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Füssenich K, Boshuizen HC, Nielen MMJ, Buskens E, Feenstra TL. Mapping chronic disease prevalence based on medication use and socio-demographic variables: an application of LASSO on administrative data sources in healthcare in the Netherlands. BMC Public Health 2021; 21:1039. [PMID: 34078308 PMCID: PMC8170948 DOI: 10.1186/s12889-021-10754-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Policymakers generally lack sufficiently detailed health information to develop localized health policy plans. Chronic disease prevalence mapping is difficult as accurate direct sources are often lacking. Improvement is possible by adding extra information such as medication use and demographic information to identify disease. The aim of the current study was to obtain small geographic area prevalence estimates for four common chronic diseases by modelling based on medication use and socio-economic variables and next to investigate regional patterns of disease. METHODS Administrative hospital records and general practitioner registry data were linked to medication use and socio-economic characteristics. The training set (n = 707,021) contained GP diagnosis and/or hospital admission diagnosis as the standard for disease prevalence. For the entire Dutch population (n = 16,777,888), all information except GP diagnosis and hospital admission was available. LASSO regression models for binary outcomes were used to select variables strongly associated with disease. Dutch municipality (non-)standardized prevalence estimates for stroke, CHD, COPD and diabetes were then based on averages of predicted probabilities for each individual inhabitant. RESULTS Adding medication use data as a predictor substantially improved model performance. Estimates at the municipality level performed best for diabetes with a weighted percentage error (WPE) of 6.8%, and worst for COPD (WPE 14.5%)Disease prevalence showed clear regional patterns, also after standardization for age. CONCLUSION Adding medication use as an indicator of disease prevalence next to socio-economic variables substantially improved estimates at the municipality level. The resulting individual disease probabilities could be aggregated into any desired regional level and provide a useful tool to identify regional patterns and inform local policy.
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Affiliation(s)
- Koen Füssenich
- RIVM (National Institute for Public Health and the Environment), Centre for Nutrition, Prevention and Health Services, P.O. Box 1, 3720, BA, Bilthoven, The Netherlands.
- Groningen University, UMCG, Department of Epidemiology, Groningen, The Netherlands.
- Capaciteitsorgaan (Council for Medical Manpower Planning), Utrecht, The Netherlands.
| | - Hendriek C Boshuizen
- RIVM (National Institute for Public Health and the Environment), Centre for Nutrition, Prevention and Health Services, P.O. Box 1, 3720, BA, Bilthoven, The Netherlands
- Wageningen University and Research, Biometris, Wageningen, The Netherlands
| | - Markus M J Nielen
- RIVM (National Institute for Public Health and the Environment), Centre for Health and Society, Bilthoven, The Netherlands
- NIVEL (Netherlands Institute for Health Srvices Research), Utrecht, The Netherlands
| | - Erik Buskens
- Groningen University, UMCG, Department of Epidemiology, Groningen, The Netherlands
- Groningen University, Faculty of Economics and Business, Groningen, The Netherlands
| | - Talitha L Feenstra
- RIVM (National Institute for Public Health and the Environment), Centre for Nutrition, Prevention and Health Services, P.O. Box 1, 3720, BA, Bilthoven, The Netherlands
- Groningen University, Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, Groningen, The Netherlands
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Badenbroek IF, Nielen MMJ, Hollander M, Stol DM, de Wit NJ, Schellevis FG. Characteristics and motives of non-responders in a stepwise cardiometabolic disease prevention program in primary care. Eur J Public Health 2021; 31:991-996. [PMID: 33970254 PMCID: PMC8565495 DOI: 10.1093/eurpub/ckab060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A high response rate is an important condition for effective prevention programs. We aimed at gaining insight into the characteristics and motives of non-responders in different stages of a stepwise prevention program for cardiometabolic diseases (CMD) in primary care. METHODS We performed a non-response analysis within a randomized controlled trial assessing the effectiveness of a stepwise CMD prevention program in the Netherlands. Patients between 45 and 70 years without known CMD were invited for stage 1 of the program, completing a CMD risk score. Patients with an increased risk were advised to visit their general practice for additional measurements, stage 2 of the program. We analyzed determinants of non-response using data from the risk score, electronic medical records, questionnaires and Statistics Netherlands. RESULTS Non-response in stage 1 was associated with a younger age, male sex, a migration background, a low prosperity score, self-employment, being single and having lower consultations rates in general practice. Non-response in stage 2 was associated with a low prosperity score, being employed, having no chronic illness, smoking, a normal waist circumference, a negative family history for cardiovascular disease or diabetes and having a lower consultation rate. More than half of the non-responders in stage 2 reported not visiting the GP because they did not expect to have any CMD, despite their increased risk. CONCLUSIONS To achieve a larger and more equal uptake of prevention programs for CMD, we should use methods adapted to characteristics of non-responders, such as targeted invitation methods and improved risk communication.
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Affiliation(s)
- Ilse F Badenbroek
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Research Program for General Medicine, Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Markus M J Nielen
- Research Program for General Medicine, Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Monika Hollander
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Daphne M Stol
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Research Program for General Medicine, Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Niek J de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - François G Schellevis
- Research Program for General Medicine, Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.,Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Verberne LDM, Leemrijse CJ, Nielen MMJ, Friele RD. Intermediate weight changes and follow-up of dietetic treatment in primary health care: an observational study. BMC Nutr 2020; 6:62. [PMID: 33292684 PMCID: PMC7667732 DOI: 10.1186/s40795-020-00377-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary health care data have shown that most patients who were treated for overweight or obesity by a dietitian did not accomplish the recommended treatment period. It is hypothesised that a slow rate of weight loss might discourage patients from continuing dietetic treatment. This study evaluated intermediate weight changes during regular dietetic treatment in Dutch primary health care, and examined whether weight losses at previous consultations were associated with attendance at follow-up consultations. METHODS This observational study was based on real life practice data of overweight and obese patients during the period 2013-2017, derived from Dutch dietetic practices that participated in the Nivel Primary Care Database. Multilevel regression analyses were conducted to estimate the mean changes in body mass index (BMI) during six consecutive consultations and to calculate odds ratios for the association of weight change at previous consultations with attendance at follow-up consultations. RESULTS The total study population consisted of 25,588 overweight or obese patients, with a mean initial BMI of 32.7 kg/m2. The BMI decreased between consecutive consultations, with the highest weight losses between the first and second consultation. After six consultations, a mean weight loss of - 1.5 kg/m2 was estimated. Patients who lost weight between the two previous consultations were more likely to attend the next consultation than patients who did not lose weight or gained weight. CONCLUSIONS Body mass index decreased during consecutive consultations, and intermediate weight losses were associated with a higher attendance at follow-up consultations during dietetic treatment in overweight patients. Dietitians should therefore focus on discussing intermediate weight loss expectations with their patients.
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Affiliation(s)
- Lisa D M Verberne
- Nivel, Netherlands Institute for Health Services Research, P.O. Box 1568, Utrecht, 3500 BN, The Netherlands.
| | - Chantal J Leemrijse
- Nivel, Netherlands Institute for Health Services Research, P.O. Box 1568, Utrecht, 3500 BN, The Netherlands
| | - Markus M J Nielen
- Nivel, Netherlands Institute for Health Services Research, P.O. Box 1568, Utrecht, 3500 BN, The Netherlands
| | - Roland D Friele
- Nivel, Netherlands Institute for Health Services Research, P.O. Box 1568, Utrecht, 3500 BN, The Netherlands.,Tilburg School of Social and Behavioral Sciences, Tilburg University, Tranzo, P.O. Box 90153, Tilburg, 5000 LE, The Netherlands
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4
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Slobbe LCJ, Füssenich K, Wong A, Boshuizen HC, Nielen MMJ, Polder JJ, Feenstra TL, van Oers HAM. Estimating disease prevalence from drug utilization data using the Random Forest algorithm. Eur J Public Health 2020; 29:615-621. [PMID: 30608539 PMCID: PMC6660107 DOI: 10.1093/eurpub/cky270] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Aggregated claims data on medication are often used as a proxy for the prevalence of diseases, especially chronic diseases. However, linkage between medication and diagnosis tend to be theory based and not very precise. Modelling disease probability at an individual level using individual level data may yield more accurate results. Methods Individual probabilities of having a certain chronic disease were estimated using the Random Forest (RF) algorithm. A training set was created from a general practitioners database of 276 723 cases that included diagnosis and claims data on medication. Model performance for 29 chronic diseases was evaluated using Receiver-Operator Curves, by measuring the Area Under the Curve (AUC). Results The diseases for which model performance was best were Parkinson’s disease (AUC = .89, 95% CI = .77–1.00), diabetes (AUC = .87, 95% CI = .85–.90), osteoporosis (AUC = .87, 95% CI = .81–.92) and heart failure (AUC = .81, 95% CI = .74–.88). Five other diseases had an AUC >.75: asthma, chronic enteritis, COPD, epilepsy and HIV/AIDS. For 16 of 17 diseases tested, the medication categories used in theory-based algorithms were also identified by our method, however the RF models included a broader range of medications as important predictors. Conclusion Data on medication use can be a useful predictor when estimating the prevalence of several chronic diseases. To improve the estimates, for a broader range of chronic diseases, research should use better training data, include more details concerning dosages and duration of prescriptions, and add related predictors like hospitalizations.
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Affiliation(s)
- Laurentius C J Slobbe
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Tilburg University, Department Tranzo, Tilburg, The Netherlands
| | - Koen Füssenich
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Groningen University, University Medical Center, Department of Epidemiology, Groningen, The Netherlands
| | - Albert Wong
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Hendriek C Boshuizen
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Wageningen University and Research, Wageningen, The Netherlands
| | - Markus M J Nielen
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Johan J Polder
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Tilburg University, Department Tranzo, Tilburg, The Netherlands
| | - Talitha L Feenstra
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Groningen University, University Medical Center, Department of Epidemiology, Groningen, The Netherlands
| | - Hans A M van Oers
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Tilburg University, Department Tranzo, Tilburg, The Netherlands
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5
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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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6
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Mitratza M, Kunst AE, Harteloh PPM, Nielen MMJ, Klijs B. Prevalence of diabetes mellitus at the end of life: An investigation using individually linked cause-of-death and medical register data. Diabetes Res Clin Pract 2020; 160:108003. [PMID: 31911247 DOI: 10.1016/j.diabres.2020.108003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/12/2019] [Accepted: 12/31/2019] [Indexed: 11/17/2022]
Abstract
AIMS Although diabetes mellitus at the end of life is associated with complex care, its end-of-life prevalence is uncertain. Our aim is to estimate diabetes prevalence in the end-of-life population, to evaluate which medical register has the largest added value to cause-of-death data in detecting diabetes cases, and to assess the extent to which reporting of diabetes as a cause of death is associated with disease severity. METHODS Our study population consisted of deaths in the Netherlands (2015-2016) included in Nivel Primary Care Database (Nivel-PCD; N = 18,162). The proportion of deaths with diabetes (Type 1 or 2) within the last two years of life was calculated using individually linked cause-of-death, general practice, medication, and hospital discharge data. Severity status of diabetes was defined with dispensed medicines. RESULTS According to all data sources combined, 28.7% of the study population had diabetes at the end of life. The estimated end-of-life prevalence of diabetes was 7.7% using multiple cause-of-death data only. Addition of general practice data increased this estimate the most (19.7%-points). Of the cases added by primary care data, 76.3% had a severe or intermediate status. CONCLUSIONS More than one fourth of the Dutch end-of-life population has diabetes. Cause-of-death data are insufficient to monitor this prevalence, even of severe cases of diabetes, but could be enriched particularly with general practice data.
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Affiliation(s)
- Marianna Mitratza
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Anton E Kunst
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Peter P M Harteloh
- Department of Health and Care, Statistics Netherlands, The Hague, the Netherlands
| | - Markus M J Nielen
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands
| | - Bart Klijs
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Health and Care, Statistics Netherlands, The Hague, the Netherlands
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Verberne LDM, Leemrijse CJ, Nielen MMJ, Friele RD. Achievement of weight loss in patients with overweight during dietetic treatment in primary health care. PLoS One 2019; 14:e0225065. [PMID: 31774845 PMCID: PMC6880966 DOI: 10.1371/journal.pone.0225065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 07/15/2019] [Accepted: 10/28/2019] [Indexed: 02/05/2023] Open
Abstract
Introduction Dietitians are the preferred primary health care professionals for nutritional care in overweight patients. Guidelines for dietitians recommend a weight reduction of ≥ 5% of initial body weight after one year of treatment. The purpose of this study was to evaluate weight change in patients with overweight who were treated by dietitians in Dutch primary health care, and to identify patient characteristics that were associated with it. Materials and methods This observational study data was based on real life practice data of patients with overweight during the period 2013–2017, derived from dietetic practices that participated in the Nivel Primary Care Database. Multilevel linear regression analyses were performed to investigate weight change after dietetic treatment and to explore associations with patient characteristics. Results In total, data were evaluated from 56 dietetic practices and 4722 patients with a body mass index (BMI) ≥ 25 kg/m2. The mean treatment time was 3 hours within an average timeframe of 5 months. Overall, patients had a mean weight change of -3.5% (95% CI: -3.8; -3.1) of their initial body weight, and a quarter of the patients reached a weight loss of 5% or more, despite the fact that most patients did not meet the recommended treatment duration of at least one year. The mean BMI change was -1.1 kg/m2 (95% CI: -1.2; -1.0). Higher weight reductions were shown for patients with a higher initial BMI and for patients with a longer treatment time. Sex and age were not associated with weight change, and patients with other dietetic diagnoses, such as diabetes, hypertension, and hypercholesterolemia, had lower weight reductions. Conclusions This study showed that dietetic treatment in primary health care coincided with modest weight reduction in patients with overweight. The weight loss goals were not reached for most patients, which was possibly due to a low treatment adherence.
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Affiliation(s)
- Lisa D. M. Verberne
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- * E-mail:
| | - Chantal J. Leemrijse
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Markus M. J. Nielen
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Roland D. Friele
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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8
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Kleipool EEF, Nielen MMJ, Korevaar JC, Harskamp RE, Smulders YM, Serné E, Thijs A, Peters MJL, Muller M. Prescription patterns of lipid lowering agents among older patients in general practice: an analysis from a national database in the Netherlands. Age Ageing 2019; 48:577-582. [PMID: 31074492 DOI: 10.1093/ageing/afz034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 12/17/2018] [Revised: 02/10/2019] [Accepted: 03/25/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Dutch cardiovascular risk management guidelines state almost every older adult (≥70 years) is eligible for a lipid lowering drug (LLD). However, life expectancy, frailty or comorbidities may influence this treatment decision. OBJECTIVE investigate how many older adults, according to age, frailty (Drubbel-frailty index) and comorbidities were prescribed LLDs. METHODS data of 244,328 adults ≥70 years from electronic health records of 415 Dutch general practices from 2011-15 were used. Number of LLD prescriptions in patients with (n = 55,309) and without (n = 189,019) cardiovascular disease (CVD) was evaluated according to age, frailty and comorbidities. RESULTS about 69% of adults ≥70 years with CVD and 36% without CVD were prescribed a LLD. LLD prescriptions decreased with age; with CVD: 78% aged 70-74 years and 29% aged ≥90 years were prescribed a LLD, without CVD: 37% aged 70-74 years and 12% aged ≥90 years. In patients with CVD and within each age group, percentage of LLD prescriptions was 20% point(pp) higher in frail compared with non-frail. In patients without CVD, percentage of LLD prescriptions in frail patients was 11pp higher in adults aged 70-74 years and 40pp higher in adults aged ≥90 years compared to non-frail. Similar trends were seen in the analyses with number of comorbidities. CONCLUSION in an older population, LLD prescriptions decreased with age but-contrary to our expectations-LLD prescriptions increased with higher frailty levels.
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Affiliation(s)
- E E F Kleipool
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - M M J Nielen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - J C Korevaar
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - R E Harskamp
- Amsterdam UMC, University of Amsterdam, Department of General Practice, Amsterdam, The Netherlands
| | - Y M Smulders
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - E Serné
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - A Thijs
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - M J L Peters
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - M Muller
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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9
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Verberne LDM, Nielen MMJ, Leemrijse CJ, Verheij RA, Friele RD. Recording of weight in electronic health records: an observational study in general practice. BMC Fam Pract 2018; 19:174. [PMID: 30447691 PMCID: PMC6240309 DOI: 10.1186/s12875-018-0863-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 02/06/2018] [Accepted: 11/06/2018] [Indexed: 11/10/2022]
Abstract
Background Routine weight recording in electronic health records (EHRs) could assist general practitioners (GPs) in the identification, prevention, and management of overweight patients. However, the extent to which weight management is embedded in general practice in the Netherlands has not been investigated. The purpose of this study was to evaluate the frequency of weight recording in general practice in the Netherlands for patients who self-reported as being overweight. The specific objectives of this study were to assess whether weight recording varied according to patient characteristics, and to determine the frequency of weight recording over time for patients with and without a chronic condition related to being overweight. Methods Baseline data from the Occupational and Environmental Health Cohort Study (2012) were combined with data from EHRs of general practices (2012–2015). Data concerned 3446 self-reported overweight patients who visited their GP in 2012, and 1516 patients who visited their GP every year between 2012 and 2015. Logistic multilevel regression analyses were performed to identify associations between patient characteristics and weight recording. Results In 2012, weight was recorded in the EHRs of a quarter of patients who self-reported as being overweight. Greater age, lower education level, higher self-reported body mass index, and the presence of diabetes mellitus, chronic obstructive pulmonary disease, and/or cardiovascular disorders were associated with higher rates of weight recording. The strongest association was found for diabetes mellitus (adjusted OR = 10.3; 95% CI [7.3, 14.5]). Between 2012 and 2015, 90% of patients with diabetes mellitus had at least one weight measurement recorded in their EHR. In the group of patients without a chronic condition related to being overweight, this percentage was 33%. Conclusions Weight was frequently recorded for overweight patients with a chronic condition, for whom regular weight measurement is recommended in clinical guidelines, and for which weight recording is a performance indicator as part of the payment system. For younger patients and those without a chronic condition related to being overweight, weight was less frequently recorded. For these patients, routine recording of weight in EHRs deserves more attention, with the aim to support early recognition and treatment of overweight. Electronic supplementary material The online version of this article (10.1186/s12875-018-0863-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lisa D M Verberne
- Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500 BN, Utrecht, The Netherlands.
| | - Markus M J Nielen
- Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500 BN, Utrecht, The Netherlands
| | - Chantal J Leemrijse
- Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500 BN, Utrecht, The Netherlands
| | - Robert A Verheij
- Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500 BN, Utrecht, The Netherlands
| | - Roland D Friele
- Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500 BN, Utrecht, The Netherlands.,Tilburg School of Social and Behavioral Sciences, Tilburg University, Tranzo, P.O. Box 90153, 5000 LE, Tilburg, The Netherlands
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10
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Stol DM, Hollander M, Nielen MMJ, Badenbroek IF, Schellevis FG, de Wit NJ. Implementation of selective prevention for cardiometabolic diseases; are Dutch general practices adequately prepared? Scand J Prim Health Care 2018; 36:20-27. [PMID: 29357728 PMCID: PMC5901436 DOI: 10.1080/02813432.2018.1426151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Current guidelines acknowledge the need for cardiometabolic disease (CMD) prevention and recommend five-yearly screening of a targeted population. In recent years programs for selective CMD-prevention have been developed, but implementation is challenging. The question arises if general practices are adequately prepared. Therefore, the aim of this study is to assess the organizational preparedness of Dutch general practices and the facilitators and barriers for performing CMD-prevention in practices currently implementing selective CMD-prevention. DESIGN Observational study. SETTING Dutch primary care. SUBJECTS General practices. MAIN OUTCOME MEASURES Organizational characteristics. RESULTS General practices implementing selective CMD-prevention are more often organized as a group practice (49% vs. 19%, p = .000) and are better organized regarding chronic disease management compared to reference practices. They are motivated for performing CMD-prevention and can be considered as 'frontrunners' of Dutch general practices with respect to their practice organization. The most important reported barriers are a limited availability of staff (59%) and inadequate funding (41%). CONCLUSIONS The organizational infrastructure of Dutch general practices is considered adequate for performing most steps of selective CMD-prevention. Implementation of prevention programs including easily accessible lifestyle interventions needs attention. All stakeholders involved share the responsibility to realize structural funding for programmed CMD-prevention. Aforementioned conditions should be taken into account with respect to future implementation of selective CMD-prevention. Key Points There is need for adequate CMD prevention. Little is known about the organization of selective CMD prevention in general practices. • The organizational infrastructure of Dutch general practices is adequate for performing most steps of selective CMD prevention. • Implementation of selective CMD prevention programs including easily accessible services for lifestyle support should be the focus of attention. • Policy makers, health insurance companies and healthcare professionals share the responsibility to realize structural funding for selective CMD prevention.
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Affiliation(s)
- Daphne M. Stol
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- CONTACT Daphne M. Stol Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, Utrecht, 3508 GA, The Netherlands
| | - Monika Hollander
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Markus M. J. Nielen
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Ilse F. Badenbroek
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - François 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, VU University Medical Center, Amsterdam, The Netherlands
| | - Niek J. de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Abstract
OBJECTIVES Healthcare costs and usage are rising. Evidence-based online health information may reduce healthcare usage, but the evidence is scarce. The objective of this study was to determine whether the release of a nationwide evidence-based health website was associated with a reduction in healthcare usage. DESIGN Interrupted time series analysis of observational primary care data of healthcare use in the Netherlands from 2009 to 2014. SETTING General community primary care. POPULATION 912 000 patients who visited their general practitioners 18.1 million times during the study period. INTERVENTION In March 2012, an evidence-based health information website was launched by the Dutch College of General Practitioners. It was easily accessible and understandable using plain language. At the end of the study period, the website had 2.9 million unique page views per month. MAIN OUTCOMES MEASURES Primary outcome was the change in consultation rate (consultations/1000 patients/month) before and after the release of the website. Additionally, a reference group was created by including consultations about topics not being viewed at the website. Subgroup analyses were performed for type of consultations, sex, age and socioeconomic status. RESULTS After launch of the website, the trend in consultation rate decreased with 1.620 consultations/1000 patients/month (p<0.001). This corresponds to a 12% decline in consultations 2 years after launch of the website. The trend in consultation rate of the reference group showed no change. The subgroup analyses showed a specific decline for consultations by phone and were significant for all other subgroups, except for the youngest age group. CONCLUSIONS Healthcare usage decreased by 12% after providing high-quality evidence-based online health information. These findings show that e-Health can be effective to improve self-management and reduce healthcare usage in times of increasing healthcare costs.
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Affiliation(s)
- Wouter A Spoelman
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Tobias N Bonten
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Margot W M de Waal
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Ton Drenthen
- Dutch College of General Practitioners, Utrecht, The Netherlands
| | - Ivo J M Smeele
- Dutch College of General Practitioners, Utrecht, The Netherlands
| | - Markus M J Nielen
- Department of Primary Care, NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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12
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Abstract
OBJECTIVES Dutch primary out-of-hours care is provided by general practice cooperatives (GPCs). Although most GPCs use the same standardised triage system, differences between GPCs exist in the urgency assigned to patients' health problems. This cross-sectional study aims to provide insight into factors associated with the variation in assigned urgency between GPCs. DESIGN AND METHODS Data were derived from routine electronic health records of 895 253 patients who attended 17 GPCs in 2012. Patients' gender, age, travel distance to the GPC, and the use of a computer-based decision support system for triage were investigated as possibly affecting assigned urgency. Multilevel linear regression analyses were executed for the 3 most frequently presented health problems (cystitis/other urinary infection, laceration/cut and fever). RESULTS Variation in urgency levels between GPCs was significant for the selected health problems (p=0.00). Assigned urgency was mainly related to patient gender and age. It was not associated with the use of a computer-based decision support system, or with travel distance to the GPC. Most variation in urgency (93.4-96.7%) could be ascribed to variation in patient characteristics. CONCLUSIONS There is significant variation in urgency levels between GPCs, even for the same health problem. This variation is mainly associated with differences in characteristics of individuals contacting the GPCs, rather than with variables such as patients' travel distance or the use of a computer-based decision support system. Since patient characteristics are likely to affect patients' clinical need, our results are an indication of the adequate functioning of the triage system.
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Affiliation(s)
- Marieke Zwaanswijk
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Markus M J Nielen
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Karin Hek
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Robert A Verheij
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
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Petter J, Reitsma-van Rooijen MM, Korevaar JC, Nielen MMJ. Willingness to participate in prevention programs for cardiometabolic diseases. BMC Public Health 2015; 15:44. [PMID: 25637105 PMCID: PMC4323020 DOI: 10.1186/s12889-015-1379-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 04/23/2014] [Accepted: 01/08/2015] [Indexed: 11/13/2022] Open
Abstract
Background Cardiometabolic diseases are the leading cause of death worldwide and result in decreased quality of life for patients and increased healthcare costs. Population-based prevention programs may prevent the onset and development of cardiometabolic diseases. The effectiveness of these programs depends on participation rates. This study identified factors related to willingness to participate in health checks and lifestyle intervention programs to prevent cardiometabolic diseases. Methods A questionnaire was sent to 1,500 Dutch adults, participating in the Dutch Health Care Consumer Panel of NIVEL. The questionnaire was developed by NIVEL. Predictors of willingness to participate were identified with logistic regression analyses. Predictors investigated were socio-demographic variables, risk factors for cardiometabolic diseases and motivational aspects. Results The response rate was 63%. 56% of the participants in our study were willing to participate in a health check. Higher age was associated with increased willingness to participate, as was the desire to know the actual risk for cardiometabolic diseases (OR = 4.6). Becoming unnecessarily worried was identified as a barrier (OR = 0.3). 47% were willing to participate in a lifestyle intervention program. People aged 39–65 were most willing to participate. Attention for prevention relapse behavior (OR = 3.3), informing the general practitioner about results (OR = 2.6) and conducting the program in a group (OR = 2.0) were positively associated with willingness to participate in lifestyle interventions. Conclusions Willingness to participate in a health check depended on personal beliefs, whereas social aspects contributed most to willingness to participate in a lifestyle intervention program. This information can be used to optimize and tailor the promotion of prevention programs.
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Affiliation(s)
- Jessica Petter
- NIVEL (Netherlands Institute for Health Services Research), P.O. Box 1568, 3500 BN, Utrecht, The Netherlands.
| | | | - Joke C Korevaar
- NIVEL (Netherlands Institute for Health Services Research), P.O. Box 1568, 3500 BN, Utrecht, The Netherlands.
| | - Markus M J Nielen
- NIVEL (Netherlands Institute for Health Services Research), P.O. Box 1568, 3500 BN, Utrecht, The Netherlands.
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Vos HMM, Van Delft DHWJM, De Kleijn MJJ, Nielen MMJ, Schellevis FG, Lagro-Janssen ALM. Selective prevention of cardiometabolic diseases in general practice: attitudes and working methods of male and female general practitioners before and after the introduction of the Prevention Consultation guideline in the Netherlands. J Eval Clin Pract 2014; 20:478-85. [PMID: 24910340 DOI: 10.1111/jep.12179] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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] [Accepted: 04/17/2014] [Indexed: 11/27/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES In 2011 the module cardiometabolic risk of the Prevention Consultation guideline was introduced in the Netherlands in order to prevent cardiometabolic diseases. We aimed to compare attitudes and working methods of Dutch general practitioners (GPs) towards selective prevention of cardiometabolic diseases before and after the introduction of the guideline and to study the effect of GP gender on these attitudes and working methods. METHODS We compared attitudes and working methods in prevention of cardiometabolic diseases in a cross-sectional survey among Dutch GPs in 2013 to the results of a comparable study performed in 2008. RESULTS Both in 2008 and 2013 30% responded. In 2013, more GPs reported to actively invite patients for preventive measurements. Thirty per cent of the GPs implemented the module cardiometabolic risk. In 2013, less GPs reported that it is worthwhile to make an effort to detect patients at increased risk for cardiometabolic diseases, and more GPs suggested that prevention may be performed by other stakeholders compared with 2008. Financial support and evidence for prevention programmes were mentioned as main facilitators for prevention. In 2013, more male than female GPs actively invite patients for preventive measurements. CONCLUSIONS More GPs report active preventive working methods after the introduction of the Prevention Consultation guideline, but only 30% implemented the guideline. More male than female GPs actively invite patients for preventive measurements. Compared with 2008 less GPs think it is worthwhile to make an effort to detect patients at increased risk and more GPs are willing to delegate preventive actions to other health institutions in 2013. As financial support and evidence for prevention are important facilitators for prevention, further research of the effectiveness of the guideline in preventing cardiometabolic diseases is necessary, and political choices have to be made in order to financially facilitate selective prevention in general practice.
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Affiliation(s)
- Hedwig M M Vos
- Department of Primary and Community Care, Gender and Women's Health, Radboud UMC, Nijmegen, The Netherlands
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Nielen MMJ, Ursum J, Schellevis FG, Korevaar JC. The validity of the diagnosis of inflammatory arthritis in a large population-based primary care database. BMC Fam Pract 2013; 14:79. [PMID: 24128086 PMCID: PMC3682903 DOI: 10.1186/1471-2296-14-79] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 06/06/2013] [Indexed: 11/10/2022]
Abstract
Background Large population-based databases based on electronic medical records (EMRs) of patients in primary care are a useful data source to investigate morbidity and health care utilization. Diagnoses recorded in EMRs are doctor-defined, but their validity can be disputed. In this study we investigated the validity of the diagnosis inflammatory arthritis (IA), a group of chronic rheumatic diseases, including rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis, in primary care based EMRs. Methods In five general practices, participating in the Netherlands Information Network of General Practice (LINH), EMRs of 219 patients with a diagnostic code of IA were systematically reviewed on characteristics which are not routinely extracted for the LINH database. The diagnosis IA was confirmed when we found, based on a correspondence with a medical specialist, the following diagnoses in the free text fields of the EMR: oligoarthritis, polyarthritis, rheumatoid arthritis and/or spondyloarthropathy. These results were used to determine the validity of the diagnosis IA in EMRs and to develop an algorithm to improve diagnostic validity. Results From the 219 patients diagnosed as IA in the database, the diagnosis IA was confirmed in 155 patients (70.8%). The algorithm, which resulted in a group of patients with as many as possible confirmed IA-diagnosed patients without excluding too many patients from our dataset, was when patients fulfilled at least one of the following three criteria: 1) a repeat prescription for a disease-modifying antirheumatic drug (DMARD) and/or biological agent, 2) ≥ four contacts or one episode with a diagnostic code for IA, combined with at least two IA-related prescriptions (excluding DMARDs/biological agents), and 3) age at diagnosis ≥ 61 years. After applying this algorithm, the percentage of correctly diagnosed IA patients increased from 71% to 78% reducing the size of our study population by 36%. Conclusions Based on additional diagnostic information, the diagnosis IA from EMRs of patients in primary care is sufficiently valid when using the proposed algorithm. After applying the algorithm, the percentage of correctly diagnosed IA patients increased from 71% to 78%.
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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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Nielen MMJ, van Sijl AM, Peters MJL, Verheij RA, Schellevis FG, Nurmohamed MT. Cardiovascular disease prevalence in patients with inflammatory arthritis, diabetes mellitus and osteoarthritis: a cross-sectional study in primary care. BMC Musculoskelet Disord 2012; 13:150. [PMID: 22906083 PMCID: PMC3493278 DOI: 10.1186/1471-2474-13-150] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 08/17/2012] [Indexed: 11/19/2022] Open
Abstract
Background There is accumulating evidence for an increased cardiovascular burden in inflammatory arthritis, but the true magnitude of this cardiovascular burden is still debated. We sought to determine the prevalence rate of non-fatal cardiovascular disease (CVD) in inflammatory arthritis, diabetes mellitus and osteoarthritis (non-systemic inflammatory comparator) compared to controls, in primary care. Methods Data on CVD morbidity (ICPC codes K75 (myocardial infarction), K89 (transient ischemic attack), and/or K90 (stroke/cerebrovascular accident)) from patients with inflammatory arthritis (n = 1,518), diabetes mellitus (n = 11,959), osteoarthritis (n = 4,040) and controls (n = 158,439) were used from the Netherlands Information Network of General Practice (LINH), a large nationally representative primary care based cohort. Data were analyzed using multi-level logistic regression analyses and corrected for age, gender, hypercholesterolemia and hypertension. Results CVD prevalence rates were significantly higher in inflammatory arthritis, diabetes mellitus and osteoarthritis compared with controls. These results attenuated - especially in diabetes mellitus - but remained statistically significant after adjustment for age, gender, hypertension and hypercholesterolemia for inflammatory arthritis (OR = 1.5 (1.2-1.9)) and diabetes mellitus (OR = 1.3 (1.2-1.4)). The association between osteoarthritis and CVD reversed after adjustment (OR = 0.8 (0.7-1.0)). Conclusions These results confirm an increased prevalence rate of CVD in inflammatory arthritis to levels resembling diabetes mellitus. By contrast, lack of excess CVD in osteoarthritis further suggests that the systemic inflammatory load is critical to the CVD burden in inflammatory arthritis.
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Affiliation(s)
- Markus M J Nielen
- NIVEL (Netherlands Institute for Health Services Research), P,O, Box 1568, 3500BN, Utrecht, 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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van Eijk IC, Nielen MMJ, van der Horst-Bruinsma I, Tijhuis GJ, Boers M, Dijkmans BAC, van Schaardenburg D. Aggressive therapy in patients with early arthritis results in similar outcome compared with conventional care: the STREAM randomized trial. Rheumatology (Oxford) 2011; 51:686-94. [PMID: 22166255 PMCID: PMC3306166 DOI: 10.1093/rheumatology/ker355] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [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] [Indexed: 11/14/2022] Open
Abstract
Objective. To compare the effects of aggressive tight control therapy and conventional care on radiographic progression and disease activity in patients with early mild inflammatory arthritis. Methods. Patients with two to five swollen joints, Sharp–van der Heijde radiographic score (SHS) <5 and symptom duration ≤2 years were randomized between two strategies. Patients with a definite non-RA diagnosis were excluded. The protocol of the aggressive group aimed for remission (DAS < 1.6), with consecutive treatment steps: MTX, addition of adalimumab and combination therapy. The conventional care group followed a strategy with traditional DMARDs (no prednisone or biologics) without DAS-based guideline. Outcome measures after 2 years were SHS (primary), remission rate and HAQ score (secondary). Results. Eighty-two patients participated (60% ACPA positive). In the aggressive group (n = 42), 19 patients were treated with adalimumab. In the conventional care group (n = 40), 24 patients started with hydroxychloroquin (HCQ), 2 with sulfasalazine (SSZ) and 14 with MTX. After 2 years, the median SHS increase was 0 [interquartile range (IQR) 0–1.1] and 0.5 (IQR 0–2.5), remission rates were 66 and 49% and HAQ decreased with a mean of −0.09 (0.50) and −0.25 (0.59) in the aggressive and conventional care group, respectively. All comparisons were non-significant. Conclusion. In patients with early arthritis of two to five joints, both aggressive tight-control therapy including adalimumab and conventional therapy resulted in remission rates around 50%, low radiographic damage and excellent functional status after 2 years. However, full disease control including radiographic arrest in all patients remains an elusive target even in moderately active early arthritis. Trial registration. Dutch Trial Register, http://www.trialregister.nl/, NTR 144.
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Affiliation(s)
- Izhar C van Eijk
- Jan van Breemen Research Institute/Reade, Dr Jan van Breemenstraat 2, 1056 AB, Amsterdam, 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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van Schaardenburg D, Nielen MMJ, Lems WF, Twisk JWR, Reesink HW, van de Stadt RJ, van der Horst-Bruinsma IE, de Koning MHMT, Habibuw MR, Dijkmans BAC. Bone metabolism is altered in preclinical rheumatoid arthritis: Table 1. Ann Rheum Dis 2010; 70:1173-4. [DOI: 10.1136/ard.2010.135723] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Goekoop-Ruiterman YPM, de Vries-Bouwstra JK, Kerstens PJSM, Nielen MMJ, Vos K, van Schaardenburg D, Speyer I, Seys PEH, Breedveld FC, Allaart CF, Dijkmans BAC. DAS-driven therapy versus routine care in patients with recent-onset active rheumatoid arthritis. Ann Rheum Dis 2010; 69:65-9. [PMID: 19155234 DOI: 10.1136/ard.2008.097683] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To compare the efficacy of Disease Activity Score (DAS)-driven therapy and routine care in patients with recent-onset rheumatoid arthritis. METHODS Patients with recent-onset rheumatoid arthritis receiving traditional antirheumatic therapy from either the BeSt study, a randomised controlled trial comparing different treatment strategies (group A), or two Early Arthritis Clinics (group B) were included. In group A, systematic DAS-driven treatment adjustments aimed to achieve low disease activity (DAS < or =2.4). In group B, treatment was left to the discretion of the treating doctor. Functional ability (Health Assessment Questionnaire (HAQ)), Disease Activity Score in 28 joints (DAS28) and Sharp/van der Heijde radiographic score (SHS) were evaluated. RESULTS At baseline, patients in group A (n = 234) and group B (n = 201) had comparable demographic characteristics and a mean HAQ of 1.4. Group A had a longer median disease duration than group B (0.5 vs 0.4 years, p = 0.016), a higher mean DAS28 (6.1 vs 5.7, p<0.001), more rheumatoid factor-positive patients (66% vs 42%, p<0.001) and more patients with erosions (71% vs 53%, p<0.001). After 1 year, the HAQ improvement was 0.7 vs 0.5 (p = 0.029), and the percentage in remission (DAS28 <2.6) 31% vs 18% (p<0.005) in groups A and B, respectively. In group A, the median SHS progression was 2.0 (expected progression 7.0), in group B, the SHS progression was 1.0 (expected progression 4.4). CONCLUSIONS In patients with recent-onset rheumatoid arthritis receiving traditional treatment, systematic DAS-driven therapy results in significantly better clinical improvement and possibly improves the suppression of joint damage progression.
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Affiliation(s)
- Y P M Goekoop-Ruiterman
- Leiden University Medical Centre, Department of Rheumatology C-1-R, PO Box 9600, 2300 RC Leiden, The Netherlands.
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Nielen MMJ, Schellevis FG, Verheij RA. The usefulness of a free self-test for screening albuminuria in the general population: a cross-sectional survey. BMC Public Health 2009; 9:381. [PMID: 19818129 PMCID: PMC2767353 DOI: 10.1186/1471-2458-9-381] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [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: 05/26/2009] [Accepted: 10/09/2009] [Indexed: 11/24/2022] Open
Abstract
Background In this study we evaluated the usefulness of a free self-test for screening albuminuria in the general population. Methods Dutch adults were invited by the Dutch Kidney Foundation to order a free albuminuria self-test, consisting of three semi quantitative dipstick tests, via the Internet. Results were classified in negative, low-positive and high-positive. In case of a positive test result, the tester was recommended to visit a GP for supplementary examination and/or treatment. Participants of the programme were sent a questionnaire for evaluation by e-mail eight weeks after receiving the self-test. Results During the first 30 days of the self-test programme, 996,927 self-tests were ordered. In total, 71,714 participants completed the questionnaire: 79% had a negative test result and 21% had a positive test result (20% low-positive and 1% high-positive). Of the positive testers, 25% visited a GP after testing for albuminuria. Among the 3,983 participants who visited a GP, 193 new diseases were detected: 25 chronic renal failure, 152 hypertension and 31 diabetes mellitus. Conclusion Using a free self-test for screening albuminuria in the general population resulted in a large response and a number of newly detected diseases. However, we found a very high percentage of positive testers of which probably a large part is false positive. Furthermore, only a small part of the positive testers visited a GP for additional examination and/or treatment. The efficiency of such a campaign could be increased by embedding the testing in health care to reduce the number of false-positive results and to ensure follow-up and treatment in case of a positive test result.
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Affiliation(s)
- Markus M J Nielen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.
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Peters MJL, Visman I, Nielen MMJ, Van Dillen N, Verheij RA, van der Horst-Bruinsma IE, Dijkmans BAC, Nurmohamed MT. Ankylosing spondylitis: a risk factor for myocardial infarction?: Table 1. Ann Rheum Dis 2009; 69:579-81. [DOI: 10.1136/ard.2009.110593] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
ObjectiveTo ascertain the prevalence of myocardial infarction (MI) in ankylosing spondylitis (AS) relative to that in the general population.MethodsA questionnaire was sent to 593 patients with AS, aged between 50 and 75 years and registered at the Jan van Breemen Institute or VU University Medical Centre. A total of 383 (65%) patients with AS returned their questionnaire that covered the primary outcome, (non-fatal) MI. The prevalence of MI was calculated with data from the general population provided by Netherlands Information Network of General Practice databases as reference.ResultsThe overall prevalence for MI was 4.4% in patients with AS versus 1.2% in the general population, resulting in an age- and gender-adjusted odds ratio of 3.1 (95% CI 1.9 to 5.1) for patients with AS. When non-responders (35%) were considered as non-MI the odds ratio decreased to 1.9 (95% CI 1.2 to 3.2).ConclusionsThese observations indicate that the prevalence of MI is increased in patients with AS.
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Nielen MMJ, Schellevis FG, Verheij RA. Inter-practice variation in diagnosing hypertension and diabetes mellitus: a cross-sectional study in general practice. BMC Fam Pract 2009; 10:6. [PMID: 19159455 PMCID: PMC2632987 DOI: 10.1186/1471-2296-10-6] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Accepted: 01/21/2009] [Indexed: 11/10/2022]
Abstract
Background Previous studies of inter-practice variation of the prevalence of hypertension and diabetes mellitus showed wide variations between practices. However, in these studies inter-practice variation was calculated without controlling for clustering of patients within practices and without adjusting for patient and practice characteristics. Therefore, in the present study inter-practice variation of diagnosed hypertension and diabetes mellitus prevalence rates was calculated by 1) using a multi-level design and 2) adjusting for patient and practice characteristics. Methods Data were used from the Netherlands Information Network of General Practice (LINH) in 2004. Of all 168.045 registered patients, the presence of hypertension, diabetes mellitus and all available ICPC coded symptoms and diseases related to hypertension and diabetes, were determined. Also, the characteristics of practices were used in the analyses. Multilevel logistic regression analyses were performed. Results The 95% prevalence range for the practices for the prevalence of diagnosed hypertension and diabetes mellitus was 66.3 to 181.7 per 1000 patients and 22.2 to 65.8 per 1000 patients, respectively, after adjustment for patient and practice characteristics. The presence of hypertension and diabetes was best predicted by patient characteristics. The most important predictors of hypertension were obesity (OR = 3.5), presence of a lipid disorder (OR = 3.0), and diabetes mellitus (OR = 2.6), whereas the presence of diabetes mellitus was particularly predicted by retinopathy (OR = 8.5), lipid disorders (OR = 2.8) and hypertension (OR = 2.7). Conclusion Although not the optimal case-mix could be used in this study, we conclude that even after adjustment for patient (demographic variables and risk factors for hypertension and diabetes mellitus) and practice characteristics (practice size and presence of a practice nurse), there is a wide difference between general practices in the prevalence rates of diagnosed hypertension and diabetes mellitus.
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Affiliation(s)
- Markus M J Nielen
- Netherlands Institute for Health Services Research, Utrecht, the Netherlands.
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Bos WH, Nielen MMJ, Dijkmans BAC, van Schaardenburg D. Duration of pre-rheumatoid arthritis anti-cyclic citrullinated peptide positivity is positively associated with age at seroconversion. Ann Rheum Dis 2008; 67:1642. [DOI: 10.1136/ard.2007.085456] [Citation(s) in RCA: 9] [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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Nielen MMJ, van Schaardenburg D, Lems WF, van de Stadt RJ, de Koning MHMT, Reesink HW, Habibuw MR, van der Horst-Bruinsma IE, Twisk JWR, Dijkmans BAC. Vitamin D deficiency does not increase the risk of rheumatoid arthritis: comment on the article by Merlino et al. ACTA ACUST UNITED AC 2006; 54:3719-20. [PMID: 17075887 DOI: 10.1002/art.22191] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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van Eijk IC, Nielen MMJ, van Soesbergen RM, Hamburger HL, Kerstens PJSM, Dijkmans BAC, van Schaardenburg D. Cervical spine involvement is rare in early arthritis. Ann Rheum Dis 2006; 65:973-4. [PMID: 16769788 PMCID: PMC1798217 DOI: 10.1136/ard.2005.041269] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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van Halm VP, Nielen MMJ, Nurmohamed MT, van Schaardenburg D, Reesink HW, Voskuyl AE, Twisk JWR, van de Stadt RJ, de Koning MHMT, Habibuw MR, van der Horst-Bruinsma IE, Dijkmans BAC. Lipids and inflammation: serial measurements of the lipid profile of blood donors who later developed rheumatoid arthritis. Ann Rheum Dis 2006; 66:184-8. [PMID: 16760255 PMCID: PMC1798498 DOI: 10.1136/ard.2006.051672] [Citation(s) in RCA: 145] [Impact Index Per Article: 8.1] [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: 11/03/2022]
Abstract
BACKGROUND Rheumatoid arthritis is characterised by inflammation and an increased cardiovascular risk. It was recently shown that active early rheumatoid arthritis is associated with dyslipidaemia, which may partially explain the enhanced cardiovascular risk. However, it is unknown when this dyslipidaemia starts. OBJECTIVE To investigate the progression of the lipid profile over time and the influence of inflammatory parameters on this lipid profile, in people who later developed rheumatoid arthritis. METHODS Levels of total cholesterol, high-density lipoprotein cholesterol (HDLc), triglycerides, apolipoprotein AI (apo AI), apolipoprotein B (apo B) and lipoprotein(a) (Lp(a)) were determined in 1078 stored, deep-frozen, serial blood bank samples, collected between 1984 and 1999, of 79 blood donors who later developed rheumatoid arthritis. These samples were compared with 1071 control samples of unselected blood donors, matched for age, sex and storage time. RESULTS Samples of patients who later developed rheumatoid arthritis showed, on average, 4% higher total cholesterol, 9% lower HDLc, 17% higher triglyceride and 6% higher apo B levels than matched controls (p< or =0.05). The magnitude of the differences in lipid levels between groups, explained by C reactive protein (CRP), was limited. For example, only 3.6% of the difference in HDLc levels between the groups was explained by the CRP concentrations. CONCLUSION Patients who later develop rheumatoid arthritis have a considerably more atherogenic lipid profile than matched blood donors at least 10 years before onset of symptoms. As inflammation only marginally explains the differences between the two groups, a modulating effect of lipids on inflammatory processes is hypothesised.
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Affiliation(s)
- V P van Halm
- Departments of Internal Medicine and Rheumatology, VU University Medical Centre, PO Box 7057, 1007 MB Amsterdam, The Netherlands
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Nielen MMJ, van Schaardenburg D, Reesink HW, Twisk JWR, van de Stadt RJ, van der Horst-Bruinsma IE, de Koning MHMT, Habibuw MR, Dijkmans BAC. Simultaneous development of acute phase response and autoantibodies in preclinical rheumatoid arthritis. Ann Rheum Dis 2005; 65:535-7. [PMID: 16079166 PMCID: PMC1798080 DOI: 10.1136/ard.2005.040659] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.1] [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: 11/04/2022]
Abstract
OBJECTIVE To investigate the temporal relationship between onset of inflammation (as measured by secretory phospholipase A2 (sPLA2) and C reactive protein (CRP)) and the presence of autoantibodies (IgM rheumatoid factor (IgM RF) and antibodies against citrullinated peptides (anti-CCP)) in the preclinical phase of rheumatoid arthritis (RA). METHODS For 79 patients with RA who had been blood donors before the onset of disease, a median of 13 serum samples per patient was available. sPLA2 was measured in patient and matched control samples and related to previous CRP, IgM RF, and anti-CCP measurements. The temporal relationship between the increased markers of inflammation and autoantibodies was analysed with time lag analysis. RESULTS IgM RF and anti-CCP concentrations were significantly associated (p<0.001) with concentrations of sPLA2, CRP, and the combination of sPLA2 and CRP at the same time point. However, we found no stronger association between the two autoantibody tests and the three inflammation measures 1, 2, and 3 years before or after a time point than for measurements at the same time, in the whole group or in subgroups of IgM RF and anti-CCP positive patients. CONCLUSION Both the acute phase response and autoantibody formation often develop years before the first symptoms of RA occur, and these phenomena are probably closely connected in time.
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Affiliation(s)
- M M J Nielen
- Jan van Breemen Institute, Amsterdam, The Netherlands
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Nielen MMJ, van der Horst AR, van Schaardenburg D, van der Horst-Bruinsma IE, van de Stadt RJ, Aarden L, Dijkmans BAC, Hamann D. Antibodies to citrullinated human fibrinogen (ACF) have diagnostic and prognostic value in early arthritis. Ann Rheum Dis 2005; 64:1199-204. [PMID: 15640269 PMCID: PMC1755615 DOI: 10.1136/ard.2004.029389] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.1] [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: 11/04/2022]
Abstract
BACKGROUND The anti-cyclic citrullinated peptide (CCP) test has a high sensitivity and specificity for rheumatoid arthritis, although CCP is not the physiological target of the autoantibodies. Citrullinated fibrin is abundant in inflamed synovium OBJECTIVE To assess the diagnostic and prognostic value of antibodies against citrullinated fibrinogen (ACF), a soluble precursor of fibrin, in comparison with IgM-rheumatoid factor (IgM-RF) and the second generation anti-CCP test. METHODS In 379 patients with early arthritis (258 rheumatoid and 121 undifferentiated), the sensitivity, specificity, and positive predictive value of ACF, anti-CCP, and IgM-RF for diagnosing rheumatoid arthritis were calculated. Multivariate logistic regression analysis was used to assess the diagnostic and prognostic value (radiographic progression after two years) of the tests. RESULTS The sensitivities of the ACF, anti-CCP, and IgM-RF tests were 55.8%, 57.8%, and 44.6%, with specificities of 92.6%, 94.2%, and 96.7%, respectively. Approximately 30% of the IgM-RF negative patients were positive for ACF or anti-CCP or both. The ACF and anti-CCP test had a high agreement in early arthritis (kappa = 0.84). Of all baseline characteristics, the ACF test and the anti-CCP test were the best predictors for diagnosing rheumatoid arthritis at one year (odds ratio (OR) = 10.3 and 10.6, respectively) and for radiographic progression after two years (OR = 12.1 and 14.8). CONCLUSIONS ACF is as sensitive as anti-CCP and more sensitive than IgM-RF in diagnosing rheumatoid arthritis in early arthritis. The ACF test is also a good predictor of radiographic progression, with a performance similar to the anti-CCP test. The ACF test and the anti-CCP test are especially valuable in IgM-RF negative arthritis.
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Affiliation(s)
- M M J Nielen
- Jan van Breemen Institute, Amsterdam, Netherlands
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Nielen MMJ, van Schaardenburg D, Reesink HW, Twisk JWR, van de Stadt RJ, van der Horst-Bruinsma IE, de Gast T, Habibuw MR, Vandenbroucke JP, Dijkmans BAC. Increased levels of C-reactive protein in serum from blood donors before the onset of rheumatoid arthritis. ACTA ACUST UNITED AC 2004; 50:2423-7. [PMID: 15334453 DOI: 10.1002/art.20431] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.2] [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: 11/07/2022]
Abstract
OBJECTIVE We previously reported that approximately half of the patients with rheumatoid arthritis (RA) have specific serologic abnormalities (elevated serum concentrations of IgM rheumatoid factor and/or anti-cyclic citrullinated peptide antibodies) starting several years before the onset of symptoms. In this study, the presence of serologic signs of inflammation in patients with preclinical RA was investigated with serial measurements of C-reactive protein (CRP). METHODS Seventy-nine patients (61% female; mean age at onset of symptoms 51 years) who had been blood donors before the onset of RA were identified. Frozen serum samples from each donor were retrieved, together with 1 sample from a control donor matched for age, sex, and date of donation. CRP was measured using a highly sensitive latex-enhanced assay. The dates of donation were categorized into 15 1-year periods preceding the onset of RA symptoms. For each period, the median CRP levels in the patient and control groups were compared using the Mann-Whitney U test. The course of CRP concentrations over time in the patient group was estimated with random coefficient analysis. RESULTS A median of 13 samples (range 1-51) per patient were available; the earliest donation was made a median of 7.5 years (range 0.4-14.5 years) before the onset of symptoms. A total of 1,078 patient samples and 1,071 control samples were tested. For all 1-year periods, the median CRP concentration was increased in the patient group compared with the control group, but this difference was statistically significant only for the periods 0-1 year, 1-2 years, and 4-5 years before the onset of symptoms. The CRP concentration increased significantly over time in patients with preclinical RA; levels were slightly higher in the group of patients who had serologic abnormalities before the onset of symptoms than in those without such serologic abnormalities. CONCLUSION After observing specific serologic abnormalities 5 years before the onset of RA symptoms, we now report increased levels of CRP in blood donors in whom RA later developed; these increases were most common within the 2 years before the onset of symptoms. The preclinical increase in CRP levels was observed both in donors with and in those without serologic abnormalities.
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Nielen MMJ, van Schaardenburg D, Reesink HW, van de Stadt RJ, van der Horst-Bruinsma IE, de Koning MHMT, Habibuw MR, Vandenbroucke JP, Dijkmans BAC. Specific autoantibodies precede the symptoms of rheumatoid arthritis: a study of serial measurements in blood donors. ACTA ACUST UNITED AC 2004; 50:380-6. [PMID: 14872479 DOI: 10.1002/art.20018] [Citation(s) in RCA: 1223] [Impact Index Per Article: 61.2] [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: 12/12/2022]
Abstract
OBJECTIVE Autoantibodies have been demonstrated in single serum samples from healthy subjects up to 10 years before they developed rheumatoid arthritis (RA). However, the time course for the development of antibodies before onset of clinical RA is unknown, nor is it known which antibody, or combinations of antibodies, might be most sensitive or specific for predicting future development of the disease. The present study was undertaken to investigate this. METHODS Patients with RA who had been blood donors before the onset of disease symptoms were enrolled. Frozen serum samples from each donor were retrieved, together with 2 serum samples from controls matched for age, sex, and date of donation. All samples were tested for IgM rheumatoid factor (IgM-RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies. RESULTS Seventy-nine patients with RA (62% female; mean age at onset of symptoms 51 years) were included. A median of 13 samples (range 1-51) per patient were available; the earliest samples had been collected a median of 7.5 years (range 0.1-14.5) before the onset of symptoms. Thirty-nine patients (49%) were positive for IgM-RF and/or anti-CCP on at least one occasion before the development of RA symptoms, a median of 4.5 years (range 0.1-13.8) before symptom onset. Of the 2,138 control samples, 1.1% were positive for IgM-RF, and 0.6% were positive for anti-CCP. CONCLUSION Approximately half of patients with RA have specific serologic abnormalities several years before the onset of symptoms. A finding of an elevated serum level of IgM-RF or anti-CCP in a healthy individual implies a high risk for the development of RA. We conclude that IgM-RF and anti-CCP testing with appropriately high specificity may assist in the early detection of RA in high-risk populations.
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