Implementation of a shared care guideline for back pain: effect on unnecessary referrals.

Objective: To determine the effect of the implementation of a shared care guideline for the lumbosacral radicular syndrome (LRS) on unnecessary early referrals and the duration of the total diagnostic procedure.

Design: Introduction of shared care guideline in November 2005. Pre-test in 2005 (April to October), a first post-test in 2006 (April to October) and a second post-test in 2007 (April to October).

Patient-oriented intervention in addition to centrally organised checkups improves diabetic patient outcome in primary care.

Background: Logistic support to general practitioners improves the care processes for patients with diabetes but is not sufficient to meet all criteria.

Aim: To introduce patient-oriented interventions by a practice nurse in general practices which already use logistic support to improve the care processes for patients with diabetes.

Design Of Study: A controlled before-after study with delayed intervention in the control group.

Do patients matter? Contribution of patient and care provider characteristics to the adherence of general practitioners and midwives to the Dutch national guidelines on imminent miscarriage.

Objective: To assess the relative contribution of patient and care provider characteristics to the adherence of general practitioners (GPs) and midwives to two specific recommendations in the Dutch national guidelines on imminent miscarriage. The study focused on performing physical examinations at the first contact and making a follow up appointment after 10 days because these are essential recommendations and there was much variation in adherence between different groups of providers.

Design: Prospective recording by GPs and midwives of care provided for patients with symptoms of imminent miscarriage.

Reasons why patients bypass their GP to visit a hospital emergency department.

Knowledge about what motivates patients to visit the emergency department (ED) of a hospital for minor complaints, instead of visiting their general practitioner (GP), can help to reduce unnecessary utilization of expensive services. This paper reports on a study designed to investigate the reasons why patients visit the ED and to determine the influence of patient characteristics on specific motives. A multidimensional measurement instrument was designed to identify the motives of patients who bypass their GP and visit the ED.

Does the care given by general practitioners and midwives to patients with (imminent) miscarriage meet the wishes and expectations of the patients?

Objective: In 1989 a Dutch national guideline on (imminent) miscarriage was developed for use in general practice. A prospective recording study was carried out to determine how the patients evaluated the care they received from general practitioners (GPs) and midwives who agreed to adhere to this (imminent) miscarriage guideline and to determine the aspects that influence this evaluation.

Setting: GP practices and midwifery practices in The Netherlands.

Well-being and symptoms in relation to insulin therapy in type 2 diabetes.

Objective: To determine the influence of insulin therapy on physical symptoms, emotional and general well-being, and treatment satisfaction in patients with type 2 diabetes.

Research Design And Methods: A descriptive prospective 2-year cohort study was performed. The study population consisted of 272 eligible NIDDM patients of Dutch origin > or = 40 years of age who had a known diabetes duration > or = 3 months and who were treated with diet and/or oral hypoglycemic agents.

The effects of involvement of the general practitioner and guidance of the hearing impaired on hearing-aid use.

A number of international and national publications report that hearing aids are sometimes under used. In this paper, results are reported of a project to increase the effective use of hearing aids. The first intervention was aimed at a more effective exchange of information between the general practitioner (GP) and the ENT specialist.

Sustained good glycaemic control in NIDDM patients by implementation of structured care in general practice: 2-year follow-up study.

In primary care it is difficult to treat the growing number of non-insulin-dependent diabetic (NIDDM) patients according to (inter)national guidelines. A prospective, controlled cohort study was designed to assess the intermediate term (2 years) effect of structured NIDDM care in general practice with and without 'diabetes service' support on glycaemic control, cardiovascular risk factors, general well-being and treatment satisfaction. The 'diabetes service', supervised by a diabetologist, included a patient registration system, consultation facilities of a dietitian and diabetes nurse educator, and protocolized blood glucose lowering therapy advice which included home blood glucose monitoring and insulin therapy.

The quality of the discharge planning process: the effect of a liaison nurse.

A project employing a liaison nurse has been started in the Dutch Zaandam region. The liaison project will focus on the experience of problems in preparing for hospital discharge and on continuity between hospital and home care. This article discusses the effect of the liaison nurse on the quality of the discharge planning process.

The problems of elderly people at home one week after discharge from an acute care setting.

The problems of elderly people following discharge from hospital is a worldwide focus of nursing attention. Actual and local insight into the nature and extent of post-discharge problems is needed as a base for improving and evaluating discharge planning. Problems following discharge were investigated as the first part of a larger study.

Adherence by midwives to the Dutch national guidelines on threatened miscarriage in general practice: a prospective study.

Objective: To determine the feasibility for midwives to adhere to Dutch national guidelines on threatened miscarriage in general practice.

Design: Prospective recording of appointments by midwives who agreed to adhere to the guidelines on threatened miscarriage. Interviews with the midwives after they had recorded appointments for one year.

The prevalence and determinants of foot ulceration in type II diabetic patients in a primary health care setting.

The purpose of the study was to assess the prevalence of foot (pre-)ulcers and their determinants in type II diabetic patients in a primary health care setting. Six hundred and nine patients (246 men, mean age 64.8 (range, 40-94) years, diabetes duration, 4.

[Cause for referral by family physicians and obstetricians in Amsterdam in (threatened) miscarriage as reflected in the guideline '(Threatened) abortion' of the Dutch Society for Family Physicians].

Objective: To determine the reasons general practitioners (GPs) and midwives have for referring patients with symptoms of imminent miscarriage to hospital and the management in hospital.

Design: Prospective and descriptive.

Setting: Research Centre Primary/Secondary Health Care, University Hospital Free University, the "Onze Lieve Vrouwe Gasthuis' hospital, both in Amsterdam, the Netherlands.

Primary health care replacing hospital care--the effect on quality of care.

In order to change current practice concerning hospital stays, a project was initiated in which shortening hospital stay was combined with shifting care to primary health care. Research was aimed at assessing quality of care of shortened hospital stays with home care by the community nurse and/or the general practitioner (GP). A randomized clinical trial was conducted with three subgroups: 1.

Retinopathy screening in type 2 diabetes: reliability of wide angle fundus photography.

The purpose of the study was to assess the reliability of mydriatic 60 degrees fundus photography in a retinopathy screening programme for Type 2 diabetic patients in a primary health care setting. In 323 eligible consecutive Type 2 diabetic patients above 40 years of age, attending a regional shared care diabetes project, mydriatic wide angle fundus photography was compared with standardized fundoscopy in dilated pupils as the recommended test for the detection of diabetic retinopathy. Fundus photography included two black and white transparencies per eye visualizing the central and nasal retinal field.

Psychiatric consultation for somatizing patients in the family practice setting: a feasibility study.

Objective: The purpose of the study was to assess the feasibility of a psychiatric consultation intervention for somatizing patients in the family practice setting in terms of 1) patient compliance, 2) patient satisfaction, and 3) compliance and satisfaction of general practitioners (GPs).

Method: In a period of nine months, forty-six patients were selected for psychiatric consultation in six solo family practices in a semi-urban area in the Netherlands. The consultation included an interview with the consulting psychiatrist, the patient, and the GP.

Care for the imminent miscarriage by midwives and GPs.

A postal questionnaire was sent to a random sample of 495 Dutch general practitioners (GPs) and 278 midwives to evaluate the use of the 'imminent miscarriage' standard used by the Dutch College of General Practitioners. The response rates were 63 and 87% respectively. The first questions asked related to the respondents' routine management of an imminent miscarriage.

Acute bronchitis: general practitioners' views regarding diagnosis and treatment.

A survey was conducted among 800 Dutch general practitioners to establish their views on the diagnosis and treatment of bronchitis and related disorders with reference to 12 theoretical patients. The answers of the 467 respondents (response rate 60%) showed no clear relationship between signs and symptoms of the patients and the diagnosis made. In the authors' opinion the diagnosis of pneumonia was made too often.

Encouraging the development of integrated health centres: a critical analysis of lower referral rates.

Dutch government policy places considerable emphasis on the strengthening of the primary health care sector. In this connection, it has been shown that health centres tend to reduce costs. The referral rate for GPs in health centres is considerably lower than for GPs practising alone.

Lower referral rates for integrated health centres in The Netherlands.

The strengthening of primary health care is an important issue in health policy in The netherlands. The stimulation of co-operation and cohesion within primary health care and, in particular, the stimulation of integrated health centres is supposed to be an important mean to reduce the expansive growth of expenditures in the so-called second line (mainly medical specialists and hospitals). This article first describes recent trends in co-operation within primary health care and referral rates.