Can small group education and peer review improve care for patients with asthma/chronic obstructive pulmonary disease?

Objective: To study the effectiveness of an intensive small group education and peer review programme aimed at implementing national guidelines on asthma/chronic obstructive pulmonary disease (COPD) on care provision by general practitioners (GPs) and on patient outcomes.

Design: A randomised experimental study with pre-measurement and post-measurement (after one year) in an experimental group and a control group in Dutch general practice.

Subjects And Intervention: Two groups of GPs were formed and randomised.

Evidence-based implementation of evidence-based medicine.

Background: The slow and haphazard process of translating research findings into clinical practice compromises the potential benefits of clinical research. Most quality improvement (QI) initiatives are based on the beliefs of decision makers rather than on the growing theoretical and empirical knowledge about organizational and provider behavior change. If future QI activities are to improve the translation of evidence into practice, they should be based on an understanding of the different models and strategies for implementing research evidence and the evidence base supporting their use.

Feasibility of a national cholesterol guideline in daily practice. A randomized controlled trial in 20 general practices.

Objective: To evaluate the feasibility and implementation needs of a cholesterol guideline by assessing the effectiveness of simple dissemination as well as extensive implementation of this guideline on actual performance of general practitioners (GPs).

Design: Randomized controlled trial.

Setting And Subjects: Thirty-two Dutch GPs in 20 general practices, 3950 patient records.

Improving population-based cervical cancer screening in general practice: effects of a national strategy.

Objective: To assess the effects of a Dutch national prevention programme, aimed at general practitioners (GPs), on the adherence to organizational guidelines for effective cervical cancer screening in general practice. To identify the characteristics of general practices determining success.

Design: A prospective questionnaire study with pre- and post-measurement (before and 15 months after the introduction of the national programme).

Effect of mailed reminders on the response rate in surveys among patients in general practice.

Randomized trials were performed in Denmark and The Netherlands to determine the effect of mailed reminders on the response rate in surveys among patients in general practice. In both countries, general practitioners handed out questionnaires to 200 adult patients who came to visit them. An intervention group of 100 patients received reminders at 3 weeks after the visit, whereas a control group of the remaining 100 patients did not receive reminders.

General practice care and patients' priorities in Europe: an international comparison.

Insight into patients' priorities with respect to health care should complement the views of professionals and policy makers on what is thought to be appropriate health care. To determine the strengths and weaknesses of general practice care from patients' perspectives written surveys were performed among patients in Denmark, Germany, Israel, Netherlands, Norway, Portugal, Sweden and United Kingdom (n = 3540). The potential quality problems identified were spread over the different countries: the low involvement of general practitioners in out-of-hours services in Portugal; the low provision of routine screening in Sweden, Norway and The Netherlands; the lack of a defined patient population in Germany; the lack of a formal gatekeeper role to secondary care in general practice in Germany and Sweden; and the low number of home visits in Sweden.

Patients' priorities with respect to general practice care: an international comparison. European Task Force on Patient Evaluations of General Practice (EUROPEP).

Background And Objectives: Improving the sensitivity of general practice to patients' needs demands a good understanding of patients' expectations and priorities in care provision. Insight into differences in expectations of patients in different cultures and health care systems may support decision-making on desirable models for care provision in general practice. An international study was conducted to determine priorities of patients in general practice care: which views do patients in different countries have in common and which views differ?

Methods: Written surveys in general practices in the UK, Norway, Sweden, Denmark, The Netherlands, Germany, Portugal and Israel were performed.

Interventions to improve the delivery of preventive services in primary care.

Objectives: This review was conducted to determine the effectiveness of different interventions to improve the delivery of preventive services in primary care.

Methods: MEDLINE searches and manual searches of 21 scientific journals and the Cochrane Effective Professional and Organization of Care of trials were used to identify relevant studies. Randomized controlled trials and controlled before-and-after studies were included if they focused on interventions designed to improve preventive activities by primary care clinicians.

Assessment of management in general practice: validation of a practice visit method.

Background: Practice management (PM) in general practice is as yet ill-defined; a systematic description of its domain, as well as a valid method to assess it, are necessary for research and assessment.

Aim: To develop and validate a method to assess PM of general practitioners (GPs) and practices.

Method: Relevant and potentially discriminating indicators were selected from a systematic framework of 2410 elements of PM to be used in an assessment method (VIP = visit instrument PM).

A systematic review of the literature on patient priorities for general practice care. Part 1: Description of the research domain.

To make health care more responsive to patient needs, insight into patient priorities is needed. A systematic literature review, using electronic and manual searches, was made of studies on patient priorities with regard to primary health care. Data-extraction was performed by two researchers, followed by systematic analyses of study features.

Structure and process: the relationship between practice management and actual clinical performance in general practice.

Objectives: The precise relationship between practice management (structure) and the doctor's actual performance (process) in general practice is tenuous. Analysis of their mutual relationship may yield insight into the way they contribute to outcome and into corresponding assessment procedures.

Method: In a cross-sectional study, consultations of 93 GPs were videotaped in their own practice and assessed by peer-observers on medical performance and on communication with patients, followed by a practice visit by a non-physician observer using a validated Visitation Instrument to assess Practice management and organization (VIP).

Attributes of clinical guidelines that influence use of guidelines in general practice: observational study.

Objective: To determine which attributes of clinical practice guidelines influence the use of guidelines in decision making in clinical practice.

Design: Observational study relating the use of 47 different recommendations from 10 national clinical guidelines to 12 different attributes of clinical guidelines-for example, evidence based, controversial, concrete.

Setting: General practice in the Netherlands.

Which aspects of general practitioners' behaviour determine patients' evaluations of care?

This qualitative study explored those behaviours of a general practitioner which were used by patients in their evaluations of 14 aspects of general practice care. Thirty patients were interviewed immediately after visiting their general practitioner. Interview transcripts were analyzed by two authors, who independently marked general practitioners' behaviours used by patients.

Dissemination of guidelines: which sources do physicians use in order to be informed?

Objective: To gain insight into processes of dissemination of clinical guidelines, sources of information physicians use to become informed about them, and factors influencing these processes.

Design: National survey among a random sample of family physicians using a structured questionnaire.

Setting: Family practice in The Netherlands; evaluation of a national programme of (evidence based) practice guidelines.

Tailored outreach visits as a method for implementing guidelines and improving preventive care.

Objectives: Authors of successful outreach visit studies stress the importance of tailoring the intervention to the unique attributes and needs of each practice. For a better understanding of the outreach visit method, the tailoring mechanism is explored in this article. The variation among practices in preventive outreach visits to implement guidelines and characteristics that determine the variation (baseline adherence to organizational guidelines, practice and visitor characteristics) are described.

Implementing guidelines and innovations in general practice: which interventions are effective?

It is crucial that research findings are implemented in general practice if high-quality care is to be achieved. Multifaceted interventions are usually assumed to be more effective than single interventions, but this hypothesis has yet to be tested for general practice care. This review evaluates the effectiveness of interventions in influencing the implementation of guidelines and adoption of innovations in general practice.

Relationship between practice organization and cardiovascular risk factor recording in general practice.

Background: Research findings suggest that the level of cardiovascular risk factor recording in general practice is not yet optimal. Several studies indicate a relation between the organization of cardiovascular disease prevention at practice level and cardiovascular risk factor recording.

Aim: To explore the relation between the organization of cardiovascular disease prevention and risk factor recording in general practice.

Do general practices adhere to organizational guidelines for effective cervical cancer screening?

Background: Well-organized cervical screening has been shown to be effective in the reduction of both morbidity and mortality from cancer of the uterine cervix. In The Netherlands, the GP plays an important role in the cervical screening. The question is whether the general practices are able to organize an effective cervical cancer screening.

Barriers to preventive care in general practice: the role of organizational and attitudinal factors.

Background: There are numerous barriers to preventive care. In this paper we focus on barriers related to the organization of preventive services and to the general practitioners' (GPs') attitudes and self-efficacy expectations. The prevention of cardiovascular disease was taken as a case study.

What makes a good general practitioner: do patients and doctors have different views?

Background: General practitioners (GPs) are expected to be responsive to patients' expectations, but patients and doctors may have different views on what constitutes good general practice care.

Aim: To elicit areas of controversy as well as areas of mutual agreement between the opinions of patients and GPs with regard to good general practice care.

Method: A questionnaire, distributed to 850 patients and 400 GPs, measured which of 40 aspects of general practice care were given priority.

Predictors of change and continuity in home care for dementia patients.

Objective: To investigate predictors of change in the sense of competence of primary caregivers and continuity in home care for dementia patients.

Design: A prospective longitudinal study with a follow-up period of 10 months.

Setting: Dementia patients living in the community selected by Dutch general practitioners.

The reliability of patients' judgements of care in general practice: how many questions and patients are needed?

Objectives: To estimate the number of questions and patients that are needed to achieve reliable measurements of patients' judgements of care in general practice.

Design: Sensitivity study, using generalisibility theory and real data from surveys of patients.

Subjects: 739 patients with chronic illness from 23 general practitioners in The Netherlands.