Discontinuity of psychiatric care among patients with bipolar disorder in the Netherlands.

Background: Patients with bipolar disorder benefit from guidelines recommended continuous community-oriented psychiatric and somatic healthcare, but often discontinue psychiatric care.

Aims: The first objective was to identify predictive factors of discontinuity of psychiatric care among patients who had received psychiatric care. The second objective was to examine if practice variation in discontinuity of psychiatric care existed between providers of psychiatric care.

Discontinuity of psychiatric care for patients with schizophrenia, relation to previous psychiatric care and practice variation between providers: a retrospective longitudinal cohort study.

Background: Patients with schizophrenia need continuous integrated healthcare, but many discontinue their treatment, often experiencing adverse outcomes. The first objective of this study is to assess whether patient characteristics or treatment history are associated with discontinuity of psychiatric elective care. The second objective is to assess whether practice variation between providers of psychiatric care contributes to discontinuity of elective care.

The Impact of Antipsychotic Formulations on Time to Medication Discontinuation in Patients with Schizophrenia: A Dutch Registry-Based Retrospective Cohort Study.

Background: Many patients with schizophrenia discontinue antipsychotic medication, frequently with adverse outcomes. Although different antipsychotic formulations are associated with different times to discontinuation, not much is known about discontinuation rates with oral-weekly formulations. Such a formulation of penfluridol is available in both the Netherlands and several other countries.

Rising co-payments coincide with unwanted effects on continuity of healthcare for patients with schizophrenia in the Netherlands.

Background: Co-payments, used to control rising costs of healthcare, may lead to disruption of appropriate outpatient care and to increases in acute crisis treatment or hospital admission in patients with schizophrenia. An abrupt rise in co-payments in 2012 in the Netherlands offered a natural experiment to study the effects of co-payments on continuity of healthcare in schizophrenia.

Methods: Retrospective longitudinal registry-based cohort study.

How does an integrated primary care approach for patients in deprived neighbourhoods impact utilization patterns? An explorative study.

Background: To explore changes in utilization patterns for general practice (GP) and hospital care of people living in deprived neighbourhoods when primary care providers work in a more coherent and coordinated manner by applying an integrated approach.

Methods: We compared expected (based on consumption patterns of a health insurers' total population) and actual utilization patterns in a deprived Dutch intervention district in the city of Utrecht (Overvecht) with control districts 1 (Noordwest) and 2 (Kanaleneiland) over the period 2006-2011, when an integrated care approach was increasingly provided in the intervention district. Standardized insurance claims data were used to indicate use of GP care and hospital care.

Schizophrenia in the Netherlands: Continuity of Care with Better Quality of Care for Less Medical Costs.

Background: Patients with schizophrenia need continuous elective medical care which includes psychiatric treatment, antipsychotic medication and somatic health care. The objective of this study is to assess whether continuous elective psychiatric is associated with less health care costs due to less inpatient treatment.

Methods: Data concerning antipsychotic medication and psychiatric and somatic health care of patients with schizophrenia in the claims data of Agis Health Insurance were collected over 2008-2011 in the Netherlands.

A health insurance company-initiated practice support intervention for optimizing acid-suppressing drug prescriptions in primary care.

Background: A health insurance-initiated programme to improve cost-effectiveness of acid-suppressing drugs (ASDs).

Aim: To evaluate the effect of two different interventions of general practitioner support in reducing drug prescription.

Materials And Methods: A sequential cluster randomized controlled trial with 90 participating general practitioners in a telephone support (TS) group or practice visit (PV) group.

A health insurance company-initiated multifaceted intervention for optimizing acid-suppressing drug prescriptions in primary care: a randomized controlled trial.

Objective: To evaluate the effectiveness of a health insurance company-initiated intervention strategy aimed at optimizing acid-suppressing drug (ASD) prescriptions in primary care.

Methods: In a cluster randomized controlled trial design, 112 primary care physician (PCP) peer review groups (993 PCPs) in the central region of the Netherlands were randomized. The PCPs in the intervention group received an ASD prescription optimization protocol, a list of their patients taking ASDs frequently on a long-term basis, and financial compensation for additional consultations with these patients.