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Background Low socioeconomic position (SEP) is related to higher healthcare use in out-of-hours primary care services (OPCSs). We aimed to determine whether inequalities persist when taking the generally poorer health status of socioeconomically vulnerable individuals into account. To put OPCS use in perspective, this was compared with healthcare use in daytime general practice (DGP). Methods Electronic health record (EHR) data of 988 040 patients in 2017 (251 DGPs, 27 OPCSs) from Nivel Primary Care Database were linked to socio-demographic data (Statistics, The Netherlands). We analyzed associations of OPCS and DGP use with SEP (operationalized as patient household income) using multilevel logistic regression. We controlled for demographic characteristics and the presence of chronic diseases. We additionally stratified for chronic disease groups. Results An income gradient was observed for OPCS use, with higher probabilities within each lower income group [lowest income, reference highest income group: odds ratio (OR) = 1.48, 95% confidence interval (CI): 1.45–1.51]. Income inequalities in DGP use were considerably smaller (lowest income: OR = 1.17, 95% CI: 1.15–1.19). Inequalities in OPCS were more substantial among patients with chronic diseases (e.g. cardiovascular disease lowest income: OR = 1.60, 95% CI: 1.53–1.67). The inequalities in DGP use among patients with chronic diseases were similar to the inequalities in the total population. Conclusions Higher OPCS use suggests that chronically ill patients with lower income had additional healthcare needs that have not been met elsewhere. Our findings fuel the debate how to facilitate adequate primary healthcare in DGP and prevent vulnerable patients from OPCS use.

Background Falls are an important health threat among frail older people. GPs are often the first to contact for health issues and therefore they can be seen as the designated professional to offer fall prevention. At the moment, it is unknown what GPs in the Netherlands exactly do regarding fall prevention. This study aims to describe what GPs in the Netherlands do during daily practice in regards to fall prevention. Methods Thirty-four GP practices located throughout the Netherlands were followed for a period of 12 months. When a GP entered specific ICPC-codes related to frailty and falls in the Hospital Information System, the GP received a pop-up with the question “Is this patient frail?”. If according to the GP the patient was frail, the GP subsequently completed a short questionnaire. Results About 65 GPs completed 1396 questionnaires. More than half (n = 726) of the patients had experienced a fall in the previous year and/or had a fear of falling (FOF). Of 276 patients, GPs did not know if they had experienced a fall and of 408 patients if they had a FOF. Of the patients that had experienced a fall in the previous year and/or had a FOF, 37% received fall preventive care. Reasons for not offering such care were i) GP and patient did not think that the patient had a high fall risk (38%), ii) the patient finds treatment too intensive or too much of a hassle (21%) and iii) the patient was not convinced (s)he had a high fall risk and so treatment was not necessary (12%). The three most often treated underlying causes were mobility problems, FOF and cardiovascular risk factors. Conclusions The results show that GPs are not always aware of a patient's fall history or FOF and that only part of the patients that had experienced a fall and/or had a FOF receives fall preventive care. Hence, it is important to develop and implement strategies for GP practices to systematically screen for fall risk and to offer fall preventive care to reduce falls among frail older people. Key messages Thirty-seven percent of the frail older people that experienced a fall in the previous year and/or had a fear of falling, received fall preventive care. The three most treated underlying causes are mobility problems, fear of falling, cardiovascular factors.

Background Falls are a major problem among older people. Healthcare professionals are often unaware of the high fall risk of their patients because systematic screening does not take place. In the primary care setting systematic implementation of fall risk screening and referral to fall prevention interventions is lacking. This study aims to evaluate the implementation of a systematic and targeted fall risk screening among independently living frail older people in the primary care setting. Methods The implementation strategy used in this study consists of the provision of tools to screen for fall risk and identify the underlying causes, and services by physio- and exercise therapists who offer evidence-based interventions. The Theoretical Domains Framework of Huijg et al., (2014) is applied to identify barriers and facilitators of the implementation process. Online focus groups and informal interviews are conducted with the healthcare professionals involved. Preliminary results Participating GPs, practice nurses and district nurses acknowledged that fall prevention is part of their job, meaningful, and that they have the knowledge and skills to offer fall prevention. They also highlighted that the underlying causes of falls differ across patients, so personalized care is required. Experienced barriers are the complexity of diagnosing and treating high fall risk adequately versus lack of time, limited reimbursement, and patient's shame or limited motivation. Experienced facilitators are a good professional network, collaboration between GP practices and homecare providers, a motivated practice nurse, and adequate communication and support within the GP practice. Conclusions Identifying main barriers and facilitators offers opportunities for improving systematic fall prevention for older people. Hence, fall prevention can become more structurally available, reducing a major threat for the quality of life of older people living independently. Key messages Primary care professionals acknowledged systematic screening and fall prevention as meaningful and part of their job. Main facilitators are a good network of professionals, a motivated practice nurse, and adequate communication and support within the GP practice.

Background Little is known about the public health impact of chronic exposure to physical and social stressors in the human environment. Objective of this study was to investigate the immediate and long-term health effects of living in an environment with gas-mining induced earthquakes and related stressors in the Netherlands. Methods Data on psychological, somatic and social problems recorded routinely in electronic health records by general practitioners during a 6-year period (2010–2015) were combined with socioeconomic status and seismicity data. To assess immediate health effects of exposure to ML≥1.5 earthquakes, relative risk ratios were calculated for patients in the week of an earthquake and the week afterwards, and compared to the week before the earthquake. To analyse long-term health effects, relative risks of different groups, adjusted for age, sex and socioeconomic status, were computed per year and compared. Results Apart from an increase in suicidality, few immediate health changes were found in an earthquake week or week afterwards. Generally, the prevalence of health problems was higher in the mining province in the first years, but dropped to levels equal to or even below the control group in subsequent years, with lower relative risks observed in more frequently exposed patients. Conclusions From a public health perspective, the findings are fascinating. Contrary to our expectation, health problems presented in general practice in the earthquake province decreased during the study period. More frequently exposed populations reported fewer health issues to general practitioners, which might point at health adaptation to chronic exposure to stressors.