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Background Various models exist to organize out-of-hours primary care (OOH-PC). We aimed to provide an up-to-date overview of prevailing organizational models in the European Union (EU), implemented changes over the last decade and future plans. This baseline overview may provide information for countries considering remodelling their OOH-PC system. Methods A cross-sectional web-based questionnaire among 93 key informants from EU countries, Norway and Switzerland. Key informants with expertise in the field of primary health care were invited to participate. Themes in the questionnaire were the existing organizational models for OOH-PC, model characteristics, major organizational changes implemented in the past decade and future plans. Results All 26 included countries had different coexisting OOH-PC models, varying from 3 to 10 models per country. ‘GP cooperative was the dominant model in most countries followed by primary care centre and rota group’. There was a large variation in characteristics between the models, but also within the models, caused by differences between countries and regions. Almost all countries had implemented changes over the past 10 years, mostly concerning the implementation of telephone triage and a change of organizational model by means of upscaling and centralization of OOH-PC. Planned changes varied from fine-tuning the prevailing OOH-PC system to radical nationwide organizational transitions in OOH-PC. Conclusions Different organizational models for OOH-PC exist on international and national level. Compared with a decade ago, more primary care-oriented organizational models are now dominant. There is a trend towards upscaling and centralization; it should be evaluated whether this improves the quality of health care.

BackgroundThe Netherlands Triage Standard (NTS) is a triage system that can be used by different types of emergency care organisations. Our objective was to determine the interrater reliability and construct validity of the NTS when applied to self-presenting patients.MethodsWe performed a cross-sectional case scenario study consisting of two parts: (1) paediatric triage in January-February 2019 and (2) adult triage in October-November 2020. In each part, we invited nurse triagists from three general practitioner cooperatives, three ambulance dispatching centres and three hospital emergency departments in the Netherlands to participate. We used 40 case scenarios involving paediatric patients and 41 involving adult patients who could self-present to any emergency care organisation. In advance, an expert panel determined the urgency (six levels) of the case scenarios (reference standard). The main outcome for reliability was the intraclass correlation coefficient (ICC) for urgency level. The main outcomes for validity were degree of agreement with the reference standard, for urgency level, and sensitivity and specificity for high versus low urgency. We used descriptive statistics and logistic multilevel modelling with both case and triagist as random effects.Results218 out of 240 invited triagists participated. The ICC among all triagists was 0.73 for paediatric cases and 0.88 for adult cases and was highest in general practitioner cooperatives. For paediatric cases, there was 62.3% agreement with the reference standard about urgency, 17.4% underestimation and 20.2% overestimation. The sensitivity of the NTS for identifying highly urgent paediatric cases was 85.2%; the specificity was 89.7%. For adult cases, there was 68.3% agreement, 13.7% underestimation and 18.0% overestimation. The sensitivity of triage for high urgency in adults was 94.5% and the specificity 83.3%.ConclusionNTS appears to have good reliability and construct validity for estimating the urgency of health complaints of non-referred patients presenting themselves in emergency care.

De spoedzorg van palliatieve patienten tijdens ANW-uren is de laatste tien jaar weliswaar sterk verbeterd, maar er zijn nog knelpunten, met name rond persoonlijke continuiteit, informatieoverdracht, identificatie van palliatieve patienten en de voorbereiding op het palliatieve traject.

To determine the inter-rater reliability and validity of the Netherlands Triage Standard (NTS) for paediatric triage.A cross-sectional study using fictional cases for telephone and physical triage.An expert panel established in advance the urgency of 40 cases concerning emergency help requests from non-referred children (the reference standard). These requests were presented in an online survey to triagists from three general practitioner (GP) out-of-hours practices, three ambulance dispatching centres and three hospital emergency departments. Triagists assessed all cases, using the NTS. We determined the agreement on degrees of urgency between different triagists and compared them with the reference standard. The outcome measure for inter-rater reliability was the intraclass correlation coefficient (ICC). The outcome measures for validity were the degree of agreement with the reference standard, under-triage and over-triage, and sensitivity and specificity in identifying high-urgency (U0-U2) versus low-urgency cases (U30U5).In total, 116 triagists participated in the study (response: 86%). The ICC was 0.73 among all triagists, and was highest in the out-of-hours GP cooperatives. There was 62.3% agreement with the reference standard, 17.4% under-triage and 20.2% over-triage. Of the divergent urgencies, 77% differed by only one urgency category. The sensitivity was 85.2% and the specificity 89.7%. The sensitivity and specificity of triage by the GP out-of-hours practices (82.7% and 92.7%, respectively) were almost the same as that by the hospital emergency departments (79.6% and 92.5%, respectively). Triage by the ambulance dispatching centres had relatively high sensitivity (93%), but relatively low specificity (82.4%).The results of the study contribute to the evidence that the NTS is a reliable and valid triage standard for paediatric patients. The urgency assessments by triagists in the GP out-of-hours practices, ambulance dispatching centres and hospital emergency departments were broadly in agreement. Results were limited by cases being on paper and triage only on anamnestic characteristics.

Inleiding Continuiteit in de zorg voor palliatieve patienten verhoogt de kwaliteit van de zorg. Tijdens avond-, nacht- en weekenduren (ANW-uren) verricht de huisartsenpost of de eigen huisarts de palliatieve zorg. Doel van dit onderzoek is het in kaart brengen van de bereikbaarheid en beschikbaarheid van Nederlandse huisartsen voor palliatieve zorg voor de eigen patient tijdens ANW-uren. Methode Observationeel dwarsdoorsnedeonderzoek met behulp van een digitale vragenlijst onder alle praktijkhoudende huisartsen van tien huisartsenposten verspreid over Nederland. Resultaten De onderzoekers kregen 524 (29,6%) bruikbare vragenlijsten terug. Van de huisartsen is 60,8% tijdens ANW-uren via de eigen privetelefoon persoonlijk beschikbaar voor eigen patienten (telefonisch en voor visites). Acht procent draagt de zorg over aan een collega uit dezelfde huisartsenpraktijk en een klein deel van de huisartsen (12,2%) delegeert de palliatieve zorg volledig aan de huisartsenpost. Mannelijke huisartsen, huisartsen die meer dagen per week werken en huisartsen op het platteland zijn significant vaker persoonlijk beschikbaar voor hun palliatieve patienten. Er is geen relatie met leeftijd, werkervaring en soort praktijk. Conclusie Bijna tweederde van de huisartsen is tijdens ANW-uren persoonlijk beschikbaar voor de eigen palliatieve patienten en slechts een klein deel van de huisartsen delegeert de zorg voor deze groep volledig aan de huisartsenpost. Aangezien de concentratie van zorg voor palliatieve patienten in de terminale fase fors toeneemt, pleiten de auteurs voor een zo groot mogelijke bereikbaarheid en beschikbaarheid van huisartsen in deze fase.

Inleiding De huisarts van de huisartsenpost (HAP) voert U1-zorgaanvragen zelf als U1-visite uit of leidt ze door naar de Meldkamer Ambulancezorg (MKA) met het verzoek een ambulance met A1-urgentie in te zetten. We wilden nagaan of bij U1-zorgaanvragen de juiste hulpverlener met de juiste urgentie is ingezet. Methode Een crosssectioneel onderzoek uitgevoerd met behulp van dossiers van alle U1-visites gedurende 21 maanden op een grote HAP in een grootstedelijk gebied. U1-aanvragen die de huisarts naar de MKA heeft doorgeleid werden ook geanalyseerd. Follow-upgegevens zijn verkregen via de eigen huisarts door middel van een vragenlijst. Resultaten Patient- en zorgkenmerken van 1081 visites: 401 HAP-visites, 570 ambulanceritten en 110 gecombineerde HAP-ambulanceritten. Van 598 patienten kregen we de ingevulde vragenlijst van de huisarts retour (55,3%). Ongeveer 40% van de visites had volgens de huisartsen met een lagere urgentie kunnen worden uitgevoerd en ongeveer 50% door een andere zorgaanbieder. ‘Pijn op de borst’ was de meest voorkomende reden om een ambulance in te zetten (60,7%). Conclusie Bij 40% van de U1-visiteaanvragen op de HAP was er sprake van overtriage en bij de helft had volgens beoordeling achteraf beter een andere zorgverlener ingezet kunnen worden (een huisarts in plaats van de ambulancedienst, of vice versa). Verder onderzoek is nodig om het proces van triage en toewijzing van zorg bij U1-aanvragen te optimaliseren, in het bijzonder voor patienten met pijn op de borst.

Background: General practitioners experience a high workload during out-of-hours care. A possible solution is the shifting of care to nurse practitioners. Objectives: To provide insight into patient- and care characteristics, safety, efficiency, and patient satisfaction of substituting general practitioners with nurse practitioners for home visits by out-of-hours primary care services. Design: Quasi-experimental non-randomised study comparing home visits by nurse practitioners (intervention group; one out-of-hours care service) with home visits by general practitioners (control group; two out-of-hours care services) for 24 protocolised health problems. Setting: Three out-of-hours primary care services in the East of the Netherlands. Participants: 1601 patients who received a home visit by a nurse practitioner (N=386) or a general practitioner (N = 1215). Of these patients, 639 gave informed consent to be included in the protocol adherence assessment and follow-up record review (nurse practitioner: N=358; general practitioner: N=281). Methods: Five nurse practitioners with experience in ambulance care were recruited and trained. From September 2016 to March 2017 the nurse practitioners took over home visits under supervision of a general practitioners. This was evaluated using: (1) data-extraction from the patient registration system, (2) follow-up record review in the patients' general practices, and (3) patient satisfaction survey. Two general practitioners independently assessed protocol adherence based on the extracted registration data. Results: Nurse practitioners prescribed medication significantly less often than general practitioners (19.9% versus 30.6%), and referred patients significantly more often to the hospital (24.1% versus 15.9%). The mean length of the home visit was significantly longer for nurse practitioners (34.1 versus 21.1 min). Nurse practitioners adhered to the protocol significantly more often than general practitioners (84.9% versus 76.2%) and their medication prescribing was significantly more often appropriate (93.7% versus 79.5%). There were no differences in the number of missed diagnoses and complications. The number of follow-up contacts was also similar in both groups. Patient satisfaction was generally high and significantly higher for nurse practitioners on several items. Conclusions: Nurse practitioners with experience in ambulance care can safely, efficiently, and satisfactorily perform low complex out-of-hours primary care home visits. It is recommended to study the safety and efficiency of nurse practitioners' home visits in other regions and with nurse practitioners with different educational levels and different specialisations. In addition, we recommend to evaluate the cost-effectiveness and if it leads increased quality of care. (C) 2019 Elsevier Ltd. All rights reserved.

Item does not contain fulltext OBJECTIVE: To assess the quality of after-hours clinical care as delivered by general practitioner (GP) cooperatives in The Netherlands. METHODS: A cross-sectional analysis was undertaken of patient health records of five GP cooperatives during 1 year. We used quality indicators derived from national guidelines for the appropriate prescription of pain medication and antibiotics, clinical performance in emergency cases and referral to medical specialists. Data were collected from electronic health records. RESULTS: We analysed 7660 patient contacts. Average adherence to the guidelines was 77%. The guidelines on referrals to medical specialists and prescription of pain medication had the highest adherence scores (92% and 90%, respectively). Prescribing antibiotics and treatment in emergency cases had the lowest scores (69% and 71%, respectively). Antibiotics were overprescribed in 42% of the cases and underprescribed in 21%. CONCLUSIONS: In general, GPs adhered well to after-hours service national guidelines. There is room for improvement in care for people with acute illnesses and in the prescription of antibiotics. 5 p.

Several lines of evidence indicate that people with Parkinson's disease are impaired at detecting their own motor errors. In the present study, we use a component of the event-related brain potential called the error-related negativity (ERN) to ask whether a high-level, generic error-processing system is compromised in Parkinson's disease. We recorded the electroencephalogram (EEG) from nine patients with mild to moderate Parkinson's disease and from nine normal control subjects while they performed a choice reaction time task. We found that the amplitude of the ERN was the same for both populations, indicating that the error-processing system associated with the ERN is not severely compromised in this Parkinson's disease population. These results are discussed in terms of disease progression.

This study investigated characteristics of motor cortex activation and response generation in Parkinson's disease with measures of electrocortical activity (lateralized readiness potential [LRP]), electromyographic activity (EMG), and isometric force in a noise-compatibility task. When presented with stimuli consisting of incompatible target and distractor elements asking for responses of opposite hands, patients were less able than control subjects to suppress activation of the motor cortex controlling the wrong response hand. This was manifested in the pattern of reaction times and in an incorrect lateralization of the LRP. Onset latency and rise time of the LRP did not differ between patients and control subjects, but EMG and response force developed more slowly in patients. Moreover, in patients but not in control subjects, the rate of development of EMG and response force decreased as reaction time increased. We hypothesize that this dissociation between electrocortical activity and peripheral measures in Parkinson's disease is the result of changes in motor cortex function that alter the relation between signal-related and movement-related neural activity in the motor cortex. In the LRP, this altered balance may obscure an abnormal development of movement-related neural activity.