Patients' ideas, fears and expectations of their coronary risk: barriers for primary prevention.

The application of cardiovascular guidelines and risk tables may be impeded by many barriers. In the present paper, we explored the role of patients in the feasibility of cardiovascular preventive care in general practice. Patient-related barriers were examined by means of a qualitative study.

Impact of spirometry on GPs' diagnostic differentiation and decision-making.

Background: Spirometry is increasingly implemented in general practice, while the ability of general practitioners (GPs) to interpret flow volume curves (F-V curves) has been questioned. Furthermore, the role of spirometry in the GPs decision-making process has barely been studied.

Aim: To compare the achievements of trained GPs in spirometric diagnosis with an expert consensus panel (1) and to assess the influence of spirometry on the GPs decision-making (2).

Health education on self-management and seeking health care in older adults: a randomised trial.

The aim of this randomised trial was to determine the effects of a health education strategy for older adults living at home on GP attendance. The health education comprised a written booklet on five frequently by GP unnoticed, highly prevalent and potentially treatable health problems: hearing impairment, visual impairment, urinary incontinence, depression and Lower Urinary Tract Symptoms (LUTS). The information comprised structured guidance to enhance decision-making on seeking health care by their GP and contained advice on self-management.

Comparing cost effects of two quality strategies to improve test ordering in primary care: a randomized trial.

Objective: To determine the costs and cost reductions of an innovative strategy aimed at improving test ordering routines of primary care physicians, compared with a traditional strategy.

Design: Multicenter randomized controlled trial with randomization at the local primary care physicians group level.

Setting: Primary care: local primary care physicians groups in five regions of the Netherlands with diagnostic centers.

Use of prescribed and non-prescribed medication for dyspepsia.

Objective: To explore patient factors related to the use of prescribed and non-prescribed drugs for dyspepsia in The Netherlands.

Design: Patient survey study.

Setting And Subjects: Questionnaires sent to patients who had a prescription for dyspepsia medication from their general practitioner.

Vaccination of high-risk patients against influenza: impact on primary care contact rates during epidemics. Analysis of routinely collected data.

A general practice (GP) based retrospective cohort study was conducted to assess the effects of influenza vaccination on the primary care contact rate during influenza epidemics. Given the rising workload of family physicians, particularly due to ageing of the population, it is very relevant to know to whether influenza vaccination of high-risk patients reduces the contact rate during epidemics. No effect of vaccination was found on the contact rate of GP during a mild epidemic period.

Assessing the quality of life of adults with chronic respiratory diseases in routine primary care: construction and first validation of the 10-Item Respiratory Illness Questionnaire-monitoring 10 (RIQ-MON10).

Background: As doctors' judgements about the burden of a disease often differ from patients' own assessments a manageable method to incorporate the latter into routine care might support patient-centered decision-making. For this purpose we shortened the 55-Item Quality of Life for Respiratory Illness Questionnaire (QoL-RIQ).

Methods: Secondary analyses of the data of 3 controlled studies (n = 328, 502 and 555).

Variation in test ordering behaviour of GPs: professional or context-related factors?

Objective: The aim of this study was to describe GPs' test ordering behaviour, and to establish professional and context-related determinants of GPs' inclination to order tests.

Methods: A cross-sectional analysis was carried out of 229 GPs in 40 local GP groups from five regions in The Netherlands of the combined number of 19 laboratory and eight imaging tests ordered by GPs, collected from five regional diagnostic centres. In a multivariable multilevel regression analysis, these data were linked with survey data on professional characteristics such as knowledge about and attitude towards test ordering, and with data on context-related factors such as practice type or experience with feedback on test ordering data.

Attitudes and managing alcohol problems in general practice: an interaction analysis based on findings from a WHO collaborative study.

Aims: To determine if GPs' attitudes towards working with drinkers moderated the impact that training and support had on screening and brief intervention activity in routine practice.

Methods: Subjects were 340 GPs from four countries who were part of a World Health Organization randomized controlled trial to evaluate the effectiveness of training and support in increasing screening and brief alcohol intervention. GPs' self-reported attitudes towards working with drinkers were measured with the Shortened Alcohol and Alcohol Problems Perception Questionnaire.

The effect of a distance-learning programme on patient self-management of Lower Urinary Tract Symptoms (LUTS) in general practice: a randomised controlled trial.

Objective: To determine whether a distance-learning programme on LUTS provided to the general practitioner affected patient self-management.

Methods: A randomised trial was performed to examine the effects of the distance-learning programme (an educational package for the GP and a patient information leaflet) compared with written guidelines on LUTS mailed to the GP. In 63 general practices (32 intervention and 31 control) across the Netherlands all patients older than 50 years presenting LUTS for the first time were invited to participate.

Patients and nurses determine variation in adherence to guidelines at Dutch hospitals more than internists or settings.

Aims: To measure adherence to recently developed diabetes guidelines at Dutch hospital outpatient clinics and distinguish determinants for variations in care on hospital, internist and patient levels.

Methods: Thirteen general hospitals with 58 internists recruited 1950 diabetic patients. Data were extracted from medical files (n = 1915) and from patient questionnaires (n = 1465).

Engaging general practitioners in the management of hazardous and harmful alcohol consumption: results of a meta-analysis.

Objective: A systematic review was undertaken of studies that test the effectiveness of different strategies used to increase general practitioners' rates of screening for and giving advice about hazardous and harmful alcohol consumption.

Method: Resources were MEDLINE, EMBASE, Cinahl and the Cochrane Library (1966-2001). Inclusion criteria were those of the Effective Practice and Organisation of Care Group of the Cochrane Collaboration.

GPs' views on involvement of older patients: an European qualitative study.

Involvement of older patients in general practice care is regarded as important, but is not widespread. To determine specific barriers to the involvement of older patients in general practice care and to identify variations between countries, we performed an international comparative study based on qualitative interviews with 233 general practitioners (GPs) in 11 countries. Most GPs thought that involving older patients had positive outcomes.

Patient-directed strategy to reduce prescribing for patients with dyspepsia in general practice: a randomized trial.

Background: The percentage of patients receiving long-term treatment with acid suppressive drugs, mainly proton pump inhibitors, is higher than the prevalence of diseases that are commonly accepted as the proper indication for long-term proton pump inhibitor use.

Aim: To evaluate whether a patient-directed intervention (direct mail) reduced the prescription of antisecretory medication for dyspepsia in general practice.

Methods: A cluster-randomized trial was performed.

Impact of nurse practitioners on workload of general practitioners: randomised controlled trial.

Objective: To examine the impact on general practitioners' workload of adding nurse practitioners to the general practice team.

Design: Randomised controlled trial with measurements before and after the introduction of nurse practitioners.

Setting: 34 general practices in a southern region of the Netherlands.

What drives change? Barriers to and incentives for achieving evidence-based practice.

To bridge the gap between scientific evidence and patient care we need an in-depth understanding of the barriers and incentives to achieving change in practice. Various theories and models for change point to a multitude of factors that may affect the successful implementation of evidence. However, the evidence for their value in the field is still limited.

Which are the best instruments for measuring disabilities in gait and gait-related activities in patients with rheumatic disorders.

Objectives: Our first objective was to make an inventory of available instruments for the assessment of disabilities in gait and related activities in patients with rheumatic disorders. Our second aim was to investigate which of these instruments have acceptable methodological quality with regard to reliability and validity. Our third aim was to investigate the assumption that the evaluation of convergent construct validity results in stronger correlations when validated against a more similar construct.

How can we increase the involvement of primary health care in the treatment of tobacco dependence? A meta-analysis.

Aims: A systematic review of studies testing the effectiveness of educational and practice base strategies to increase the involvement of primary health-care practitioners in the treatment of tobacco dependence.

Data Sources: MEDLINE, EMBASE, CINAHL and the Cochrane Library (1966-2001). Selection criteria included studies that used randomized or controlled clinical designs, controlled before and after trials and interrupted time-series designs and that presented objective and interpretable measures of practitioners' behaviour and biochemically verified patient quit rates.

Perceptions of cardiovascular risk among patients with hypertension or diabetes.

We aimed to examine risk perceptions among patients at moderate to high cardiovascular risk. A questionnaire about perceived absolute risk of myocardial infarction and stroke was sent to 2424 patients with hypertension or diabetes. Response rate was 86.

The influence of providing a clinical practice guideline on dental students' decision making.

The aim of this study was to assess the effect of the provision of a clinical practice guideline (CPG) on dental students' decisions to remove asymptomatic, impacted lower third molars. All dental students, who in 2001 were in the 3rd, 4th or 5th (final) year of their study at the Nijmegen College of Dental Sciences, were invited to participate. A pre-test-post-test control group design was used.

Literature review of evidence based physiotherapy in patients with facial nerve paresis.

A variety of physiotherapeutic approaches have been tried out during the past 25 years to alleviate the plight of patients with peripheral facial nerve paresis. The objective of this review was to assess the effectiveness of physiotherapy in patients with facial nerve paresis. Trials were identified by computerised searches of biomedical databases, reference lists, and by contacting investigators.

Communication at the interface: do better referral letters produce better consultant replies?

A study of the quality of 637 referral letters from general practitioners (GPs) and corresponding reply letters from medical specialists showed that both types of letters can be improved, and that specific requests by GPs were addressed explicitly by the specialists in only a limited number of cases. Better referral letters resulted only partly in better reply letters. A letter is considered to be of higher quality when a specialist commences a letter with a reference to the specific request by the GP.

Attitudes and management of alcohol problems in general practice: descriptive analysis based on findings of a World Health Organization international collaborative survey.

Aims: To determine if general practitioners' (GPs) experience of education on alcohol, support in their working environment for intervening with alcohol problems, and their attitudes have an impact on the number of patients they manage with alcohol problems.

Methods: 1300 GPs from nine countries were surveyed with a postal questionnaire as part of a World Health Organization (WHO) collaborative study.

Results: GPs who received more education on alcohol (OR = 1.

The effect of small peer group continuous quality improvement on the clinical practice of midwives in The Netherlands.

Objective: To study the effects of small group continuous quality improvement (CQI) on the clinical practice of midwives in the Netherlands.

Design: Randomised pre-/post-test (balanced block).

Intervention: The CQI groups were assigned to either the set of peer review topics including 'perineal repair' and 'artificial rupture of the membranes (ARM)', or to the set of topics including 'airway aspiration' and 'measuring blood pressure'.

Patient involvement in general practice care: a pragmatic framework.

This paper presents a pragmatic framework to guide decisions on involving people in general practice care. Patient involvement may be defined as: enabling patients to take an active role in deciding about and planning their healthcare. It can be located at different levels of care, including the patient-clinician contact or episode of care, and the patient population served by a care provider, or the regional or national population.