The binding study advice in medical education: a 2-year experience.

To improve the effectiveness of higher education, Dutch universities implemented the binding study advice at medical faculties. Accordingly, medicine students of Radboud University need to gain ≥ 42 out of 60 European Credit Transfer System (ECTS) credits to obtain a positive binding study advice and to continue their study programme. In case of a negative advice, the student is obliged to terminate the study, and he/she cannot register for the same study programme in the Netherlands within the next three years.

Experienced continuity of care in patients at risk for depression in primary care.

Background: Existing studies about continuity of care focus on patients with a severe mental illness.

Objectives: Explore the level of experienced continuity of care of patients at risk for depression in primary care, and compare these to those of patients with heart failure.

Methods: Explorative study comparing patients at risk for depression with chronic heart failure patients.

Heart failure patients' experiences with continuity of care and its relation to medication adherence: a cross-sectional study.

Background: A growing number of health care providers are nowadays involved in heart failure care. This could lead to discontinuity and fragmentation of care, thus reducing trust and hence poorer medication adherence. This study aims to explore heart failure patients' experiences with continuity of care, and its relation to medication adherence.

Measurement properties of questionnaires measuring continuity of care: a systematic review.

Background: Continuity of care is widely acknowledged as a core value in family medicine. In this systematic review, we aimed to identify the instruments measuring continuity of care and to assess the quality of their measurement properties.

Methods: We did a systematic review using the PubMed, Embase and PsycINFO databases, with an extensive search strategy including 'continuity of care', 'coordination of care', 'integration of care', 'patient centered care', 'case management' and its linguistic variations.

Measuring continuity of care: psychometric properties of the Nijmegen Continuity Questionnaire.

Background: Recently, the Nijmegen Continuity Questionnaire (NCQ) was developed. It aims to measure continuity of care from the patient perspective across primary and secondary care settings. Initial pilot testing proved promising.

Continuity in different care modes and its relationship to quality of life: a randomised controlled trial in patients with COPD.

Background: New care modes in primary care may affect patients' experienced continuity of care.

Aim: To analyse whether experienced continuity for patients with chronic obstructive pulmonary disease (COPD) changes after different care modes are introduced, and to analyse the relationship between continuity of care and patients' quality of life.

Design And Setting: Randomised controlled trial with 2-year follow-up in general practice in the Netherlands.

How unique is continuity of care? A review of continuity and related concepts.

Background: The concept of 'continuity of care' has changed over time and seems to be entangled with other care concepts, for example coordination and integration of care. These concepts may overlap, and differences between them often remain unclear.

Objective: In order to clarify the confusion of tongues and to identify core values of these patient-centred concepts, we provide a historical overview of continuity of care and four related concepts: coordination of care, integration of care, patient-centred care and case management.

Nijmegen Continuity Questionnaire: development and testing of a questionnaire that measures continuity of care.

Objective: To develop and pilot test a generic questionnaire to measure continuity of care from the patient's perspective across primary and secondary care settings.

Study Design And Setting: We developed the Nijmegen Continuity Questionnaire (NCQ) based on a systematic literature review and analysis of 30 patient interviews. The questionnaire consisted of 16 items about the patient-provider relationship to be answered for five different care providers and 14 items each on the collaboration between four groups of care providers.

Trends in COPD prevalence and exacerbation rates in Dutch primary care.

Background: Changes in the burden of chronic obstructive pulmonary disease (COPD) and its exacerbations on primary health care are not well studied.

Aim: To identify trends in the prevalence of physician-diagnosed COPD and exacerbation rates by age, sex, and socioeconomic status in a general practice population.

Design Of Study: Trend analysis of COPD data from a 27-year prospective cohort of a dynamic general practice population.

Pulse oximetry in family practice: indications and clinical observations in patients with COPD.

Purpose: To establish situations in which family physicians (FPs) consider pulse oximetry a valuable addition to their clinical patient assessment; to explore pulse oximetry results (SpO(2)) when used by FPs in patients with chronic obstructive pulmonary disease (COPD); to explore associations between SpO(2) and other markers of COPD severity.

Methods: We performed three separate studies: (i) interviews plus a Delphi consensus procedure with FPs experienced in using pulse oximetry to elucidate indications for pulse oximetry; (ii) analysis of SpO(2) and clinical data in COPD patients who presented to FPs with deteriorating symptoms and (iii) analysis of SpO(2), spirometry and clinical data in patients with stable COPD.

Results: Interviewed FPs (n = 11) used their pulse oximeter for a range of acute (14) and non-acute (11) indications but valued it highest in acute (worsening of) dyspnoea, in suspected respiratory insufficiency/failure and in patients with COPD.

All in the family: times are changing.

Background: General practitioners are familiar with the fact that individual use of care is determined by the family. This paper describes to what extent patterns found in the 1970s can still be replicated in the early 21(st) century, analyzing the impact of the family on frequency of presenting minor illnesses in general practice.

Methods: We used the data of the families in the CMR database during two five-year periods: 1971-1975 and 2001-2005.

Changes in the pattern of service utilisation and health problems of women, men and various age groups following a destructive disaster: a matched cohort study with a pre-disaster assessment.

Objectives: Female gender and young age are known risk factors for psychological morbidity after a disaster, but this conclusion is based on studies without a pre-disaster assessment. The aim of this study in family practice was to investigate if these supposed risk factors would still occur in a study design with a pre-disaster measurement.

Methods: A matched cohort study with pre-disaster (one year) and post-disaster (five years) data.

Comparing patient characteristics and treatment processes in patients receiving physical therapy in the United States, Israel and the Netherlands: cross sectional analyses of data from three clinical databases.

Background: Many assume that outcomes from physical therapy research in one country can be generalized to other countries. However, no well designed studies comparing outcomes among countries have been conducted. In this exploratory study, our goal was to compare patient demographics and treatment processes in outpatient physical therapy practice in the United States, Israel and the Netherlands.

Rude or aggressive patient behaviour during out-of-hours GP care: challenges in communication with patients.

Objective: GPs in out-of-hours care report that they feel at risk of rude or aggressive patient behaviour. We tried to get information about the incidence, types and patient characteristics of rude or aggressive behaviour.

Methods: Retrospective, observational study involving the analysis of medical records of all patients who contacted a Dutch GP cooperative between June 2001 and June 2002.

Changes in the sociodemographic composition of the lowest socioeconomic group over time, 1987-2001.

Background: When comparing health differences of groups with equal socioeconomic status (SES) over time, the sociodemographic composition of such a SES group is considered to be constant. However, when the periods are sufficiently spaced in time, sociodemographic changes may have occurred. The aim of this study is to examine in which respects the sociodemographic composition of lowest SES group changed between 1987 and 2001.

Health problems presented to family practices in the Netherlands 1 year before and 1 year after a disaster.

Background: Disasters often have negative health consequences. Studies of health problems presented in family practice before and after a disaster are rare. The present study analyzed health problems before and after a disaster and predictors of increased morbidity after the disaster as presented in family practice.

Safety of telephone triage in general practitioner cooperatives: do triage nurses correctly estimate urgency?

Background: In recent years, there has been a growth in the use of triage nurses to decrease general practitioner (GP) workloads and increase the efficiency of telephone triage. The actual safety of decisions made by triage nurses has not yet been assessed.

Objectives: To investigate whether triage nurses accurately estimate the urgency level of health complaints when using the national telephone guidelines, and to examine the relationship between the performance of triage nurses and their education and training.

General practice cooperatives: long waiting times for home visits due to long distances?

Background: The introduction of large-scale out-of-hours GP cooperatives has led to questions about increased distances between the GP cooperatives and the homes of patients and the increasing waiting times for home visits in urgent cases. We studied the relationship between the patient's waiting time for a home visit and the distance to the GP cooperative. Further, we investigated if other factors (traffic intensity, home visit intensity, time of day, and degree of urgency) influenced waiting times.

Carpal tunnel syndrome in general practice (1987 and 2001): incidence and the role of occupational and non-occupational factors.

Background: Most studies on the incidence of the carpal tunnel syndrome and the relation of this disorder with occupation are population-based. In this study we present data from general practice.

Aim: To compare incidence rates of carpal tunnel syndrome in 1987 with those in 2001, and to study the relationship between carpal tunnel syndrome and occupation.

Striking variations in consultation rates with general practice reveal family influence.

Background: The reasons why patients decide to consult a general practitioner vary enormously. While there may be individual reasons for this variation, the family context has a significant and unique influence upon the frequency of individuals' visits. The objective of this study was to explore which family factors can explain the differences between strikingly high, and correspondingly low, family consultation rates in families with children aged up to 21.

All in the family: headaches and abdominal pain as indicators for consultation patterns in families.

Purpose: Headaches and abdominal pain are examples of minor ailments that are generally self-limiting. We examined the extent to which patterns of visits to family physicians for minor ailments, such as headaches or abdominal pain, cluster within families.

Methods: Using information from the Second Dutch National Survey of General Practice for 96 family practices, we analyzed the visits of families with at least 1 child aged 12 years or younger during a period of 12 months.

The effects of a team-based continuous quality improvement intervention on the management of primary care: a randomised controlled trial.

Aim: To study the effects of a team-based model for continuous quality improvement (CQI) on primary care practice management.

Design Of Study: Randomised controlled trial.

Setting: Twenty-six intervention and 23 control primary care practices in the Netherlands.

Patients evaluate accessibility and nurse telephone consultations in out-of-hours GP care: determinants of a negative evaluation.

Objective: The shift towards large-scale organization of out-of-hours primary healthcare in different western countries has created an important role for the nurse telephone consultation. We explored the association between negative patient evaluation of nurse telephone consultations and characteristics of patients and GP cooperatives.

Methods: A cross-sectional study using postal patient questionnaires sent to patients receiving a nurse telephone consultation from one of 26 GP cooperatives in the Netherlands.

"It can always happen": the impact of urinary incontinence on elderly men and women.

Objective: To determine the impact of urinary incontinence (UI) on the quality of life of the elderly in the general population and to identify factors with the greatest effect.

Design: Qualitative and quantitative analyses of interview data.

Setting: Patients from the nine family practices of the Nijmegen University Research Network.

GPs' attitudes to personal continuity: findings from everyday practice differ from postal surveys.

We conducted a study in which we measured GPs' attitudes towards personal continuity directly after consultations, and identified which factors predicted its perceived importance. Moreover, we related these data to attitudes as measured by a postal survey. GPs varied considerably in their attitudes towards personal continuity.