Effect of an evidence-based website on healthcare usage: an interrupted time-series study.

Objectives: Healthcare costs and usage are rising. Evidence-based online health information may reduce healthcare usage, but the evidence is scarce. The objective of this study was to determine whether the release of a nationwide evidence-based health website was associated with a reduction in healthcare usage.

Should the diagnosis of COPD be based on a single spirometry test?

Clinical guidelines indicate that a chronic obstructive pulmonary disease (COPD) diagnosis is made from a single spirometry test. However, long-term stability of diagnosis based on forced expiratory volume in 1 s over forced vital capacity (FEV/FVC) ratio has not been reported. In primary care subjects at risk for COPD, we investigated shifts in diagnostic category (obstructed/non-obstructed).

[The NHG guidelines 'Adult asthma' and 'COPD'].

The Dutch College of General Practitioners (NHG) guidelines 'Adult asthma' and 'COPD' have been revised. New spirometry reference values from the Global Lung Function Initiative are recommended. Airway obstruction is defined as a FEV1/FVC ratio below the 5th percentile for the reference population.

[What do you think of Thuisarts.nl? Experiences after 3 years of www.Thuisarts.nl].

Many people need information on health and disease, but the internet is a maze of medical information. In order to offer patients reliable medical information, and to support general practitioners, the Dutch College of General Practitioners (NHG) set up the public website Thuisarts.nl in 2011, which was later followed by an app.

Impact of switching to new spirometric reference equations on severity staging of airflow obstruction in COPD: a crosssectional observational study in primary care.

Background: Severity of airflow obstruction in chronic obstructive pulmonary disease (COPD) is based on forced expiratory volume in one second expressed as percentage predicted (FEV1%predicted) derived from reference equations for spirometry results.

Aims: To establish how switching to new spirometric reference equations would affect severity staging of airflow obstruction in the Dutch primary care COPD patient population.

Methods: Spirometry tests of 3,370 adults aged >40 years with obstruction (postbronchodilator FEV1/forced vital capacity (FVC) <0.

Diagnostic accuracy of primary care asthma/COPD working hypotheses, a real life study.

Unlabelled: Misdiagnoses are inevitable when working hypotheses of asthma/COPD of General Practitioners (GPs) are not checked by spirometry. To reduce misdiagnoses, Asthma/COPD-support services (AC-services) offer support by performing spirometry assessed together with written medical history by consulting pulmonologists.

Research Questions: Which criteria do GPs use to justify their asthma/COPD working hypotheses? How do diagnostic assessments by an AC-service change GPs' working hypotheses? Do GPs' justifications for their working hypotheses influence the extent to which working hypotheses correspond with diagnoses given by an AC-service?

Method: We investigated the working hypotheses of 17 GPs for 284 patients with respiratory problems and their justifications: "clinical symptoms", "office spirometry", or "specialist's correspondence".

Lung function decline in relation to diagnostic criteria for airflow obstruction in respiratory symptomatic subjects.

Background: Current COPD guidelines advocate a fixed < 0.70 FEV1/FVC cutpoint to define airflow obstruction. We compared rate of lung function decline in respiratory symptomatic 40+ subjects who were 'obstructive' or 'non-obstructive' according to the fixed and/or age and gender specific lower limit of normal (LLN) FEV1/FVC cutpoints.

[Increased multimorbidity in patients in general practice in the period 2003-2009].

Objective: To determine the prevalence of chronic multimorbidity and its increase in primary care.

Design: Descriptive longitudinal study.

Method: We selected patients suffering from chronic pulmonary disease, chronic cardiovascular disease, or diabetes from a national representative general practice research database (LINH).

Low body mass index, airflow obstruction, and dyspnoea in a primary care COPD patient population.

Aim: The objective of our study was to explore the existence/co-existence of factors - as per American Thoracic Society (ATS)/European Respiratory Society (ERS) standards - for staging patients in a primary care COPD population.

Method: A representative sample of COPD patients in primary care was studied. Cross-sectional information on airflow obstruction, body mass index (BMI), and dyspnoea (Modified Medical Research Council [MMRC] score) were collected.

An expert-supported monitoring system for patients with chronic obstructive pulmonary disease in general practice: results of a cluster randomised controlled trial.

Objective: To investigate the long-term effectiveness of a general practice monitoring system with respiratory expert recommendations for general practitioners' management of patients with chronic obstructive pulmonary disease (COPD), compared with usual care.

Design, Settings And Participants: A multicentre randomised controlled trial of patients with COPD, clustered by general practices; 200 participants were recruited to maintain at least 75 participants per group for analysis. The trial took place from July 2005 to February 2008 in the south-western region of the Netherlands.

Diagnostic assessments of spirometry and medical history data by respiratory specialists supporting primary care: are they reliable?

Aim: To determine the intra- and inter-observer reliability of respiratory specialists' diagnostic assessments of spirometry and written medical history data obtained from primary care.

Method: Five respiratory specialists assessed spirometry data and the history of 156 patients randomly selected from referrals to an asthma/COPD-service. The inter-observer reliability was evaluated.