[Respiratory complaints in the time of COVID-19].

The current guidelines for diagnosis and treatment of primary respiratory infections are still useful during the COVID-19 epidemic.Telephone triage of patients with respiratory complaints aims to identify patients with complications or an increased risk of complications.There are no indications to test for SARS-CoV-2 virus in general practice.

Is guideline-adherent prescribing associated with quality of life in patients with type 2 diabetes?

Background: Guideline-adherent prescribing for treatment of multiple risk factors in type 2 diabetes (T2D) patients is expected to improve clinical outcomes. However, the relationship to Health-Related Quality of Life (HRQoL) is not straightforward since guideline-adherent prescribing can increase medication burden.

Objectives: To test whether guideline-adherent prescribing and disease-specific medication burden are associated with HRQoL in patients with T2D.

Safe use of proton pump inhibitors in patients with cirrhosis.

Aims: Proton pump inhibitors (PPIs) belong to the most frequently used drugs, also in patients with cirrhosis. PPIs are extensively metabolized by the liver, but practice guidance on prescribing in cirrhosis is lacking. We aim to develop practical guidance on the safe use of PPIs in patients with cirrhosis.

Evidence-Based Recommendations to Improve the Safe Use of Drugs in Patients with Liver Cirrhosis.

Introduction: The presence of liver cirrhosis can have a major impact on pharmacodynamics and pharmacokinetics, but guidance for prescribing is lacking.

Objective: The aim of this study is to provide an overview of evidence-based recommendations developed for the safe use of drugs in liver cirrhosis.

Methods: Recommendations were based on a systematic literature search combined with expert opinion from a panel of 10 experts.

Development and validation of prescribing quality indicators for patients with type 2 diabetes.

Aim: Quality indicators are used to measure whether healthcare professionals act according to guidelines, but few indicators focus on the quality of pharmacotherapy for diabetes. The aim of this study was to develop and validate a set of prescribing quality indicators (PQIs) for type 2 diabetes in primary care, and to apply this set in practice. To take into account the stepwise treatment of chronic disease, clinical action indicators were specifically considered.

Development and initial validation of prescribing quality indicators for patients with chronic kidney disease.

Background: Quality assessment is a key element for improving the quality of care. Currently, a comprehensive indicator set for measuring the quality of medication treatment in patients with chronic kidney disease (CKD) is lacking. Our aim was to develop and validate a set of prescribing quality indicators (PQIs) for CKD care, and to test the feasibility of applying this set in practice.

Process quality indicators for chronic kidney disease risk management: a systematic literature review.

Background And Objectives: Quality indicators (QIs) can be used for measuring the quality of actions of healthcare providers. This systematic review gives an overview of such QIs measuring processes of care for chronic kidney disease (CKD), and identifies the QIs that have content, face, operational and/or predictive validity.

Methods: PubMed and Embase were searched using a strategy combining the terms "quality of care," "quality indicators" and "chronic kidney disease".

Evaluating the safety and dosing of drugs in patients with liver cirrhosis by literature review and expert opinion.

Introduction: Liver cirrhosis can have a major impact on drug pharmacokinetics and pharmacodynamics. Patients with cirrhosis often suffer from potentially preventable adverse drug reactions. Guidelines on safe prescribing for these patients are lacking.

[Revised NHG practice guideline 'Lumbosacral radicular syndrome'].

The Dutch College of General Practitioners (NHG) recently published the practice guideline 'Lumbosacral radicular syndrome'. This guideline provides general practitioners with guidance for the diagnostic workup and treatment of patients with lumbosacral radicular syndrome. In this article we discuss the most important changes and modifications to this guideline point by point.

Patient characteristics associated with measurement of routine diabetes care: an observational study.

Background: Non-modifiable patient characteristics, including age, gender, ethnicity as well as the occurrence of multi-morbidities, are associated with processes and outcomes of diabetes care. Information on these factors can be used in case mix adjustment of performance measures. However, the practical relevance of such adjustment is not clear.

[The NHG guideline 'Sleep problems and sleeping pills'].

The Dutch College of General Practitioners' (NHG) guideline 'Sleep problems and sleeping pills' provides recommendations for the diagnosis and treatment of the most prevalent sleep problems and for the management of chronic users of sleeping pills. The preferred approach for sleeplessness is not to prescribe medication but to give information and behavioural advice. Practice assistants of the Dutch Association of Mental Health and Addiction Care are also expected to be able to undertake this management.

[Practice guideline on 'Acute diarrhoea' from the Dutch College of General Practitioners].

The revised guideline on 'Acute diarrhoea' from the Dutch College of General Practitioners covers the diagnosis and management of suspected acute infectious diarrhoea. Acute diarrhoea resulting from infectious gastroenteritis is often caused by a virus and is usually self-limiting; stool testing is rarely indicated. The main complication of acute diarrhoea is dehydration, although this is rare in the Netherlands.

Effectiveness of improvement plans in primary care practice accreditation: a clustered randomized trial.

Background: Accreditation of healthcare organizations is a widely used method to assess and improve quality of healthcare. Our aim was to determine the effectiveness of improvement plans in practice accreditation of primary care practices, focusing on cardiovascular risk management (CVRM).

Method: A two-arm cluster randomized controlled trial with a block design was conducted with measurements at baseline and follow-up.

Effect of accreditation on the quality of chronic disease management: a comparative observational study.

Background: Practice accreditation is widely used to assess and improve quality of healthcare providers. Little is known about its effectiveness, particularly in primary care. In this study we examined the effect of accreditation on quality of care regarding diabetes, chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD).

Organizational determinants of high-quality routine diabetes care.

Objective: Randomized trials showed that changes in healthcare organization improved diabetes care. This study aimed to identify which organizational determinants were associated with patient outcomes in routine diabetes care.

Design: Observational study, in which multilevel regression analyses were applied to examine the impact of 12 organizational determinants on diabetes care as separate measures and as a composite score.

[Summary of the NHG guideline 'The STD consultation'].

The guideline 'The STD consultation' of the Dutch College of General Practitioners provides guidelines for the diagnosis and management of patients with symptoms of a sexually transmitted disease (STD), patients at high risk of being infected with a STD (risk groups), and patients with questions or concerns about STDs. The test policy depends on the patient's symptoms and risks and is extensively described in the guideline. Men who have sex with men (MSM), prostitutes, people who visit prostitutes, people from countries in which STDs are endemic, people with multiple sexual partners, and people with a partner from one of these groups are at increased risk of contracting one of the five major STDs (chlamydia, gonorrhoea, syphilis, hepatitis B, and HIV).

[Summary of the 'Thyroid disorders' guideline of the Dutch College of General Practitioners' (NHG)].

The 'Thyroid disorders' guideline of the Dutch College of General Practitioners (NHG) provides recommendations for the diagnosis and management of hypothyroidism, hyperthyroidism and changes in the size of the thyroid gland, such as goitre and thyroid nodules. Hypothyroid patients younger than 60 years and without cardiac comorbidity should receive the full substitution dose of levothyroxine at treatment onset. In case of hypothyroidism in pregnancy, the levothyroxine dose should be immediately increased by 25%.

[Revised Dutch College of General Practitioners' practice guideline 'Acute coronary syndrome'].

The practice guideline 'Acute coronary syndrome' gives the general practitioner (GP) guidance on the diagnosis, treatment and long-term management of adults with (experienced) acute coronary syndrome (ACS). Not every patient with ACS presents with chest pain as the main symptom. The GP should evaluate every sign and symptom that may indicate ACS in the same way in both men and women.

Precision of individual and composite performance scores: the ideal number of indicators in an indicator set.

Background: In many countries, quality indicators are used to assess the quality of care of family practice. Such assessments need to have an adequate precision, so that the results can be interpreted correctly. However, a small sample size per practitioner can lead to inadequate precision.

Effectiveness and efficiency of a practice accreditation program on cardiovascular risk management in primary care: study protocol of a clustered randomized trial.

Background: Cardiovascular risk management is largely provided in primary healthcare, but not all patients with established cardiovascular diseases receive preventive treatment as recommended. Accreditation of healthcare organizations has been introduced across the world with a range of aims, including the improvement of clinical processes and outcomes. The Dutch College of General Practitioners has launched a program for accreditation of primary care practices, which focuses on chronic illness care.

Consistency of performance indicators for cardiovascular risk management across procedures and panels.

Introduction: Delphi procedures are frequently used to develop performance indicators, but little is known about the validity of this method. We aimed to examine the consistency of indicator selection across different procedures and across different panels.

Methods: Analysis of three indicator set development procedures: the EPA Cardio project, which used international GP panels; the UniRap project, a Dutch GP indicator project; and the Vitale Vaten project, which used a national multidisciplinary health professional panel and a stakeholder panel.