Stepwise treatment of uncontrolled HyperTensioN (Stepwise-HTN): Study design of a cluster randomised controlled trial in primary care.

Background: Uncontrolled hypertension is a major health problem, and a key risk factor for cardiovascular disease. Most patients are detected and managed in primary care, but approximately 50% remains uncontrolled. Our aim is to assess whether a guided stepwise work-up management strategy for patients with uncontrolled hypertension in primary care would result in better blood pressure control in these patients compared to usual care.

Cardiovascular risk screening of patients with serious mental illness or use of antipsychotics in family practice.

Background: Patients with serious mental illness (SMI) and patients on antipsychotics (AP) have an elevated risk for cardiovascular diseases. In the Netherlands, the mental healthcare for these patients is increasingly taken care of by family practitioners (FP) as a result of a shift from secondary to primary care. Therefore, it is essential to increase our knowledge regarding the characteristics of this patient group and the (somatic) care provided by their FPs.

Heart failure in primary care: prevalence related to age and comorbidity.

Background: Diagnosing heart failure (HF) in primary care can be challenging, especially in elderly patients with comorbidities. Insight in the prevalence, age, comorbidity and routine practice of diagnosing HF in general practice may improve the process of diagnosing HF.

Aim: To examine the prevalence of HF in relation to ageing and comorbidities, and routine practice of diagnosing HF in general practice.

What Patients with Mild-to-Moderate Kidney Disease Know, Think, and Feel about Their Disease: An In-Depth Interview Study.

Introduction: It is unknown what patients in primary care with mild-to-moderate chronic kidney disease (CKD) know, think, and feel about their diagnoses and how they value the information provided. The aim of the study was to explore their knowledge, thoughts, and experiences concerning their CKD and the information given to them.

Method: Qualitative interview study with patients with mild-to-moderate CKD who know their diagnoses and are treated mainly by family physicians.

General practitioners' perspectives on management of early-stage chronic kidney disease: a focus group study.

Background: Guideline adherence in chronic kidney disease management is low, despite guideline implementation initiatives. Knowing general practitioners' (GPs') perspectives of management of early-stage chronic kidney disease (CKD) and the applicability of the national interdisciplinary guideline could support strategies to improve quality of care.

Method: Qualitative focus group study with 27 GPs in the Netherlands.

Is the plasma aldosterone-to-renin ratio associated with blood pressure response to treatment in general practice?

Background: Individualized antihypertensive treatment based on specific biomarkers such as renin may lead to more effective blood pressure control in patients with newly diagnosed essential hypertension. Recent studies suggested that the plasma aldosterone-to-renin ratio (ARR) may also be a candidate predictor for this purpose.

Objective: To assess whether the ARR is associated with the blood pressure response to antihypertensive treatment in patients with newly diagnosed hypertension.

Adherence to chronic kidney disease guidelines in primary care patients is associated with comorbidity.

Background: GPs insufficiently follow guidelines regarding consultation and referral for chronic kidney disease (CKD).

Objective: To identify patient characteristics and quality of care (QoC) in CKD patients with whom consultation and referral recommendations were not followed.

Method: A 14 month prospective observational cohort study of primary care patients with CKD stage 3-5.

Web-based consultation between general practitioners and nephrologists: a cluster randomized controlled trial.

Background: Consultation of a nephrologist is important in aligning care for patients with chronic kidney disease (CKD) at the primary-secondary care interface. However, current consultation methods come with practical difficulties that can lead to postponed consultation or patient referral instead.

Objective: This study aimed to investigate whether a web-based consultation platform, telenephrology, led to a lower referral rate of indicated patients.

Quality of chronic kidney disease management in primary care: a retrospective study.

Background: Early detection and appropriate management of chronic kidney disease (CKD) in primary care are essential to reduce morbidity and mortality.

Aim: To assess the quality of care (QoC) of CKD in primary healthcare in relation to patient and practice characteristics in order to tailor improvement strategies.

Design And Setting: Retrospective study using data between 2008 and 2011 from 47 general practices (207 469 patients of whom 162 562 were adults).

[Timely referral for predialysis; multiple players in the field].

Timely referral is essential in patients with end-stage renal disease. Time is needed to inform the patient on the options of dialysis or kidney transplantation and for the placement of arteriovenous fistulae if haemodialysis is indicated; early referral is associated with lower morbidity and mortality. A prerequisite for timely referral is that patients with chronic kidney disease are recognised, which involves the following factors: chronic kidney disease should be mentioned in the patient's history; the patient should be informed of the diagnosis; and patients, general practitioners, pharmacists and specialists should have knowledge of the risk factors for acute-on-chronic kidney disease.

Exploring the impact of chronic obstructive pulmonary disease (COPD) on diabetes control in diabetes patients: a prospective observational study in general practice.

Background: Little is known about the association between COPD and diabetes control parameters.

Aims: To explore the association between comorbid COPD and longitudinal glycaemic control (HbA1C) and systolic blood pressure (SBP) in a primary care cohort of diabetes patients.

Methods: This is a prospective cohort study of type 2 diabetes patients in the Netherlands.

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.

Liraglutide reverses pronounced insulin-associated weight gain, improves glycaemic control and decreases insulin dose in patients with type 2 diabetes: a 26 week, randomised clinical trial (ELEGANT).

Aims/hypothesis: The best treatment strategy for a patient with type 2 diabetes who shows pronounced weight gain after the introduction of insulin treatment is unclear. We determined whether addition of a glucagon-like peptide-1 (GLP-1) analogue could reverse pronounced insulin-associated weight gain while maintaining glycaemic control, and compared this with the most practised strategy, continuation and intensification of standard insulin therapy.

Methods: In a 26-week, randomised controlled trial (ELEGANT), conducted in the outpatient departments of one academic and one large non-academic teaching hospital in the Netherlands, adult patients with type 2 diabetes with ≥ 4% weight gain during short-term (≤ 16 months) insulin therapy received either open-label addition of liraglutide 1.

Effect of shared care on blood pressure in patients with chronic kidney disease: a cluster randomised controlled trial.

Background: Chronic kidney disease (CKD) is highly prevalent in patients with diabetes or hypertension in primary care. A shared care model could improve quality of care in these patients

Aim: To assess the effect of a shared care model in managing patients with CKD who also have diabetes or hypertension. Design and setting A cluster randomised controlled trial in nine general practices in The Netherlands.

Impact on cardiovascular risk follow-up from a shift to the CKD-EPI formula for eGFR reporting: a cross-sectional population-based primary care study.

Objective: To assess the impact on cardiovascular risk factor management in primary care by the introduction of chronic kidney disease epidemiological collaboration (CKD-EPI) for estimated-glomerular filtration rate (eGFR) reporting.

Design And Setting: Cross-sectional study of routine healthcare provision in 47 primary care practices in The Netherlands with Modification of Diet and Renal Disease Study eGFR reporting.

Methods: eGFR values were recalculated using CKD-EPI in patients with available creatine tests.

Initial implementation of a web-based consultation process for patients with chronic kidney disease.

Purpose: A Web-based consultation system (telenephrology) enables family physicians to consult a nephrologist about a patient with chronic kidney disease. Relevant data are exported from the patient's electronic file to a protected digital environment from which advice can be formulated by the nephrologist. The primary purpose of this study was to assess the potential of telenephrology to reduce in-person referrals.

Patients' and partners' illness perceptions in screen-detected versus clinically diagnosed type 2 diabetes: partners matter!

Background: In type 2 diabetes, educational interventions that target differences between patients' and partners' illness perceptions have been advocated.

Objective: To investigate how the route to diagnosis of type 2 diabetes (through screening versus clinical symptoms) affects illness perceptions of patients and their partners.

Methods: In a cross-sectional study, we enrolled patients aged 40-75 years from general practices in the Netherlands with a new diagnosis of type 2 diabetes (≤3 years), detected by either screening (n = 77) or clinical symptoms (n = 32).

Vascular outcomes in patients with screen-detected or clinically diagnosed type 2 diabetes: Diabscreen study follow-up.

Purpose: Screening guidelines for type 2 diabetes recommend targeting high-risk individuals. Our objective was to assess whether diagnosis of type 2 diabetes based on opportunistic targeted screening results in lower vascular event rates compared with diagnosis on the basis of clinical signs or symptoms.

Methods: In a prospective, nonrandomized, observational study, we enrolled patients aged 45 to 75 years from 10 family practices in the Netherlands with a new diagnosis of type 2 diabetes, detected either by (1) opportunistic targeted screening (n = 359) or (2) clinical signs or symptoms (n = 206).

A pharmacy medication alert system based on renal function in older patients.

Background: Patients with diabetes or cardiovascular disease are at risk of reduced renal function and frequently use drugs that interact with renal function. GPs monitor renal function in these patients. Computerised prescription systems produce alerts in patients labelled as having chronic kidney disease, but alerts are often ignored.

Structuring and validating a cost-effectiveness model of primary asthma prevention amongst children.

Background: Given the rising number of asthma cases and the increasing costs of health care, prevention may be the best cure. Decisions regarding the implementation of prevention programmes in general and choosing between unifaceted and multifaceted strategies in particular are urgently needed. Existing trials on the primary prevention of asthma are, however, insufficient on their own to inform the decision of stakeholders regarding the cost-effectiveness of such prevention strategies.

[Acute renal failure due to RAAS-inhibitors combined with dehydration].

Two men (61 and 81 years old) with mild impaired kidney function developed acute renal failure due to dehydration combined with the use of inhibitors of the renin-angiotensin-aldosterone system (RAAS). After rehydration, correction of hyperkalaemia and stopping RAAS-inhibition and diuretics, they recovered completely. Many patients using RAAS-inhibitors have impaired renal function.

Yield of opportunistic targeted screening for type 2 diabetes in primary care: the diabscreen study.

Purpose: In screening for type 2 diabetes, guidelines recommend targeting high-risk individuals. Our objectives were to assess the yield of opportunistic targeted screening for type 2 diabetes in primary care and to assess the diagnostic value of various risk factors.

Methods: In 11 family practices (total practice population = 49,229) in The Netherlands, we conducted a stepwise opportunistic screening program among patients aged 45 to 75 years by (1) identifying high-risk individuals (=1 diabetes risk factor) and low-risk individuals using the electronic medical record, (2) obtaining a capillary fasting plasma glucose measurement, repeated on a separate day if the value was greater than 110 mg/dL, and (3) obtaining a venous sample if both capillary fasting plasma glucose values were greater than 110 mg/dL and at least 1 sample was 126 mg/dL or greater.

Screening for type 2 diabetes in primary care using a stepwise protocol: the Diabscreen study.

Aim: To evaluate a stepwise protocol in opportunistic screening for type 2 diabetes.

Methods: From 2000 to 2001, in 11 Dutch general practices (n=49,229) we invited at-risk patients during usual care for a capillary fasting plasma glucose (cFPG1) measurement. If >6.