receiving prolonged attention, medication, and referral during each year have been calculated. RESULTS More than 75% of patients with a recorded mental health problem received some kind of treatment, most often medication. In 15-20% of cases medication was accompanied by prolonged attention; 9-13% of these patients were referred (given referrals), the majority to specialized mental health care. Age is the most important variable associated with treatment received. During the period 2004-2008, treatment with medication declined slightly and referrals increased slightly. CONCLUSION Treatment for psychological disorders is mostly delivered in general practice. Although in recent years restraint has been advocated in prescribing medication and collaboration between primary and secondary care has been recommended, these recommendations are only partially reflected in the treatment provided.
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Affiliation(s)
- Peter F M Verhaak
- NIVEL, Netherlands Institute of Health Services Research, Utrecht, the Netherlands.
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Heins MJ, Korevaar JC, Rijken PM, Schellevis FG. For which health problems do cancer survivors visit their General Practitioner? Eur J Cancer 2012; 49:211-8. [PMID: 22897842 DOI: 10.1016/j.ejca.2012.07.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 07/13/2012] [Accepted: 07/16/2012] [Indexed: 01/19/2023]
Abstract
Primary health care use of cancer patients is increased, even years after active treatment. Insight into the reasons for this could help in developing and improving guidelines and planning of health care, which is important given the expected increase in cancer survivors. Using data from the Netherlands Information Network of Primary Care, we selected 1256 adult breast cancer, 503 prostate cancer and 487 colorectal cancer patients diagnosed between 2001 and 2006. We compared diseases and complaints for which they contacted their General Practitioner (GP) 2-5 years after diagnosis to age and sex matched non-cancer controls from the same practice. Cancer patients consulted their GP more often than controls for acute symptoms such as abdominal pain and fatigue (18% more in breast cancer, 26% more in prostate cancer) and infections, such as cystitis or respiratory infections (45% in breast cancer and 17% in colorectal cancer). Consultations for chronic diseases and psychosocial problems were slightly increased: breast cancer patients had more contacts related to diabetes (55%), sleep disturbance (60%) and depression (64%), prostate cancer patients had more contacts related to hypertension (53) and chronic obstructive pulmonary disease (COPD, 34%). Adverse drug effects were almost twice as often observed in prostate and colorectal cancer patients than in controls. Fear of cancer recurrence was noted as the reason for consulting the GP in only 20 patients. Concluding, increased primary health care use in cancer survivors is mostly related to common infections and acute symptoms, which may be due to direct effects of cancer treatment or increased health concerns.
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Affiliation(s)
- M J Heins
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
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Uijen AA, Heinst CW, Schellevis FG, van den Bosch WJHM, van de Laar FA, Terwee CB, Schers HJ. Measurement properties of questionnaires measuring continuity of care: a systematic review. PLoS One 2012; 7:e42256. [PMID: 22860100 PMCID: PMC3409169 DOI: 10.1371/journal.pone.0042256] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 07/05/2012] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Continuity of care is widely acknowledged as a core value in family medicine. In this systematic review, we aimed to identify the instruments measuring continuity of care and to assess the quality of their measurement properties. METHODS We did a systematic review using the PubMed, Embase and PsycINFO databases, with an extensive search strategy including 'continuity of care', 'coordination of care', 'integration of care', 'patient centered care', 'case management' and its linguistic variations. We searched from 1995 to October 2011 and included articles describing the development and/or evaluation of the measurement properties of instruments measuring one or more dimensions of continuity of care (1) care from the same provider who knows and follows the patient (personal continuity), (2) communication and cooperation between care providers in one care setting (team continuity), and (3) communication and cooperation between care providers in different care settings (cross-boundary continuity). We assessed the methodological quality of the measurement properties of each instrument using the COSMIN checklist. RESULTS We included 24 articles describing the development and/or evaluation of 21 instruments. Ten instruments measured all three dimensions of continuity of care. Instruments were developed for different groups of patients or providers. For most instruments, three or four of the six measurement properties were assessed (mostly internal consistency, content validity, structural validity and construct validity). Six instruments scored positive on the quality of at least three of six measurement properties. CONCLUSIONS Most included instruments have problems with either the number or quality of its assessed measurement properties or the ability to measure all three dimensions of continuity of care. Based on the results of this review, we recommend the use of one of the four most promising instruments, depending on the target population Diabetes Continuity of Care Questionnaire, Alberta Continuity of Services Scale-Mental Health, Heart Continuity of Care Questionnaire, and Nijmegen Continuity Questionnaire.
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Affiliation(s)
- Annemarie A Uijen
- Radboud University Nijmegen Medical Centre, Department of Primary and Community Care, Nijmegen, The Netherlands.
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Uijen AA, Bischoff EW, Schellevis FG, Bor HH, van den Bosch WJ, Schers HJ. Continuity in different care modes and its relationship to quality of life: a randomised controlled trial in patients with COPD. Br J Gen Pract 2012; 62:e422-8. [PMID: 22687235 PMCID: PMC3361122 DOI: 10.3399/bjgp12x649115] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Revised: 11/14/2011] [Accepted: 12/14/2011] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND New care modes in primary care may affect patients' experienced continuity of care. AIM To analyse whether experienced continuity for patients with chronic obstructive pulmonary disease (COPD) changes after different care modes are introduced, and to analyse the relationship between continuity of care and patients' quality of life. DESIGN AND SETTING Randomised controlled trial with 2-year follow-up in general practice in the Netherlands. METHOD A total of 180 patients with COPD were randomly assigned to three different care modes: self-management, regular monitoring by a practice nurse, and care provided by the GP at the patient's own initiative (usual care). Experienced continuity of care as personal continuity (proportion of visits with patient's own GP) and team continuity (continuity by the primary healthcare team) was measured using a self-administered patient questionnaire. Quality of life was measured using the Chronic Respiratory Questionnaire. RESULTS Of the final sample (n = 148), those patients receiving usual care experienced the highest personal continuity, although the chance of not contacting any care provider was also highest in this group (29% versus 2% receiving self-management, and 5% receiving regular monitoring). There were no differences in experienced team continuity in the three care modes. No relationship was found between continuity and changes in quality of life. CONCLUSION Although personal continuity decreases when new care modes are introduced, no evidence that this affects patients' experienced team continuity or patients' quality of life was found. Patients still experienced smooth, ongoing care, and considered care to be connected. Overall, no evidence was found indicating that the introduction of new care modes in primary care for patients with COPD should be discouraged.
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Affiliation(s)
- Annemarie A Uijen
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Assendelft WJJ, Nielen MMJ, Hettinga DM, van der Meer V, van Vliet M, Drenthen AJM, Schellevis FG, van Oosterhout MJW. Bridging the gap between public health and primary care in prevention of cardiometabolic diseases; background of and experiences with the Prevention Consultation in The Netherlands. Fam Pract 2012; 29 Suppl 1:i126-i131. [PMID: 22399541 PMCID: PMC3296474 DOI: 10.1093/fampra/cmr120] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 11/15/2011] [Accepted: 11/18/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is an increasing need for programmatic prevention of cardiometabolic diseases (cardiovascular disease, type 2 diabetes and chronic kidney disease). Therefore, in the Netherlands, a prevention programme linked to primary care has been developed. This initiative was supported by the national professional organizations of GPs and occupational physicians as well as three large health foundations. OBJECTIVES To describe and discuss the content, structure of and first experiences with this initiative. METHODS Description of context, risk assessment tool, guideline, content of the Prevention Consultation and pilot studies. RESULTS Preceding surveys revealed a need for proactive disease prevention, linked to primary care. An evidence-based guideline was developed using a validated eight-question screening list. According to the guideline, high-risk participants were advised to attend two consultations at the general practice, for completing the risk assessment and for tailored advice. Three pilot studies revealed that the programme was feasible and that (sufficient) participants with a condition requiring treatment were detected. We learned that with a 'passive' recruitment (with only posters and brochures), screening uptake is limited. A more active approach with a personal invitation from the GP is more effective. Both an Internet as written questionnaire should be available and reminders are necessary. The need for a consultation with the GP practice after a high-risk test result should be emphasized. The first consultation can be performed by a practice nurse. CONCLUSIONS A national systematic screening programme for cardiometabolic diseases linked to primary care is feasible. The cost-effectiveness still has to be established.
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Affiliation(s)
- Willem J J Assendelft
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
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Raterman HG, Nielen MMJ, Peters MJL, Verheij RA, Nurmohamed MT, Schellevis FG. Coexistence of hypothyroidism with inflammatory arthritis is associated with cardiovascular disease in women. Ann Rheum Dis 2012; 71:1216-8. [DOI: 10.1136/annrheumdis-2011-200836] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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van den Dungen C, Hoeymans N, Boshuizen HC, van den Akker M, Biermans MCJ, van Boven K, Brouwer HJ, Verheij RA, de Waal MWM, Schellevis FG, Westert GP. The influence of population characteristics on variation in general practice based morbidity estimations. BMC Public Health 2011; 11:887. [PMID: 22111707 PMCID: PMC3280203 DOI: 10.1186/1471-2458-11-887] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 11/24/2011] [Indexed: 11/14/2022] Open
Abstract
Background General practice based registration networks (GPRNs) provide information on morbidity rates in the population. Morbidity rate estimates from different GPRNs, however, reveal considerable, unexplained differences. We studied the range and variation in morbidity estimates, as well as the extent to which the differences in morbidity rates between general practices and networks change if socio-demographic characteristics of the listed patient populations are taken into account. Methods The variation in incidence and prevalence rates of thirteen diseases among six Dutch GPRNs and the influence of age, gender, socio economic status (SES), urbanization level, and ethnicity are analyzed using multilevel logistic regression analysis. Results are expressed in median odds ratios (MOR). Results We observed large differences in morbidity rate estimates both on the level of general practices as on the level of networks. The differences in SES, urbanization level and ethnicity distribution among the networks' practice populations are substantial. The variation in morbidity rate estimates among networks did not decrease after adjusting for these socio-demographic characteristics. Conclusion Socio-demographic characteristics of populations do not explain the differences in morbidity estimations among GPRNs.
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Affiliation(s)
- C van den Dungen
- National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, the Netherlands.
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van Baal PH, Engelfriet PM, Boshuizen HC, van de Kassteele J, Schellevis FG, Hoogenveen RT. Co-occurrence of diabetes, myocardial infarction, stroke, and cancer: quantifying age patterns in the Dutch population using health survey data. Popul Health Metr 2011; 9:51. [PMID: 21884614 PMCID: PMC3175448 DOI: 10.1186/1478-7954-9-51] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 09/01/2011] [Indexed: 11/10/2022] Open
Abstract
Background The high prevalence of chronic diseases in Western countries implies that the presence of multiple chronic diseases within one person is common. Especially at older ages, when the likelihood of having a chronic disease increases, the co-occurrence of distinct diseases will be encountered more frequently. The aim of this study was to estimate the age-specific prevalence of multimorbidity in the general population. In particular, we investigate to what extent specific pairs of diseases cluster within people and how this deviates from what is to be expected under the assumption of the independent occurrence of diseases (i.e., sheer coincidence). Methods We used data from a Dutch health survey to estimate the prevalence of pairs of chronic diseases specified by age. Diseases we focused on were diabetes, myocardial infarction, stroke, and cancer. Multinomial P-splines were fitted to the data to model the relation between age and disease status (single versus two diseases). To assess to what extent co-occurrence cannot be explained by independent occurrence, we estimated observed/expected co-occurrence ratios using predictions of the fitted regression models. Results Prevalence increased with age for all disease pairs. For all disease pairs, prevalence at most ages was much higher than is to be expected on the basis of coincidence. Observed/expected ratios of disease combinations decreased with age. Conclusion Common chronic diseases co-occur in one individual more frequently than is due to chance. In monitoring the occurrence of diseases among the population at large, such multimorbidity is insufficiently taken into account.
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Affiliation(s)
- Pieter H van Baal
- Expertise Centre for Methodology and Information Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
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Gieteling MJ, Lisman-van Leeuwen Y, van der Wouden JC, Schellevis FG, Berger MY. Childhood nonspecific abdominal pain in family practice: incidence, associated factors, and management. Ann Fam Med 2011; 9:337-43. [PMID: 21747105 PMCID: PMC3133581 DOI: 10.1370/afm.1268] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE Nonspecific abdominal pain (NSAP) is a common complaint in childhood. In specialist care, childhood NSAP is considered to be a complex and time-consuming problem, and parents are hard to reassure. Little is known about NSAP in family practice, but the impression is that family physicians consider it to be a benign syndrome needing little more than reassurance. This discrepancy calls for a better understanding of NSAP in family practice. METHODS Data were obtained from the Second Dutch National Survey of General Practice (2001). Using registration data of 91 family practices, we identified children aged 4 to 17 years with NSAP. We calculated the incidence, and we studied factors associated with childhood NSAP, referrals, and prescriptions. RESULTS The incidence of NSAP was 25.0 (95% confidence interval [CI], 23.7-26.3) per 1,000 person years. Most children (92.7%) with newly diagnosed NSAP (N = 1,480) consulted their doctor for this condition once or twice. Factors independently associated with NSAP were female sex (odds ratio [OR] = 1.4; 95% CI, 1.3-1.5), nongastrointestinal-nonspecific somatic symptoms (OR = 1.3; 95% CI, 1.1-1.5), and health care use (OR = 1.04; 95% CI, 1.03-1.05). When NSAP was diagnosed at the first visit, 3% of the patients were referred to specialist care, and 1% received additional testing. Family physicians prescribed medication in 21.3% of the visits for NSAP. CONCLUSIONS Childhood NSAP is a common problem in family practice. Most patients visit their doctor once or twice for this problem. Family physicians use little additional testing and make few referrals in their management of childhood NSAP. Despite the lack of evidence for effectiveness, family physicians commonly prescribe medication for NSAP.
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Affiliation(s)
- Marieke J Gieteling
- Department of General Practice, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
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Nielen MMJ, Assendelft WJJ, Drenthen AJM, van den Hombergh P, van Dis I, Schellevis FG. Primary prevention of cardio-metabolic diseases in general practice: a Dutch survey of attitudes and working methods of general practitioners. Eur J Gen Pract 2011; 16:139-42. [PMID: 20825271 DOI: 10.3109/13814788.2010.501372] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To study the attitudes and working methods of general practitioners (GPs) in primary prevention of cardiovascular diseases, diabetes mellitus and chronic kidney diseases. METHODS A questionnaire with questions about attitude and working methods in the primary prevention of cardiovascular diseases, diabetes mellitus and chronic kidney diseases in general practice was sent to a representative sample of 1,100 Dutch GPs. The questionnaire was developed in collaboration with experts in general practice, cardiovascular disease, diabetes and kidney disease. RESULTS A total of 330 GPs completed and returned the questionnaire (30% response). Only a quarter of the GP's actively invite patients for preventive measurements. Preventive measures are mainly performed by the GP when a patient asks for it or when patients visit a GP for other complaints. The main reasons for performing preventive tests were a positive family history, obesity and smoking. Most GPs consider detection of these diseases as worthwhile, but detection should particularly focus on the group of patients with the highest risk on these diseases. CONCLUSION GPs have a positive attitude towards primary prevention of cardiovascular diseases, diabetes mellitus and chronic kidney diseases, but primary prevention should be focused on patients at risk.
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Affiliation(s)
- Markus M J Nielen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, the Netherlands.
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Jellema P, Schellevis FG, van der Windt DAWM, Kneepkens CMF, van der Horst HE. Lactose malabsorption and intolerance: a systematic review on the diagnostic value of gastrointestinal symptoms and self-reported milk intolerance. QJM 2010; 103:555-72. [PMID: 20522486 DOI: 10.1093/qjmed/hcq082] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND When lactose malabsorption gives rise to symptoms, the result is called 'lactose intolerance'. Although lactose intolerance is often bothersome for patients, once recognized it may be managed by simple dietary adjustments. However, diagnosing lactose intolerance is not straightforward, especially in primary care. AIM To summarize available evidence on the diagnostic performance of gastrointestinal symptoms and self-reported milk (lactose) intolerance in primary care, and the relationship between lactose malabsorption and intolerance. DATA SOURCES PubMed, EMBASE and reference screening. STUDY SELECTION Studies were selected if the design was a primary diagnostic study; the patients were adults consulting because of non-acute abdominal symptoms; the diagnostic test included gastrointestinal symptoms and/or self-reported milk intolerance. A total of 26 primary diagnostic studies were included in the review. DATA EXTRACTION Quality assessment and data extraction were performed by two reviewers independently. They adhered to the most recent guidelines for conducting a diagnostic review as described in the Cochrane Diagnostic Reviewers' Handbook. RESULTS The diagnostic performance of diarrhea, abdominal pain, bloating, flatulence and self-reported milk intolerance was highly variable. A non-Caucasian ethnic origin was associated with the presence of lactose malabsorption. Both lactose malabsorbers and lactose absorbers reported symptoms during the lactose hydrogen breath test. CONCLUSION Our review shows that high-quality studies on the diagnosis of lactose malabsorption and intolerance in primary care are urgently needed. An important prerequisite would be to clearly define the concept of lactose intolerance, as well as how it should be assessed.
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Affiliation(s)
- P Jellema
- Department of General Practice, EMGO Institute for Health and Care research, VU University Medical Centre and NIVEL (Netherlands Institute for Health Services Research), Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
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Wendel S, Bes RE, de Jong JD, Schellevis FG, Friele RD. [The fat doctor and the fat patient--can a doctor also be allowed to transgress?]. Ned Tijdschr Geneeskd 2010; 154:A2897. [PMID: 21211080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Evaluation of opinions of patients with regard to an unhealthy lifestyle of the doctor and assessment as to whether or not this is dependent on the patient's own lifestyle (healthy or unhealthy). DESIGN Descriptive questionnaire study. METHOD An online questionnaire was sent to 1000 members of a panel. They were asked to score a set of statements about their trust in a doctor who smokes, drinks or is overweight and the willingness to follow the advice of such a doctor. The items were scored on a 5-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree, 5 = strongly agree). RESULTS The respondents found it very important that doctors should serve as a role model. A striking finding was that two-thirds would follow the advice of a doctor who does not serve as a role model. Furthermore, smoking, drinking and overweight respondents were shown to have more trust in a smoking, drinking or overweight doctor than non-smokers, non-drinkers or respondents who are not overweight. Regarding the willingness to follow a doctor's advice, we found that drinking and overweight respondents were more likely to follow the advice of a drinking or overweight doctor than non-drinkers or respondents who are not overweight. We did not find a significant difference between smokers and non-smokers and their willingness to follow the advice from a smoking doctor. CONCLUSION Respondents found it important that doctors serve as a role model. Yet, a majority of the respondents would follow the advice of a doctor who does not serve as a role model. Respondents who struggle with the same unhealthy lifestyle habits as their doctor reported that they are more likely to follow his or her advice than respondents who do not have these unhealthy lifestyle habits.
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Affiliation(s)
- Sonja Wendel
- Nederlands instituut voor onderzoek van de gezondheidszorg (NIVEL), Utrecht, the Netherlands
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Maas J, Verheij RA, de Vries S, Spreeuwenberg P, Schellevis FG, Groenewegen PP. Morbidity is related to a green living environment. J Epidemiol Community Health 2009; 63:967-73. [PMID: 19833605 DOI: 10.1136/jech.2008.079038] [Citation(s) in RCA: 457] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND As a result of increasing urbanisation, people face the prospect of living in environments with few green spaces. There is increasing evidence for a positive relation between green space in people's living environment and self-reported indicators of physical and mental health. This study investigates whether physician-assessed morbidity is also related to green space in people's living environment. METHODS Morbidity data were derived from electronic medical records of 195 general practitioners in 96 Dutch practices, serving a population of 345,143 people. Morbidity was classified by the general practitioners according to the International Classification of Primary Care. The percentage of green space within a 1 km and 3 km radius around the postal code coordinates was derived from an existing database and was calculated for each household. Multilevel logistic regression analyses were performed, controlling for demographic and socioeconomic characteristics. RESULTS The annual prevalence rate of 15 of the 24 disease clusters was lower in living environments with more green space in a 1 km radius. The relation was strongest for anxiety disorder and depression. The relation was stronger for children and people with a lower socioeconomic status. Furthermore, the relation was strongest in slightly urban areas and not apparent in very strongly urban areas. CONCLUSION This study indicates that the previously established relation between green space and a number of self-reported general indicators of physical and mental health can also be found for clusters of specific physician-assessed morbidity. The study stresses the importance of green space close to home for children and lower socioeconomic groups.
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Affiliation(s)
- J Maas
- EMGO Institute, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
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Jellema P, van der Windt DAWM, Schellevis FG, van der Horst HE. Systematic review: accuracy of symptom-based criteria for diagnosis of irritable bowel syndrome in primary care. Aliment Pharmacol Ther 2009; 30:695-706. [PMID: 19575763 DOI: 10.1111/j.1365-2036.2009.04087.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite the trend towards making a positive diagnosis of irritable bowel syndrome (IBS), many health care providers approach IBS as a diagnosis of exclusion. AIM To summarize available evidence on the diagnostic performance of symptom-based IBS criteria in excluding organic diseases, and of individual signs and symptoms in diagnosing IBS and to additionally assess the influence of sources of heterogeneity on diagnostic performance. METHODS We searched PubMed and EMBASE and screened references. Studies were selected if the design was a primary diagnostic study; the patients were adults consulting because of non-acute abdominal symptoms; the diagnostic test included an externally validated set of IBS criteria, signs, or symptoms. Data extraction and quality assessment were performed by two reviewers independently. The review adhered to the most recent guidelines as described in the Cochrane Diagnostic Reviewers' Handbook. RESULTS A total of 25 primary diagnostic studies were included in the review. The performance of symptom-based criteria in the exclusion of organic disease was highly variable. Patients fulfilling IBS criteria had, however, a lower risk of organic diseases than those not fulfilling the criteria. CONCLUSIONS With none of the criteria showing sufficiently homogeneous and favourable results, organic disease cannot be accurately excluded by symptom-based IBS criteria alone. However, the low pre-test probability of organic disease especially among patients who meet symptom-based criteria in primary care argues against exhaustive diagnostic evaluation. We advise validation of the new Rome III criteria in primary care populations.
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Affiliation(s)
- P Jellema
- Department of General Practice, EMGO Institute for Health and Care research, VU university medical center, Amsterdam, The Netherlands
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Peters MJL, Nielen MMJ, Raterman HG, Verheij RA, Schellevis FG, Nurmohamed MT. Increased cardiovascular disease in patients with inflammatory arthritis in primary care: a cross-sectional observation. J Rheumatol 2009; 36:1866-8. [PMID: 19648308 DOI: 10.3899/jrheum.090010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To compare the prevalence of cardiovascular disease (CVD) in patients with inflammatory arthritis and control subjects registered in primary care. METHODS Conditional logistic regression analyses were used to compare the CVD prevalence in patients and controls, aged 50-75 years. RESULTS Overall, the CVD prevalence was 66.1 per 1000 patients in inflammatory arthritis and 37.3 per 1000 patients in controls, resulting in an odds ratio of 1.83 (95% confidence interval 1.33-2.51). CONCLUSION Inflammatory arthritis patients registered in primary care are associated with an increased cardiovascular burden, which emphasizes the need for cardiovascular risk management in the primary care setting.
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Affiliation(s)
- Mike J L Peters
- VU University Medical Center, Department of Internal Medicine, Amsterdam, The Netherlands.
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Abstract
OBJECTIVE The aim of this study was to provide insight into the referral pattern of newly diagnosed patients with urinary incontinence in general practice and into the prescription of medication and incontinence pads by general practitioners (GPs). We also examined the influence of gender and age of patient/GP on these patterns. METHODS Data were obtained from the Second Dutch National Survey of General Practice. We used registered new episodes for urinary incontinence of patients of 25 years and older in the year 2001 and examined the initial management. RESULTS Twelve per cent of the patients were referred to a physiotherapist, 2.4% to a gynaecologist and 2.9% to a urologist. Medication was prescribed to 9.8% and 12.7% received incontinence pads. The number of female patients referred decreased significantly after 60 years of age and the number of incontinence pads and medication prescribed was higher in this age patient group. Gender of the GP did not influence the prescription or referral rate. Male patients were significantly less frequently referred than female patients. CONCLUSION The lower referral rate and higher prescription rate of incontinence pads and medication at older age indicate that GPs are not sufficiently aware of the benefits of pelvic floor muscle training and bladder training at older age. We did not find an influence of gender of the GP on management of urinary incontinence, unlike previous research. GPs were reluctant in prescribing medication, which is in agreement with national and international guidelines.
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Affiliation(s)
- Maaike A G van Gerwen
- Doctor, Department of General Practice, Radboud University Nijmegen Medical Centre, Amsterdam, The Netherlands
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Schram MT, Frijters D, van de Lisdonk EH, Ploemacher J, de Craen AJM, de Waal MWM, van Rooij FJ, Heeringa J, Hofman A, Deeg DJH, Schellevis FG. Setting and registry characteristics affect the prevalence and nature of multimorbidity in the elderly. J Clin Epidemiol 2008; 61:1104-12. [PMID: 18538993 DOI: 10.1016/j.jclinepi.2007.11.021] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2007] [Revised: 11/16/2007] [Accepted: 11/30/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of the study was to investigate how settings and registry characteristics affect the prevalence and nature of multimorbidity in elderly individuals. STUDY DESIGN AND SETTING We used data from three population-based studies, two general practitioner registries, one hospital discharge register, and one nursing home registry to estimate the prevalence of multimorbidity. Individuals aged 55 years and over were included. RESULTS Multimorbidity was most prevalent in nursing homes (82%), followed by the general population and general practitioner registries (56%-72%) and the hospital setting (22%). There were large differences in the nature of multimorbidity between settings. Combinations of hypertension, heart disease, and osteoarthritis were dominant in the population-based setting, whereas hypertension in combination with osteoarthritis, obesity, disorders of lipid metabolism, and diabetes dominated in the general practitioner setting. In the hospital setting, combinations of heart diseases had the highest prevalence. Combinations of dementia, hypertension, and stroke were dominant within the nursing home setting. CONCLUSION This study shows that setting and registry characteristics have an important influence on the outcome of multimorbidity studies. We recommend provision of at least information about the setting, the (list of) conditions included, the data collection method, and the time frame used, when reporting about the size and nature of multimorbidity.
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Affiliation(s)
- Miranda T Schram
- Extramural Medicine (EMGO Institute), VU University Medical Center, Amsterdam, The Netherlands
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Puts MTE, Deeg DJH, Hoeymans N, Nusselder WJ, Schellevis FG. Changes in the prevalence of chronic disease and the association with disability in the older Dutch population between 1987 and 2001. Age Ageing 2008; 37:187-93. [PMID: 18250095 DOI: 10.1093/ageing/afm185] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND most studies of older populations in developed countries show a decrease in the prevalence of disabilities, and an increase in chronic diseases over the past decades. Data in the Netherlands, however, mostly show an increase in the prevalence of chronic diseases and mixed results with regard to the prevalence of disability. This study aims at comparing changes in the prevalence, as well as the association between chronic diseases and disability between 1987 and 2001 in the older Dutch population using data representative of the general population. Most studies, so far, have only dealt with self-reported diseases, but in this study, we will use both self-reported and GP-registered diseases. STUDY DESIGN data from the first (1987) and second (2001) Dutch National Survey of General Practice were used. In 1987, 103 general practices, compared to 104 in 2001, participated. Approximately 5% of the listed persons aged 18 years and over was asked to participate in an extensive health interview survey. An all-age random sample was drawn by the researchers from the patients listed in the participating practices (in 1987 n = 2, 708; in 2001 n = 3, 474). Both surveys are community based, with an age range between 55 and 97 years. Data on chronic diseases were based on GP registries and self-report. RESULTS the prevalence of disability and of asthma/COPD, cardiac disease, stroke, and osteoarthritis decreased between 1987 and 2001, while the prevalence of diabetes increased. Changes were largely similar for GP-registered and self-reported diseases. Cardiac disease, asthma/COPD, and depression led to less disability, whereas low back pain and osteoarthritis led to more disability. CONCLUSIONS in general, there were reductions in GP-registered chronic diseases as well as in self-reported diseases and disability. Results suggest that the disabling impact of fatal diseases decreased, while the impact of non-fatal diseases increased.
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Affiliation(s)
- M T E Puts
- EMGO Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
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