Effectiveness of case management among older adults with early symptoms of dementia and their primary informal caregivers: a randomized clinical trial.

Background: It is believed that timely recognition and diagnosis of dementia is a pre-condition for improving care for both older adults with dementia and their informal caregivers. However, diagnosing dementia often occurs late in the disease. This means that a significant number of patients with early symptoms of dementia and their informal caregivers may lack appropriate care.

Evaluating primary care research networks: a review of currently available tools.

Background: An increasing number of primary care research networks (PCRNs) are being developed around the world. Despite the fact that they have existed for a long time in some countries, little is known about what they have actually achieved. There is an ongoing debate in the literature about the appropriate framework for the evaluation of PCRNs.

Training GP's to use a minimal intervention for stress-related mental disorders with sick leave (MISS): Effects on performance: Results of the MISS project; a cluster-randomised controlled trial [ISRCTN43779641].

Objective: To study the effects of a brief patient-stress management training on the performance of general practitioners (GPs).

Methods: After training in the Minimal Intervention for Stress-related mental disorders with Sick leave (MISS), the performance of 24 GPs was compared with the usual care provided by 22 GPs. Outcome measures in this intervention were: assignment of a diagnosis, taking an activating approach and monitoring the symptoms.

Cost-effectiveness of a minimal intervention for stress-related sick leave in general practice: results of an economic evaluation alongside a pragmatic randomised control trial.

Background: Stress-related mental health problems negatively impact quality of life and productivity. Worldwide, treatment is often sought in primary care. Our objective was to determine whether a general practitioner-based minimal intervention for workers with stress-related sick leave (MISS) was cost-effective compared to usual care (UC).

Test-retest reliability of the PRIME-MD: limitations in diagnosing mental disorders in primary care.

Background: The primary care evaluation of mental disorders (PRIME-MD) can be seen as characteristic for successive refinements of criteria and structured interview techniques for diagnosing psychiatric disorders in primary care. It is one of the most widely used instruments, but there is no evidence to support its test-retest reliability.

Methods: With 1-week intervals between interviews, a test-retest study of the PRIME-MD was conducted in a general practice population of 100 distressed patients (20- to 60-years old) who were on sick leave.

Self-reports on the IQCODE in older adults: a psychometric evaluation.

The Informant Questionnaire on Cognitive Decline (IQCODE) has been successful in identifying demented persons in a general population. In this study, this questionnaire was used as a self-report screening for dementia symptoms. The object was to investigate the feasibility, homogeneity, and construct validity of self-reports on the IQCODE.

Are psychological treatments for depression in primary care cost-effective?

Background: Depression is a highly prevalent condition that is associated with high levels of work absenteeism and high health care costs. Most patients are treated in primary care. A large group of patients prefers psychological treatments to antidepressants.

Cost-effectiveness of usual general practitioner care with or without antidepressant medication for patients with minor or mild-major depression.

Background: Minor depression is common in primary care and associated with increased health care costs. Many mildly depressed patients are prescribed antidepressants, although there is insufficient information on the cost-effectiveness of antidepressants for these patients. The objective of this study was to evaluate whether usual care without antidepressants is equivalent to (i.

Development and feasibility of a patient feedback programme to improve consultation skills in general practice training.

Objective: To develop an attractive and effective patient feedback training programme for general practice trainees (GPTs).

Methods: First, an exploratory study was conducted in which patients and GPTs were interviewed after they had worked with patient feedback. This contributed to the development of the patient feedback training programme.

Somatic chronic diseases and 6-year change in cognitive functioning among older persons.

The influence of seven highly prevalent somatic chronic diseases on changes in cognitive functioning is investigated in older persons in a prospective design covering a 6-year follow-up period. The data were collected as part of the Longitudinal Aging Study Amsterdam (LASA). The associations between chronic diseases and cognitive functioning during 6 years of follow-up were analyzed among 1358 respondents (age 62-85) using generalized estimated equations (GEE).

Impact of physical symptoms on perceived health in the community.

Objective: Physical symptoms, such as musculoskeletal pain, dizziness, or headache, are common. People with more symptoms are reported to use more healthcare and have higher sickness absenteeism. We studied the impact of the number of symptoms on perceived health in a community sample.

Interdisciplinary cooperation of GPs in palliative care at home: a nationwide survey in The Netherlands.

Objective: To investigate the occurrence and predictors of interdisciplinary cooperation of GPs with other caregivers in palliative care at home.

Design: In a prospective study among 96 general practices, the GPs involved identified all dying patients during the study period of 12 months. The GPs received an additional post-mortem questionnaire for each patient who died during the study period, and registered the healthcare providers with whom they cooperated.

Primary care patients with mental health problems: outcome of a randomised clinical trial.

Background: The prevalence of patients with mental health problems in general practice is high, and at least one-third of these problems last for 6 months or longer. Patients with these problems take up more time during a consultation and attend more frequently.

Aim: This study investigated the effectiveness of problem-solving treatment for primary care patients with mental health problems.

Symptoms in patients receiving palliative care: a study on patient-physician encounters in general practice.

Most people with an incurable disease prefer to stay and die at home, cared for by their general practitioner (GP). This paper aims at describing the prevalence of symptoms in patients receiving palliative care at home. Within the framework of a nation wide survey of general practice in the Netherlands, GPs received a questionnaire for all patients who died within the 1-year survey period to determine whether patients received palliative care (n = 2,194).

Diagnosing dementia with confidence by GPs.

Background: Earlier reports suggest limited clinical reasoning and substantial uncertainty of GPs in assessing patients suspected of dementia.

Objective: To explore the predictors of GPs to decide on the presence and absence of dementia as well as the predictors of diagnostic confidence of GPs.

Design: An observational study was set up among 107 patients of 64 GPs.

Depression in old age (75+), the PIKO study.

Background: Old people (75+) are underrepresented in studies on the prevalence of and risk factors for depression while the number of elderly people suffering from this mood disorder may be considerably higher than previously assumed. The role--if any--of age and gender in 'Geriatric Depression' is still unclear.

Methods: In this community-based study, prevalence of depressive symptomatology and risk indicators were assessed in 2850 participants aged 75 years or more.

Low back pain in general practice: cost-effectiveness of a minimal psychosocial intervention versus usual care.

An intervention that can prevent low back pain (LBP) becoming chronic, may not only prevent great discomfort for patients, but also save substantial costs for the society. Psychosocial factors appear to be of importance in the transition of acute to chronic LBP. The aim of this study was to compare the cost-effectiveness of an intervention aimed at psychosocial factors to usual care in patients with (sub)acute LBP.

Sense of competence questionnaire among informal caregivers of older adults with dementia symptoms: a psychometric evaluation.

Background: The Sense of Competence Questionnaire (SCQ) was originally developed for informal caregivers of patients with diagnosed dementia. In order to study the validity and usefulness of the SCQ when applied to informal caregivers of older adults with dementia symptoms (i.e.

Survey among 78 studies showed that Lasagna's law holds in Dutch primary care research.

Objective: Research in general practice has grown considerably over the past decades, but many projects face problems when recruiting patients. Lasagna's Law states that medical investigators overestimate the number of patients available for a research study. We aimed to assess factors related to success or failure of recruitment in general practice research.

A cluster-randomised trial evaluating an intervention for patients with stress-related mental disorders and sick leave in primary care.

Objective: Mental health problems often affect functioning to such an extent that they result in sick leave. The worldwide reported prevalence of mental health problems in the working population is 10%-18%. In developed countries, mental health problems are one of the main grounds for receiving disability benefits.

The effectiveness of adding cognitive behavioural therapy aimed at changing lifestyle to managed diabetes care for patients with type 2 diabetes: design of a randomised controlled trial.

Background: In patients with type 2 diabetes, the risk for cardiovascular disease is substantial. To achieve a more favourable risk profile, lifestyle changes on diet, physical activity and smoking status are needed. This will involve changes in behaviour, which is difficult to achieve.

Yield of a new method to detect cognitive impairment in general practice.

Objective: To examine whether a new screening method that identified patients with cognitive impairment who needed further examination on the presence of dementia yielded patients who were not detected by their general practitioner (GP), and to identify factors associated with GPs' awareness of patients identified by the screening.

Methods: Cross-sectional comparison between two methods used to identify dementia symptoms: (1) usual identification of dementia by GPs; (2) a two-stage screening to identify cognitive impairment. The two methods were implemented on the same older general practice population.

Depression and anxiety, an indicated prevention (DIP) protocol in homes for the elderly: feasibility and (cost) effectiveness of a stepped care programme.

Background: Depressive and anxiety disorders are a very common, serious and underdetected problem in homes for the elderly. Elderly persons in residential homes are at high risk for developing major depressive and anxiety disorders, and, therefore, deserve attention with regard to prevention.

Methods/design: This protocol describes a randomised trial on the feasibility and (cost) effectiveness of a stepped-care programme for prevention of depressive and anxiety disorders in homes for the elderly.

Nurse-led case management for ambulatory complex patients in general health care: a systematic review.

Objective: The aim of this study was to summarize the available literature on the effectiveness of ambulatory nurse-led case management for complex patients in general health care.

Method: We searched MEDLINE, EMBASE, the Cochrane Controlled Trials Register, and Cinahl. We included randomized controlled trials, controlled clinical trials, controlled before/after study, and time series studies; identified references were screened by two reviewers.

Cost-effectiveness of a nurse-led case management intervention in general medical outpatients compared with usual care: an economic evaluation alongside a randomized controlled trial.

Objective: The objective of this study was to evaluate the cost-effectiveness of a nurse-led, home-based, case-management intervention (NHI) after hospital discharge in addition to usual care.

Methods: Economic evaluation alongside a randomized controlled trial after being discharged home with 24 weeks of follow-up. Patients discharged to their home from a general hospital were randomly assigned to NHI or usual care.