Attitudes and managing alcohol problems in general practice: an interaction analysis based on findings from a WHO collaborative study.

Aims: To determine if GPs' attitudes towards working with drinkers moderated the impact that training and support had on screening and brief intervention activity in routine practice.

Methods: Subjects were 340 GPs from four countries who were part of a World Health Organization randomized controlled trial to evaluate the effectiveness of training and support in increasing screening and brief alcohol intervention. GPs' self-reported attitudes towards working with drinkers were measured with the Shortened Alcohol and Alcohol Problems Perception Questionnaire.

A multidisciplinary guideline for the acute phase of stroke: barriers perceived by Dutch neurologists.

Rationale, Aims And Objectives: Guidelines for stroke management should improve quality of care. Dissemination of guidelines, however, does not guarantee guideline adherence. The aim of this paper is to investigate barriers for guideline adherence to bring about suggestions for possible implementation strategies.

The effect of a distance-learning programme on patient self-management of Lower Urinary Tract Symptoms (LUTS) in general practice: a randomised controlled trial.

Objective: To determine whether a distance-learning programme on LUTS provided to the general practitioner affected patient self-management.

Methods: A randomised trial was performed to examine the effects of the distance-learning programme (an educational package for the GP and a patient information leaflet) compared with written guidelines on LUTS mailed to the GP. In 63 general practices (32 intervention and 31 control) across the Netherlands all patients older than 50 years presenting LUTS for the first time were invited to participate.

Engaging general practitioners in the management of hazardous and harmful alcohol consumption: results of a meta-analysis.

Objective: A systematic review was undertaken of studies that test the effectiveness of different strategies used to increase general practitioners' rates of screening for and giving advice about hazardous and harmful alcohol consumption.

Method: Resources were MEDLINE, EMBASE, Cinahl and the Cochrane Library (1966-2001). Inclusion criteria were those of the Effective Practice and Organisation of Care Group of the Cochrane Collaboration.

A pressure ulcer audit and feedback project across multi-hospital settings in the Netherlands.

Objective: To examine whether participating in a pressure ulcer prevalence survey and receiving feedback results in an improvement in quality of care.

Design: Cross-sectional studies from 1998 to 2002 were compared over time.

Setting: Sixty-two acute care hospitals in the Netherlands.

GPs' views on involvement of older patients: an European qualitative study.

Involvement of older patients in general practice care is regarded as important, but is not widespread. To determine specific barriers to the involvement of older patients in general practice care and to identify variations between countries, we performed an international comparative study based on qualitative interviews with 233 general practitioners (GPs) in 11 countries. Most GPs thought that involving older patients had positive outcomes.

Development of clinical practice guidelines: evaluation of 2 methods.

The aim of this study was to compare 2 methods for developing a clinical practice guideline (CPG) on the management of asymptomatic, impacted mandibular third molars. Outcome measures were the mean time invested by the participants for each method, the quality of the CPGs measured using the Appraisal of Guidelines for Research and Evaluation (AGREE) indicator and observations of the group discussions. We used a national consensus procedure following the Rand modified Delphi procedure (2 panels) and a local consensus procedure (2 existing dental peer groups).

Barriers to implementing cardiovascular risk tables in routine general practice.

Design: Qualitative study. GPs were interviewed after analysing two audiotaped cardiovascular consultations.

Setting: Primary health care.

Impact of national health care systems on patient evaluations of general practice in Europe.

Objective: To examine associations between patient evaluations of general practice and characteristics of national health care systems.

Methods: International comparative study in 17 countries, using international patient survey data (n= 25052) and data-bases for health care system characteristics. Dependent variable was patients' evaluation of general practice care.

Acquisition of clinical skills in postgraduate training for general practice.

Background: Postgraduate training in general practice aims to develop clinical competence. However, little is known about its effect on trainees' development of clinical skills.

Aim: To assess the acquisition of clinical skills during a 3-year training programme and to evaluate whether a satisfactory level is achieved towards the end of training.

Impact of nurse practitioners on workload of general practitioners: randomised controlled trial.

Objective: To examine the impact on general practitioners' workload of adding nurse practitioners to the general practice team.

Design: Randomised controlled trial with measurements before and after the introduction of nurse practitioners.

Setting: 34 general practices in a southern region of the Netherlands.

Which data source in clinical performance assessment? A pilot study comparing self-recording with patient records and observation.

Objective: A pilot study aimed to determine the extent to which each of three data sources could provide complete and reliable data for valid assessment of clinical performance.

Design: Clinical decisions taken in 168 consultations by seven family physicians were reviewed against guidelines for 15 clinical conditions. In total, 206 criteria were reviewed using three sources: medical records, observation in surgery, and structured self-recording by the physicians.

What drives change? Barriers to and incentives for achieving evidence-based practice.

To bridge the gap between scientific evidence and patient care we need an in-depth understanding of the barriers and incentives to achieving change in practice. Various theories and models for change point to a multitude of factors that may affect the successful implementation of evidence. However, the evidence for their value in the field is still limited.

Multifaceted support to improve preventive cardiovascular care: a nationwide, controlled trial in general practice.

Background: Multifaceted interventions improve the quality of preventive cardiovascular care in general practice when applied in small-scale research trials.

Aim: To test the transferability of observations from research trials on preventive cardiovascular care to a real-world situation and, therefore, evaluate the effectiveness of a nationwide project with a large number of practices. The intervention comprised a combination of conferences, dissemination of manuals, and support from trained non-physicians during outreach visits.

Perceptions of cardiovascular risk among patients with hypertension or diabetes.

We aimed to examine risk perceptions among patients at moderate to high cardiovascular risk. A questionnaire about perceived absolute risk of myocardial infarction and stroke was sent to 2424 patients with hypertension or diabetes. Response rate was 86.

Process evaluation of a multifaceted intervention to improve cardiovascular disease prevention in general practice.

Objectives: To perform a process evaluation of a multifaceted intervention to improve cardiovascular and diabetes care in general practice.

Methods: The feasibility of the intervention, carried out by outreach visitors in 62 practices, was addressed by evaluating whether the intervention programme was performed as planned and the extent to which it was accepted by the practice team. In addition, the costs of the programme were determined.

Family medicine trainees still value continuity of care.

Background And Objectives: Continuity of care in family medicine is under pressure due to an increase in part-time work, delegation of tasks, and the development of walk-in centers. It is uncertain to what extent newly qualified professionals value personal continuity. Insight into trainees' views may be helpful for training purposes and for improving continuity of care for patients in the future.

Communication at the interface: do better referral letters produce better consultant replies?

A study of the quality of 637 referral letters from general practitioners (GPs) and corresponding reply letters from medical specialists showed that both types of letters can be improved, and that specific requests by GPs were addressed explicitly by the specialists in only a limited number of cases. Better referral letters resulted only partly in better reply letters. A letter is considered to be of higher quality when a specialist commences a letter with a reference to the specific request by the GP.

Attitudes and management of alcohol problems in general practice: descriptive analysis based on findings of a World Health Organization international collaborative survey.

Aims: To determine if general practitioners' (GPs) experience of education on alcohol, support in their working environment for intervening with alcohol problems, and their attitudes have an impact on the number of patients they manage with alcohol problems.

Methods: 1300 GPs from nine countries were surveyed with a postal questionnaire as part of a World Health Organization (WHO) collaborative study.

Results: GPs who received more education on alcohol (OR = 1.

The effect of small peer group continuous quality improvement on the clinical practice of midwives in The Netherlands.

Objective: To study the effects of small group continuous quality improvement (CQI) on the clinical practice of midwives in the Netherlands.

Design: Randomised pre-/post-test (balanced block).

Intervention: The CQI groups were assigned to either the set of peer review topics including 'perineal repair' and 'artificial rupture of the membranes (ARM)', or to the set of topics including 'airway aspiration' and 'measuring blood pressure'.

Changing relationships: attitudes and opinions of general practitioners and pharmacists regarding the role of the community pharmacist.

Background: Relationship between general practitioners and pharmacists.

Aim: To explore similarities and differences in opinions between general practitioners and pharmacists about the pharmacist's role. To identify factors which determine the attitude of the general practitioner towards the role of the pharmacist as a care provider.

Feedback based on patient evaluations: a tool for quality improvement?

Feedback regarding patient evaluations of health care is expected to be a tool for quality improvement. This study examined the response of general practitioners to such feedback in a randomised trial. Practitioners in the intervention group read and discussed the feedback report and then reported on a range of actions that can be undertaken to improve the quality of care.

From best evidence to best practice: effective implementation of change in patients' care.

Major difficulties arise when introducing evidence and clinical guidelines into routine daily practice. Data show that many patients do not receive appropriate care, or receive unnecessary or harmful care. Many approaches claim to offer solutions to this problem; which ones are as yet the most effective and efficient is unclear.

Organisational determinants of cardiovascular prevention in general practice.

Objective: To assess organisational determinants in the prevention of cardiovascular disease.

Design: A cross-sectional study.

Setting And Subjects: 130 general practices in The Netherlands.