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Item does not contain fulltext OBJECTIVE: We introduced a stepped-care strategy (SCS) for hip and knee osteoarthritis, focusing on delivery of high-quality stepped care. In this study, we aimed to identify factors associated with various steps of the SCS. METHODS: We used data from a 2-year observational prospective cohort study, including 313 patients visiting their general practitioner (GP) with a new episode of hip/knee osteoarthritis. We used logistic multilevel analyses to identify factors at the level of the patient, the GP, and the general practice, related to treatment limited to primary care, referral to nonsurgical secondary care, or surgical procedures. RESULTS: Patients whose treatment had been limited to primary care tended to function physically better (odds ratio [OR] 1.03). Furthermore, they less often received exercise therapy (OR 0.46), intraarticular injections (OR 0.08), and radiologic assessments (OR 0.06). Continuation of nonsurgical care after referral was more likely in employed patients (OR 2.90) and patients who had no exercise therapy (OR 0.19) or nonsteroidal antiinflammatory drugs (OR 0.35). Surgically treated patients more often received exercise therapy (OR 7.42). Referral and surgical treatment depended only to a limited extent on the GP or the general practice. CONCLUSION: After implementation of the SCS in primary care, the performance of exercise therapy, rather than disease severity or psychologic factors, seems to play a key role in the decision whether or not to refer for surgical or nonsurgical treatment in secondary care. To optimize patient-tailored treatment, future research should be adressed to determine the optimal moment of switching from primary to secondary care in patients with hip/knee osteoarthritis.

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Contains fulltext : 52424.pdf (Publisher’s version ) (Closed access) BACKGROUND: This study aims to examine the impact of women's characteristics (demographics, risk behaviour, and beliefs) on the uptake of cervical cancer screening, taking practice characteristics (demographic and organizational) into account. METHODS: Routinely collected data of screening status were sampled from electronic medical records of 32 Dutch general practices. Additionally, a questionnaire was sent to a sample of 2224 listed women-1204 screened, 1020 unscreened. We used a step-by-step, logistic, multilevel approach to examine determinants of the screening uptake. RESULTS: Analyses of data for 1392 women (968 screened and 424 unscreened) showed that women's beliefs about cervical screening and attendance are the best predictors of screening uptake, even when demographic and organizational aspects are taken into account. Women aged 40-50 years who felt high personal moral obligation, who had only one sexual partner ever, and who were invited and reminded by their own general practice had the greatest likelihood of screening uptake. A non-response study was performed; the non-responders to the questionnaire (mainly unscreened) thought they had less risk of cervical cancer, were less motivated, less often intended to get future screening, and were more convinced that cervical cancer cannot be cured. CONCLUSION: To improve the uptake rate, we should focus on the personal moral obligation of eligible women, beliefs about the risks of cervical cancer, and available cures. Invitations and reminders within general practices enhance the uptake rate.

Contains fulltext : 52489.pdf ( ) (Open Access) BACKGROUND: The continuity of care is one of the cornerstones of general practice. General practitioners find personal relationships with their patients important as they enable them to provide a higher quality of care. A long-lasting relationship with patients is assumed to be a prior condition for attaining this high quality. We studied the differences in use of care between recently enlisted patients and those patients who have been enlisted for a longer period. METHODS: 104 general practices in the Netherlands participated the study. We performed a retrospective cohort study in which patients who have been enlisted for less than 1 year (n = 10,102) were matched for age, sex and health insurance with patients who have been enlisted for longer in the same general practice. The two cohorts were compared with regard to the number of contacts with the general practice, diagnoses, rate of prescribing, and the referral rate in a year. These variables were chosen as indicators of differences in the use of care. RESULTS: In the year following their enlistment, a higher percentage of recently enlisted patients had at least one contact with the practice, received a prescription or was referred. They also had a higher probability of receiving a prescription for an antibiotic. Furthermore, they had a higher mean number of contacts and referrals, but not a higher mean number of prescriptions. CONCLUSION: Recently enlisted patients used more health care resources in the first year after their enlistment compared to patients enlisted longer. This could not be explained by differences in health.

Item does not contain fulltext OBJECTIVE: To investigate the six-month recommended follow-up after mass screening of Pap smears because of the absence of endocervical columnar cells (ECC-) or ECC+ smears with atypical squamous or glandular cells of undetermined origin (ASCUS/AGUS) or low-grade squamous or glandular intraepithelial lesions (LSIL/LGIL) in a Dutch mass screening cervical cancer programme. METHODS: Data were extracted from computerised medical records of national representative Dutch general practices. We have studied the attendance at and the outcome of the subsequent Pap smears after a 6-month recommendation. RESULTS: The six-month follow-up was linked to 8.7% of the Pap smears (n = 1,002); 77.6% were without endocervical columnar cells (ECC-). Clear differences were found between the follow-up of ECC+ and ECC- smears; after 36 weeks of follow-up of 43.5% the women had an ECC- smear and 66.9% had other conditions. For initial ECC- Pap smears, 84.1% had no abnormalities in the subsequent Pap smear; for initial ECC+ Pap smears, in about 64% of the cases no abnormalities were found (p < 0.0001). CONCLUSIONS: Repeating ECC- smears has a low follow-up rate but also lacks evidence-based necessity. However, for the other 6-month recommended Pap smears, one in five women had still not responded within one year, so improvement is necessary.

Contains fulltext : 59136.pdf (Publisher’s version ) (Closed access) 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. During a 'normal' influenza epidemic, the workload was reduced through fewer contacts by patients with cardiovascular or diabetic diseases. Epidemic periods severe enough to show contact rate reduction occurred approximately every other year.

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Contains fulltext : 221858.pdf (Publisher’s version ) (Open Access) The working hours of general practitioners (GPs) play a central role in analysing their workload and to enable health workforce planning. Triggered by signals of Dutch GPs experiencing an irresponsible workload, it has become increasingly important to objectively measure their actual workload in terms of time-use during a working week. In this research of Daniël van Hassel, an innovative time-use measurement tool based on SMS text messaging was applied among more than 1,000 GPs. The assessment shows that this tool has many advantages over other methods of time-use measurement. It implies minimal burdening for GPs, provide nearly real time responses and avoids recall bias. In addition, it was found that the working hours of Dutch GPs differ in particular by gender, regardless their age and employment position. Another result is that the image of a higher workload in rural practices does not completely match the working hours of GPs in these areas. Radboud University, 09 september 2020 Promotores : Batenburg, R.S., Bakker, D.H. de Co-promotor : Velden, L.F.J. van der 224 p.

Contains fulltext : 80774.pdf (Publisher’s version ) (Open Access) RU Radboud Universiteit Nijmegen, 08 januari 2009 Promotores : Vries Robbe, P.F. de, Zielhuis, G.A. Co-promotor : Bakker, D.H. de 163 p.

Contains fulltext : 49122.pdf (Publisher’s version ) (Open Access) RU Radboud Universiteit Nijmegen, 30 november 2005 Promotores : Grol, R.P.T.M., Groenewegen, P.P. Co-promotores : Braspenning, J.C.C., Bakker, D.H. de 166 p.