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Contains fulltext : 236277.pdf (Publisher’s version ) (Closed access) Tabaksverslaving wordt, in tegenstelling tot verslaving aan alcohol en drugs, vaak ten onrechte gezien als een ongezonde leefstijl. Tabaksverslaving is een verslaving zoals alle andere, waarbij biologische, psychologische en sociale factoren een interacterende rol spelen. De DSM-5 geeft criteria voor een 'Stoornis in het gebruik van tabak'. Patiënten met een ernstige tabaksverslaving hebben intensievere, gespecialiseerde behandeling nodig. Door tabaksverslaving niet langer te beschouwen als een leefstijlprobleem maar als een verslavingsziekte, zal de bereidheid van zorgmedewerkers om het probleem bespreekbaar te maken, groter worden. Dat vergroot ook de bereidheid van rokers om in behandeling te gaan. Leefstijlgeneeskunde en verslavingsgeneeskunde omarmen elkaar. Vanuit het oogpunt van preventie is dat geheel terecht. Preventie van het gebruik van verslavende stoffen kan veel narigheid voorkomen. Tabaksverslaving wordt echter, in tegenstelling tot verslaving aan alcohol en drugs, vaak ten onrechte gezien als een ongezonde leefstijl, een leefstijlprobleem. In dit artikel betogen wij dat een verschuiving in de visie op tabaksverslaving van leefstijlprobleem naar echte verslaving bijdraagt aan betere zorg voor patiënten met een tabaksverslaving. 4 p.

Objectives To gain insight into SSc patients’ perspective on quality of care and to survey their preferred quality indicators. Methods An online questionnaire about healthcare setting, perceived quality of care (CQ index) and quality indicators, was sent to 2093 patients from 13 Dutch hospitals. Results Six hundred and fifty patients (mean age 59 years, 75% women, 32% limited cutaneous SSc, 20% diffuse cutaneous SSc) completed the questionnaire. Mean time to diagnosis was 4.3 years (s.d. 6.9) and was longer in women compared with men (4.8 (s.d. 7.3) vs 2.5 (s.d. 5.0) years). Treatment took place in a SSc expert centre for 58%, regional centre for 29% or in both for 39% of patients. Thirteen percent of patients was not aware of whether their hospital was specialized in SSc. The perceived quality of care was rated with a mean score of 3.2 (s.d. 0.5) (range 1.0–4.0). There were no relevant differences between expert and regional centres. The three prioritized process indicators were: good patient-physician interaction (80%), structural multidisciplinary collaboration (46%) and receiving treatment according to SSc guidelines (44%). Absence of disease progression (66%), organ involvement (33%) and digital ulcers (27%) were the three highest rated outcome indicators. Conclusion The perceived quality of care evaluated in our study was fair to good. No differences between expert and regional centres were observed. Our prioritized process and outcome indicators can be added to indicators suggested by SSc experts in earlier studies and can be used to evaluate the quality of care in SSc.

Objectives: Direct-acting antivirals (DAAs) for treatment of chronic hepatitis C virus (HCV) infection can cause drug–drug interactions (DDIs) with combination antiretroviral therapy (cART) and non-cART co-medication. We mapped how physicians manage DDIs between DAAs and co-medication and analysed treatment outcomes.Methods: Data were prospectively collected as part of the ATHENA HIV observational cohort and retrospectively analysed. Dutch patients with HIV/HCV coinfection who initiated treatment with DAAs between January 2015 and May 2016 were included. Co-medication 3 months prior to and during DAA therapy was identified. Potential DDIs with the DAAs were checked using http://hep-druginteractions.org. DDIs were categorized as: (1) no interaction expected; (2) potential interaction; (3) contra-indication; (4) no recommendation. These categories were used to determine which patients switched or had a DDI during DAA therapy with co-medication.Results: A total of 423 patients were treated with DAAs, of whom 418 (99%) used cART and 251 (59%) used non-cART co-medication. Before commencing DAA treatment, in 17 of 84 (20%) patients the non-cART co-medication which could result in a category 2/3 DDI was discontinued before DAA initiation, including two of six (33%) prescriptions of category 3 drugs. A total of 196 of 418 (47%) patients had a category 2/3 DDI between their DAA regimen and cART. Category 2/3 DDIs were prevented by switching cART in 78 of 147 (53%) and 47 of 49 (98%) patients. Overall, 367 of 423 (87%) patients have achieved a sustained virological response (33 in follow-up).Conclusions: Prescription patterns suggest that physicians are aware of potential DDIs between co-medication and DAAs, in particular potential DDIs with cART. Greater awareness is needed concerning category 3 interactions between non-cART co-medication and DAAs.