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Background Health checks for cardiometabolic diseases could play a role in the identification of persons at high risk for disease. To improve the uptake of these health checks in primary care, we need to know what barriers and facilitators determine participation.Methods We used an iterative search strategy consisting of three steps: (a) identification of key-articles; (b) systematic literature search in PubMed, Medline and Embase based on keywords; (c) screening of titles and abstracts and subsequently full-text screening. We summarised the results into four categories: characteristics, attitudes, practical reasons and healthcare provider-related factors.Results Thirty-nine studies were included. Attitudes such as wanting to know of cardiometabolic disease risk, feeling responsible for, and concerns about one’s own health were facilitators for participation. Younger age, smoking, low education and attitudes such as not wanting to be, or being, worried about the outcome, low perceived severity or susceptibility, and negative attitude towards health checks or prevention in general were barriers. Furthermore, practical issues such as information and the ease of access to appointments could influence participation.Conclusion Barriers and facilitators to participation in health checks for cardiometabolic diseases were heterogeneous. Hence, it is not possible to develop a ‘one size fits all’ approach to maximise the uptake. For optimal implementation we suggest a multifactorial approach adapted to the national context with special attention to people who might be more difficult to reach. Increasing the uptake of health checks could contribute to identifying the people at risk to be able to start preventive interventions.

Objective.Patients with inflammatory arthritis (IA) have an increased risk of cardiovascular diseases (CVD), suggesting a high rate of CVD-related hospitalizations, but data on this topic are limited. Our study addressed hospital admissions for CVD in a primary care–based population of patients with IA and controls.Methods.All newly diagnosed patients with IA between 2001 and 2010 were selected from electronic medical records of the Netherlands Institute for Health Services Research Primary Care database, representing a national network of general practices. Two control patients matched for age, sex, and practice were selected for each patient with IA. Hospital admission data for all patients was retrieved from the Dutch Hospital Data.Results.There were 2615 patients with IA and 5555 controls included in our study. CVD-related hospital admissions were observed more frequently among patients with IA as compared with control patients: 48% versus 36% (p < 0.001) in a followup period of 4 years. Patients with IA were more often hospitalized because of ischemic heart disease (OR 1.7, 95% CI 1.2–2.2) and for day-care admission because of cerebrovascular disease (OR 2.2, 95% CI 1.0–4.9).Conclusion.Increased hospital admission rates confirm the higher CVD burden among patients with IA compared with controls, and underscore the need for proper CVD risk management in patients with IA.

ObjectiveTo determine the effect of patient exercise adherence within the prescribed physical therapy treatment period and after physical therapy discharge on patient outcomes of pain, physical function, and patient selfperceived effect in individuals with osteoarthritis OA of the hip andor knee.MethodsWe performed a prospective observational followup study in which 150 patients with OA of the hip andor knee receiving exercise therapy were followed for 60 months. Data were obtained from a randomized controlled trial, with assessments at baseline and 3, 15, and 60 months of followup. The association between exercise adherence and patient outcomes of pain, physical function, and selfperceived effect was examined using generalized estimating equations analyses.ResultsAdherence to recommended home exercises and being more physically active were significantly associated with better treatment outcomes of pain, selfreported physical function, physical performance, and selfperceived effect. The association between adherence and outcome was consistent over time. Adherence to home activities was only associated with better selfperceived effect.ConclusionBetter adherence to recommended home exercises as well as being more physically active improves the longterm effectiveness of exercise therapy in patients with OA of the hip andor knee. Both within and after the treatment period, better adherence is associated with better patient outcomes of pain, physical function, and selfperceived effect. Since exercise adherence declines over time, future research should focus on how exercise behavior can be stimulated and maintained in the long term.

Does behavioural graded activity result in better exercise adherence and more physical activity than usual care in people with osteoarthritis of the hip or knee?

There exists limited knowledge regarding the relation between depression and healthcare utilization in stroke patients. The objective of this register-based study was to examine the impact of having preexisting depression at the time of hospital admission for acute stroke on length of hospital stay and discharge destination.

To determine the long‐term effectiveness (≥6 months after treatment) of exercise therapy on pain, physical function, and patient global assessment of effectiveness in patients with osteoarthritis (OA) of the hip and/or knee.We conducted an extensive literature search in PubMed, EMBase, CINAHL, SciSearch, PEDro, and the Cochrane Central Register of Controlled Trials. Both randomized clinical trials and controlled clinical trials on the long‐term effectiveness of exercise therapy were included. The followup assessments were at least 6 months after treatment ended. Methodologic quality was independently assessed by 2 reviewers. Effect estimates were calculated and a best evidence synthesis was performed based on design, methodologic quality, and statistical significance of findings.Five high‐quality and 6 low‐quality randomized clinical trials were included. Strong evidence was found for no long‐term effectiveness on pain and self‐reported physical function, moderate evidence for long‐term effectiveness on patient global assessment of effectiveness, and conflicting evidence for observed physical function. For exercise programs with additional booster sessions, moderate evidence was found for long‐term effectiveness on pain, self‐reported physical function, and observed physical function.The positive posttreatment effects of exercise therapy on pain and physical function in patients with OA of the hip and/or knee are not sustained in the long term. Long‐term effectiveness was only found for patient global assessment of effectiveness. However, additional booster sessions after the treatment period positively influenced maintenance of beneficial posttreatment effects on pain and physical function in the long term.

Objectives: To examine the presentation and pattern of childhood morbidity in general practice compared with 14 years ago.Methods: We used data of all children aged 0–17 years from two cross-sectional surveys performed in 1987 and 2001 in general practice in the Netherlands. The total number of children in the practices participating in these surveys were 86,577 children in 1987 and 82,053 children in 2001. First of all, we compared consultation rates of children in general practice. Secondly, childhood morbidity was assessed by episodes of disease, coded according to the International Classification of Primary Care (ICPC). We compared childhood morbidity in 1987 and 2001 by assessing the distribution of episodes among ICPC chapters stratified by ethnicity, and by comparing incidence rates of most frequently presented diseases.Results: Childhood consultation rates have decreased from 2.7 visits a year per child in 1987 to 2.1 in 2001. The distribution of episodes among ICPC chapters has also changed. Respiratory problems are still the most frequently presented health problem in children but the proportion has decreased from 25.5 in 1987 to 23.3 in 2001. Skin problems were presented more often (23.0 in 2001 versus 17.8 in 1987), and Western children more often presented with skin problems than with respiratory problems in 2001. Incidence rates of most respiratory diseases have decreased and specific skin diseases (dermatomycosis, impetigo and eczema) were diagnosed more often.Conclusion: In the Netherlands, childhood morbidity has changed. Skin diseases have become more important in general practice and respiratory problems are declining.

Background. In many European countries, primary care surveillance networks play a role in public health surveillance. Objectives. To update an inventory of surveillance networks, to describe them and to report on their organization and function in a standardized way. To investigate whether and under what conditions their information can contribute to surveillance at a European level. Methods. Surveillance networks were defined as ‘A network of practices or community based primary care physicians who monitor one or more specific illness problems on a regular and continuing basis’. For the inventory questionnaires were sent out, followed by site visits to seven networks using a standardized audit checklist. Results. We sent out 75 questionnaires and received 57 back (73% response rate), with 33 (58% of responders) fitting our selection criteria. National surveillance networks were identified in 11 countries. Many had an infectious disease surveillance component, particularly for influenza. Most were funded by the Ministry of Health, some by research funds. The median number of general practitioners was 120, comprising a stable group of general practitioners and covering a representative sample of the general population. The frequency of reporting varied from daily to annually, depending on the purpose of the network. Conclusions. A large number of primary care surveillance networks exist in Europe. Their value has been shown with the surveillance of influenza, but the challenge is now to extend their use to other diseases. When fulfilling identical minimal criteria they can provide comparable estimates of morbidity, ultimately leading to improved national and European surveillance.

Background. The main complications of herpes zoster (HZ) are postherpetic neuralgia and, in case of HZ ophthalmicus, eye disorders. Antiviral treatment may modify the course of disease and reduce the risk of complications. Objective. To assess which doctors and patients characteristics were related to prescription of antiviral therapy for HZ. Methods. Ninety general practices (358 008 patients) in The Netherlands registered all patient contacts in a database for one year as part of the Second Dutch National Survey of General Practice. The present study used ICPC code S70 to search that database for patients with a new diagnosis of HZ. The full-text medical records of the selected patients were then reviewed and the potential determinants for the prescription of antiviral drugs (including characteristics of patients, GPs, and practices) analysed using multilevel logistic regression modelling. Results. Of the 1129 patients diagnosed with HZ (incidence 3.2/1000 patients/year), 22.5% received antiviral drugs. Independent determinants for prescription of antiviral therapy were age [45–54 years: adjusted odds ratio (OR) 2.9 (95% CI 1.6–5.0); 55–64 years: OR 4.2 (95% CI 2.4–7.6); 65–74 years: OR 5.1 (95% CI 2.7–9.6); ≥75 years: OR 8.1 (95% CI 4.4–15.1)], ophthalmic localisation of the shingles (OR 3.2, 95% CI 1.6–6.7), and the presence of asthma/COPD (OR 1.6, 95% CI 1.0–2.6). GPs who reported to strongly adhere to professional guidelines prescribe more frequently antiviral drugs (OR 1.9, 95% CI 1.2–3.1). Conclusions. A minority of HZ patients were prescribed antiviral treatment. Increasing age, ophthalmic localisation, presence of asthma/COPD, and adherence to professional guidelines were factors favouring prescription. More information on the determinants of GPs treatment decisions is necessary for successful implementation of HZ guidelines.

&lt;it>Objectives&lt;/it>: The aim of this study was to assess the association between general practitioners' (GPs') characteristics and the volume of second-choice antibiotics for acute respiratory tract (RT) episodes by GPs. &lt;it>Methods&lt;/it>: Morbidity and antibiotic prescription data originated from the Second Dutch National Survey of General Practice (DNSGP-2). GPs' characteristics, including professional activities and views on RT symptoms and antibiotics, were measured by a written questionnaire. Multiple regression was carried out to assess associations between possible determinants and volume of second-choice antibiotic prescriptions. &lt;it>Results&lt;/it>: In ∼39% of acute RT episodes antibiotics were prescribed, with one-quarter being second-choice antibiotics, relatively more frequently in lower than in upper RT episodes: 30 versus 19%. GPs who were more frequently consulted by patients with RT episodes (β &equals; 0.29; 95% CI 0.13–0.41), who labelled RT episodes more as diagnoses than as symptoms (β &equals; 0.27; 95% CI 0.15–0.42), who less frequently used national GP guidelines (β &equals; −0.17; 95% CI −0.31 to −0.03) and who were more inclined to prescribe new drugs (β &equals; 0.26; 95% CI 0.13–0.40), prescribed more second-choice antibiotics. &lt;it>Conclusions&lt;/it>: Given the growing number of prescriptions of second-choice antibiotics, it is important to implement professional guidelines in daily practice, while training in being reluctant to prescribe new drugs and being alert to the marketing activities of pharmaceutical companies should be started in the medical curriculum.

Background. In many European countries, maturity onset diabetes mellitus (DM) is to a large extent managed in general practice. Objective. Our aim was to compare management of DM in general practice in five European countries in order to contribute to international guidelines on the management of DM by GPs. Methods. Routine monitoring of patients presenting with DM was performed during a 12 month period (1999–2000) to GPs in established sentinel practice surveillance networks in five European countries (Belgium, Croatia, England, Spain and The Netherlands). Results were stratified by age and country. Results. The proportion of patients treated by diet only varied from 13% (The Netherlands) to 25% (Spain); diet and oral antidiabetics from 51% (England) to 62% (Belgium); a combination of diet and insulin varied from 15% (Belgium and Croatia) to 26% (The Netherlands); and a combination of diet, oral antidiabetics and insulin was <10% in all countries. In the older age groups, insulin is prescribed most frequently in The Netherlands. Spain and Croatia show high consultation rates for DM; England and The Netherlands show low rates. Referral percentages vary considerably between countries (highest in Croatia). Conclusions. National differences found included the use of insulin in the elderly, the consultation frequency in general practice and the referral rate to ophthalmologist and diabetic specialists. Further quantitative and qualitative studies are needed to explore the needs for support in diabetes management in general practice in Europe.