Search

Item does not contain fulltext Context Knowledge of incidence, prevalence and trends in morbidity support the diagnostic process of general practitioners (GPs). GPs use estimated probabilities of probable diagnoses to guide their policy on testing and referral. However, GPs estimations often are implicit and imprecise. The International Classification of Primary Care (ICPC) has the potential to incorporate the doctor and patient's perspective within a clinical encounter. The patient perspective is reflected in the Reason for encounter (RFE) which is the 'literal uttered reason' of the patient to contact the GP and comprises the patient's priority for seeking care. Previous research showed the predictive value of some RFEs in diagnosing cancer. Objective Our aim is to analyze the predictive value of the RFE for the final diagnosis, taking into account patient's age and sex. Study Design and Analysis In this cohort study, we determined the relationship between RFE, age, sex and the final diagnosis with multilevel analysis and distribution analysis. We focused on the top 10 most common RFEs. Dataset FaMe-Net database, containing coded routine health data from GP registration network (7 GP practices; 40.000 patients). GPs code the RFE and diagnosis of all contacts with patients, using the ICPC-2 within an episode of care (EoC) structure. An EoC is defined as a health problem in an individual from the first encounter until completion in the last encounter. Population Studied We used data from 1989-2020 and selected all patients with a RFE in the top 10 most common RFEs and the corresponding final diagnoses. Outcome Measures The predictive value is shown in odds risk and frequencies. Results We included 162,315 contacts from 37,194 patients. Multilevel analysis showed significant impact of the additional RFE on the final diagnosis (p

Additional file 3. Recommendations through open-ended question.

Background Timely initiation of advance care planning (ACP) in general practice is challenging, especially in patients with non-malignant conditions. Our aim was to investigate how perceived optimal timing of ACP initiation and its triggers relate to recorded actual timing in patients with cancer, organ failure, or multimorbidity. Methods In this mixed-methods study in the Netherlands, we analysed health records selected from a database with primary care routine data and with a recorded ACP conversation in the last two years before death of patients who died with cancer, organ failure, or multimorbidity. We compared actual timing of ACP initiation as recorded in health records of 51 patients with the perceived optimal timing as determined by 83 independent GPs who studied these records. Further, to identify and compare triggers for GPs to initiate ACP, we analysed the health record documentation around the moments of the recorded actual timing of ACP initiation and the perceived optimal timing of ACP initiation. We combined quantitative descriptive statistics with qualitative content analysis. Results The recorded actual timing of ACP initiation was significantly closer to death than the perceived optimal timing in patients with cancer (median 88 vs. 111 days before death (p = 0.049)), organ failure (227 vs. 306 days before death (p = 0.02)) and multimorbidity (113 vs. 338 days before death (p = 0.006)). Triggers for recorded actual versus perceived optimal timing were similar across the three groups, the most frequent being ‘expressions of patients’ reflections or wishes’ (14% and 14% respectively) and ‘appropriate setting’ (10% and 13% respectively). Conclusion ACP in general practice was initiated and recorded later in the illness trajectory than considered optimal, especially in patients with organ failure or multimorbidity. As triggers were similar for recorded actual and perceived optimal timing, we recommend that GPs initiate ACP shortly after a trigger is noticed the first time, rather than wait for additional or more evident triggers when the illness is in an advanced stage.

Additional file 2. Dutch OA-QI questionnaire.

Additional file 1. Overview of OA-QI questionnaire.

Additional file 1: Appendix 1. Data extraction form.

Contains fulltext : 231542.pdf (Publisher’s version ) (Closed access) BACKGROUND: Respiratory tract infections (RTIs) are common in children with febrile illness visiting the general practitioner (GP) or emergency department. We studied the management of children with fever and RTI at 3 different levels of healthcare in The Netherlands, focusing on antibiotic prescription. METHODS: This prospective observational study is part of the Management and Outcome of Febrile children in Europe study. Data were used from face-to-face patient contacts of children with febrile illness in three healthcare settings in Nijmegen, The Netherlands during 2017. These settings were primary (GP), secondary (general hospital) and tertiary care (university hospital). RESULTS: Of 892 cases with RTI without complex comorbidities, overall antibiotic prescription rates were 29% with no differences between the 3 levels of healthcare, leading to an absolute number of 5031 prescriptions per 100,000 children per year in primary care compared with 146 in secondary and tertiary care combined. The prescription rate in otitis media was similar in all levels: 60%. In cases with lower RTI who received nebulizations prescription rates varied between 19% and 55%. CONCLUSIONS: Antibiotic prescription rates for RTIs in children were comparable between the 3 levels of healthcare, thus leading to a majority of antibiotics being prescribed in primary care. Relatively high prescription rates for all foci of RTIs were found, which was not in agreement with the national guidelines. Antibiotic stewardship needs improvement at all 3 levels of healthcare. Guidelines to prescribe small spectrum antibiotics for RTIs need to be better implemented in hospital care settings.

De afgelopen jaren is er veel geëxperimenteerd met vormen van arbeidsgerichte zorg in de eerstelijnszorg. Desondanks is er tot op heden geen effectieve aanpak voor dit type zorg, waar op grote schaal gebruik van wordt gemaakt. In het project ‘Arbeidsgerelateerde zorg in de eerste lijn’ wordt op basis van bewezen effectieve componenten een geïntegreerde interventie voor arbeidsgerelateerde zorg in de eerste lijn ontwikkeld, geïmplementeerd en geëvalueerd. De interventie richt zich op vroegsignalering en behandeling van werkgerelateerde gezondheidsklachten. Het uiteindelijke doel van de interventie is het reduceren van ziekteverzuim en het bevorderen van de inzetbaarheid van de patiënt.

Samenvatting De aandoeningen van de luchtwegen worden onderscheiden naar lokalisatie. Als grens tussen bovenste en onderste luchtwegen wordt het strottenhoofd aangehouden: tot en met de larynx worden ziekten en klachten toegerekend aan de bovenste luchtwegen. Het aandeel van ziekten van de luchtwegen in de totale incidentie bedraagt rond de 30%. Deze komen daarmee in de rangorde van frequentie van voorkomen op de eerste plaats. Veel van de aandoeningen van de bovenste luchtwegen vormen dan ook dagelijkse kost voor de huisarts.

Samenvatting De bespreking van ziektebeelden in dit boek wordt begonnen met infectieziekten, niet zozeer omdat deze een van de belangrijkste categorieën in de huisartspraktijk zouden vormen, maar omdat alle classificatiesystemen van ziekten hiermee beginnen. Op de keper beschouwd bieden de classificatiesystemen onder het hoofdstuk infectieziekten een restgroep van ziekten omdat een aantal infecties niet hier, maar bij orgaansystemen is ondergebracht. Luchtweginfecties bijvoorbeeld, die zo’n groot deel van het werk van de huisarts uitmaken, worden onder de tractus respiratorius geregistreerd (en in dit boek in hoofdstuk 8 besproken). Soms worden nieuwe infectieziekten aan het hoofdstuk infectieziekten toegevoegd (zoals hiv-infectie). Het bekend worden van de rol van een micro-organisme in de etiologie van een aandoening leidt overigens niet altijd tot aanpassingen (bijvoorbeeld Helicobacter pylori-infectie bij ulcus duodeni en ulcus ventriculi).

Item does not contain fulltext 5 p.

Risk stratification, the systematic assessment of patients’ profiles in order to assign individual risk scores, can be used to provide personalized and population care according to that risk. In different countries, risk stratification is used to identify the right subpopulations for specific care interventions and lower expensive care utilization such as emergency care and hospitalization. In the Netherlands, risk stratification is not yet notably used in primary care. Despite the great possibilities due to the widespread catchment area of primary care in the Netherlands and the gatekeepers function of general practitioners, systematic risk stratification approaches in Dutch primary care are minimal. The aim of this dissertation was therefor to identify and asses a suitable risk stratification tool to be used in Dutch primary care. The main question was answered by describing a study assessing the model performance of US-based hospitalization and high costs models applied in the Dutch primary care setting. Both models showed good performance regarding discrimination and calibration properties. In addition, the models were adjusted to best fit the Dutch primary care situation. Coefficients of the underlying predictors of the models were adjusted, improving the good model performances for both the hospitalization and the high costs model.

After primary treatment for prostate cancer, patient enter the survivorship phase. Prostate cancer survivorship care includes the surveillance for cancer recurrence and the management of long-term and late effects. The sequel of prostate cancer and its treatment can influence men’s quality of life. A central question in this thesis is what prostate cancer survivors find important in their follow-up care and what their perspectives are on current follow-up practices. During follow-up care, some patients may encounter physical or psychosocial problems. For example, in one study they found that at 1-year follow-up, prostate cancer patients perceived erectile problems (56%), problems with the recovery period (29%), urinary problems (28%), fatigue (24%), and bowel problems (17%) to be worse than expected. It is important that clinicians working in follow-up care provide supportive care and address information needs of these patients. To guide clinicians, (tailored) supportive care interventions can help to meet the informational, emotional, social and physical needs of prostate cancer patients. Another central question in this thesis is whether primary care should play a more prominent role in the follow-up of prostate cancer survivors. As many (prostate) cancer patients also deal with other chronic conditions, primary care seems to be a suitable place to take a holistic approach to cancer follow-up. Currently, Wollersheim coordinates a randomized controlled trial that investigates the (cost-)effectiveness of primary care-based versus hospital-based prostate cancer follow-up care, called the PROstate cancer follow-up care in Secondary and Primary hEalth Care (PROSPEC) study. The results of the 2-year follow-up of this trial are expected in 2023. During the trial, a process evaluation was conducted to help interpret the study results. The reach of the trial showed that 67% of the patients and their general practitioners were willing to receive/provide primary care-based follow-up care. Nevertheless, several challenges and requirement were identified in this study: guidelines should be developed and implemented, communication and collaboration between primary and secondary care should be improved, quality indicators should be collected, and general practitioners should be compensated. If the trial shows that primary care- is equally effective and safe as specialist-based follow-up, this process evaluation can be used to enable a smooth transition of prostate cancer follow-up to primary care. Barbara Wollersheim will defend her thesis with the title ‘’prostate cancer follow-up care in secondary and primary healthcare’’ at Tilburg University on Tuesday July 5, 2022.