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Weesie YM, van Dijk L, Bouvy ML, Hek K. Immediate release fentanyl in general practices: Mostly off-label prescribing. Eur J Gen Pract 2023; 29:2165644. [PMID: 36695153 PMCID: PMC9879195 DOI: 10.1080/13814788.2023.2165644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The immediacy of the onset of opioids may be associated with the risk of dependency and accidental overdose. Nasal and oromucosal fentanyl dosage forms are so called immediate release fentanyl (IRF). These IRFs have been approved to treat breakthrough pain in patients with cancer who are on chronic opioid treatment only. There are signals of increased off-label prescribing of IRFs in general practices. OBJECTIVES This study aims to provide insight into the frequency of IRF prescription in Dutch general practices and the extent to which IRF is prescribed off-label. METHODS Routinely collected electronic health records of general practices (GPs) participating in Nivel Primary Care Database were used. Adult patients with IRF prescriptions in 2019 were selected from whom dispensing data on 2018 and 2019 was available. Diagnoses were recorded by GPs using International Classification of Primary Care. Descriptive analyses were performed. RESULTS This study included 342 GPs with a patient population of 1,297,942 patients, 1,368 patients received at least one IRF prescription in 2019, which is equal to 1.1 patients per 1,000 registered patients. Most patients (74.9%) with an IRF prescription received an off-label prescription. A slight majority had a cancer diagnosis but nearly 65.2% did not have a maintenance therapy and 14% were opioid-naive before receiving their first IRF prescription. CONCLUSION IRFs are not prescribed frequently in Dutch general practices. However, when prescribed, a relatively large portion of patients received an off-label prescription.
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Affiliation(s)
- Yvette M. Weesie
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands,Department of PharmacoTherapy, -Epidemiology & -Economics (PTEE), Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands,CONTACT Yvette M. Weesie Otterstraat 118 – 124, Utrecht, 3513 CR, The Netherlands
| | - Liset van Dijk
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands,Department of PharmacoTherapy, -Epidemiology & -Economics (PTEE), Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Marcel L. Bouvy
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University (UU), Utrecht, The Netherlands
| | - Karin Hek
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
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2
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Kiliç B, Biermans MCJ, Rutten FH, Deinum J, Spiering W, van der Wel MC, de Grauw WJC, Bots ML, Hollander M. Stepwise treatment of uncontrolled HyperTensioN (Stepwise-HTN): Study design of a cluster randomised controlled trial in primary care. Contemp Clin Trials 2023; 126:107062. [PMID: 36632924 DOI: 10.1016/j.cct.2022.107062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 12/18/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Uncontrolled hypertension is a major health problem, and a key risk factor for cardiovascular disease. Most patients are detected and managed in primary care, but approximately 50% remains uncontrolled. Our aim is to assess whether a guided stepwise work-up management strategy for patients with uncontrolled hypertension in primary care would result in better blood pressure control in these patients compared to usual care. METHODS A cluster randomised controlled trial aiming at randomizing 40 general practices to either "a protocolised stepwise work-up" or to "usual care". Uncontrolled hypertension is defined as an office blood pressure (BP) >140/90 mmHg while being prescribed three or more antihypertensive drugs simultaneously from different therapeutic classes for three or more months in an adequate dose. In the intervention arm, patients with uncontrolled hypertension will receive the stepwise approach, consisting of (i) excluding a white coat effect, (ii) re-evaluation of lifestyle, (iii) re-evaluation of drug adherence, (iv) optimalisation of antihypertensive treatment and (v) referral if the office BP is still >140/90 mmHg. The control group receives usual care in a regular program for cardiovascular risk management. The primary outcome is the absolute difference in the mean 24-h systolic BP between intervention and control arm after 8 months. Secondary outcomes include differences in the percentage of patients achieving a controlled BP, and time to reach a controlled BP. CONCLUSION If stepwise treatment of uncontrolled hypertension is proven effective, the strategy could be implemented by blending the approach to the cardiovascular risk management already applied in general practice. Trial registration NTR7304, https://www.trialregister.nl/trial/7099.
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Affiliation(s)
- Birsen Kiliç
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Marion C J Biermans
- Department of Primary and Community Care, Radboud university medical Center, Nijmegen, the Netherlands
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jaap Deinum
- Department of Internal Medicine, Radboud university medical Center, Nijmegen, the Netherlands
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Mark C van der Wel
- Department of Primary and Community Care, Radboud university medical Center, Nijmegen, the Netherlands
| | - Wim J C de Grauw
- Department of Primary and Community Care, Radboud university medical Center, Nijmegen, the Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Monika Hollander
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, Utrecht University, Utrecht, the Netherlands
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Chehal PK, Selvin E, DeVoe JE, Mangione CM, Ali MK. Diabetes And The Fragmented State Of US Health Care And Policy. Health Aff (Millwood) 2022; 41:939-946. [PMID: 35759725 PMCID: PMC10420383 DOI: 10.1377/hlthaff.2022.00299] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Progress in the prevention and treatment of type 2 diabetes-the dominant form of diabetes-appears to have stalled in the US over the past decade, and diabetes-related morbidity has increased nationally. The most geographically and socioeconomically disadvantaged segments of the population have been especially hard hit, and interventions that reduce the risk for diabetes have not reached these populations. In this overview article we lay out how fragmentation in health policy and governance, payers and reimbursement design, and service delivery in the US has contributed to low accountability and coordination, and thus stagnation and persistent inequities. We also review the evidence regarding past, ongoing, and new reforms that may help address fragmentation, lower diabetes burdens, and narrow disparities.
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Affiliation(s)
| | | | - Jennifer E DeVoe
- Jennifer E. DeVoe, Oregon Health & Science University, Portland, Oregon
| | - Carol M Mangione
- Carol M. Mangione, University of California Los Angeles, Los Angeles, California
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Müskens JL, van Dulmen SA, Wiersma T, Burgers JS, Hek K, Westert GP, Kool RB. Low-value pharmaceutical care among Dutch GPs: a retrospective cohort study. Br J Gen Pract 2022; 72:e369-e377. [PMID: 35314429 PMCID: PMC8966784 DOI: 10.3399/bjgp.2021.0625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/31/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Low-value pharmaceutical care exists in general practice. However, the extent among Dutch GPs remains unknown. AIM To assess the prevalence of low-value pharmaceutical care among Dutch GPs. DESIGN AND SETTING Retrospective cohort study using data from patient records. METHOD The prevalence of three types of pharmaceutical care prescribed by GPs between 2016 and 2019 were examined: topical antibiotics for conjunctivitis, benzodiazepines for non-specific lower back pain, and chronic acid-reducing medication (ARM) prescriptions. Multilevel logistic regression analysis was performed to assess prescribing variation and the influence of patient characteristics on receiving a low-value prescription. RESULTS Large variation in prevalence as well as practice variation was observed among the types of low-value pharmaceutical GP care examined. Between 53% and 61% of patients received an inappropriate antibiotics prescription for conjunctivitis, around 3% of patients with lower back pain received an inappropriate benzodiazepine prescription, and 88% received an inappropriate chronic ARM prescription during the years examined. The odds of receiving an inappropriate antibiotic or benzodiazepine prescription increased with age (P<0.001), but decreased for chronic inappropriate ARM prescriptions (P<0.001). Sex affected only the odds of receiving a non-indicated chronic ARM, with males being at higher risk (P<0.001). The odds of receiving an inappropriate ARM increased with increasing neighbourhood socioeconomic status (P<0.05). Increasing practice size decreased the odds of inappropriate antibiotic and benzodiazepine prescriptions (P<0.001). CONCLUSION The results show that the prevalence of low-value pharmaceutical GP care varies among these three clinical problems. Significant variation in inappropriate prescribing exists between different types of pharmaceutical care - and GP practices.
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Affiliation(s)
- Joris Ljm Müskens
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Centre, Nijmegen
| | - Simone A van Dulmen
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Centre, Nijmegen
| | | | - Jako S Burgers
- Department of General Practice, School CAPHRI, Maastricht University, Maastricht; senior consultant, Dutch College of General Practitioners, Utrecht
| | - Karin Hek
- Nivel, Netherlands Institute for Health Services Research, Utrecht
| | - Gert P Westert
- 'Doen of laten?', IQ Healthcare, Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen
| | - Rudolf B Kool
- 'Doen of laten?', IQ Healthcare, Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen
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Effectiveness of ibuprofen plus paracetamol combination on persistence of acute musculoskeletal disorders in primary care patients. Int J Clin Pharm 2021; 43:1045-1054. [PMID: 33411104 DOI: 10.1007/s11096-020-01215-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Abstract
Background General practitioners often deal with patients suffering acute musculoskeletal disorders. Paracetamol, non-steroidal anti-inflammatory drugs, and opioids are the most prescribed medications, according to pain intensity and patient's features. Combinations of different analgesics can be adopted to enhance pain relief, but only one fixed-dose combination has been recently launched to treat acute musculoskeletal pain. Objective This study aimed to investigate the effectiveness of ibuprofen plus paracetamol (fixed-dose) combination compared to other analgesics in preventing musculoskeletal pain persistence. Setting Italian outpatients' data extracted from a national general practice database. Method A retrospective cohort study was conducted on the Health Search Database. Patients prescribed with analgesics for acute musculoskeletal painful conditions were considered (i.e., non-chronic painful conditions, identified using a query validated by two expert General Practitioners (GPs)). For each patient, the first prescription of an analgesic was defined as index date. A new GP's visit related to musculoskeletal disorders in the first 3 months following the index date was defined as "pain persistence". Main outcome measure Risk of pain persistence among users of the ibuprofen plus paracetamol combination compared to other systemic analgesics. Results Overall, 102,216 patients were treated with systemic analgesics for acute musculoskeletal disorders. Most patients were middle-aged or elderly women. 939 (0.92%) patients were prescribed with the fixed-dose ibuprofen plus paracetamol combination for a mean duration of 7.23 ± 2.68 days, mainly for low back pain and cervicalgia. Musculoskeletal pain persistence was found in 22,125 (21.65%) patients. Compared to other systemic analgesics, the ibuprofen plus paracetamol combination resulted significantly more effective in preventing pain persistence (adjusted hazard ratio 0.72, 95% confidence interval 0.61-0.85). Conclusion These findings suggest that the fixed-dose ibuprofen plus paracetamol combination might be effective in controlling musculoskeletal pain persistence.
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Jakobs KM, Posthuma A, de Grauw WJC, Schalk BWM, Akkermans RP, Lucassen P, Schermer T, Assendelft WJJ, Biermans MJC. Cardiovascular risk screening of patients with serious mental illness or use of antipsychotics in family practice. BMC FAMILY PRACTICE 2020; 21:153. [PMID: 32727372 PMCID: PMC7391510 DOI: 10.1186/s12875-020-01225-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 07/19/2020] [Indexed: 12/02/2022]
Abstract
Background Patients with serious mental illness (SMI) and patients on antipsychotics (AP) have an elevated risk for cardiovascular diseases. In the Netherlands, the mental healthcare for these patients is increasingly taken care of by family practitioners (FP) as a result of a shift from secondary to primary care. Therefore, it is essential to increase our knowledge regarding the characteristics of this patient group and the (somatic) care provided by their FPs. The aim was to examine the rate of cardiovascular risk screening in patients with SMI or the use of AP in family practice. Methods We performed a retrospective cohort study of 151.238 patients listed in 24 family practices in the Netherlands. From electronic medical records we extracted data concerning diagnoses, measurement values of CVR factors, medication and frequency of visits over a 2 year period. Primary outcome was the rate of patients who were screened for CVR factors. We compared three groups: patients with SMI/AP without diabetes or CVD (SMI/AP-only), patients with SMI/AP and diabetes mellitus (SMI/AP + DM), patients with SMI/AP and a history of cardiovascular disease (SMI/AP + CVD). We explored factors associated with adequate screening using multilevel logistic regression. Results We identified 1705 patients with SMI/AP, 834 with a SMI diagnosis, 1150 using AP. The screening rate for CVR in the SMI/AP-only group (n = 1383) was adequate in 8.5%. Screening was higher in the SMI/AP − +DM (n = 206, 68.4% adequate, OR 24.6 (95%CI, 17.3–35.1) and SMI/AP + CVD (n = 116, 26.7% adequate, OR 4.2 (95%CI, 2.7–6.6). A high frequency of visits, age, the use of AP and a diagnosis of COPD were associated with a higher screening rate. In addition we also examined differences between patients with SMI and patients using AP without SMI. Conclusion CVR screening in patients with SMI/AP is performed poorly in Dutch family practices. Acceptable screening rates were found only among SMI/AP patients with diabetes mellitus as comorbidity. The finding of a large group of AP users without a SMI diagnosis may indicate that FPs often prescribe AP off-label, lack information about the diagnosis, or use the wrong code.
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Affiliation(s)
- Kirsti M Jakobs
- Department of Primary and Community Care (117-ELG), Radboud University Medical Centre, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, The Netherlands.
| | - Anne Posthuma
- Department of Primary and Community Care (117-ELG), Radboud University Medical Centre, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Wim J C de Grauw
- Department of Primary and Community Care (117-ELG), Radboud University Medical Centre, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Bianca W M Schalk
- Department of Primary and Community Care (117-ELG), Radboud University Medical Centre, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Reinier P Akkermans
- Department of Primary and Community Care (117-ELG), Radboud University Medical Centre, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Peter Lucassen
- Department of Primary and Community Care (117-ELG), Radboud University Medical Centre, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Tjard Schermer
- Department of Primary and Community Care (117-ELG), Radboud University Medical Centre, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Willem J J Assendelft
- Department of Primary and Community Care (117-ELG), Radboud University Medical Centre, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Marion J C Biermans
- Department of Primary and Community Care (117-ELG), Radboud University Medical Centre, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
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7
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Weesie YM, Hek K, Schermer TRJ, Schellevis FG, Leufkens HGM, Rook EJ, van Dijk L. Use of Opioids Increases With Age in Older Adults: An Observational Study (2005-2017). Front Pharmacol 2020; 11:648. [PMID: 32477127 PMCID: PMC7241279 DOI: 10.3389/fphar.2020.00648] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 04/22/2020] [Indexed: 11/13/2022] Open
Abstract
Aim Pain is increasingly treated with opioids. Potential harms of opioid therapy disproportionally affect older patients. This study aims to provide information on trends, nature and duration of opioid prescribing to older adults, in primary care and to explore differences between older patients from different ages. Methods Primary care data (2005-2017) were derived from routine electronic medical records of patients in Nivel Primary Care Database. All opioid prescriptions with Anatomical Therapeutic Chemical Classification (ATC) code N02A were selected (except for codeine). Diagnoses were recorded using the International Classification of Primary Care (ICPC). Patients were categorized in three age groups (65-74, 75-84, and ≥85 years). Descriptive analyses were used to describe the trend of opioid prescriptions for specific opioids, the duration of use and underlying diagnoses. Results 283,600 patients were included of which 32,287 had at least one opioid prescription in 2017. An increase in the number of older adults who received at least one opioid was seen between 2005 and 2017. The oldest patients were more likely to be prescribed an opioid, especially when it comes to strong opioids, the increase in the volume of prescribing was highest in this group. Moreover, over 40% of the oldest patients used strong opioids chronically. Strong opioids were mostly prescribed for musculoskeletal diagnoses. Cancer was the second most common diagnosis for strong opioids in the younger subgroups, whereas less specified diagnoses were as second in the oldest subgroup. Conclusion Opioid prescription changes with increasing age in frequency, nature, and duration, despite higher harm risks among older patients. Because of the high prevalence of chronic use, it is important to monitor the patient throughout the treatment and to critically evaluate the initiation and continuation of opioid prescriptions.
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Affiliation(s)
- Yvette M Weesie
- Pharmaceutical Care, Netherlands Institute for Health Services Research (Nivel), Utrecht, Netherlands
| | - Karin Hek
- Pharmaceutical Care, Netherlands Institute for Health Services Research (Nivel), Utrecht, Netherlands
| | - Tjard R J Schermer
- Pharmaceutical Care, Netherlands Institute for Health Services Research (Nivel), Utrecht, Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands
| | - Francois G Schellevis
- Pharmaceutical Care, Netherlands Institute for Health Services Research (Nivel), Utrecht, Netherlands.,Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers location VUmc, Amsterdam, Netherlands
| | - Hubertus G M Leufkens
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University (UU), Utrecht, Netherlands
| | | | - Liset van Dijk
- Pharmaceutical Care, Netherlands Institute for Health Services Research (Nivel), Utrecht, Netherlands.,Department of PharmacoTherapy,-Epidemiology & -Economics (PTEE), Faculty of Mathematics and Natural Sciences, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
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8
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Nielen MMJ, Spronk I, Davids R, Korevaar JC, Poos R, Hoeymans N, Opstelten W, van der Sande MAB, Biermans MCJ, Schellevis FG, Verheij RA. Estimating Morbidity Rates Based on Routine Electronic Health Records in Primary Care: Observational Study. JMIR Med Inform 2019; 7:e11929. [PMID: 31350839 PMCID: PMC6688441 DOI: 10.2196/11929] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 04/30/2019] [Accepted: 06/17/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Routinely recorded electronic health records (EHRs) from general practitioners (GPs) are increasingly available and provide valuable data for estimating incidence and prevalence rates of diseases in the population. This paper describes how we developed an algorithm to construct episodes of illness based on EHR data to calculate morbidity rates. OBJECTIVE The goal of the research was to develop a simple and uniform algorithm to construct episodes of illness based on electronic health record data and develop a method to calculate morbidity rates based on these episodes of illness. METHODS The algorithm was developed in discussion rounds with two expert groups and tested with data from the Netherlands Institute for Health Services Research Primary Care Database, which consisted of a representative sample of 219 general practices covering a total population of 867,140 listed patients in 2012. RESULTS All 685 symptoms and diseases in the International Classification of Primary Care version 1 were categorized as acute symptoms and diseases, long-lasting reversible diseases, or chronic diseases. For the nonchronic diseases, a contact-free interval (the period in which it is likely that a patient will visit the GP again if a medical complaint persists) was defined. The constructed episode of illness starts with the date of diagnosis and ends at the time of the last encounter plus half of the duration of the contact-free interval. Chronic diseases were considered irreversible and for these diseases no contact-free interval was needed. CONCLUSIONS An algorithm was developed to construct episodes of illness based on routinely recorded EHR data to estimate morbidity rates. The algorithm constitutes a simple and uniform way of using EHR data and can easily be applied in other registries.
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Affiliation(s)
- Mark M J Nielen
- Netherlands Institute for Health Services Research, Utrecht, Netherlands.,Centre for Health and Society, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Inge Spronk
- Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Rodrigo Davids
- Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Joke C Korevaar
- Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - René Poos
- Centre for Health and Society, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Nancy Hoeymans
- Centre for Health and Society, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Wim Opstelten
- Dutch College of General Practitioners, Utrecht, Netherlands
| | - Marianne A B van der Sande
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands.,Julius Center for Health Sciences and Primary Care, Julius Global Health, Utrecht, Netherlands
| | - Marion C J Biermans
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Robert A Verheij
- Netherlands Institute for Health Services Research, Utrecht, Netherlands
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Spronk I, Korevaar JC, Poos R, Davids R, Hilderink H, Schellevis FG, Verheij RA, Nielen MMJ. Calculating incidence rates and prevalence proportions: not as simple as it seems. BMC Public Health 2019; 19:512. [PMID: 31060532 PMCID: PMC6501456 DOI: 10.1186/s12889-019-6820-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/15/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Incidence rates and prevalence proportions are commonly used to express the populations health status. Since there are several methods used to calculate these epidemiological measures, good comparison between studies and countries is difficult. This study investigates the impact of different operational definitions of numerators and denominators on incidence rates and prevalence proportions. METHODS Data from routine electronic health records of general practices contributing to NIVEL Primary Care Database was used. Incidence rates were calculated using different denominators (person-years at-risk, person-years and midterm population). Three different prevalence proportions were determined: 1 year period prevalence proportions, point-prevalence proportions and contact prevalence proportions. RESULTS One year period prevalence proportions were substantially higher than point-prevalence (58.3 - 206.6%) for long-lasting diseases, and one year period prevalence proportions were higher than contact prevalence proportions (26.2 - 79.7%). For incidence rates, the use of different denominators resulted in small differences between the different calculation methods (-1.3 - 14.8%). Using person-years at-risk or a midterm population resulted in higher rates compared to using person-years. CONCLUSIONS All different operational definitions affect incidence rates and prevalence proportions to some extent. Therefore, it is important that the terminology and methodology is well described by sources reporting these epidemiological measures. When comparing incidence rates and prevalence proportions from different sources, it is important to be aware of the operational definitions applied and their impact.
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Affiliation(s)
- Inge Spronk
- Nivel, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500BN, Utrecht, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Joke C. Korevaar
- Nivel, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500BN, Utrecht, The Netherlands
| | - René Poos
- Centre for Health and Society, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Rodrigo Davids
- Nivel, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500BN, Utrecht, The Netherlands
| | - Henk Hilderink
- Centre for Health and Society, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - François G. Schellevis
- Nivel, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500BN, Utrecht, The Netherlands
- Department of General Practice & Elderly Care Medicine/EMGO Institute for health and care research, VU University Medical Center, Amsterdam, The Netherlands
| | - Robert A. Verheij
- Nivel, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500BN, Utrecht, The Netherlands
| | - Mark M. J. Nielen
- Nivel, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500BN, Utrecht, The Netherlands
- Centre for Health and Society, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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10
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Marconi E, Bettiol A, Lombardi N, Crescioli G, Parretti L, Vannacci A, Medea G, Cricelli C, Lapi F. Prescribing patterns of allopurinol and febuxostat according to directives on the reimbursement criteria and clinical guidelines: analysis of a primary care database. Curr Med Res Opin 2019; 35:683-688. [PMID: 30358452 DOI: 10.1080/03007995.2018.1541315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE According to American clinical guidelines, allopurinol and febuxostat may be prescribed as first-line therapy to treat hyperuricemia. However, the Italian Medicines Agency directive, called Nota 91, allows the reimbursement of second-line febuxostat in the case of failure and/or intolerance of a previous allopurinol therapy, so partially embracing European League Against Rheumatism recommendations and the British Society for Rheumatology Guideline. Such inconsistency might lead to heterogeneity among General Practitioners (GPs) in treatment of hyperuricemia. This study, therefore, aimed to evaluate the prescribing behavior of GPs in terms of compliance with Nota 91 and/or official guidelines. METHODS Using the Health Search Database, a retrospective cohort study was conducted to evaluate the patterns of use of allopurinol and febuxostat between 2011 and 2016. RESULTS In total, 44,257 and 5837 patients were prescribed with allopurinol and febuxostat, respectively. Among febuxostat users, 4321 (74%) had a previous allopurinol treatment; 92% of switches to febuxostat were related to hyperuricemia, whereas 9% of switchers presented intolerance to allopurinol; 26% of patients were prescribed with febuxostat as first-line therapy. The presence of diabetes and/or moderate/severe renal disease were statistically significant determinants of febuxostat use as first-line therapy. CONCLUSION Prescriptions of febuxostat were highly compliant to Nota 91. Only a sub-group of frontline prescriptions of febuxostat were mainly driven by the presence of renal dysfunction, which is able to increase the risk of allopurinol intolerance and/or inefficacy. These findings indicate that GPs' prescribing behavior for hyperuricemia is highly compliant with both regulatory directives and clinical guidelines.
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Affiliation(s)
- Ettore Marconi
- a Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology , University of Florence , Florence , Italy
- b Health Search , Italian College of General Practitioners and Primary Care , Florence , Italy
| | - Alessandra Bettiol
- a Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology , University of Florence , Florence , Italy
| | - Niccolò Lombardi
- a Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology , University of Florence , Florence , Italy
| | - Giada Crescioli
- a Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology , University of Florence , Florence , Italy
| | - Luca Parretti
- c Institute of Gerontology and Geriatrics, Department of Medicine , University of Perugia , Perugia , Italy
| | - Alfredo Vannacci
- a Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology , University of Florence , Florence , Italy
| | - Gerardo Medea
- d Italian College of General Practitioners and Primary Care , Florence , Italy
| | - Claudio Cricelli
- d Italian College of General Practitioners and Primary Care , Florence , Italy
| | - Francesco Lapi
- b Health Search , Italian College of General Practitioners and Primary Care , Florence , Italy
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Lombardi N, Vannacci A, Bettiol A, Marconi E, Pecchioli S, Magni A, Cricelli C, Lapi F. Prescribing Trends of Codeine-containing Medications and Other Opioids in Primary Care After A Regulatory Decision: An Interrupted Time Series Analysis. Clin Drug Investig 2019; 39:455-462. [DOI: 10.1007/s40261-019-00767-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Šabanović Š, Ljiljana MT, Babič F, Vadovský M, Paralič J, Včev A, Holzinger A. Metabolic syndrome in hypertensive women in the age of menopause: a case study on data from general practice electronic health records. BMC Med Inform Decis Mak 2018; 18:24. [PMID: 29609615 PMCID: PMC5880083 DOI: 10.1186/s12911-018-0601-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 03/05/2018] [Indexed: 02/06/2023] Open
Abstract
Background There is potential for medical research on the basis of routine data used from general practice electronic health records (GP eHRs), even in areas where there is no common GP research platform. We present a case study on menopausal women with hypertension and metabolic syndrome (MS). The aims were to explore the appropriateness of the standard definition of MS to apply to this specific, narrowly defined population group and to improve recognition of women at high CV risk. Methods We investigated the possible uses offered by available data from GP eHRs, completed with patients interview, in goal of the study, using a combination of methods. For the sample of 202 hypertensive women, 47–59 years old, a data set was performed, consisted of a total number of 62 parameters, 50 parameters used from GP eHRs. It was analysed by using a mixture of methods: analysis of differences, cutoff values, graphical presentations, logistic regression and decision trees. Results The age range found to best match the emergency of MS was 51–55 years. Deviations from the definition of MS were identified: a larger cut-off value of the waist circumference measure (89 vs 80 cm) and parameters BMI and total serum cholesterol perform better as components of MS than the standard parameters waist circumference and HDL-cholesterol. The threshold value of BMI at which it is expected that most of hypertensive menopausal women have MS, was found to be 25.5. The other best means for recognision of women with MS include triglycerides above the threshold of 1.7 mmol/L and information on statins use. Prevention of CVD should focus on women with a new onset diabetes and comorbidities of a long-term hypertension with anxiety/depression. Conclusions The added value of this study goes beyond the current paradigm on MS. Results indicate characteristics of MS in a narrowly defined, specific population group. A comprehensive view has been enabled by using heterogenoeus data and a smart combination of various methods for data analysis. The paper shows the feasibility of this research approach in routine practice, to make use of data which would otherwise not be used for research.
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Affiliation(s)
- Šefket Šabanović
- Department for Internal Medicine, Family Medicine and the History of Medicine, Faculty of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia, Huttlerova 10b, 31 000, Osijek, Croatia
| | - Majnarić Trtica Ljiljana
- Department for Internal Medicine, Family Medicine and the History of Medicine, Faculty of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia, Huttlerova 10b, 31 000, Osijek, Croatia
| | - František Babič
- Department of Cybernetics and Artificial Intelligence, Technical University of Košice, Faculty of Electrical Engineering and Informatics, Letná 9/B, 042 00, Košice, Slovakia
| | - Michal Vadovský
- Department of Cybernetics and Artificial Intelligence, Technical University of Košice, Faculty of Electrical Engineering and Informatics, Letná 9/B, 042 00, Košice, Slovakia
| | - Ján Paralič
- Department of Cybernetics and Artificial Intelligence, Technical University of Košice, Faculty of Electrical Engineering and Informatics, Letná 9/B, 042 00, Košice, Slovakia
| | - Aleksandar Včev
- Department for Internal Medicine, Family Medicine and the History of Medicine, Faculty of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia, Huttlerova 10b, 31 000, Osijek, Croatia
| | - Andreas Holzinger
- Medical University Graz, Institute for Medical Informatics/Statistic, Auenbruggerplatz 2/V, 8036, Graz, Austria.
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Vannacci A, Lombardi N, Simonetti M, Fornasari D, Fanelli A, Cricelli I, Cricelli C, Lora Aprile P, Lapi F. Regular use of acetaminophen or acetaminophen-codeine combinations and prescription of rescue therapy with non-steroidal anti-inflammatory drugs: a population-based study in primary care. Curr Med Res Opin 2017; 33:1141-1148. [PMID: 28318320 DOI: 10.1080/03007995.2017.1308920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE There are contrasting positions concerning the benefit-risk ratio of acetaminophen use for osteoarthritis (OA)-related pain. To clarify the effectiveness of acetaminophen or acetaminophen-codeine combinations according to their regimen of use, we evaluated whether being a regular user (adherent) of these medications decreased the occurrence of rescue therapy with non-steroidal anti-inflammatory drugs (NSAIDs). METHODS Using the Health Search IMS Health Longitudinal Patient Database, we formed a cohort of patients aged ≥18 years and newly treated with acetaminophen or acetaminophen-codeine combinations for OA between 1 January 2001 and 31 December 2013. These patients were followed up for one year in which they were categorized as regular or irregular users of these medications according to a variable medication possession ratio (VMPR) ≥ 50% or lower. We operationally defined the rescue therapy as the use of any NSAIDs prescribed for OA-related pain. RESULTS Overall, 40,029 patients (69.5% females; mean age: 68 ± 13.57) treated with acetaminophen or acetaminophen-codeine combinations formed the cohort. After the first year of treatment, regular users showed a statistically significantly lower risk of being prescribed with rescue therapy with NSAIDs (OR = 0.89; 95% CI 0.84-0.96). CONCLUSION These findings show that regular use of acetaminophen or acetaminophen-codeine combinations may reduce the need for NSAIDs to treat OA-related pain.
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Affiliation(s)
- Alfredo Vannacci
- a Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology , University of Florence , Florence , Italy
| | - Niccolò Lombardi
- a Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology , University of Florence , Florence , Italy
| | - Monica Simonetti
- b Health Search , Italian College of General Practitioners and Primary Care , Florence , Italy
| | - Diego Fornasari
- c Department of Medical Biotechnology and Translational Medicine , University of Milan , Milan , Italy
| | - Andrea Fanelli
- d Unit of Anaesthesiology and Pain Therapy , General Hospital S. Orso Malpighi, University Hospital of Bologna , Bologna , Italy
| | - Iacopo Cricelli
- b Health Search , Italian College of General Practitioners and Primary Care , Florence , Italy
| | - Claudio Cricelli
- e Italian College of General Practitioners and Primary Care , Florence , Italy
| | | | - Francesco Lapi
- b Health Search , Italian College of General Practitioners and Primary Care , Florence , Italy
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Boshuizen HC, Poos MJJC, van den Akker M, van Boven K, Korevaar JC, de Waal MWM, Biermans MCJ, Hoeymans N. Estimating incidence and prevalence rates of chronic diseases using disease modeling. Popul Health Metr 2017; 15:13. [PMID: 28381229 PMCID: PMC5382408 DOI: 10.1186/s12963-017-0130-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 03/23/2017] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Morbidity estimates between different GP registration networks show large, unexplained variations. This research explores the potential of modeling differences between networks in distinguishing new (incident) cases from existing (prevalent) cases in obtaining more reliable estimates. METHODS Data from five Dutch GP registration networks and data on four chronic diseases (chronic obstructive pulmonary disease [COPD], diabetes, heart failure, and osteoarthritis of the knee) were used. A joint model (DisMod model) was fitted using all information on morbidity (incidence and prevalence) and mortality in each network, including a factor for misclassification of prevalent cases as incident cases. RESULTS The observed estimates vary considerably between networks. Using disease modeling including a misclassification term improved the consistency between prevalence and incidence rates, but did not systematically decrease the variation between networks. Osteoarthritis of the knee showed large modeled misclassifications, especially in episode of care-based registries. CONCLUSION Registries that code episodes of care rather than disease generally provide lower estimates of the prevalence of chronic diseases requiring low levels of health care such as osteoarthritis. For other diseases, modeling misclassification rates does not systematically decrease the variation between registration networks. Using disease modeling provides insight in the reliability of estimates.
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Affiliation(s)
- Hendrike C Boshuizen
- , PO box 1 3720 BA, Bilthoven, The Netherlands. .,Biometrics, Wageningen University, PO Box 16 6700AA, Wageningen, The Netherlands.
| | | | - Marjan van den Akker
- Department of Family Medicine, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.,Department of Public Health and Primary Care, Academic Center for General Practice, Kapucijnenvoer 33, blok J, PB 7001, 3000, Leuven, KU, Belgium
| | - Kees van Boven
- Department of Primary and Community Care, Radboud university medical center, Internal post ELG 117, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Joke C Korevaar
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-124, P.O. Box 1568, 3500 BN, Utrecht, The Netherlands
| | - Margot W M de Waal
- Department of Public Health and Primary Care, Leiden University Medical Center, Postal zone V-0-P, PO-box 9600, 2300 RC, Leiden, The Netherlands
| | - Marion C J Biermans
- Department of Primary and Community Care, Radboud university medical center, Internal post ELG 117, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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Lapi F, Cassano N, Pegoraro V, Cataldo N, Heiman F, Cricelli I, Levi M, Colombo D, Zagni E, Cricelli C, Vena GA. Epidemiology of chronic spontaneous urticaria: results from a nationwide, population-based study in Italy. Br J Dermatol 2016; 174:996-1004. [PMID: 26872037 DOI: 10.1111/bjd.14470] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is a common skin disease, but there is a paucity of precise epidemiological data on this disease. OBJECTIVES To obtain information on the epidemiology of CSU in Italy. METHODS The data source was the Health Search IMS Health Longitudinal Patient Database. The study population was formed by patients aged ≥ 15 years, registered with a total of 700 general practitioners, homogeneously distributed across Italy. An algorithm based on the International Classification of Diseases, ninth revision, Clinical Modification was used for the identification of patients with CSU. The annual prevalence and incidence rates of CSU over a 12-year period (2002-2013) were estimated, along with demographic and clinical determinants. RESULTS The annual prevalence of CSU ranged from 0·02% in 2002 to 0·38% in 2013. The incidence was 0·10-1·50 per 1000 person-years. For both prevalence and incidence rates, female patients outnumbered male. The risk of CSU was statistically significantly higher in the presence of the following variables: obesity; anxiety, dissociative and somatoform disorders; malignancies; use of immunosuppressive drugs; and chronic use of systemic corticosteroids. History of autoimmune thyroiditis showed a trend towards an increased risk of CSU, though it was not statistically significant. Smoking was associated with a significantly reduced risk of CSU. CONCLUSIONS Our findings on CSU prevalence are consistent with those obtained in previous studies. Furthermore, this large population-based study provides important information regarding the association of CSU with demographic and clinical determinants, which have been examined in the primary-care setting.
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Affiliation(s)
- F Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - N Cassano
- Dermatology and Venereology Private Practice, Bari/Barletta, Italy
| | - V Pegoraro
- IMS Health Information Solutions Srl, Milan, Italy
| | - N Cataldo
- IMS Health Information Solutions Srl, Milan, Italy
| | - F Heiman
- IMS Health Information Solutions Srl, Milan, Italy
| | - I Cricelli
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - M Levi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - D Colombo
- Novartis Farma S.p.A., Origgio, Varese, Italy
| | - E Zagni
- Novartis Farma S.p.A., Origgio, Varese, Italy
| | - C Cricelli
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - G A Vena
- Dermatology and Venereology Private Practice, Bari/Barletta, Italy
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Hoffmans R, Schermer T, van der Linde K, Bor H, van Boven K, van Weel C, Fokkens W. Rhinosinusitis in morbidity registrations in Dutch General Practice: a retro-spective case-control study. BMC FAMILY PRACTICE 2015; 16:120. [PMID: 26362443 PMCID: PMC4567828 DOI: 10.1186/s12875-015-0332-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 08/28/2015] [Indexed: 11/30/2022]
Abstract
Background There is only limited accurate data on the epidemiology of rhinosinusitis in primary care. This study was conducted to assess the incidence of acute and chronic rhinosinusitis by analysing data from two Dutch general practice registration projects. Several patient characteristics and diseases are related to the diagnosis rhinosinusitis. Methods The Continuous Morbidity Registration (CMR) and the Transitionproject (TP) are used to analyse the data on rhinosinusitis in primary practice. Both registries use codes to register diagnoses. Results In the CMR 3244 patients are registered with rhinosinusitis and in the TP 5424 CMR: The absolute incidence of (acute) rhinosinusitis is 5191 (18.8 per 1000 patient years). Regarding an odds ratio of 5.58, having nasal polyps is strongest related to rhinosinusitis compared to the other evaluated comorbidities. A separate code for chronic rhinosinusitis exists, but is not in use. TP: Acute and chronic rhinosinusitis are coded as one diagnosis. The incidence of rhinosinusitis is 5574 or 28.7 per 1000 patient years. Patients who visit their general practitioner with “symptoms/complaints of sinus”, allergic rhinitis and “other diseases of the respiratory system” have the highest chances to be diagnosed with rhinosinusitis. Medication is prescribed in 90.6 % of the cases. Conclusions Rhinosinusitis is a common diagnosis in primary practice. In the used registries no difference could be made between acute and chronic rhinosinusitis, but they give insight in comorbidity and interventions taken by the GP in case of rhinosinusitis.
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Affiliation(s)
- Ruth Hoffmans
- Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands.
| | - Tjard Schermer
- Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands.
| | - Karin van der Linde
- Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands.
| | - Hans Bor
- Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands.
| | - Kees van Boven
- Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands.
| | - Chris van Weel
- Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands. .,Australian Primary Health Care Research Institute, Australian National University, Canberra, Australia.
| | - Wytske Fokkens
- Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands.
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Jamoulle M. Quaternary prevention, an answer of family doctors to overmedicalization. Int J Health Policy Manag 2015; 4:61-4. [PMID: 25674569 DOI: 10.15171/ijhpm.2015.24] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 02/02/2015] [Indexed: 11/09/2022] Open
Abstract
In response to the questioning of Health Policy and Management (HPAM) by colleagues on the role of rank and file family physicians in the same journal, the author, a family physician in Belgium, is trying to highlight the complexity and depth of the work of his colleagues and their contribution to the understanding of the organization and economy of healthcare. It addresses, in particular, the management of health elements throughout the ongoing relationship of the family doctor with his/her patients. It shows how the three dimensions of prevention, clearly included in the daily work, are complemented with the fourth dimension, quaternary prevention or prevention of medicine itself, whose understanding could help to control the economic and human costs of healthcare.
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Affiliation(s)
- Marc Jamoulle
- Espace Temps, Maison de Santé, Charleroi, Belgium, and Department of General Practice, University of Liege, Liège, Belgium
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van den Dungen C, Hoeymans N, van den Akker M, Biermans MCJ, van Boven K, Joosten JHK, Verheij RA, de Waal MWM, Schellevis FG, van Oers JAM. Do practice characteristics explain differences in morbidity estimates between electronic health record based general practice registration networks? BMC FAMILY PRACTICE 2014; 15:176. [PMID: 25358247 PMCID: PMC4231185 DOI: 10.1186/s12875-014-0176-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 10/10/2014] [Indexed: 11/13/2022]
Abstract
Background General practice based registration networks (GPRNs) provide information on population health derived from electronic health records (EHR). Morbidity estimates from different GPRNs reveal considerable, unexplained differences. Previous research showed that population characteristics could not explain this variation. In this study we investigate the influence of practice characteristics on the variation in incidence and prevalence figures between general practices and between GPRNs. Methods We analyzed the influence of eight practice characteristics, such as type of practice, percentage female general practitioners, and employment of a practice nurse, on the variation in morbidity estimates of twelve diseases between six Dutch GPRNs. We used multilevel logistic regression analysis and expressed the variation between practices and GPRNs in median odds ratios (MOR). Furthermore, we analyzed the influence of type of EHR software package and province within one large national GPRN. Results Hardly any practice characteristic showed an effect on morbidity estimates. Adjusting for the practice characteristics did also not alter the variation between practices or between GPRNs, as MORs remained stable. The EHR software package ‘Medicom’ and the province ‘Groningen’ showed significant effects on the prevalence figures of several diseases, but this hardly diminished the variation between practices. Conclusion Practice characteristics do not explain the differences in morbidity estimates between GPRNs. Electronic supplementary material The online version of this article (doi:10.1186/s12875-014-0176-7) contains supplementary material, which is available to authorized users.
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Orueta JF, Nuño-Solinis R, Mateos M, Vergara I, Grandes G, Esnaola S. Monitoring the prevalence of chronic conditions: which data should we use? BMC Health Serv Res 2012; 12:365. [PMID: 23088761 PMCID: PMC3529101 DOI: 10.1186/1472-6963-12-365] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 10/17/2012] [Indexed: 11/13/2022] Open
Abstract
Background Chronic diseases are an increasing threat to people’s health and to the sustainability of health organisations. Despite the need for routine monitoring systems to assess the impact of chronicity in the population and its evolution over time, currently no single source of information has been identified as suitable for this purpose. Our objective was to describe the prevalence of various chronic conditions estimated using routine data recorded by health professionals: diagnoses on hospital discharge abstracts, and primary care prescriptions and diagnoses. Methods The ICD-9-CM codes for diagnoses and Anatomical Therapeutic Chemical (ATC) codes for prescriptions were collected for all patients in the Basque Country over 14 years of age (n=1,964,337) for a 12-month period. We employed a range of different inputs: hospital diagnoses, primary care diagnoses, primary care prescriptions and combinations thereof. Data were collapsed into the morbidity groups specified by the Johns Hopkins Adjusted Clinical Groups (ACGs) Case-Mix System. We estimated the prevalence of 12 chronic conditions, comparing the results obtained using the different data sources with each other and also with those of the Basque Health Interview Survey (ESCAV). Using the different combinations of inputs, Standardized Morbidity Ratios (SMRs) for the considered diseases were calculated for the list of patients of each general practitioner. The variances of the SMRs were used as a measure of the dispersion of the data and were compared using the Brown-Forsythe test. Results The prevalences calculated using prescription data were higher than those obtained from diagnoses and those from the ESCAV, with two exceptions: malignant neoplasm and migraine. The variances of the SMRs obtained from the combination of all the data sources (hospital diagnoses, and primary care prescriptions and diagnoses) were significantly lower than those using only diagnoses. Conclusions The estimated prevalence of chronic diseases varies considerably depending of the source(s) of information used. Given that administrative databases compile data registered for other purposes, the estimations obtained must be considered with caution. In a context of increasingly widespread computerisation of patient medical records, the complementary use of a range of sources may be a feasible option for the routine monitoring of the prevalence of chronic diseases.
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Affiliation(s)
- Juan F Orueta
- Osakidetza, Basque Health Service, C/ Alava n° 45, Vitoria-Gazteiz 01006, Spain.
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van den Dungen C, Hoeymans N, Boshuizen HC, van den Akker M, Biermans MCJ, van Boven K, Brouwer HJ, Verheij RA, de Waal MWM, Schellevis FG, Westert GP. The influence of population characteristics on variation in general practice based morbidity estimations. BMC Public Health 2011; 11:887. [PMID: 22111707 PMCID: PMC3280203 DOI: 10.1186/1471-2458-11-887] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 11/24/2011] [Indexed: 11/14/2022] Open
Abstract
Background General practice based registration networks (GPRNs) provide information on morbidity rates in the population. Morbidity rate estimates from different GPRNs, however, reveal considerable, unexplained differences. We studied the range and variation in morbidity estimates, as well as the extent to which the differences in morbidity rates between general practices and networks change if socio-demographic characteristics of the listed patient populations are taken into account. Methods The variation in incidence and prevalence rates of thirteen diseases among six Dutch GPRNs and the influence of age, gender, socio economic status (SES), urbanization level, and ethnicity are analyzed using multilevel logistic regression analysis. Results are expressed in median odds ratios (MOR). Results We observed large differences in morbidity rate estimates both on the level of general practices as on the level of networks. The differences in SES, urbanization level and ethnicity distribution among the networks' practice populations are substantial. The variation in morbidity rate estimates among networks did not decrease after adjusting for these socio-demographic characteristics. Conclusion Socio-demographic characteristics of populations do not explain the differences in morbidity estimations among GPRNs.
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Affiliation(s)
- C van den Dungen
- National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, the Netherlands.
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Krul M, van der Wouden JC, Schellevis FG, van Suijlekom-Smit LWA, Koes BW. Acute non-traumatic hip pathology in children: incidence and presentation in family practice. Fam Pract 2010; 27:166-70. [PMID: 20026553 DOI: 10.1093/fampra/cmp092] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The differential diagnosis of children with acute non-traumatic hip pathology varies from quite harmless conditions such as transient synovitis of the hip to more severe problems like Perthes' disease, slipped capital femoral epiphysis (SCFE) and life-threatening conditions such as septic arthritis of the hip. OBJECTIVE To provide population-based data on symptom presentation and incidence rates of non-traumatic acute hip pathology in family practice. METHODS We analysed data from a large national survey of family practice (104 practices), which was carried out by the Netherlands Institute for Health Services Research (NIVEL) in 2001. We included all children aged 0-14 years. Incidence rates were calculated by dividing the total number of cases (numerator) by the average study population at risk (denominator). RESULTS Our study population consisted of 73 954 children aged 0-14 years, yielding 68 202 person-years. These children presented with 101 episodes of acute non-traumatic hip pathology. The presenting feature in 81.5% of the children was pain, in 8.6% limping and 9.9% presented with both symptoms. Only 27% of the participating family practitioners (FPs) reported whether the child had a fever. The incidence rate for all acute non-traumatic hip pathology was 148.1 per 100 000 person-years, and for transient synovitis, this was 76.2 per 100 000 person-years. CONCLUSION In family practice, most children with acute non-traumatic hip pathology present with pain as the initial symptom. FPs need to be more aware that fever is the main distinguishing factor between a harmless condition and a life-threatening condition. Transient synovitis is the diagnosis with the highest incidence rate.
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Affiliation(s)
- Marjolein Krul
- Department of General Practice, Erasmus MC-University Medical Center Rotterdam, Room Ff304, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
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Berendsen AJ, Groenier KH, de Jong GM, Meyboom-de Jong B, van der Veen WJ, Dekker J, de Waal MWM, Schuling J. Assessment of patient's experiences across the interface between primary and secondary care: Consumer Quality Index Continuum of care. PATIENT EDUCATION AND COUNSELING 2009; 77:123-127. [PMID: 19375266 DOI: 10.1016/j.pec.2009.01.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Revised: 01/07/2009] [Accepted: 01/25/2009] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Development and validation of a questionnaire that measures patients' experiences of collaboration between general practitioners (GPs) and specialists. METHODS A questionnaire was developed using the method of the consumer quality index and validated in a cross-sectional study among a random sample of patients referred to medical specialists in the Netherlands. Validation included factor analysis, ascertain internal consistency, and the discriminative ability. RESULTS The response rate was 65% (1404 patients). Exploratory factor analysis indicated that four domains could be distinguished (i.e. GP Approach; GP Referral; Specialist; Collaboration). Cronbach's alpha coefficients ranged from 0.51 to 0.93 indicating sufficient internal consistency to make comparison of groups of respondents possible. The Pearson correlation coefficients between the domains were <0.4, except between the domains GP Approach and GP Referral. All domains clearly produced discriminating scores for groups with different characteristics. CONCLUSIONS The Consumer Quality Index (CQ-index) Continuum of Care can be a useful instrument to assess aspects of the collaboration between GPs and specialists from patients' perspective. PRACTICE IMPLICATIONS It can be used to give feedback to both medical professionals and policy makers. Such feedback creates an opportunity for implementing specific improvements and evaluating quality improvement projects.
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Affiliation(s)
- Annette J Berendsen
- Department of General Practice, University Medical Centre Groningen, University of Groningen, The Netherlands.
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van den Dungen C, Hoeymans N, Gijsen R, van den Akker M, Boesten J, Brouwer H, Smeets H, van der Veen WJ, Verheij R, de Waal M, Schellevis F, Westert G. What factors explain the differences in morbidity estimations among general practice registration networks in the Netherlands? A first analysis. Eur J Gen Pract 2008; 14 Suppl 1:53-62. [PMID: 18949646 DOI: 10.1080/13814780802436218] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Information on the incidence and prevalence of diseases is a core indicator for public health. There are several ways to estimate morbidity in a population (e.g., surveys, healthcare registers). In this paper, we focus on one particular source: general practice based registers. Dutch general practice is a potentially valid source because nearly all non-institutionalized inhabitants are registered with a general practitioner (GP), and the GP fulfils the role as "gatekeeper". However, there are some unexplained differences among morbidity estimations calculated from the data of various general practice registration networks (GPRNs). OBJECTIVE To describe and categorize factors that may explain the differences in morbidity rates from different GPRNs, and to provide an overview of these factors in Dutch GPRNs. RESULTS Four categories of factors are distinguished: "healthcare system", "methodological characteristics", "general practitioner", and "patient". The overview of 11 Dutch GPRNs reveals considerable differences in factors. CONCLUSION Differences in morbidity estimation depend on factors in the four categories. Most attention is dedicated to the factors in the "methodology characteristics" category, mainly because these factors can be directly influenced by the GPRN.
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Schram MT, Frijters D, van de Lisdonk EH, Ploemacher J, de Craen AJM, de Waal MWM, van Rooij FJ, Heeringa J, Hofman A, Deeg DJH, Schellevis FG. Setting and registry characteristics affect the prevalence and nature of multimorbidity in the elderly. J Clin Epidemiol 2008; 61:1104-12. [PMID: 18538993 DOI: 10.1016/j.jclinepi.2007.11.021] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2007] [Revised: 11/16/2007] [Accepted: 11/30/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of the study was to investigate how settings and registry characteristics affect the prevalence and nature of multimorbidity in elderly individuals. STUDY DESIGN AND SETTING We used data from three population-based studies, two general practitioner registries, one hospital discharge register, and one nursing home registry to estimate the prevalence of multimorbidity. Individuals aged 55 years and over were included. RESULTS Multimorbidity was most prevalent in nursing homes (82%), followed by the general population and general practitioner registries (56%-72%) and the hospital setting (22%). There were large differences in the nature of multimorbidity between settings. Combinations of hypertension, heart disease, and osteoarthritis were dominant in the population-based setting, whereas hypertension in combination with osteoarthritis, obesity, disorders of lipid metabolism, and diabetes dominated in the general practitioner setting. In the hospital setting, combinations of heart diseases had the highest prevalence. Combinations of dementia, hypertension, and stroke were dominant within the nursing home setting. CONCLUSION This study shows that setting and registry characteristics have an important influence on the outcome of multimorbidity studies. We recommend provision of at least information about the setting, the (list of) conditions included, the data collection method, and the time frame used, when reporting about the size and nature of multimorbidity.
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Affiliation(s)
- Miranda T Schram
- Extramural Medicine (EMGO Institute), VU University Medical Center, Amsterdam, The Netherlands
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