Does an in-house internist at a GP practice result in reduced referrals to hospital-based specialist care?

Objective: Consistent evidence on the effects of specialist services in the primary care setting is lacking. Therefore, this study evaluated the effects of an in-house internist at a GP practice on the number of referrals to specialist care in the hospital setting. Additionally, the involved GPs and internist were asked to share their experiences with the intervention.

Symptomatic pectus excavatum in seniors: an exploratory study on clinical presentation and incidence in daily practice.

Objectives. Doctors all over the world consider a pectus excavatum usually as an incidental finding. There is some evidence suggesting that a pectus excavatum may cause symptoms in the elderly.

Pretest expectations strongly influence interpretation of abnormal laboratory results and further management.

Background: Abnormal results of diagnostic laboratory tests can be difficult to interpret when disease probability is very low. Although most physicians generally do not use Bayesian calculations to interpret abnormal results, their estimates of pretest disease probability and reasons for ordering diagnostic tests may--in a more implicit manner--influence test interpretation and further management. A better understanding of this influence may help to improve test interpretation and management.

Evaluation of an open access echocardiography service in the Netherlands: a mixed methods study of indications, outcomes, patient management and trends.

Background: In our region (Eastern South Limburg, The Netherlands) an open access echocardiography service started in 2002. It was the first service of this kind in The Netherlands. Our study aims were: (1) to evaluate demand for the service, participation, indications, echocardiography outcomes, and management by the general practitioner (GP); (2) to analyse changes in indications and outcomes over the years.

Reasons for ordering laboratory tests and relationship with frequency of abnormal results.

Objective: Laboratory tests are ordered on a daily basis, even though disease probability is often very low. Abnormal results, especially mildly abnormal results, can be difficult to interpret in these circumstances. Further insights into the occurrence of abnormalities can help improve rational test ordering and test interpretation.

Cascade effects of laboratory testing are found to be rare in low disease probability situations: prospective cohort study.

Objectives: (1) To investigate the frequency of cascades of further diagnostic investigations and referrals after abnormal laboratory results in situations of low disease probability; (2) to investigate pretest and posttest determinants; and (3) to describe the cascades that occur.

Study Design And Setting: Prospective cohort study in primary care in The Netherlands. Numbers of investigations/referrals were recorded during 6 months of follow-up for 256 patients with normal and abnormal laboratory results.

Treatment adherence and patients' acceptance of home infusions with adenosine 5'-triphosphate (ATP) in palliative home care.

Goals Of Work: In preterminal cancer patients, provision of palliative care in the patients' own environment is preferred. The aim of the present study was to evaluate patients' and caregivers' treatment adherence and patients' acceptance of home infusions with adenosine 5'-triphosphate (ATP).

Patients And Methods: Preterminal cancer patients (life expectancy <6 months) with mixed tumor types were eligible for the study.

Effects of a behaviour independent financial incentive on prescribing behaviour of general practitioners.

Rationale And Objectives: It is difficult to keep control over prescribing behaviour in general practice. The purpose of this study was to assess the initial effects of a behaviour independent financial incentive on the volume of drug prescribing of general practitioners (GPs).

Design: 2-Year Controlled Before After study with an intervention region and a concurrent control region.

Design and evaluation of a computer reminder system to improve prescribing behaviour of GPs.

Objective: To evaluate the implementation of a decision support system with reactive computer reminders to improve drug prescribing behaviour.

Methods: A clustered RCT with an incomplete block design was carried out in the south of the Netherlands: 25 GPs received reminders on antibiotics and asthma/COPD prescriptions, 28 GPs received reminders on cholesterol prescriptions. Prescribing guidelines were integrated into the GP information system, which was installed in the GPs practices of the intervention group.

Does a joint development and dissemination of multidisciplinary guidelines improve prescribing behaviour: a pre/post study with concurrent control group and a randomised trial.

Background: It is difficult to keep control over prescribing behaviour in general practices. The purpose of this study was to assess the effects of a dissemination strategy of multidisciplinary guidelines on the volume of drug prescribing.

Methods: The study included two designs, a quasi-experimental pre/post study with concurrent control group and a random sample of GPs within the intervention group.

GP concordance with advice for treatment following a multidisciplinary psychogeriatric assessment.

Objective: To evaluate the concordance of General Practitioners (GPs) with advice for treatment after a multidisciplinary psychogeriatric assessment by the Diagnostic Observation Centre for PsychoGeriatric patients (DOC-PG).

Method: Concordance checklists, listing the recommendations from the multidisciplinary team, were sent to the GPs in order to establish GP concordance. Regression models were used to study the associations between various patient and GP characteristics and level of concordance.

Out-of-hours primary care. Implications of organisation on costs.

Background: To perform out-of-hours primary care, Dutch general practitioners (GPs) have organised themselves in large-scale GP cooperatives. Roughly, two models of out-of-hours care can be distinguished; GP cooperatives working separate from the hospital emergency department (ED) and GP cooperatives integrated with the hospital ED. Research has shown differences in care utilisation between these two models; a significant shift in the integrated model from utilisation of ED care to primary care.

The impact of a primary care physician cooperative on the caseload of an emergency department: the Maastricht integrated out-of-hours service.

Objective: To determine the effect of an out-of-hours primary care physician (PCP) cooperative on the caseload at the emergency department (ED) and to study characteristics of patients utilizing out-of-hours care.

Design: A pre-post intervention design was used. During a 3-week period before and a 3-week period after establishing the PCP cooperative, all patient records with out-of-hours primary and emergency care were analyzed.

General practitioners' satisfaction with and attitudes to out-of-hours services.

Background: In recent years, Dutch general practitioner (GP) out-of-hours service has been reorganised into large-scale GP cooperatives. Until now little is known about GPs' experiences with working at these cooperatives for out-of-hours care. The purpose of this study is to gain insight into GPs' satisfaction with working at GP cooperatives for out-of-hours care in separated and integrated cooperatives.

Evaluation of an automated test ordering and feedback system for general practitioners in daily practice.

Objective: To evaluate the use of an automated test ordering and feedback system (named GRIF) in daily practice. The system produces recommendations to general practitioners (GPs) to improve the application of accepted practice guidelines for test ordering.

Methods: A randomised controlled trial with balanced block design was carried out in general practices in two regions of the Netherlands from August 2000 to July 2001.

User satisfaction with a real-time automated feedback system for general practitioners: a quantitative and qualitative study.

Objective: The GRIF automated feedback system produces real-time comments on the appropriateness of diagnostic tests ordered by general practitioners (GPs) based on recommendations from accepted national and regional practice guidelines. We investigated the experiences of GPs with this system and, more specifically, with the recommendations produced by the system as well as their views on using this system in daily practice.

Setting: We tested the GRIF system in an experiment in a laboratory setting and in a daily practice trial.

The efficacy of an automated feedback system for general practitioners.

Objective: An automated feedback system that produces comments about the non-adherence of general practitioners (GPs) to accepted practice guidelines for ordering diagnostic tests was developed. Before implementing the automated feedback system in daily practice, we assessed the potential effect of the system on the test ordering behaviour of GPs.

Design: We used a randomised controlled trial with balanced block design.

The reliability of assessing the appropriateness of requested diagnostic tests.

Despite a poor reliability, peer assessment is the traditional method to assess the appropriateness of health care activities. This article describes the reliability of the human assessment of the appropriateness of diagnostic tests requests. The authors used a random selection of 1217 tests from 253 request forms submitted by general practitioners in the Maastricht region of The Netherlands.