General Practitioner Contacts Research Articles

Depression in patients with chronic pain attending a specialised pain treatment centre: prevalence and impact on health care costs.

This cross-sectional study aimed to determine the prevalence and impact of depression on health care costs in patients with complex chronic pain. The sample included 1204 patients attending a tertiary pain management service for people with chronic disabling pain, unresponsive to medical treatment. As part of routine care, patients completed a web-based questionnaire assessing mental and physical health, functioning, and service use in the preceding 3 months. Depression was assessed using the 9-item Patient Health Questionnaire. Self-report health care utilisation was measured across 4 domains: general practitioner contacts, contacts with secondary/tertiary care doctors, accident and emergency department visits, and days hospitalised. The participation rate was 89%. Seven hundred and thirty-two patients (60.8%; 95% CI 58.0-63.6) met criteria for probable depression, and 407 (33.8%) met the threshold for severe depression. Patients with depression were more likely to be unable to work because of ill health and reported greater work absence, greater pain-related interference with functioning, lower pain acceptance, and more generalised pain. Mean total health care costs per 3-month period were £731 (95% CI £646-£817) for patients with depression, compared with £448 (95% CI £366-£530) for patients without depression. A positive association between severe depression and total health care costs persisted after controlling for key demographic, functional, and clinical covariates using multiple linear regression models. These findings reveal the extent, severity, and impact of depression in patients with chronic pain and make evident a need for action. Effective treatment of depression may improve patient health and functioning and reduce the burden of chronic pain on health care services.

Low-intensity case management increases contact with primary care in recently released prisoners: a single-blinded, multisite, randomised controlled trial

BackgroundThe world prison population is large and growing. Poor health outcomes after release from prison are common, but few programmes to improve health outcomes for ex-prisoners have been rigorously evaluated....

COMPREHENSIVE GERIATRIC CARE VERSUS STANDARD CARE FOR ELDERLY REFERRED TO A REHABILITATION UNIT – A RANDOMIZED CONTROLLED TRIAL

Objective: To investigate the effect of comprehensive geriatric care (CGC) in elderly referred to a rehabilitation unit. This article describes the considerations behind the study. Design: Participants were randomized to either CGC or standard care. Setting: Participants were recruited from two community care rehabilitation units in Aarhus Municipality, Denmark, in the period between 2012 and 2015. Participants: Inclusion: Elderly patients aged 65 and older admitted from home or hospital. Exclusion: Persons receiving palliative care or assessed by a geriatrician during the past month. Intervention: Medical history, physical examination, blood tests, medication adjustment and follow-up by a geriatrician. The control group received standard care with the general practitioners (GPs) as back-up. Outcomes: Primary outcome: Hospital contacts drawn from national registers. Secondary outcomes: GPs contacts, institutionalization, medication status and mortality collected from national registers, activities of daily living (ADL), physical and cognitive function and quality of life measures collected by a blinded occupational therapist. All outcomes were assessed at day 10, 30 and 90 after arrival at the rehabilitation unit. Conclusion: A new model of care for elderly referred to community rehabilitation was developed and implemented. The potential benefits of this model were compared with usual care in a community rehabilitation unit in a pragmatic randomized clinical trial. We hypothesized that the geriatrician-performed CGC in elderly referred to a rehabilitation unit will reduce the hospital contacts by 25 % without increase in mortality and in contacts to GPs and home care services. We expect that this model will prevent deterioration in ADL, physical and cognitive functioning, and reduce the risk of institutionalization. If the results are positive, community rehabilitation services should be encouraged to change their routines for treatment of this population accordingly.

Care around birth, infant and mother health and maternal health investments – Evidence from a nurse strike

Care around birth may impact child and mother health and parental health investments. We exploit the 2008 national strike among Danish nurses to identify the effects of care around birth on infant and mother health (proxied by health care usage) and maternal investments in the health of their newborns. We use administrative data from the population register on 39,810 Danish births in the years 2007–2010 and complementary survey and municipal administrative data on 8288 births in the years 2007–2009 in a differences-in-differences framework. We show that the strike reduced the number of mothers' prenatal midwife consultations, their length of hospital stay at birth, and the number of home visits by trained nurses after hospital discharge. We find that this reduction in care around birth increased the number of child and mother general practitioner (GP) contacts in the first month. As we do not find strong effects of strike exposure on infant and mother GP contacts in the longer run, this result suggests that parents substitute one type of care for another. While we lack power to identify the effects of care around birth on hospital readmissions and diagnoses, our results for maternal health investments indicate that strike-exposed mothers—especially those who lacked postnatal early home visits—are less likely to exclusively breastfeed their child at four months. Thus reduced care around birth may have persistent effects on treated children through its impact on parental investments.

Structured follow-up by general practitioners after deliberate self-poisoning: a randomised controlled trial.

BackgroundGeneral Practitioners (GPs) play an important role in the follow-up of patients after deliberate self-poisoning (DSP). The aim was to examine whether structured follow-up by GPs increased the content of, adherence to, and satisfaction with treatment after discharge from emergency departments.MethodsThis was a multicentre, randomised trial with blinded assignment. Five emergency departments and general practices in the catchment area participated. 202 patients discharged from emergency departments after DSP were assigned. The intervention was structured follow-up by the GP over a 6-month period with a minimum of five consultations, accompanied by written guidelines for the GPs with suggestions for motivating patients to follow treatment, assessing personal problems and suicidal ideation, and availability in the case of suicidal crisis. Outcome measures were data retrieved from the Register for the control and payment of reimbursements to health service providers (KUHR) and by questionnaires mailed to patients and GPs. After 3 and 6 months, the frequency and content of GP contact, and adherence to GP consultations and treatment in general were registered. Satisfaction with general treatment received and with the GP was measured by the EUROPEP scale.ResultsPatients in the intervention group received significantly more consultations than the control group (mean 6.7 vs. 4.5 (p = 0.004)). The intervention group was significantly more satisfied with the time their GP took to listen to their personal problems (93.1 % vs. 59.4 % (p = 0.002)) and with the fact that the GP included them in medical decisions (87.5 % vs. 54. 8 % (p = 0.009)). The intervention group was significantly more satisfied with the treatment in general than the control group (79 % vs. 51 % (p = 0.026)).ConclusionsGuidelines and structured, enhanced follow-up by the GP after the discharge of the DSP patient increased the number of consultations and satisfaction with aftercare in general practice. Consistently with previous research, there is still a need for interventional studies.Trial registrationClinicalTrials.gov Identifier: NCT01342809. Registered 18 April 2011.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-015-0635-2) contains supplementary material, which is available to authorized users.

A new approach to child mental healthcare within general practice.

BackgroundChild and adolescent mental health problems are frequently not identified and properly treated within general practice. Politicians in the Netherlands are promoting more primary healthcare treatment for mental health problems. The current study aims to evaluate an integrated primary mental healthcare approach for child and adolescent emotional and behavioural problems. This integrated approach allows general practitioners (GPs) to comprehensively explore the request for help, followed by an informed decision to refer, offer short-term treatment within general practice or postpone a decision by asking for additional consultations with youth mental health specialists.MethodThe study is a naturalistic evaluation of Dutch general practices with pre-test and post-test comparison with controls based on data from Electronic Medical Records (EMR). The intervention started in September 2010. EMR data of all GP contacts with children aged 4 to 18 (including diagnosis, prescriptions, referrals) from practices involved in the intervention was used from 1 January 2009 to 31 December 2012. Extra codes were added to the EMR to record aspects of the intervention. Comparable EMR data was used in control practices in 2011.ResultsGPs in the intervention group were able to identify more emotional and behavioural problems after the integrated service had started. They also identified more problems than GPs in the control practices. They were already reluctant to prescribe psychopharmacological medication to children before the intervention, and levels of prescription at intervention GP practices remained low for psychotropic drugs compared to control practices. Referral rates to mental healthcare remained relatively steady after the introduction of the integrated service, but referrals switched from specialized to primary mental healthcare.ConclusionAn integrated mental healthcare approach within general practice may lead to an increase in detected psychosocial problems among children, and these problems can mainly be treated within the primary care setting.

Are Cancer Patients' Socioeconomic and Cultural Factors Associated with Contact to General Practitioners in the Last Phase of Life?

Introduction. General practitioners (GPs) play an important role in end of life care, which should be offered regardless of socioeconomic position and cultural factors. The aim was to analyse associations between GP contacts at the end of life and socioeconomic and cultural characteristics of Danish cancer patients. Method. Population-based study identifying 599 adults who died of cancer from March to November 2006, in Aarhus County, Denmark. Associations between health register-based data on “total GP face-to-face contacts” and “GP home visits” during the last 90 days of life and patients' socioeconomic and cultural characteristics were calculated. Results. Having low income (RR: 1.18 (95% CI: 1.03; 1.35)) and being immigrants or descendants of immigrants (RR: 1.17 (95% CI: 1.02; 1.35)) were associated with GP face-to-face contacts. However, patients living in large municipalities had lower likelihood of having both GP face-to-face contacts in general (RR: 0.85 (95% CI: 0.77;0.95)) and GP home visits (RR: 0.89 (95% CI: 0.80; 0.99)). Conclusion. This study indicates higher proportion of GP contacts to economically deprived patients and immigrants/descendants of immigrants. These subgroups were, however, small and results should be looked upon with caution. Furthermore, palliative needs were not included and together with urban/rural the underlying causes need further investigation.

A systematic review of the predictors of health service utilisation by adults with mental disorders in the UK

ObjectivesTo identify variables that predict health service utilisation (HSU) by adults with mental disorders in the UK, and to determine the evidence level for these predictors.DesignA narrative synthesis of peer-reviewed...

Specific and non-specific symptoms of colorectal cancer and contact to general practice.

To improve survival rates for colorectal cancer, referral guidelines have been implemented. First step in the diagnostic process is for the individual to recognize the symptoms and contact his/her general practitioner (GP) for evaluation. To determine (i) the prevalence of specific and non-specific symptom experiences indicative of colorectal cancer, (ii) the proportion of subsequent contacts to GPs, (iii) to explore the possible differences in symptom experience and contact to GPs between age and sex. A nationwide study of 100000 adults, aged 20 years and older, were randomly selected in the general population and invited to participate in an internet-based survey. Items regarding experience of specific and non-specific alarm symptoms of colorectal cancer within the preceding 4 weeks and contact to GP were included. A total of 49706 subjects completed the questionnaire. Abdominal pain was the most common specific alarm symptom (19.7%) and tiredness was the most common non-specific symptom (49.8%). The experiences of symptoms were more common among women and more common in the youngest age groups for both sexes. The symptom leading to the highest proportion of GP contacts was rectal bleeding (33.8%). When experiencing any combination of two specific alarm symptoms, the proportion who contacted a GP was less than 50%. The combination of a non-specific and a specific alarm symptom gave rise to the highest proportion of GP contacts. Although specific and non-specific alarm symptoms of colorectal cancer are common in the general population, the proportion of GP contacts is low.

Consequences of interaction of functional, somatic, mental and social problems in community-dwelling older people.

This study explores the combination of four common health problems in older people and whether problems on four domains result in an additional effect on indicators of poor health. For this purpose, a total of 2681 participants (32% male, mean age 82 years) of the Integrated Systematic Care for Older People (ISCOPE) study were screened on the presence of health problems on four domains (functional, somatic, mental, social) with the postal ISCOPE questionnaire. Extensive interview data on health indicators were obtained at baseline and at 12-months follow-up, including disability (Groningen Activities Restriction Scale, GARS), cognitive function (Mini-Mental State Examination, MMSE), depressive symptoms (Geriatric Depression Scale-15, GDS), loneliness (loneliness scale of De Jong Gierveld), and health-related quality of life (EQ-5D). General practitioner (GP) contact time (min/year) was estimated via GP electronic medical records. Of the study population, 9% had no health problems according to the screening, 8% had problems on one domain, 27% on two, 38% on three and 18% on four domains. At baseline, the number of health domains with problems was associated with poorer scores on the GARS, the MMSE, the GDS-15, the loneliness scale, the EQ-5D and with more GP contact time (p <0.001). Problems on all four domains had an additional negative effect on these health indicators (all pinteraction <0.001). At follow-up, an increased number of domains with problems was associated with an increased decline in health indicators (all p<0.001) and with an additional negative effect on GP contact time of the presence of problems on all four domains (pinteraction <0.001). We conclude that combinations of functional, somatic, mental and social problems are associated with poor health indicators in community-dwelling older people. Since problems on four domains have an additional effect on health, individuals with combined functional, somatic, mental and social problems could benefit from integrated care.Trial registrationNetherlands Trial Register: NTR1946.

Alarm symptoms of upper gastrointestinal cancer and contact to general practice – A population-based study

Introduction. Survival of upper gastrointestinal (GI) cancer depends on early stage diagnosis. Symptom-based guidelines and fast-track referral systems have been implemented for use in general practice. To improve diagnosis of upper GI cancer, knowledge on prevalence of alarm symptoms in the general population and subsequent healthcare-seeking is needed. Material and methods. A nationwide study of 100,000 adults, who were randomly selected from the general population were invited to participate in an internet-based survey. People aged ≥45 years were included in this study. Items regarding experience of specific and nonspecific alarm symptoms of upper GI cancer within the preceding 4 weeks and contact to general practitioner (GP) were included. Results. Of the 60,562 subjects aged ≥45 years, 33,040 (54.6%) completed the questionnaire. The prevalence of the specific alarm symptoms ranged between 1.1% (“repeated vomiting”) and 3.4% (“difficulty swallowing”). Women had higher odds of experiencing “repeated vomiting” and “persistent and recent-onset abdominal pain”, but lower odds of experiencing “upper GI bleeding”. The proportion of people contacting their GP with each of the four specific alarm symptoms ranged from 24.3% (“upper GI bleeding”) to 39.9% (“repeated vomiting”). For each combination of two specific alarm symptoms, at least 52% contacted their GP. Conclusion. The specific alarm symptoms of upper GI cancer are not very prevalent in the general population. The proportion of GP contacts with each of the four specific symptoms varied between 24.3% and 39.9%. The proportion of GP contacts was higher in the older age and with combinations of two symptoms.

Safety of vaccination against influenza A (H1N1) during pregnancy in the Netherlands: results on pregnancy outcomes and infant's health: cross-sectional linkage study.

This study aims to assess the safety of Influenza A(H1N1), vaccination administered during the second and third trimester and containing MF59 and thiomersal (Focetria(®) ), measured by pregnancy outcomes and infant's health. Cross-sectional linkage study. A sample of pregnant women, eligible for prenatal screening, were invited to participate. Questionnaire data were linked with the Netherlands Perinatal Registry (n=1920). Information on infant growth, development (n=1739) and infection-related contacts with the general practitioner (GP) during the first year of life (n=1671) was obtained. Multivariate logistic regression was used to assess the association between H1N1 vaccination and small-for-gestational-age infant, preterm delivery and a composite adverse outcome, i.e. low Apgar-score, neonatal intensive care unit admission, neonatal resuscitation or perinatal death. Influence of maternal vaccination on growth, development and GP infection-related contact rates were assessed using multivariate linear mixed modelling and multivariate negative binomial regression, respectively. Response rate was 21%. Though we found differences in characteristics between unvaccinated and vaccinated women, in the multivariate analyses no association was found between H1N1 vaccination and small-for-gestational-age (odds ratio [OR] 0.84; 95% confidence interval [95% CI] 0.50-1.43), preterm delivery (OR 0.98; 95% CI 0.59-1.62) and the composite adverse outcome (OR 0.84; 95% CI 0.44-1.60). We found no differences in weight-for-age (-0.05; 95% CI -0.13 to 0.04), length-for-age (-0.01; 95% CI -0.09 to 0.06), head-circumference-for-age (-0.05; 95% CI -0.13 to 0.03), developmental scores (-0.06; 95% CI -0.28 to 0.17) and infection-related GP contact rates (incidence rate ratio 1.07; 95% CI 0.91-1.28) between infants of unvaccinated and vaccinated mothers. Pregnancy outcomes did not differ between H1N1-vaccinated and unvaccinated women. Furthermore, growth, development and GP infection-related contact rates, assessed after the first year of life, were similar in offspring of vaccinated and unvaccinated mothers. No increased risk for adverse pregnancy outcomes and infant's health following influenza vaccination.

A randomised clinical trial of the effectiveness of home-based health care with telemonitoring in patients with COPD

We studied the effect of telemonitoring in addition to usual care compared to usual care alone in patients with chronic obstructive pulmonary disease (COPD). A total of 110 patients with moderate to severe COPD were recruited from a specialist respiratory service in Northern Ireland. Patients had at least two of: emergency department admissions, hospital admissions or emergency general practitioner (GP) contacts in the 12 months before the study. Exclusion criteria were patients who had any respiratory disorder other than COPD, or were cognitively unable to learn the process of monitoring. Patients were randomised to receive six months of home telemonitoring with usual care, or six months of usual care. The primary outcome measure was disease-specific quality of life, as measured by the St George’s Respiratory Questionnaire for COPD patients (SGRQ-C). Of 100 patients completing the study, 48 patients were randomised to telemonitoring and 52 patients were randomised to the control group. The SGRQ-C scores improved significantly in the intervention group compared to usual care (P = 0.001). The HADS anxiety score was significantly higher in the telehealth group compared to the usual care group (P = 0.01). There were significantly more contacts with the Community Respiratory Team in the telemonitoring group compared to the control group (P = 0.029). There were no significant between group differences in EQ-5D scores, HADS depression scores, GP activity, emergency department visits, hospital admissions or exacerbations. The total cost to the health service of the intervention over the 6-month study period was £2039, giving an estimated ICER of £203,900. In selected patients with COPD, telemonitoring was effective in improving health-related quality of life and anxiety, but was not a cost-effective intervention.

The combined effect of cancer and chronic diseases on general practitioner consultation rates

AimMore than two-thirds of cancer patients have one or more chronic diseases besides cancer. The purpose of this study was to get detailed insight into the combined effect of cancer and chronic diseases on general practitioner (GP) consultation rates. MethodsFrom the NIVEL Primary Care Database we identified cancer patients with diabetes mellitus (n=629), osteoarthritis (n=425), coronary artery disease (n=466), COPD (n=383) or without a chronic disease (n=1507), diagnosed with cancer between 2002 and 2010. They were matched on sex, age, practice and chronic disease to 6645 non-cancer controls. Results2–5 years after diagnosis, cancer patients without a chronic disease had on average 6.5 GP contacts per year, those with a comorbid disease almost twice as many (ranging from 10 for osteoarthritis to 12.4 for COPD). A similar difference was seen in non-cancer controls. The number of GP contacts for chronic diseases did not differ between cancer patients and controls. The increase in the number of GP consultations with age and number of chronic diseases was similar in cancer patients and controls. Consultation rates were similar in cancer patients and controls if they were stratified by number of chronic diseases while counting cancer as a chronic disease. ConclusionsTwo to five years after diagnosis, cancer leads to an increase in GP contacts that is similar to having a chronic disease. This increase does not differ between those with and without a chronic disease and cancer does not seem to increase the impact of having a chronic disease.

Does ongoing general practitioner care in elderly patients help reduce the risk of unplanned hospitalization related to Beers potentially inappropriate medications?

To compare estimates of unplanned hospitalizations associated with exposure to Beers potentially inappropriate medications (PIM) in elderly people receiving different levels of ongoing general practitioner (GP) care. Using the pharmaceutical claims and other linked health data of 245,436 Western Australians aged ≥65 years with one or more claims for a medication from a PIM-related drug class (1993-2005), we applied an enhanced case-time-control design to obtain odds ratios (OR) for unplanned hospitalization, from which attributable fractions, numbers, proportions and rates of admissions related to PIM exposure were derived. Overall, 383,150 unplanned hospitalizations ("index subjects") were identified. PIM exposure was associated with a similar relative risk of unplanned hospitalization in elderly people receiving the lowest and highest levels of ongoing GP care, but with a decreasing risk in the three highest tiers; adjusted OR (95% CI; attributable fractions) were 1.15 (1.09-1.21; 12.9%), 1.36 (1.27-1.46; 26.6%), 1.20 (1.15-1.26; 16.9%) and 1.13 (1.09-1.17; 11.4%) for groups from the lowest to highest levels. However, those with higher GP coverage had higher rates of PIM-related hospitalization. Similar patterns were shown for commonly used high-risk PIM (temazepam, diazepam, oxazepam, naproxen and digoxin). Increased requirement for ongoing GP contact in less healthy elderly people appears to help minimize their risk of unplanned hospitalization due to PIM-related harm. GPs should continue to avoid Beers medications in older patients where possible, given their greater predisposition to medication exposure (including PIM) and adverse drug events. Nevertheless, close monitoring of elderly patients who need to use PIM should prove beneficial.

Implementation of chronic illness care in German primary care practices--how do multimorbid older patients view routine care? A cross-sectional study using multilevel hierarchical modeling.

BackgroundIn primary care, patients with multiple chronic conditions are the rule rather than the exception. The Chronic Care Model (CCM) is an evidence-based framework for improving chronic illness care, but little is known about the extent to which it has been implemented in routine primary care. The aim of this study was to describe how multimorbid older patients assess the routine chronic care they receive in primary care practices in Germany, and to explore the extent to which factors at both the practice and patient level determine their views.MethodsThis cross-sectional study used baseline data from an observational cohort study involving 158 general practitioners (GP) and 3189 multimorbid patients. Standardized questionnaires were employed to collect data, and the Patient Assessment of Chronic Illness Care (PACIC) questionnaire used to assess the quality of care received. Multilevel hierarchical modeling was used to identify any existing association between the dependent variable, PACIC, and independent variables at the patient level (socio-economic factors, weighted count of chronic conditions, instrumental activities of daily living, health-related quality of life, graded chronic pain, no. of contacts with GP, existence of a disease management program (DMP) disease, self-efficacy, and social support) and the practice level (age and sex of GP, years in current practice, size and type of practice).ResultsThe overall mean PACIC score was 2.4 (SD 0.8), with the mean subscale scores ranging from 2.0 (SD 1.0, subscale goal setting/tailoring) to 3.5 (SD 0.7, delivery system design). At the patient level, higher PACIC scores were associated with a DMP disease, more frequent GP contacts, higher social support, and higher autonomy of past occupation. At the practice level, solo practices were associated with higher PACIC values than other types of practice.ConclusionsThis study shows that from the perspective of multimorbid patients receiving care in German primary care practices, the implementation of structured care and counseling could be improved, particularly by helping patients set specific goals, coordinating care, and arranging follow-up contacts. Studies evaluating chronic care should take into consideration that a patient’s assessment is associated not only with practice-level factors, but also with individual, patient-level factors.Trial registrationCurrent Controlled Trials ISRCTN89818205.

Partners of cancer patients consult their GPs significantly more often with both somatic and psychosocial problems

Objective. Partners of cancer patients experience psychological distress and impaired physical health around and after the diagnosis of cancer. It is unknown whether these problems are presented to the general practitioner (GP). This study aimed to establish partners’ GP use around the diagnosis of cancer. Design. Cohort study. Setting. Primary care. Subjects. Partners of 3071 patients with breast, prostate, colorectal, or lung cancer were included. Patients were diagnosed in 2001–2009 and were alive at least two years after diagnosis. Main outcome measures. Number of GP contacts and health problems in partners between six months before and two years after diagnosis. Results. In the first six months after diagnosis, partners’ GP use was similar to baseline (18 to six months before diagnosis). Between six and 24 months after diagnosis, GP use was increased in partners of patients with breast, prostate, and colorectal cancer, an increase of 31% (p = 0.001), 26% (p = 0.001), and 19% (p = 0.042), respectively. In partners of patients with breast cancer and colorectal cancer, GP use was increased for both somatic and psychosocial symptoms. In partners of prostate cancer patients, an increase was seen in somatic symptoms, whereas in partners of lung cancer patients, GP use was only increased for psychosocial symptoms. “Problems with the illness of the partner” was a frequently recorded reason for contact in the first six months after diagnosis. Conclusion. GP use of partners of cancer patients is increased 6–24 months after diagnosis, but health problems vary between cancer types. GPs should be alert for somatic and psychosocial problems in partners of cancer patients.

Primary care of hypertensive patients and the risk of acute cardiovascular events

Purpose: Hypertension is one of the most important risk factors for acute cardiovascular events such as myocardial infarction and stroke. It is unknown which aspects are most important in determining which hypertensive patients have more risk to get an acute myocardial infarction or stroke and get hospitalised for this event. The objective of this study was to establish which factors play a role in determining the risk of an acute cardiovascular event in hypertensive patients. We specifically assessed the difference in use of general practitioner (GP) care, medication and clinical and demographic parameters by comparing two groups of hypertensive patients: those who were hospitalised with an acute cardiovascular event and those who did not experience any acute cardiovascular event. Methods: We linked Dutch Register of General Practitioners (DRGP) and Hospital Discharge Register using personal identification number. From DRGP we identified patients that were diagnosed with hypertension (ICPC code K85, K86 and K87) in 2009 or before. Further we identified which of those patients were hospitalised for myocardial infarction (ICD-9-CM 410) or stroke (ICD-9-CM 430-436) in 2010. Using multilevel logistic regression we identified the risk factors for these hypertensive patients to be hospitalised with an acute myocardial infarction (AMI) or stroke. Findings: In total 34328 hypertensive patients were identified in DRGP. Of those patients 448 were hospitalised with AMI or stroke in 2010. The risk of hospitalisation for AMI or stroke significantly increased with age and with increasing number of cardiovascular diseases (other than hypertension). The risk of hospitalisation for women was lower than that for men. Patients hospitalised for an acute cardiovascular event had more GP contacts of all types (mean = 9,7 contacts for patients hospitalised with an acute event versus 7.9 contacts for patients without acute events). Patients hospitalised with an acute event had also significantly more drugs prescribed, European Forum for Primary Care Conference, Istanbul, September 9-10, 2013. 2 International Journal of Integrated Care – Volume 13, 06 November – URN:NBN:NL:UI:10-1-114900–http://www.ijic.org/ except lipid modifying agents that were equally often prescribed in both groups with and without acute cardiovascular events. Both mean systolic and mean diastolic blood pressure was significantly elevated in patients that were hospitalised with AMI or stroke. Patients hospitalised for an acute event had about 4 times higher risk to have a frequent number (13+) of GP contacts per year. This risk was partly explained by the number of other chronic and other cardiovascular diseases that these patients had. Patients with hypertension that were hospitalised for an acute event had significantly more frequent contacts with their GP already 11 months before hospitalisation compared to hypertensive patients that did not experience an acute event. Discussion: Older male patients and with multiple cardiovascular conditions are at higher risk to be hospitalised for an acute myocardial infarction or stroke. These patients have significantly more contacts with their GP long before hospitalisation. Despite these more frequent contacts and higher number of prescriptions the blood pressure of those patients is less well controlled. The results of this study can help primary care providers better identify patients with hypertensions that are at higher risk for getting an acute cardiovascular event.

Factors with regard to computerisation of the Dutch and the Belgian national general practitioner sentinel networks: A comparative analysis

Background: A general practitioner (GP) sentinel network observes a sample of the population by supplying reports on the incidence and epidemiological characteristics of specific diseases and on procedures in primary health care. In the 1970s, the Dutch and the Belgian national GP sentinel networks were founded. Since the 1990s, Dutch sentinel surveillance was extended to the work of GPs (contacts, referrals, activities, prescriptions) by developing a second network and collecting data from Electronic Health Records (EHR). Then the first network was integrated into the second. The Belgian GP network kept data collection on diseases and health care topics by paper questionnaires. The objective of the study is to trace the factors which played a role for the computerisation of the Dutch sentinel system, whereas the Belgian national network remained paper-based. Methods: A comparative qualitative approach was chosen. The annual reports of the networks, project reports and methodology chapters of publications based on sentinel data are assessed with regard to factors on different levels (health system, GPs, network structure), to be complemented by expert interviews. Results: Several factors at health system, GP practice, and network level in favour of computerisation and network extension in The Netherlands were lacking in Belgium: For the impetus to do primary health services research in The Netherlands in the early 1990s and the presence of the research institute NIVEL to carry it through there was no equivalent in Belgium on national level. The stronger and more prominent position of Dutch physicians as gatekeepers to secondary care leading to continuing commitment by the Dutch Federal government; a sufficient number of Dutch GPs agreed to have their EHR data extracted; EHR systems in The Netherlands showed less diversity than in Belgium (Dutch/French language, uneven distribution of computerized systems in the Belgian Regions; only on regional level, the computerized GP network Intego was founded in Flanders). Conclusions: The considerable progress of Dutch network computerisation and extended registration of GP practice data took place in a much more supportive context; these achievements are only in part transferable to Belgium in the short run. Key messages: In the 1990s, health services research provided a key stimulus for the extension of Dutch GP network activities without an equivalent in Belgium on national level. Comparing the past development of the Dutch and Belgian GP sentinel networks more distinctly shows favourable factors for Dutch network extension and computerisation hardly present in Belgium.

Validity of self-reported utilization of physician services: a population study

Health care utilization is of central interest in epidemiology, and most of the studies rely on self-report. The objectives of this study were to assess the validity of self-reported utilization of general practitioner and specialist physician by correlating self-reported utilization with registered services utilization, and to determine the factors related to that validity. The 1997 Belgian National Health Interview Survey (BNHIS) was linked with registered medical utilization data provided by the Belgian Health Insurance Funds. Valid information on general practitioner and specialist physician utilization during the past 2 months was found for 5869 participants at the BNHIS who were aged ≥25 years. Intra-class correlation coefficients were used to determine the rate of agreement, and multinomial logistic regression to model factors influencing under- and over-reporting. The results demonstrated a substantial agreement between the self-reported and registered general practitioner contacts, and only a minor bias was found towards under-reporting. There was no significant difference between mean self-reported and registered specialist physician utilization, but the agreement was rather moderate. Gender, age, country of birth, self-rated health, number of chronic illnesses, having functional limitations and having mental health problems, were associated with under- and/or over-reporting. Studies that aim to compare the utilization of different socio-demographic groups have to take into account that the reporting errors vary by respondents characteristics.