1
|
van Maaren MC, van Hoeve JC, Korevaar JC, van Hezewijk M, Siemerink EJM, Zeillemaker AM, Klaassen-Dekker A, van Uden DJP, Volders JH, Drossaert CHC, Siesling S. The effectiveness of personalised surveillance and aftercare in breast cancer follow-up: a systematic review. Support Care Cancer 2024; 32:323. [PMID: 38695938 PMCID: PMC11065941 DOI: 10.1007/s00520-024-08530-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/27/2024] [Indexed: 05/05/2024]
Abstract
PURPOSE Breast cancer follow-up (surveillance and aftercare) varies from one-size-fits-all to more personalised approaches. A systematic review was performed to get insight in existing evidence on (cost-)effectiveness of personalised follow-up. METHODS PubMed, Scopus and Cochrane were searched between 01-01-2010 and 10-10-2022 (review registered in PROSPERO:CRD42022375770). The inclusion population comprised nonmetastatic breast cancer patients ≥ 18 years, after completing curative treatment. All intervention-control studies studying personalised surveillance and/or aftercare designed for use during the entire follow-up period were included. All review processes including risk of bias assessment were performed by two reviewers. Characteristics of included studies were described. RESULTS Overall, 3708 publications were identified, 64 full-text publications were read and 16 were included for data extraction. One study evaluated personalised surveillance. Various personalised aftercare interventions and outcomes were studied. Most common elements included in personalised aftercare plans were treatment summaries (75%), follow-up guidelines (56%), lists of available supportive care resources (38%) and PROs (25%). Control conditions mostly comprised usual care. Four out of seven (57%) studies reported improvements in quality of life following personalisation. Six studies (38%) found no personalisation effect, for multiple outcomes assessed (e.g. distress, satisfaction). One (6.3%) study was judged as low, four (25%) as high risk of bias and 11 (68.8%) as with concerns. CONCLUSION The included studies varied in interventions, measurement instruments and outcomes, making it impossible to draw conclusions on the effectiveness of personalised follow-up. There is a need for a definition of both personalised surveillance and aftercare, whereafter outcomes can be measured according to uniform standards.
Collapse
Affiliation(s)
- Marissa C van Maaren
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, the Netherlands.
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.
| | - Jolanda C van Hoeve
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Joke C Korevaar
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands
- The Hague University of Applied Sciences, The Hague, the Netherlands
| | | | | | | | - Anneleen Klaassen-Dekker
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | | | - José H Volders
- Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Constance H C Drossaert
- Department of Psychology, Health & Technology, University of Twente, Enschede, the Netherlands
| | - Sabine Siesling
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| |
Collapse
|
2
|
Liemburg GB, Korevaar JC, Logtenberg M, Berendsen AJ, Berger MY, Brandenbarg D. Cancer follow-up in primary care after treatment with curative intent: Views of patients with breast and colorectal cancer. Patient Educ Couns 2024; 122:108139. [PMID: 38232673 DOI: 10.1016/j.pec.2024.108139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 12/18/2023] [Accepted: 01/04/2024] [Indexed: 01/19/2024]
Abstract
OBJECTIVE Increased cancer survival leads to more patients requiring oncological follow-up. Debate about how best to coordinate this care has led to the proposed involvement of general practitioners (GPs) rather than continued reliance on hospital care. However, we still require patient opinions to inform this debate. METHODS This qualitative interview study explored opinions about organization of follow-up care of patients treated curatively for breast and colorectal cancer. Thematic analysis was applied. RESULTS We interviewed 29 patients and identified three themes concerning care substitution: "benefits and barriers," "requirements," and "suitable patient groups." Benefits included accessibility, continuity, contextual knowledge, and psychosocial support. Barriers included concerns about cancer-specific expertise of GPs and longer waiting times. Requirements were sufficient time and remuneration, sufficient training, clear protocols, and shared-care including efficient communication with specialists. CONCLUSIONS According to patients with cancer, formal GP involvement appears feasible, although important barriers must be overcome before instituting care substitution. A possible solution are personalized follow-up plans based on three-way conversations with the specialist and the GP after the initial hospital care. PRACTICE IMPLICATIONS With adequate training, time, and remuneration, formal GP involvement could ensure more comprehensive care, possibly starting with less complex cases.
Collapse
Affiliation(s)
- Geertje B Liemburg
- Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Joke C Korevaar
- NIVEL Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Mariëlle Logtenberg
- Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Annette J Berendsen
- Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marjolein Y Berger
- Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Daan Brandenbarg
- Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| |
Collapse
|
3
|
Streefkerk N, Teepen JC, Feijen EAM, Jóźwiak K, van der Pal HJH, Ronckers CM, De Vries ACH, Van der Heiden-van Der Loo M, Hollema N, van den Berg M, Loonen J, Grootenhuis MA, Bresters D, Versluys AB, van Dulmen-den Broeder E, van den Heuvel-Eibrink MM, van Leeuwen FE, Neggers SJCMM, Van Santen HM, Hawkins M, Hauptmann M, Yoneoka D, Korevaar JC, Tissing WJE, Kremer LCM. The cumulative burden of self-reported, clinically relevant outcomes in long-term childhood cancer survivors and implications for survivorship care: A DCCSS LATER study. Cancer 2024; 130:1349-1358. [PMID: 38100618 DOI: 10.1002/cncr.35148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/04/2023] [Accepted: 10/27/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND The aim of this study is to evaluate how cumulative burden of clinically relevant, self-reported outcomes in childhood cancer survivors (CCSs) compares to a sibling control group and to explore how the burden corresponds to levels of care proposed by existing risk stratifications. METHODS The authors invited 5925 5-year survivors from the Dutch Childhood Cancer Survivor Study (DCCSS LATER) cohort and their 1066 siblings to complete a questionnaire on health outcomes. Health outcomes were validated by self-reported medication use or medical record review. Missing data on clinically relevant outcomes in CCSs for whom no questionnaire data were available were imputed with predictive mean matching. We calculated the mean cumulative count (MCC) for clinically relevant outcomes. Furthermore, we calculated 30-year MCC for groups of CCSs based on primary cancer diagnosis and treatment, ranked 30-year MCC, and compared the ranking to levels of care according to existing risk stratifications. RESULTS At median 18.5 years after 5-year survival, 46% of CCSs had at least one clinically relevant outcome. CCSs experienced 2.8 times more health conditions than siblings (30-year MCC = 0.79; 95% confidence interval [CI], 0.74-0.85 vs. 30-year MCC = 0.29; 95% CI, 0.25-0.34). CCSs' burden of clinically relevant outcomes consisted mainly of endocrine and vascular conditions and varied by primary cancer type. The ranking of the 30-year MCC often did not correspond with levels of care in existing risk stratifications. CONCLUSIONS CCSs experience a high cumulative burden of clinically relevant outcomes that was not completely reflected by current risk stratifications. Choices for survivorship care should extend beyond primary tumor and treatment parameters, and should consider also including CCSs' current morbidity.
Collapse
Affiliation(s)
- Nina Streefkerk
- Department Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jop C Teepen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Katarzyna Jóźwiak
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | | | - Cecile M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Andrica C H De Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology/Hematology, Sophia Children's Hospital/Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Nynke Hollema
- Department of Anesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Marleen van den Berg
- Department of Pediatric Oncology/Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jacqueline Loonen
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Eline van Dulmen-den Broeder
- Department of Pediatric Oncology/Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology/Hematology, Sophia Children's Hospital/Erasmus Medical Center, Rotterdam, The Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Hanneke M Van Santen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mike Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Michael Hauptmann
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Daisuke Yoneoka
- Division of Biostatistics and Bioinformatics, Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Joke C Korevaar
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology/Hematology, University of Groningen/University Medical Center Groningen, Groningen, The Netherlands
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
4
|
Bennis FC, Aussems C, Korevaar JC, Hoogendoorn M. The added value of temporal data and the best way to handle it: A use-case for atrial fibrillation using general practitioner data. Comput Biol Med 2024; 171:108097. [PMID: 38412689 DOI: 10.1016/j.compbiomed.2024.108097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 02/29/2024]
Abstract
INTRODUCTION Temporal data has numerous challenges for deep learning such as irregularity of sampling. New algorithms are being developed that can handle these temporal challenges better. However, it is unclear how the performance ranges from classical non-temporal models to newly developed algorithms. Therefore, this study compares different non-temporal and temporal algorithms for a relevant use case, the prediction of atrial fibrillation (AF) using general practitioner (GP) data. METHODS Three datasets with a 365-day observation window and prediction windows of 14, 180 and 360 days were used. Data consisted of medication, lab, symptom, and chronic diseases codings registered by the GP. The benchmark discarded temporality and used logistic regression, XGBoost models and neural networks on the presence of codings over the whole year. Pattern data extracted common patterns of GP codings and tested using the same algorithms. LSTM and CKConv models were trained as models incorporating temporality. RESULTS Algorithms which incorporated temporality (LSTM and CKConv, (max AUC 0.734 at 360 days prediction window) outperformed both benchmark and pattern algorithms (max AUC 0.723, with a significant improvement using the 360 days prediction window (p = 0.04). The difference between the benchmark and the LSTM or CKConv algorithm decreased with smaller prediction windows, indicating temporal importance for longer prediction windows. The CKConv and LSTM algorithm performed similarly, possibly due to limited sequence length. CONCLUSION Temporal models outperformed non-temporal models for the prediction of AF. For temporal models, CKConv is a promising algorithm to handle temporal data using GP data as it can handle irregular data.
Collapse
Affiliation(s)
- Frank C Bennis
- Quantitative Data Analytics Group, Department of Computer Science, VU Amsterdam, Amsterdam, the Netherlands; Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands.
| | - Claire Aussems
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Joke C Korevaar
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Mark Hoogendoorn
- Quantitative Data Analytics Group, Department of Computer Science, VU Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
5
|
Damen LJ, Van Tuyl LHD, Korevaar JC, Knottnerus BJ, De Jong JD. Citizens' perspectives on relocating care: a scoping review. BMC Health Serv Res 2024; 24:202. [PMID: 38355575 PMCID: PMC10868012 DOI: 10.1186/s12913-024-10671-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 02/01/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Healthcare systems around the world are facing large challenges. There are increasing demands and costs while at the same time a diminishing health workforce. Without reform, healthcare systems are unsustainable. Relocating care, for example, from hospitals to sites closer to patients' homes, is expected to make a key contribution to keeping healthcare sustainable. Given the significant impact of this initiative on citizens, we conducted a scoping review to provide insight into the factors that influence citizens' attitudes towards relocating care. METHOD A scoping review was conducted. The search was performed in the following databases: Pubmed, Embase, Cinahl, and Scopus. Articles had to include relocating healthcare and citizens' perspectives on this topic and the articles had to be about a European country with a strong primary care system. After applying the inclusion and exclusion criteria, 70 articles remained. RESULTS Factors positively influencing citizens' attitudes towards relocating care included: convenience, familiarity, accessibility, patients having more control over their disease, and privacy. Factors influencing negative attitudes included: concerns about the quality of care, familiarity, the lack of physical examination, contact with others, convenience, and privacy. Furthermore, in general, most citizens preferred to relocate care in the studies we found, especially from the hospital to care provided at home. CONCLUSION Several factors influencing the attitude of citizens towards relocating care were found. These factors are very important when determining citizens' preferences for the location of their healthcare. The majority of studies in this review reported that citizens are in favour of relocating care. In general citizens' perspectives on relocating care are very often missing in articles. It was significant that very few studies on relocation from the hospital to the general practitioner were identified.
Collapse
Affiliation(s)
- L J Damen
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands.
| | - L H D Van Tuyl
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - J C Korevaar
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
- The Hague University of Applied Sciences, The Hague, the Netherlands
| | - B J Knottnerus
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - J D De Jong
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
- CAPHRI, Maastricht University, PO Box 616, 6200 MD Maastricht, Maastricht, the Netherlands
| |
Collapse
|
6
|
Klaassen-Dekker A, Drossaert CHC, Van Maaren MC, Van Leeuwen-Stok AE, Retel VP, Korevaar JC, Siesling S. Personalized surveillance and aftercare for non-metastasized breast cancer: the NABOR study protocol of a multiple interrupted time series design. BMC Cancer 2023; 23:1112. [PMID: 37964214 PMCID: PMC10647159 DOI: 10.1186/s12885-023-11504-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Follow-up of curatively treated primary breast cancer patients consists of surveillance and aftercare and is currently mostly the same for all patients. A more personalized approach, based on patients' individual risk of recurrence and personal needs and preferences, may reduce patient burden and reduce (healthcare) costs. The NABOR study will examine the (cost-)effectiveness of personalized surveillance (PSP) and personalized aftercare plans (PAP) on patient-reported cancer worry, self-rated and overall quality of life and (cost-)effectiveness. METHODS A prospective multicenter multiple interrupted time series (MITs) design is being used. In this design, 10 participating hospitals will be observed for a period of eighteen months, while they -stepwise- will transit from care as usual to PSPs and PAPs. The PSP contains decisions on the surveillance trajectory based on individual risks and needs, assessed with the 'Breast Cancer Surveillance Decision Aid' including the INFLUENCE prediction tool. The PAP contains decisions on the aftercare trajectory based on individual needs and preferences and available care resources, which decision-making is supported by a patient decision aid. Patients are non-metastasized female primary breast cancer patients (N = 1040) who are curatively treated and start follow-up care. Patient reported outcomes will be measured at five points in time during two years of follow-up care (starting about one year after treatment and every six months thereafter). In addition, data on diagnostics and hospital visits from patients' Electronical Health Records (EHR) will be gathered. Primary outcomes are patient-reported cancer worry (Cancer Worry Scale) and overall quality of life (as assessed with EQ-VAS score). Secondary outcomes include health care costs and resource use, health-related quality of life (as measured with EQ5D-5L/SF-12/EORTC-QLQ-C30), risk perception, shared decision-making, patient satisfaction, societal participation, and cost-effectiveness. Next, the uptake and appreciation of personalized plans and patients' experiences of their decision-making process will be evaluated. DISCUSSION This study will contribute to insight in the (cost-)effectiveness of personalized follow-up care and contributes to development of uniform evidence-based guidelines, stimulating sustainable implementation of personalized surveillance and aftercare plans. TRIAL REGISTRATION Study sponsor: ZonMw. Retrospectively registered at ClinicalTrials.gov (2023), ID: NCT05975437.
Collapse
Affiliation(s)
- A Klaassen-Dekker
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
| | - C H C Drossaert
- Health & Technology Department, University of Twente, Enschede, The Netherlands
| | - M C Van Maaren
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | | | - V P Retel
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - J C Korevaar
- Faculty of Health, Nutrition & Sport, The Hague University of Applied Sciences, The Hague, The Netherlands
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands
| | - S Siesling
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| |
Collapse
|
7
|
Kager CC, Horsselenberg M, Korevaar JC, Wagner C, Hek K. Pattern of oral anticoagulant prescribing for atrial fibrillation in general practice: an observational study in The Netherlands. BJGP Open 2023; 7:BJGPO.2022.0179. [PMID: 36720562 DOI: 10.3399/bjgpo.2022.0179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 12/18/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In the Dutch atrial fibrillation (AF) guideline for GPs, vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) are seen as equivalent, while in cardiology there is a preference for DOACs. AIM To describe the pattern of oral anticoagulant (OAC) prescribing for AF by GPs and assess whether GPs proactively convert between VKAs and DOACs in patients with AF. DESIGN & SETTING Observational study using routine practice data from 214 general practices, from 2017 until 2019. METHOD Patients aged ≥60 years diagnosed with AF, who had been prescribed OACs by their GPs in 2018 were included. A distinction was made between starters, who were participants who did not use OACs in 2017, and prevalent users. It was observed and recorded whether patients switched between VKAs and DOACs. RESULTS A total of 12 516 patients with AF were included. Four hundred and seventy-six patients (4%) started OACs in 2018; 12 040 patients were prevalent OAC users. When GPs started patients on OACs, DOACs were prescribed the most (88%). Among prevalent users, more than half of the patients used VKAs (60%). GPs switched between OACs for 1% of starters and 0.6% of prevalent users in 2018 and 2019. CONCLUSION Dutch GPs predominantly start with DOACs in newly diagnosed patients with AF. Prevalent patients predominantly use VKAs and switching from a DOAC to a VKA is unusual. Consequently, the number of patients using VKAs will decline in the upcoming years. This trend raises questions about the future of organising frequent international normalised ratio (INR) checks for VKA users.
Collapse
Affiliation(s)
- Catharina Cm Kager
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Maaike Horsselenberg
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Joke C Korevaar
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Cordula Wagner
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Karin Hek
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| |
Collapse
|
8
|
Hek K, Lghoul-Oulad Saïd F, Korevaar JC, Flinterman LE, van Dijk L, van den Bemt PMLA. Adherence to coprescribing of laxatives with opioids and associated characteristics in general practices in the Netherlands. BMC Prim Care 2022; 23:312. [PMID: 36464672 PMCID: PMC9721085 DOI: 10.1186/s12875-022-01911-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 10/07/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Guidelines recommend to prescribe a laxative with an opioid to prevent constipation. We aimed to determine the adherence by general practitioners (GPs) to this recommendation and to explore which GP- and patient related factors were associated with it from the perspective of the GP. METHODS: We conducted an observational study using GPs' prescription data from the Nivel Primary Care Database combined with a questionnaire asking for reasons of non-adherence. The proportion of first opioid prescriptions prescribed together with a laxative was determined as primary outcome. Possible explanatory factors such as the quality of registration, the level of collaboration with the pharmacy, familiarity with the recommendation and use of a clinical decision support system were explored, as were the self-reported reasons for non-adherence (classified as either GP-related or patient-related). We assessed the association of factors with the primary outcome using univariable multilevel logistic regression analysis. RESULTS The recommendation was measured in 195 general practices. The median proportion of first opioid prescriptions prescribed together with a laxative in these practices was 54% (practice range 18-88%). None of the determinants was consistently associated with the primary outcome. GPs from 211 practices filled out the questionnaire and the most frequently mentioned reason not to prescribe a laxative was that the patient has laxatives in stock, followed by that the patient doesn't want a laxative; both were patient-related factors. CONCLUSION There was room for improvement in following the guideline on laxative prescribing in opioid use. A main reason seemed to be that the patient refuses a laxative. Improvement measures should therefore focus on communication between GPs and patients on the relevance of co-using a laxative with opioids. Future studies need to establish the effect of such improvement measures, and determine whether reasons for non-adherence to the guideline changed over time.
Collapse
Affiliation(s)
- Karin Hek
- grid.416005.60000 0001 0681 4687Nivel, Netherlands Institute for Health Services Research, PO box 1568, 3500 BN Utrecht, The Netherlands
| | - Fouzia Lghoul-Oulad Saïd
- grid.5132.50000 0001 2312 1970Division of BioTherapeutics, Leiden Academic Centre for Drug Research (LACDR), Gorlaeus Laboratories, Leiden University, Leiden, The Netherlands ,grid.4494.d0000 0000 9558 4598Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands ,grid.5645.2000000040459992XDepartment of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joke C. Korevaar
- grid.416005.60000 0001 0681 4687Nivel, Netherlands Institute for Health Services Research, PO box 1568, 3500 BN Utrecht, The Netherlands
| | - Linda E. Flinterman
- grid.416005.60000 0001 0681 4687Nivel, Netherlands Institute for Health Services Research, PO box 1568, 3500 BN Utrecht, The Netherlands
| | - Liset van Dijk
- grid.416005.60000 0001 0681 4687Nivel, Netherlands Institute for Health Services Research, PO box 1568, 3500 BN Utrecht, The Netherlands ,grid.4830.f0000 0004 0407 1981Department of PharmacoTherapy, -Epidemiology and -Economics (PTEE), Groningen Research Institute of Pharmacy, Faculty of Science and Engineering, University of Groningen, Groningen, the Netherlands
| | - Patricia M. L. A. van den Bemt
- grid.4494.d0000 0000 9558 4598Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
9
|
van Kalsbeek RJ, Korevaar JC, Rijken M, Haupt R, Muraca M, Kepák T, Kepakova K, Blondeel A, Boes S, Frederiksen LE, Essiaf S, Winther JF, Hermens RPMG, Kienesberger A, Loonen JJ, Michel G, Mulder RL, O'Brien KB, van der Pal HJH, Pluijm SMF, Roser K, Skinner R, Renard M, Uyttebroeck A, Follin C, Hjorth L, Kremer LCM. Evaluating the feasibility, effectiveness and costs of implementing person-centred follow-up care for childhood cancer survivors in four European countries: the PanCareFollowUp Care prospective cohort study protocol. BMJ Open 2022; 12:e063134. [PMID: 36396317 PMCID: PMC9677022 DOI: 10.1136/bmjopen-2022-063134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Long-term survival after childhood cancer often comes at the expense of late, adverse health conditions. However, survivorship care is frequently not available for adult survivors in Europe. The PanCareFollowUp Consortium therefore developed the PanCareFollowUp Care Intervention, an innovative person-centred survivorship care model based on experiences in the Netherlands. This paper describes the protocol of the prospective cohort study (Care Study) to evaluate the feasibility and the health economic, clinical and patient-reported outcomes of implementing PanCareFollowUp Care as usual care in four European countries. METHODS AND ANALYSIS In this prospective, longitudinal cohort study with at least 6 months of follow-up, 800 childhood cancer survivors will receive the PanCareFollowUp Care Intervention across four study sites in Belgium, Czech Republic, Italy and Sweden, representing different healthcare systems. The PanCareFollowUp Care Intervention will be evaluated according to the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. Clinical and research data are collected through questionnaires, a clinic visit for multiple medical assessments and a follow-up call. The primary outcome is empowerment, assessed with the Health Education Impact Questionnaire. A central data centre will perform quality checks, data cleaning and data validation, and provide support in data analysis. Multilevel models will be used for repeated outcome measures, with subgroup analysis, for example, by study site, attained age, sex or diagnosis. ETHICS AND DISSEMINATION This study will be conducted in accordance with the guidelines of Good Clinical Practice and the Declaration of Helsinki. The study protocol has been reviewed and approved by all relevant ethics committees. The evidence and insights gained by this study will be summarised in a Replication Manual, also including the tools required to implement the PanCareFollowUp Care Intervention in other countries. This Replication Manual will become freely available through PanCare and will be disseminated through policy and press releases. TRIAL REGISTRATION NUMBER Netherlands Trial Register (NL8918; https://www.trialregister.nl/trial/8918).
Collapse
Affiliation(s)
| | - Joke C Korevaar
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Mieke Rijken
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Department of Health and Social Care Management, University of Eastern Finland-Kuopio Campus, Kuopio, Finland
| | - Riccardo Haupt
- DOPO Clinic, Department of Hematology/Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Monica Muraca
- DOPO Clinic, Department of Hematology/Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Tomáš Kepák
- International Clinical Research Centre (FNUSA-ICRC) at St Anne's University Hospital, Masaryk University Faculty of Medicine, Brno, Czech Republic
| | - Katerina Kepakova
- International Clinical Research Centre (FNUSA-ICRC) at St Anne's University Hospital, Masaryk University Faculty of Medicine, Brno, Czech Republic
| | - Anne Blondeel
- European Society for Pediatric Oncology (SIOP Europe), Brussels, Belgium
| | - Stefan Boes
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Line E Frederiksen
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Samira Essiaf
- European Society for Pediatric Oncology (SIOP Europe), Brussels, Belgium
| | - Jeanette F Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Medicine and Faculty of Health, Aarhus Universitet, Aarhus, Denmark
| | - Rosella P M G Hermens
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboudumc, Nijmegen, The Netherlands
| | | | | | - Gisela Michel
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Renée L Mulder
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Helena J H van der Pal
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- PanCare, Bussum, The Netherlands
| | - Saskia M F Pluijm
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Katharina Roser
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Roderick Skinner
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
- Royal Victoria Infirmary, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Marleen Renard
- Department of Paediatric Haematology and Oncology, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Anne Uyttebroeck
- Department of Paediatric Haematology and Oncology, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Cecilia Follin
- Department of Clinical Sciences Lund, Oncology, Lund University, Skane University Hospital, Lund, Sweden
| | - Lars Hjorth
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Skane University Hospital, Lund, Sweden
| | - Leontien C M Kremer
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Paediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
10
|
Damen L, De Jong JD, Van Tuyl L, Korevaar JC. Citizens’ perspective on ‘the right care in the right place’. Eur J Public Health 2022. [PMCID: PMC9594281 DOI: 10.1093/eurpub/ckac129.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Healthcare systems around the globe are facing challenges, from increasing demand and costs to a diminishing health workforce. Without change, healthcare will become unsustainable. In the Netherlands, the government aims to organize sustainable healthcare by among others the policy ‘the right care in the right place’. An important part of this policy is relocating healthcare, for instance, from the hospital to the general practitioner (GP) or from the GP to other healthcare providers or to citizens themselves. Relocation of care is expected to reduce costs and manpower shortages. There is, however, little known about how citizens think about this topic, although they are an important stakeholder. This research aims to investigate citizens’ perspectives on the right place for care. Methods A questionnaire was sent in December 2021 to 1.500 members of Nivel's Dutch Healthcare Consumer Panel, including 4 questions about the right care in the right place. The response was N = 796 (53%). In addition, two citizen platforms were organized in March 2022, to discuss the right care in the right place. A total of 23 citizens participated. Results First results indicate that most citizens related expertise and accessibility to the right care in the right place. Participants said that non-complex care could be relocated from the hospital to the GP if the GP has the right expertise. Expertise was mentioned as the most important aspect of care delivery. According to participants, care could be shifted from the GP to other primary care professionals, to social services or to self-sustainability, given that citizens know who to visit or what to do with health problems/worries. More results will be available by November. Conclusions Relocating care could be a possible solution to keep healthcare sustainable in the future in terms of costs and manpower. Among citizens, there seems to be support when certain conditions are met. Key messages • Citizens support the substitution of non-complex care from hospitals. • Citizens are willing to improve self-sustainability when they have the tools.
Collapse
Affiliation(s)
- L Damen
- NIVEL , Utrecht, Netherlands
| | - JD De Jong
- NIVEL , Utrecht, Netherlands
- Maastricht University , Maastricht, Netherlands
| | | | | |
Collapse
|
11
|
Bennis FC, Hoogendoorn M, Aussems C, Korevaar JC. Prediction of heart failure 1 year before diagnosis in general practitioner patients using machine learning algorithms: a retrospective case-control study. BMJ Open 2022; 12:e060458. [PMID: 36041765 PMCID: PMC9438066 DOI: 10.1136/bmjopen-2021-060458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Heart failure (HF) is a commonly occurring health problem with high mortality and morbidity. If potential cases could be detected earlier, it may be possible to intervene earlier, which may slow progression in some patients. Preferably, it is desired to reuse already measured data for screening of all persons in an age group, such as general practitioner (GP) data. Furthermore, it is essential to evaluate the number of people needed to screen to find one patient using true incidence rates, as this indicates the generalisability in the true population. Therefore, we aim to create a machine learning model for the prediction of HF using GP data and evaluate the number needed to screen with true incidence rates. DESIGN, SETTINGS AND PARTICIPANTS GP data from 8543 patients (-2 to -1 year before diagnosis) and controls aged 70+ years were obtained retrospectively from 01 January 2012 to 31 December 2019 from the Nivel Primary Care Database. Codes about chronic illness, complaints, diagnostics and medication were obtained. Data were split in a train/test set. Datasets describing demographics, the presence of codes (non-sequential) and upon each other following codes (sequential) were created. Logistic regression, random forest and XGBoost models were trained. Predicted outcome was the presence of HF after 1 year. The ratio case:control in the test set matched true incidence rates (1:45). RESULTS Sole demographics performed average (area under the curve (AUC) 0.692, CI 0.677 to 0.706). Adding non-sequential information combined with a logistic regression model performed best and significantly improved performance (AUC 0.772, CI 0.759 to 0.785, p<0.001). Further adding sequential information did not alter performance significantly (AUC 0.767, CI 0.754 to 0.780, p=0.07). The number needed to screen dropped from 14.11 to 5.99 false positives per true positive. CONCLUSION This study created a model able to identify patients with pending HF a year before diagnosis.
Collapse
Affiliation(s)
- Frank C Bennis
- Department of Computer Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| | - Mark Hoogendoorn
- Department of Computer Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Claire Aussems
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| | - Joke C Korevaar
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| |
Collapse
|
12
|
Meekes WMA, Leemrijse CJ, Korevaar JC, Stanmore EK, van de Goor LIAM. Implementing Falls Prevention in Primary Care: Barriers and Facilitators. Clin Interv Aging 2022; 17:885-902. [PMID: 35686030 PMCID: PMC9171056 DOI: 10.2147/cia.s354911] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/11/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Limited information is available concerning primary care providers’ encountered barriers and facilitators when implementing falls prevention and providing interventions in a real-life setting. This study aimed to identify barriers and facilitators when i) implementing a falls risk assessment strategy at GP practices and among community nurses and ii) providing evidence-based falls prevention interventions in a real-life setting to independently living, frail older people. Methods A researcher’s journal was maintained during the implementation of a falls risk assessment strategy, which entailed notes from informal conversations with GPs, practice nurses and community nurses. After implementation, two online focus groups with GPs, practice and community nurses, physio- and exercise therapists were conducted. Data were thematically analyzed. Results Data were collected from 32 GPs, 13 practice nurses, eight community nurses, nine physiotherapists, and two exercise therapists. The GPs and nurses acknowledged that falls prevention is part of their job, meaningful, and that they have sufficient knowledge and skills to offer falls prevention. Collaboration, a previously implemented care program for older people, resources, reimbursement for interventions, and patients’ motivation, awareness and health issues were considered to be important factors for the implementation of falls prevention. Physio- and exercise therapists described collaboration with different disciplines, receiving sufficient referrals, reimbursements, intensity and set-up of the interventions, and patients’ motivation, expectations, goals, self-confidence, awareness, and health issues as important factors when providing falls prevention interventions. Conclusion This study identified care provider-, context-, patient-, and innovation (strategy)-related barriers and facilitators when implementing falls prevention and providing interventions in primary care. Development of a more successful implementation strategy should focus on intensifying collaboration, reimbursement for interventions, availability of resources, and patients’ lack of motivation and health issues. Hence, falls prevention may become more structurally applied, reducing a major threat for the quality of life of independently living older people.
Collapse
Affiliation(s)
- Wytske M A Meekes
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Nivel, Utrecht, Netherlands
| | | | | | - Emma K Stanmore
- School of Health Sciences, University of Manchester, Manchester, UK and Manchester Academic Health Science Centre (MAHSC), Manchester, UK
| | | |
Collapse
|
13
|
Heins MJ, de Ligt KM, Verloop J, Siesling S, Korevaar JC. Opportunities and obstacles in linking large health care registries: the primary secondary cancer care registry - breast cancer. BMC Med Res Methodol 2022; 22:124. [PMID: 35477392 PMCID: PMC9044735 DOI: 10.1186/s12874-022-01601-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background The growing volume of health data provides new opportunities for medical research. By using existing registries, large populations can be studied over a long period of time. Patient-level linkage of registries leads to even more detailed and extended information per patient, but brings challenges regarding responsibilities, privacy and security, and quality of data linkage. In this paper we describe how we dealt with these challenges when creating the Primary Secondary Cancer Care Registry (PSCCR)- Breast Cancer. Methods The PSCCR – Breast Cancer was created by linking two existing registries containing data on 1) diagnosis, tumour and treatment characteristics of all Dutch breast cancer patients (NCR), and 2) consultations and diagnoses from primary care electronic health records of about 10% of Dutch GP practices (Nivel-PCD). The existing registry governance structures and privacy regulations were incorporated in those of the new registry. Privacy and security risks were reassessed. Data were restricted to females and linked using postal code and date of birth. The breast cancer diagnosis was verified in both registries and for a subsample of 44 patients with the GP as well. Results A collaboration agreement was signed in which the organisations retained data responsibility and accountability for ‘their’ registry. A Trusted Third Party performed the record linkage. Ten percent of the patients with breast cancer could be linked to the primary care registry, as was expected based on the coverage of Nivel-PCD, and finally 7 % could be included. The breast cancer diagnosis was verified by the GP in 42 of the 44 patients. Conclusions We developed and validated a procedure for patient-level linkage of health data registries without a unique identifier, while preserving the integrity and privacy of the original registries. The method described may help researchers wishing to link existing health data registries.
Collapse
Affiliation(s)
- Marianne J Heins
- Nivel, Netherlands Institute of Health Services Research, P.O Box 1568, 3500 BN, Utrecht, Netherlands.
| | - Kelly M de Ligt
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.,Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Janneke Verloop
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Sabine Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.,Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Joke C Korevaar
- Nivel, Netherlands Institute of Health Services Research, P.O Box 1568, 3500 BN, Utrecht, Netherlands
| |
Collapse
|
14
|
Heins MJ, de Ligt KM, Verloop J, Siesling S, Korevaar JC. Adverse health effects after breast cancer up to 14 years after diagnosis. Breast 2022; 61:22-28. [PMID: 34891036 PMCID: PMC8661054 DOI: 10.1016/j.breast.2021.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The number of breast cancer survivors increases, but information about long-term adverse health effects in breast cancer survivors is sparse. We aimed to get an overview of the health effects for which survivors visit their general practitioner up to 14 years after diagnosis. METHODS We retrieved data on 11,671 women diagnosed with breast cancer in 2000-2016 and 23,242 age and sex matched controls from the PSCCR-Breast Cancer, a database containing data about cancer diagnosis, treatment and primary healthcare. We built Cox regression models for 685 health effects, with time until the health effect as the outcome and survivor/control and cancer treatment as predictors. Models were built separately for four age groups (aged 18/44, 45/59, 60/74 and 75/89) and two follow-up periods (1/4 and 5/14 years after diagnosis). RESULTS 229 health effects occurred statistically significantly more often in survivors than in controls (p < 0.05). Health effects varied by age, time since diagnosis and treatment, but coughing, respiratory and urinary infections, fatigue, sleep problems, osteoporosis and lymphedema were statistically significantly increased in breast cancer survivors. Osteoporosis and chest symptoms were associated with hormone therapy; respiratory and skin infections with chemotherapy and lymphedema and skin infections with axillary dissection. CONCLUSIONS Breast cancer survivors may experience numerous adverse health effects up to 14 years after diagnosis. Insight in individual risks may assist healthcare professionals in managing patient expectations and improve monitoring, detection and treatment of adverse health effects.
Collapse
Affiliation(s)
- Marianne J Heins
- Netherlands Institute for Health Services Research (Nivel), Utrecht, the Netherlands.
| | - Kelly M de Ligt
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands; Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Janneke Verloop
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Sabine Siesling
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands; Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Joke C Korevaar
- Netherlands Institute for Health Services Research (Nivel), Utrecht, the Netherlands
| |
Collapse
|
15
|
van Kalsbeek RJ, Mulder RL, Haupt R, Muraca M, Hjorth L, Follin C, Kepak T, Kepakova K, Uyttebroeck A, Mangelschots M, Winther JF, Loonen JJ, Michel G, Bardi E, Elmerdahl Frederiksen L, den Hartogh J, Mader L, Roser K, Schneider C, Brown MC, Brunhofer M, Göttgens I, Hermens RPMG, Kienesberger A, Korevaar JC, Skinner R, van der Pal HJH, Kremer LCM. The PanCareFollowUp Care Intervention: A European harmonised approach to person-centred guideline-based survivorship care after childhood, adolescent and young adult cancer. Eur J Cancer 2022; 162:34-44. [PMID: 34953441 DOI: 10.1016/j.ejca.2021.10.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Long-term follow-up (LTFU) care, although endorsed, is not available for the majority of adult survivors of childhood, adolescence and young adult (CAYA) cancer. Barriers to implementation include lack of time, knowledge, personnel and funding. Sustainable solutions are urgently needed to address the needs of CAYA cancer survivors to improve the quality of life and reduce the burden of late effects on survivors, health care systems and society. The European Union-funded PanCareFollowUp project, initiated by the Pan-European Network for Care of Survivors after Childhood and Adolescent Cancer, was established to facilitate the implementation of person-centred survivorship care across Europe. PATIENTS AND METHODS The PanCareFollowUp Care Intervention was co-developed with survivors as part of the PanCareFollowUp project. It is a person-centred approach to survivorship care, supported by guidelines and with flexibility to adapt to local health care settings. The Care Intervention consists of three steps: (1) previsit completion of a Survivor Questionnaire (by the survivor) and Treatment Summary (by the health care provider [HCP]), (2) a clinic visit including shared decision-making, and (3) a follow-up call to finalise the individualised Survivorship Care Plan. RESULTS We developed the key components of the PanCareFollowUp Care Intervention: a PanCareFollowUp Survivor Questionnaire, Treatment Summary template, Survivorship Care Plan template, and educational materials for HCPs and survivors. Wide implementation of the PanCareFollowUp Care Intervention will be supported with a freely distributed Replication Manual on completion of the PanCareFollowUp project. CONCLUSIONS The PanCareFollowUp Care Intervention will support the implementation of person-centred, guideline-based LTFU care in different health care settings across Europe to improve survivors' health and well-being.
Collapse
Affiliation(s)
| | - Renée L Mulder
- Princess Máxima Centre for Paediatric Oncology, Utrecht, the Netherlands
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Monica Muraca
- Epidemiology and Biostatistics Unit and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Lars Hjorth
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Paediatrics, Lund, Sweden
| | - Cecilia Follin
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Oncology, Lund, Sweden
| | - Tomas Kepak
- International Clinical Research Centre (FNUSA-ICRC), St. Anne's University Hospital, Masaryk University, Brno, Czech Republic
| | - Katerina Kepakova
- International Clinical Research Centre (FNUSA-ICRC), St. Anne's University Hospital, Masaryk University, Brno, Czech Republic
| | - Anne Uyttebroeck
- Department of Oncology, Paediatric Oncology, KU Leuven, Department of Paediatric Haematology and Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Marlies Mangelschots
- Department of Oncology, Paediatric Oncology, KU Leuven, Department of Paediatric Haematology and Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Centre, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - Jacqueline J Loonen
- Department of Haematology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Gisela Michel
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Edit Bardi
- PanCare, Bussum, the Netherlands; St Anna Children's Hospital, Vienna, Austria; Department of Pediatric and Adolescent Medicine, Kepler University Clinic, Linz, Austria
| | | | - Jaap den Hartogh
- PanCare, Bussum, the Netherlands; Childhood Cancer International Europe, Vienna, Austria
| | - Luzius Mader
- Childhood Cancer Research Group, Danish Cancer Society Research Centre, Copenhagen, Denmark; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Katharina Roser
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Morven C Brown
- Population Health Sciences Institute, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom; Newcastle University Centre for Cancer, Wolfson Childhood Cancer Research Centre, Herschel Building, Newcastle Upon Tyne, United Kingdom
| | | | - Irene Göttgens
- Department of Primary and Community Care, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Rosella P M G Hermens
- Radboud University Medical Centre, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), Nijmegen, the Netherlands
| | | | - Joke C Korevaar
- Netherlands Institute for Health Services Research (Nivel), Utrecht, the Netherlands
| | - Roderick Skinner
- Newcastle University Centre for Cancer, Wolfson Childhood Cancer Research Centre, Herschel Building, Newcastle Upon Tyne, United Kingdom; Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom; Translational and Clinical Research Institute, Wolfson Childhood Cancer Research Centre, Herschel Building, Newcastle Upon Tyne, United Kingdom
| | - Helena J H van der Pal
- Princess Máxima Centre for Paediatric Oncology, Utrecht, the Netherlands; PanCare, Bussum, the Netherlands.
| | - Leontine C M Kremer
- Princess Máxima Centre for Paediatric Oncology, Utrecht, the Netherlands; Department of Paediatrics, Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands; Faculty of Medicine, Utrecht University and Utrecht Medical Centre, Utrecht, the Netherlands
| |
Collapse
|
16
|
Abstract
OBJECTIVE Although several falls risk assessment tools are available, it is unclear which have been validated and which would be most suitable for primary care practices. This systematic review aims to identify the most suitable falls risk assessment tool for the primary care setting (ie, requires limited time, no expensive equipment and no additional space) and that has good predictive performance in the assessment of falls risk among older people living independently. DESIGN A systematic review based on prospective studies. METHODS An extensive search was conducted in the following databases: PubMed, Embase, CINAHL, Cochrane and PsycINFO. Tools were excluded if they required expensive and/or advanced software that is not usually available in primary care units and if they had not been validated in at least three different studies. Of 2492 articles published between January 2000 and July 2020, 27 were included. RESULTS Six falls risk assessment tools were identified: Timed Up and Go (TUG) test, Gait Speed test, Berg Balance Scale, Performance Oriented Mobility Assessment, Functional Reach test and falls history. Most articles reported area under the curve (AUC) values ranging from 0.5 to 0.7 for these tools. Sensitivity and specificity varied substantially across studies (eg, TUG, sensitivity:10%-83.3%, specificity:28.4%-96.6%). CONCLUSIONS Given that none of the falls risk assessment tools had sufficient predictive performance (AUC <0.7), other ways of assessing high falls risk among independently living older people in primary care should be investigated. For now, the most suitable way to assess falls risk in the primary care setting appears to involve asking patients about their falls history. Compared with the other five tools, the falls history requires the least amount of time, no expensive equipment, no training and no spatial adjustments. The clinical judgement of healthcare professionals continues to be most important, as it enables the identification of high falls risk even for patients with no falls history. TRIAL REGISTRAION NUMBER The Netherlands Trial Register, NL7917; Pre-results.
Collapse
Affiliation(s)
- Wytske Ma Meekes
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | | | | | - Ien Am van de Goor
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| |
Collapse
|
17
|
Meekes WMA, Leemrijse CJ, Weesie YM, van de Goor IAM, Donker GA, Korevaar JC. Falls prevention at GP practices: a description of daily practice. BMC Fam Pract 2021; 22:190. [PMID: 34548022 PMCID: PMC8454103 DOI: 10.1186/s12875-021-01540-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 08/31/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND General practitioners (GPs) can be considered the designated professionals to identify high fall risk and to guide older people to fall preventive care. Currently it is not exactly known how GPs treat this risk. This study aims to investigate GPs' daily practice regarding fall preventive care for frail older patients. METHODS Sixty-five GPs from 32 Dutch practices participated in this study for a period of 12 months. When a GP entered specific International Classification of Primary Care-codes related to frailty and/or high fall risk in their Electronic Health Records, a pop-up appeared asking "Is this patient frail?". If the GP confirmed this, the GP completed a short questionnaire about patient's fall history and fear of falling (FOF), and the fall preventive care provided. RESULTS The GPs completed questionnaires regarding 1394 frail older patients aged ≥75. Of 20% of these patients, the GPs did not know whether they had experienced a fall or not. The GPs did not know whether a FOF existed in even more patients (29%). Of the patients with a fall history and/or a FOF (N = 726), 37% (N = 271) received fall preventive care. Two main reasons for not offering fall preventive care to these patients were: I) the patient finds treatment too intensive or too much of a hassle (37%), and II) the GP identified a high fall risk but the patient did not acknowledge this (14%). When patients were treated for high fall risk, the GP and the physiotherapist were the most frequently involved health care providers. The involved health care providers most often treated mobility limitations, cardiovascular risk factors, and FOF. CONCLUSIONS The results from this study show that GPs were frequently not aware of their frail patient's fall history and/or FOF and that the majority of the frail older patients with a fall history and/or FOF did not receive fall preventive care. Developing systematic screening strategies for the primary care setting enhancing the identification of high fall risk and the provision of fall preventive care may improve patients' quality of life and reduce health care costs.
Collapse
Affiliation(s)
- Wytske M A Meekes
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Postbus 90153, 5000 LE, Tilburg, Netherlands.
- NIVEL, Otterstraat 118-124, 3513 CR, Utrecht, Netherlands.
| | | | | | - Ien A M van de Goor
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Postbus 90153, 5000 LE, Tilburg, Netherlands
| | - Gé A Donker
- NIVEL, Otterstraat 118-124, 3513 CR, Utrecht, Netherlands
| | | |
Collapse
|
18
|
van Summeren JJGT, Rizzo C, Hooiveld M, Korevaar JC, Hendriksen JMT, Dückers MLA, Loconsole D, Chironna M, Bangert M, Demont C, Meijer A, Caini S, Pandolfi E, Paget J. Evaluation of a standardised protocol to measure the disease burden of respiratory syncytial virus infection in young children in primary care. BMC Infect Dis 2021; 21:705. [PMID: 34311699 PMCID: PMC8311415 DOI: 10.1186/s12879-021-06397-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/15/2021] [Indexed: 11/24/2022] Open
Abstract
Background A better understanding of the burden of respiratory syncytial virus (RSV) infections in primary care is needed for policymakers to make informed decisions regarding new preventive measures and treatments. The aim of this study was to develop and evaluate a protocol for the standardised measurement of the disease burden of RSV infection in primary care in children aged < 5 years. Methods The standardised protocol was evaluated in Italy and the Netherlands during the 2019/20 winter. Children aged < 5 years who consulted their primary care physician, met the WHO acute respiratory infections (ARI) case definition, and had a laboratory confirmed positive test for RSV (RT-PCR) were included. RSV symptoms were collected at the time of swabbing. Health care use, duration of symptoms and socio-economic impact was measured 14 days after swabbing. Health related Quality of life (HRQoL) was measured using the parent-proxy report of the PedsQL™4.0 generic core scales (2–4 years) and PedsQL™4.0 infant scales (0–2 years) 30 days after swabbing. The standardised protocol was evaluated in terms of the feasibility of patient recruitment, data collection procedures and whether parents understood the questions. Results Children were recruited via a network of paediatricians in Italy and a sentinel influenza surveillance network of general practitioners in the Netherlands. In Italy and the Netherlands, 293 and 152 children were swabbed respectively, 119 and 32 tested RSV positive; for 119 and 12 children the Day-14 questionnaire was completed and for 116 and 11 the Day-30 questionnaire. In Italy, 33% of the children had persistent symptoms after 14 days and in the Netherlands this figure was 67%. Parents had no problems completing questions concerning health care use, duration of symptoms and socio-economic impact, however, they had some difficulties scoring the HRQoL of their young children. Conclusion RSV symptoms are common after 14 days, and therefore, measuring disease burden outcomes like health care use, duration of symptoms, and socio-economic impact is also recommended at Day-30. The standardised protocol is suitable to measure the clinical and socio-economic disease burden of RSV in young children in primary care.
Collapse
Affiliation(s)
- J J G T van Summeren
- Nivel, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500BN, Utrecht, Utrecht, The Netherlands.
| | - C Rizzo
- IRCCS, Bambino Gesù Children's Hospital, Rome, Italy
| | - M Hooiveld
- Nivel, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500BN, Utrecht, Utrecht, The Netherlands
| | - J C Korevaar
- Nivel, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500BN, Utrecht, Utrecht, The Netherlands
| | - J M T Hendriksen
- Nivel, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500BN, Utrecht, Utrecht, The Netherlands
| | - M L A Dückers
- Nivel, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500BN, Utrecht, Utrecht, The Netherlands.,University of Groningen, Faculty of Behavioural and Social Sciences, Groningen, The Netherlands
| | - D Loconsole
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, "Aldo Moro", Bari, Italy
| | - M Chironna
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, "Aldo Moro", Bari, Italy
| | | | | | - A Meijer
- Centre for Infectious Diseases Research, Diagnostics and laboratory Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - S Caini
- Nivel, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500BN, Utrecht, Utrecht, The Netherlands
| | - E Pandolfi
- IRCCS, Bambino Gesù Children's Hospital, Rome, Italy
| | - J Paget
- Nivel, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500BN, Utrecht, Utrecht, The Netherlands
| |
Collapse
|
19
|
van Kalsbeek RJ, van der Pal HJH, Hjorth L, Winther JF, Michel G, Haupt R, Uyttebroeck A, O'Brien K, Kepakova K, Follin C, Muraca M, Kepak T, Araujo-Soares V, Bardi E, Blondeel A, Bouwman E, Brown MC, Frederiksen LE, Essiaf S, Hermens RPMG, Kienesberger A, Korevaar JC, Mader L, Mangelschots M, Mulder RL, van den Oever S, Rijken M, Roser K, Skinner R, Pluijm SMF, Loonen JJ, Kremer LCM. The European multistakeholder PanCareFollowUp project: novel, person-centred survivorship care to improve care quality, effectiveness, cost-effectiveness and accessibility for cancer survivors and caregivers. Eur J Cancer 2021; 153:74-85. [PMID: 34153717 DOI: 10.1016/j.ejca.2021.05.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/12/2021] [Accepted: 05/20/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND The majority of childhood cancer survivors are at risk of treatment-related adverse health outcomes. Survivorship care to mitigate these late effects is endorsed, but it is not available for many adult survivors of childhood cancer in Europe. The PanCareFollowUp project was initiated to improve their health and quality of life (QoL) by facilitating person-centred survivorship care. METHODS The PanCareFollowUp consortium was established in 2018, consisting of 14 project partners from ten European countries, including survivor representatives. The consortium will develop two PanCareFollowUp Interventions, including a person-centred guideline-based model of care (Care Intervention) and eHealth lifestyle coaching (Lifestyle Intervention). Their development will be informed by several qualitative studies and systematic reviews on barriers and facilitators for implementation and needs and preferences of healthcare providers (HCPs) and survivors. Implementation of the PanCareFollowUp Care Intervention as usual care will be evaluated prospectively among 800 survivors from Belgium, Czech Republic, Italy and Sweden for survivor empowerment, detection of adverse health conditions, satisfaction among survivors and HCPs, cost-effectiveness and feasibility. The feasibility of the PanCareFollowUp Lifestyle Intervention will be evaluated in the Netherlands among 60 survivors. RESULTS Replication manuals, allowing for replication of the PanCareFollowUp Care and Lifestyle Intervention, will be published and made freely available after the project. Moreover, results of the corresponding studies are expected within the next five years. CONCLUSIONS The PanCareFollowUp project is a novel European collaboration aiming to improve the health and QoL of all survivors across Europe by developing and prospectively evaluating the person-centred PanCareFollowUp Care and Lifestyle Interventions.
Collapse
Affiliation(s)
- Rebecca J van Kalsbeek
- Princess Máxima Centre for Paediatric Oncology, Heidelberglaan 25, Utrecht, 3584 CS, the Netherlands.
| | - Helena J H van der Pal
- Princess Máxima Centre for Paediatric Oncology, Heidelberglaan 25, Utrecht, 3584 CS, the Netherlands; PanCare, Jacobus Bellamylaan 16, Bussum, 1401 AZ, the Netherlands
| | - Lars Hjorth
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Paediatrics, Lasarettsgatan 40, Lund, 221 85, Sweden
| | - Jeanette F Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Centre, Strandboulevarden 49 Copenhagen, 2100, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University and Aarhus University Hospital, Palle Juul-Jensens Boulevard 82, Aarhus, 8200, Denmark
| | - Gisela Michel
- University of Lucerne, Department of Health Sciences and Medicine, Frohburgstrasse 3, P.O. Box 4466, Lucerne, 6002, Switzerland
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Via G. Gaslini, 5, Genoa, 16147, Italy
| | - Anne Uyttebroeck
- Department of Oncology, Paediatric Oncology, KU Leuven, Department of Paediatric Haematology and Oncology, University Hospitals Leuven, Herestraat 49, Leuven, 3000, Belgium
| | - Kylie O'Brien
- Pintail, Limited, 77 Springhill Avenue, Blackrock, Dublin, Ireland
| | - Katerina Kepakova
- International Clinical Research Centre (FNUSA-ICRC) at St. Anne's University Hospital, Masaryk University, Pekařská 53, Brno, 656 91, Czech Republic
| | - Cecilia Follin
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Oncology, Lasarettsgatan 40, Lund, 221 85, Sweden
| | - Monica Muraca
- Epidemiology and Biostatistics Unit and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Via G. Gaslini, 5, Genoa, 16147, Italy
| | - Tomas Kepak
- International Clinical Research Centre (FNUSA-ICRC) at St. Anne's University Hospital, Masaryk University, Pekařská 53, Brno, 656 91, Czech Republic
| | - Vera Araujo-Soares
- Department of Health Technology & Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, 7500 AE, the Netherlands
| | - Edit Bardi
- St Anna Children's Hospital, Kinderspitalgasse 6, Vienna, 1090, Austria; Kepler University Clinic, Department of Pediatric and Adolescent Medicine, Krankenhausstraße 26-30, Linz, 4020, Austria
| | - Anne Blondeel
- European Society for Paediatric Oncology, C/o BLSI, Clos Chapelle-aux-Champs 30, Bte 1.30.30, Brussels, BE-1200, Belgium
| | - Eline Bouwman
- Radboud University Medical Centre, Radboud Institute for Health Sciences, Department of Hematology, Geert Grooteplein Zuid 10, Nijmegen, 6525 GA, the Netherlands
| | - Morven C Brown
- Population Health Sciences Institute, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne, NE1 4LP, United Kingdom; Newcastle University Centre for Cancer, Wolfson Childhood Cancer Research Centre, Herschel Building, Brewery Lane, Newcastle Upon Tyne, NE1 7RU, United Kingdom
| | - Line E Frederiksen
- Childhood Cancer Research Group, Danish Cancer Society Research Centre, Strandboulevarden 49 Copenhagen, 2100, Denmark
| | - Samira Essiaf
- European Society for Paediatric Oncology, C/o BLSI, Clos Chapelle-aux-Champs 30, Bte 1.30.30, Brussels, BE-1200, Belgium
| | - Rosella P M G Hermens
- Radboud University Medical Centre, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare) Geert Grooteplein 21, Nijmegen, 6525 EZ, the Netherlands
| | - Anita Kienesberger
- Childhood Cancer International Europe, Servitengasse 5/16, Vienna, 1090, Austria
| | - Joke C Korevaar
- Netherlands Institute for Health Services Research (Nivel), P.O. Box 1568, Utrecht, 3500 BN, the Netherlands
| | - Luzius Mader
- Childhood Cancer Research Group, Danish Cancer Society Research Centre, Strandboulevarden 49 Copenhagen, 2100, Denmark; Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, Bern, 3012, Switzerland
| | - Marlies Mangelschots
- Department of Oncology, Paediatric Oncology, KU Leuven, Department of Paediatric Haematology and Oncology, University Hospitals Leuven, Herestraat 49, Leuven, 3000, Belgium
| | - Renée L Mulder
- Princess Máxima Centre for Paediatric Oncology, Heidelberglaan 25, Utrecht, 3584 CS, the Netherlands
| | - Selina van den Oever
- Princess Máxima Centre for Paediatric Oncology, Heidelberglaan 25, Utrecht, 3584 CS, the Netherlands
| | - Mieke Rijken
- Netherlands Institute for Health Services Research (Nivel), P.O. Box 1568, Utrecht, 3500 BN, the Netherlands; University of Eastern Finland, Department of Health and Social Management, P.O. Box 1627, Kuopio, FI-70211, Finland
| | - Katharina Roser
- University of Lucerne, Department of Health Sciences and Medicine, Frohburgstrasse 3, P.O. Box 4466, Lucerne, 6002, Switzerland
| | - Rod Skinner
- Newcastle University Centre for Cancer, Wolfson Childhood Cancer Research Centre, Herschel Building, Brewery Lane, Newcastle Upon Tyne, NE1 7RU, United Kingdom; Great North Children's Hospital, Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne, NE1 4 LP, United Kingdom; Translational and Clinical Research Institute, Wolfson Childhood Cancer Research Centre, Herschel Building, Brewery Lane, Newcastle Upon Tyne, NE1 7RU, United Kingdom
| | - Saskia M F Pluijm
- Princess Máxima Centre for Paediatric Oncology, Heidelberglaan 25, Utrecht, 3584 CS, the Netherlands
| | - Jacqueline J Loonen
- Radboud University Medical Centre, Radboud Institute for Health Sciences, Department of Hematology, Geert Grooteplein Zuid 10, Nijmegen, 6525 GA, the Netherlands
| | - Leontien C M Kremer
- Princess Máxima Centre for Paediatric Oncology, Heidelberglaan 25, Utrecht, 3584 CS, the Netherlands; Department of Paediatrics, Emma Children's Hospital, Amsterdam UMC, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands; Faculty of Medicine, Utrecht University and Utrecht Medical Centre, Universiteitsweg 98, Utrecht, 3584 CG, the Netherlands
| | | |
Collapse
|
20
|
de Waard AM, Korevaar JC, Hollander M, Nielen MMJ, Seifert B, Carlsson AC, Lionis C, Søndergaard J, Schellevis FG, de Wit NJ. Unwillingness to participate in health checks for cardiometabolic diseases: A survey among primary health care patients in five European countries. Health Sci Rep 2021; 4:e256. [PMID: 33778166 PMCID: PMC7988616 DOI: 10.1002/hsr2.256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 01/21/2021] [Accepted: 02/08/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND AIMS Since cardiometabolic diseases (CMD) are a frequent cause of death worldwide, preventive strategies are needed. Recruiting adults for a health check could facilitate the identification of individuals at risk for CMD. For successful results, participation is crucial. We aimed to identify factors related to unwillingness to participate in CMD health checks. METHODS We performed a cross-sectional study in the Czech Republic, Denmark, Greece, the Netherlands, and Sweden. A questionnaire was distributed among persons without known CMD consulting general practice between January and July 2017 within the framework of the SPIMEU study. RESULTS In total, 1354 persons responded. Nine percent was unwilling to participate in a CMD health check. Male gender, smoking, higher self-rated health, never been invited before, and not willing to pay were related to unwillingness to participate. The most mentioned reason for unwillingness to participate was "I think that I am healthy" (57%). Among the respondents who were willing to participate, 94% preferred an invitation by the general practitioner and 66% was willing to pay. CONCLUSION A minority of the respondents was unwilling to participate in a CMD health check with consistent results within the five countries. This provides a promising starting point to increase participation in CMD health checks in primary care.
Collapse
Affiliation(s)
- Anne‐Karien M. de Waard
- Department of General Practice, Julius CenterUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Joke C. Korevaar
- Nivel (Netherlands Institute for Health Services Research), Department of general practice careUtrechtThe Netherlands
| | - Monika Hollander
- Department of General Practice, Julius CenterUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Mark M. J. Nielen
- Nivel (Netherlands Institute for Health Services Research), Department of general practice careUtrechtThe Netherlands
| | - Bohumil Seifert
- First Faculty of MedicineInstitute of General Practice, Charles UniversityPragueCzech Republic
| | - Axel C. Carlsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS)Karolinska InstitutetStockholmSweden
- Academic Primary Healthcare Centre, Department of Primary Health Care, Stockholm RegionStockholmSweden
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of MedicineUniversity of CreteHeraklionGreece
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public HealthUniversity of Southern DenmarkOdenseDenmark
| | - François G. Schellevis
- Nivel (Netherlands Institute for Health Services Research), Department of general practice careUtrechtThe Netherlands
- Department of General Practice & Elderly Care MedicineAmsterdam Public Health Research Institute, VU University Medical CenterAmsterdamThe Netherlands
| | - Niek J. de Wit
- Department of General Practice, Julius CenterUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| |
Collapse
|
21
|
Caini S, Paget J, Spreeuwenberg P, Korevaar JC, Meijer A, Hooiveld M. Impact of influenza vaccination in the Netherlands, 2007-2016: Vaccinees consult their general practitioner for clinically diagnosed influenza, acute respiratory infections, and pneumonia more often than non-vaccinees. PLoS One 2021; 16:e0249883. [PMID: 34048429 PMCID: PMC8162646 DOI: 10.1371/journal.pone.0249883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 03/26/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction We aimed to develop an innovative population-based method to estimate the health effect of influenza vaccination based on electronic medical records collected within a general practitioner (GP)-based influenza surveillance system in the Netherlands. Methods In each season between 2006/07 and 2015/16, we fitted multilevel Poisson regression models to compare GP consultation rates for clinically diagnosed influenza, acute respiratory infections (ARI), pneumonia, and lower back pain (as a control) between vaccinated vs. unvaccinated individuals. Season-specific relative risks and 95% confidence intervals (CI) were pooled into summary risk ratio (SRR) through random-effects meta-analysis models. Analyses were stratified by patient age (<45, 45–59, 60–74, ≥75 years) and medical indication for the vaccine (any vs. none, subjects aged ≤60 years only). Results Overall, 12.6% and 21.4% of study subjects were vaccinated because of their age only or because of an underlying medical condition. Vaccine uptake declined over time, especially among subjects aged ≤74 years with medical indications for vaccination. Vaccinated individuals had significantly higher GP consultation rates for clinically diagnosed influenza (SRR 1.24, 95% CI 1.12–1.38, p-value <0.001), ARI (SRR 1.33, 95% CI 1.27–1.39, p-value <0.001), pneumonia (SRR 1.27, 95% CI 1.19–1.36, p-value <0.001), and lower back pain (SRR 1.21, 95% CI 1.14–1.28, p-value <0.001) compared to unvaccinated individuals. Discussion Contrary to expectations, influenza vaccinees have GP consultation rates for clinically diagnosed influenza, ARI and pneumonia that are 24–33% higher compared to unvaccinated individuals. The lower back pain finding suggests that the increase in consultation rates is partially caused by confounding. Importantly, considering the data are not laboratory-confirmed, our results cannot be linked directly to influenza, but only to respiratory illnesses in general.
Collapse
Affiliation(s)
- Saverio Caini
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - John Paget
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Peter Spreeuwenberg
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Joke C. Korevaar
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Adam Meijer
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Mariëtte Hooiveld
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
- * E-mail:
| |
Collapse
|
22
|
Rijken M, Stüssgen R, Leemrijse C, Bogerd MJL, Korevaar JC. Priorities and preferences for care of people with multiple chronic conditions. Health Expect 2021; 24:1300-1311. [PMID: 33938597 PMCID: PMC8369115 DOI: 10.1111/hex.13262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/15/2021] [Accepted: 04/01/2021] [Indexed: 11/29/2022] Open
Abstract
Background To guide the development of high‐quality care for people with multiple chronic conditions, partners of the European Joint Action CHRODIS developed the Integrated Multimorbidity Care Model. To assess its suitability for improving care for people with multimorbidity in the Netherlands, the model was piloted in a primary care setting with both patients and care providers. Aim This paper reports on the patient perspective, and aims to explore the priorities, underlying values and preferences for care of people with multimorbidity. Participants and methods Twenty persons with multimorbidity (selected from general practice registries) participated in a focus group or telephone interview. Subsequently, a questionnaire was completed by 863 persons with multimorbidity registered with 14 general practices. Qualitative data were thematically analysed and quantitative data by means of descriptive statistics. Results Frequently prioritized elements of care were the use of shared electronic health records, regular comprehensive assessments, self‐management support and shared decision making, and care coordination. Preferences for how these elements should be specifically addressed differed according to individual values (eg weighing safety against privacy) and needs (eg ways of coping with multimorbidity). Conclusion The JA‐CHRODIS Integrated Multimorbidity Care Model reflects the priorities and preferences for care of people with multimorbidity in the Netherlands, which supports its relevance to guide the development of person‐centred integrated care for people with multiple chronic conditions in the Netherlands. Patient contribution European patient experts contributed to the development and applicability assessment of the JA‐CHRODIS Integrated Multimorbidity Care Model; Dutch patients participated in focus groups, interviews and a survey.
Collapse
Affiliation(s)
- Mieke Rijken
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - René Stüssgen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Zorginstituut Nederland, (National Health Care Institute), Diemen, The Netherlands
| | - Chantal Leemrijse
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Mieke J L Bogerd
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Joke C Korevaar
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| |
Collapse
|
23
|
Liemburg GB, Brandenbarg D, Berger MY, Duijts SFA, Holtman GA, de Bock GH, Korevaar JC, Berendsen AJ. Diagnostic accuracy of follow-up tests for detecting colorectal cancer recurrences in primary care: A systematic review and meta-analysis. Eur J Cancer Care (Engl) 2021; 30:e13432. [PMID: 33704843 PMCID: PMC8518902 DOI: 10.1111/ecc.13432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/11/2021] [Accepted: 02/25/2021] [Indexed: 01/16/2023]
Abstract
Introduction Traditionally, follow‐up of colorectal cancer (CRC) is performed in secondary care. In new models of care, the screening part care could be replaced to primary care. We aimed to synthesise evidence on the diagnostic accuracy of commonly used screeners in CRC follow‐up applicable in primary care: carcinoembryonic antigen (CEA), ultrasound and physical examination. Methods Medline, EMBASE, Cochrane Trial Register and Web of Science databases were systematically searched. Studies were included if they provided sufficient data for a 2 × 2 contingency tables. QUADAS‐2 was used to assess methodological quality. We performed bivariate random effects meta‐analysis, generated a hypothetical cohort, and reported sensitivity and specificity. Results We included 12 studies (n = 3223, median recurrence rate 19.6%). Pooled estimates showed a sensitivity for CEA (≤ 5 μg/l) of 59% [47%–70%] and a specificity of 89% [80%–95%]. Only few studies reported sensitivities and specificities for ultrasound (36–70% and 97–100%, respectively) and clinical examination (23% and 27%, respectively). Conclusion In practice, GPs could perform CEA screening. Radiological examination in a hospital setting should remain part of the surveillance strategy. Personalised algorithms accounting for recurrence risk and changes of CEA‐values over time might add to the diagnostic value of CEA in primary care.
Collapse
Affiliation(s)
- Geertje B Liemburg
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Daan Brandenbarg
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjolein Y Berger
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Saskia F A Duijts
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gea A Holtman
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Joke C Korevaar
- NIVEL Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Annette J Berendsen
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
24
|
Meekes W, Leemrijse CJ, Korevaar JC, van de Goor LAM. Fall Prevention in Dutch Physician Practices: A Descriptive Study. Innov Aging 2020. [PMCID: PMC7740616 DOI: 10.1093/geroni/igaa057.758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Falls are an important health threat among frail older people. Physicians are often the first to contact for health issues and can be seen as designated professionals to provide fall prevention. However, it is unknown what they exactly do and why regarding fall prevention. This study aims to describe what physicians in the Netherlands do during daily practice in regards to fall prevention. About 65 physicians (34 practices) located throughout the Netherlands were followed up for 12 months. When a physician entered specific ICPC-codes related to frailty and falls in the Hospital Information System, the physician received a pop-up asking if the patient is frail. If so, the physician subsequently completed a questionnaire. The physicians 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) and 37% of these patients received fall prevention. Physicians did not know of 20% of the patients if they had experienced a fall and of 29% of the patients if they had a FOF. The three most often treated underlying causes were mobility problems, FOF and cardiovascular risk factors. The results show that physicians are not always aware of a patient’s fall history and/or FOF and that only part of these patients receives fall prevention. Hence, it might be important to develop and implement strategies for systematic fall risk screening and fall prevention provision in the primary care setting to reduce falls among frail older people.
Collapse
Affiliation(s)
- Wytske Meekes
- Tilburg University, Tilburg, Noord-Brabant, Netherlands
| | - C J Leemrijse
- Nivel (Netherlands institute for health services research), Utrecht, Utrecht, Netherlands
| | - J C Korevaar
- Nivel (Netherlands institute for health services research), Utrecht, Utrecht, Netherlands
| | - L A M van de Goor
- Nivel (Netherlands institute for health services research), Utrecht, Utrecht, Netherlands
| |
Collapse
|
25
|
Meekes W, Korevaar JC, Leemrijse CJ, van de Goor LAM. A Practical and Validated Fall Risk Screening Instrument: A Systematic Review. Innov Aging 2020. [PMCID: PMC7740560 DOI: 10.1093/geroni/igaa057.752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Early detection of a high fall risk is important to start fall preventive interventions in time and to reduce fall risk among older people. Several fall risk screening instruments are available, however it is unclear which instrument is validated and most suitable for the primary care setting. This systematic review aims to identify the most suitable fall risk screening instrument(s) for the primary care setting (i.e. requires limited time, no expensive equipment and no additional space) with good prognostic ability to assess high fall risk among independently living older people. An extensive search was conducted in the databases PubMed, EMBASE CINAHL, Cochrane and PsycINFO. Twenty-six out of 2277 articles published between January 2000 and February 2019 were included. Six fall risk screening instruments were identified; TUG test, Gait Speed test, BBS, POMA, FR test, Fall History. Most articles reported AUCs ranging from 0.5-0.7 for all instruments. Sensitivity and specificity varied substantially across studies (e.g. TUG, sens.: 10-83.3%, spec.:37-96.6%). The results showed that none of the included screening instruments had sufficient (AUC>0.7) predictive performance (Šimundić, 2009). As suitability for the primary care setting prevails for now, Fall History appears to be the most suitable screening instrument. Compared to the other instruments, Fall History requires the least amount of time, no expensive equipment, no training, and no space (adjustments). Patient’s fall history together with a health care professional’s clinical judgment, might be a promising screening strategy for the primary care setting to identify high fall risk among older people.
Collapse
Affiliation(s)
- Wytske Meekes
- Tilburg University, Tilburg, Noord-Brabant, Netherlands
| | - J C Korevaar
- Nivel (Netherlands Institute for Health Services Research), Utrecht, Utrecht, Netherlands
| | - C J Leemrijse
- Nivel (Netherlands Institute for Health Services Research), Utrecht, Utrecht, Netherlands
| | - L A M van de Goor
- Nivel (Netherlands Institute for Health Services Research), Utrecht, Utrecht, Netherlands
| |
Collapse
|
26
|
Streefkerk N, Fioole LCE, Beijer JGM, Feijen ELAM, Teepen JC, Winther JF, Ronckers CM, Loonen JJ, van Dulmen-den Broeder E, Skinner R, Hudson MM, Tissing WJE, Korevaar JC, Mulder RL, Kremer LCM. Large variation in assessment and outcome definitions to describe the burden of long-term morbidity in childhood cancer survivors: A systematic review. Pediatr Blood Cancer 2020; 67:e28611. [PMID: 32881287 DOI: 10.1002/pbc.28611] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/14/2020] [Accepted: 07/01/2020] [Indexed: 12/16/2022]
Abstract
We systematically reviewed outcome assessment methods, outcome classification, and severity grading of reported outcomes in studies investigating the burden of physical long-term morbidity in childhood cancer survivors (CCS). A MEDLINE and EMBASE search identified 56 studies reporting on three or more types of health conditions in 5-year CCS, for which information was extracted on outcome types and classification, methods of outcome ascertainment, and severity grading. There was substantial variability in classification and types of health conditions reported and in methods of outcome ascertainment. Only 59% of the included studies applied severity grading, mainly the common terminology criteria of adverse events. This large variation in assessment and definition of the burden of physical long-term morbidity in CCS challenges interpretation, comparison, and pooling data across studies. Global collaboration is needed to standardize assessments and harmonize definitions of long-term physical morbidity and associated outcomes in childhood cancer survivorship research.
Collapse
Affiliation(s)
- Nina Streefkerk
- Department of Pediatric Oncology and Pediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Lisanne C E Fioole
- Department of Pediatric Oncology and Pediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Josien G M Beijer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Elizabeth Lieke A M Feijen
- Department of Pediatric Oncology and Pediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jop C Teepen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jeanette F Winther
- Department of Clinical Sciences, Pediatric Oncology and Hematology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Cecile M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jaqueline J Loonen
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eline van Dulmen-den Broeder
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology/Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Rod Skinner
- Department of Paediatric and Adolescent Haematology and Oncology and Children's BMT Unit, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Melissa M Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen, The Netherlands
| | - Joke C Korevaar
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Renée L Mulder
- Department of Pediatric Oncology and Pediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Leontine C M Kremer
- Department of Pediatric Oncology and Pediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| |
Collapse
|
27
|
Meekes WMA, Leemrijse CJ, Korevaar JC, Henquet JMAE, Nieuwenhuis M, van de Goor LAM. Implementation and Evaluation of a Fall Risk Screening Strategy Among Frail Older Adults for the Primary Care Setting: A Study Protocol. Clin Interv Aging 2020; 15:1625-1636. [PMID: 32982197 PMCID: PMC7498482 DOI: 10.2147/cia.s254864] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 07/19/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Falls are an increasing problem among older people. There are several evidence-based interventions available to prevent falls. However, these are not always well implemented in the primary care setting. General practitioners (GPs) are often the first point of contact for health issues, making them the designated professionals for providing falls prevention. Because GPs are often unaware which patients have a high fall risk and patients themselves do not always know they have a high fall risk, this study aims to evaluate the implementation of a targeted fall risk screening strategy among independently living, frail older people in the primary care setting. MATERIALS AND METHODS The targeted fall risk screening strategy used in this study consists of tools for screening high fall risk and for identifying the underlying cause(s) of the high fall risk, an accredited training course in falls prevention for professionals, and service provision by certified physio- and exercise therapists who are able to offer evidence-based falls prevention interventions. This targeted fall risk screening strategy will be implemented in the primary care setting and evaluated at the level of the GP practice and at the level of the patient by using the RE-AIM model of Glasgow et al. In a pre-posttest design, data will be collected of the total number of frail older people who are screened, referred and enrolled for fall-preventive care. Furthermore, barriers and facilitators of the implementation of the fall risk screening strategy will be identified by conducting focus groups and interviews with the care providers and frail older patients. Additionally, the influence of the falls prevention interventions on frail older patients will be evaluated by using a pre-posttest design with a 12-month follow-up period during which data are collected regarding patients' stability, mobility, strength, balance, self-efficacy, health status, and daily activities. STUDY REGISTRATION This study is approved by the Medical Ethics Committee Brabant, the Netherlands (NL61582.028.17/ P1732) and registered at the Netherlands Trial Register, NL7917.
Collapse
Affiliation(s)
- W M A Meekes
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Noord-Brabant, Netherlands
| | | | | | - J M A E Henquet
- Huisartsenpraktijk de Ypelaer, Hilvarenbeek, Noord-Brabant, Netherlands
| | - M Nieuwenhuis
- Fysiotherapie Nieuwenhuis, Best, Noord-Brabant, Netherlands
| | - L A M van de Goor
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Noord-Brabant, Netherlands
| |
Collapse
|
28
|
Meekes WMA, Leemrijse CJ, Korevaar JC, van de Goor LAM. Fall prevention in Dutch general practices: A descriptive study. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
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.
Collapse
Affiliation(s)
- W M A Meekes
- Tranzo, Tilburg University, Tilburg, Netherlands
- Nivel, Utrecht, Netherlands
| | | | | | | |
Collapse
|
29
|
Meekes WMA, Leemrijse CJ, Korevaar JC, van de Goor LAM. Implementation of systematic fall risk screening in primary care: barriers and facilitators. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
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.
Collapse
Affiliation(s)
- W M A Meekes
- Tranzo, Tilburg University, Tilburg, Netherlands
- Nivel, Utrecht, Netherlands
| | | | | | | |
Collapse
|
30
|
Flinterman LE, Kuiper JG, Korevaar JC, van Dijk L, Hek K, Houben E, Herings R, Franken AAM, de Graaf JP, Horikx A, Janssens M, Meijer R, Wijbenga A, van Puijenbroek E, Wolffenbuttel BHR, Links TP, Bisschop PH, Fliers E. Impact of a Forced Dose-Equivalent Levothyroxine Brand Switch on Plasma Thyrotropin: A Cohort Study. Thyroid 2020; 30:821-828. [PMID: 32188356 DOI: 10.1089/thy.2019.0414] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Patients with primary hypothyroidism are treated with levothyroxine (LT4) to normalize their serum thyrotropin (TSH). Finding the optimal dosage is a long-lasting process, and a small change can have major impact. Currently, limited data are available on the impact of dose-equivalent substitution between brands. This study aimed to determine the effect of the shortage of the LT4 brand Thyrax® in the Netherlands and the resulting dose-equivalent switch to another brand on plasma TSH concentrations in a large cohort of patients. Methods: Observational cohort study. Two registries representative for the Dutch population containing prescription and laboratory test data: the Nivel Primary Care Database and the PHARMO Database Network. Patients using at least 25 μg Thyrax daily for one year or longer were included. Two cohorts were formed: a switch cohort consisting of patients who switched from Thyrax to an alternative brand, and a Thyrax cohort including patients who continued to use Thyrax. Patients in the switch cohort did switch from Thyrax to a different brand of LT4 in 2016 and had two consecutive TSH measurements on the same dose of LT4, one before and one 6 weeks after the switch. Patients in the Thyrax cohort had two consecutive TSH measurements on the same dose of Thyrax that were 6 weeks apart. Results: In the Thyrax cohort, 19% of euthyroid patients using ≤100 μg had a TSH level outside the reference range at the subsequent measurement compared with 24% in the switch cohort (p < 0.0001). For patients using >100 μg Thyrax, these figures were 24% and 63%, respectively (p < 0.0001). Furthermore, patients using >50 μg Thyrax were four to five times more likely to become hyperthyroid after a dose-equivalent switch to a different brand compared with patients who stayed on Thyrax. Conclusions: In euthyroid patients continuing the LT4 product Thyrax at the same dose, TSH was out of range in 19-24% at least 6 weeks later. A dose-equivalent switch from Thyrax to other LT4 brands induced biochemical signs of overdosing in an even larger proportion (24-63%) of patients. The results indicate that a dose-equivalent LT4 brand switch may necessitate a dose adjustment in a large number of patients.
Collapse
Affiliation(s)
- Linda E Flinterman
- Netherlands Institute for Health Services Research, Nivel, Utrecht, The Netherlands
| | | | - Joke C Korevaar
- Netherlands Institute for Health Services Research, Nivel, Utrecht, The Netherlands
| | - Liset van Dijk
- Netherlands Institute for Health Services Research, Nivel, Utrecht, The Netherlands
- Department of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Groningen, Groningen, The Netherlands
| | - Karin Hek
- Netherlands Institute for Health Services Research, Nivel, Utrecht, The Netherlands
| | - Eline Houben
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Ron Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | | | | | | | - Marijke Janssens
- Dutch Thyroid Patient Organization (SON), Amersfoort, The Netherlands
| | - Rietje Meijer
- Dutch Thyroid Patient Organization (SON), Amersfoort, The Netherlands
| | - Anneke Wijbenga
- Dutch Thyroid Patient Organization (SON), Amersfoort, The Netherlands
| | - Eugène van Puijenbroek
- Department of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Groningen, Groningen, The Netherlands
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The Netherlands
| | - Bruce H R Wolffenbuttel
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Thera P Links
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Peter H Bisschop
- Department of Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Eric Fliers
- Department of Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
31
|
Streefkerk N, Tissing WJE, Korevaar JC, van Dulmen-den Broeder E, Bresters D, van der Heiden-van der Loo M, van de Heuvel-Eibrink MM, Van Leeuwen FE, Loonen J, van der Pal HHJ, Ronckers CM, Versluys AB, de Vries ACH, Feijen EAM, Kremer LCM. A detailed insight in the high risks of hospitalizations in long-term childhood cancer survivors-A Dutch LATER linkage study. PLoS One 2020; 15:e0232708. [PMID: 32427994 PMCID: PMC7236987 DOI: 10.1371/journal.pone.0232708] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 04/21/2020] [Indexed: 02/07/2023] Open
Abstract
Background Insight in hospitalizations in long-term childhood cancer survivors (CCS) is useful to understand the impact of long-term morbidity. We aimed to investigate hospitalization rates and underlying types of diagnoses in CCS compared to matched controls, and to investigate the determinants. Methods We linked 5,650 five-year CCS from the Dutch nationwide Dutch LATER cohort and 109,605 age- and sex-matched controls to the Dutch Hospital Discharge register, which contained detailed information on inpatient hospitalizations from 1995–2016. Relative hospitalization rates (RHRs) were calculated using a Poisson regression model. Adjusting for multiple hospitalizations per person via a Poisson model for generalized estimated equations, we investigated determinants for hospitalizations for all types of underlying diagnoses among CCS. Results CCS were twice as likely to be hospitalized as reference persons (hospitalization rate 178 and 78 per 1,000 person-years respectively; RHR 2.0, 95% confidence interval (CI) 1.9–2.2). Although CCS had more hospitalizations for 17 types of underlying diagnoses, they were especially more likely to be hospitalized for endocrine conditions (RHR: 6.0, 95% CI 4.6–7.7), subsequent neoplasms (RHR: 5.6, 95% CI 4.6–6.7) and symptoms without underlying diagnoses (RHR: 5.2, 95% CI 4.6–5.8). For those types of underlying diagnoses, female sex and radiotherapy were determinants. Conclusion This study provides new insights in the high risk of hospitalizations for many types of underlying diagnoses in CCS and treatment related determinants. CCS are especially at high risk for hospitalizations for endocrine conditions, subsequent neoplasms and symptoms without an underlying diagnosis. This new knowledge is important for survivorship care and to identify possible preventable hospitalizations among CCS.
Collapse
Affiliation(s)
- Nina Streefkerk
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department Pediatric Oncology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wim J. E. Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology/Hematology, Beatrix Children’s Hospital/University of Groningen/University Medical Center Groningen, Groningen, The Netherlands
| | - Joke C. Korevaar
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Eline van Dulmen-den Broeder
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology/Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Marry M. van de Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology/Hematology, Sophia Children’s Hospital/Erasmus Medical Center, Rotterdam, The Netherlands
| | - Flora E. Van Leeuwen
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jacqueline Loonen
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Cecile M. Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department Pediatric Oncology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A. Brigitta Versluys
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology and Hematology, Wilhelmina Children’s Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andrica C. H. de Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology/Hematology, Sophia Children’s Hospital/Erasmus Medical Center, Rotterdam, The Netherlands
| | - Elizabeth A. M. Feijen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department Pediatric Oncology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Leontine C. M. Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department Pediatric Oncology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | |
Collapse
|
32
|
Heins MJ, De Ligt KM, Verloop J, Siesling S, Korevaar JC. Abstract P2-13-21: Predicting symptoms and diseases after breast cancer treatment: Development of a nomogram. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p2-13-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Women with breast cancer can experience a variety of late adverse effects, depending on age, treatment and time since diagnosis. We developed a nomogram that predicts which symptoms and diseases are likely to occur in breast cancer survivors up to 15 years after diagnosis. Methods: Data from the Netherlands Cancer Registry and NIVEL Primary Care Database were combined in the Primary-Secondary Cancer Care Registry, containing data about the cancer diagnosis/treatment and data from the primary care electronic health records of 12.850 Dutch women diagnosed with breast cancer between 2000-2016. From Nivel Primary Care Database 25.700 control women without breast cancer were obtained. First, Cox regression models were built, stratified by 4 age groups and 2 time windows (1-5 and 5-15 years after diagnosis), in order to determine which symptoms and diseases were more frequently experienced in cases compared to controls (p-value<.05). Second, for each significant symptom and disease, relevant treatment variables (chemo therapy (yes/no), radio therapy (yes/no, and lateralisation), hormone therapy (yes/no), axillary dissection (yes/no)) were added stepwise to the models. Variables with a p-value <.10 were included in a multivariate model and all variables with a p-value <.05 were retained in the final model. Findings: In total, 635 models were constructed, forming the basis for the nomogram. Late effects occurring more frequently in cases compared to controls independent of age and time since diagnosis were chest symptoms, lymphedema/arm symptoms, redness/infections of the skin, nausea, cystitis, insomnia and discussing euthanasia. Others were predominantly relevant 1-5 years after diagnosis, including vomiting and side-effects of medication. Interpretation: This nomogram can provide clinicians and women with breast cancer insight in which symptoms and diseases she has an increased risk to experience in the upcoming years, which is both applicable when making treatment decisions and at follow-up initiation. Besides, it may be a starting point to develop effective preventive measures to limit late side-effects of breast cancer and improve after care for women with breast cancer.
Citation Format: Marianne J. Heins, Kelly M. De Ligt, Janneke Verloop, Sabine Siesling, Joke C. Korevaar. Predicting symptoms and diseases after breast cancer treatment: Development of a nomogram [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-13-21.
Collapse
Affiliation(s)
- Marianne J. Heins
- 1Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Kelly M. De Ligt
- 2Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | - Janneke Verloop
- 2Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | - Sabine Siesling
- 2Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | - Joke C. Korevaar
- 1Netherlands Institute for Health Services Research, Utrecht, Netherlands
| |
Collapse
|
33
|
Vervloet M, Korevaar JC, Leemrijse CJ, Paget J, Zullig LL, van Dijk L. Interventions to Improve Adherence to Cardiovascular Medication: What About Gender Differences? A Systematic Literature Review. Patient Prefer Adherence 2020; 14:2055-2070. [PMID: 33154630 PMCID: PMC7606362 DOI: 10.2147/ppa.s260562] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/05/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Compared to men, women have lower treatment rates for cardiovascular disease (CVD), are at higher risk for medication non-adherence and have different reasons for being non-adherent. The aim of this study was to synthesize and evaluate gender-specific adherence-promoting interventions for cardiovascular medication and gender-specific effects of gender-neutral interventions. METHODS A systematic literature search was performed in PubMed, Embase, PsycINFO, CINAHL and Cochrane Library from January 2007 to October 2019. Intervention studies (with control group) aimed at improving cardiovascular medication adherence with minimally 14 weeks follow-up were included. Two reviewers independently screened titles and abstracts. Full text was obtained for selected abstracts and screened for final inclusion. Data extraction included gender-specific targeting or analysis. RESULTS The search identified 6502 citations. After screening title and abstract, full text was obtained from 127 potentially eligible articles. Ultimately, 11 articles were included that analyzed gender differences in gender-neutral interventions. Two reported a gender-specific intervention effect. Using an electronic reminder device, one study increased statin adherence in women. The other found a larger increase in adherence to CVD medication following telephone counseling for men than women. Nine studies did not identify a gender-specific effect. CONCLUSION Despite differences in levels of and reasons for non-adherence, most studies addressing adherence did not analyze potential differences in effect by gender. Moreover, none of the identified studies used gender-specific adherence promoting interventions. Increasing awareness about gender differences in adherence might lead to better tailoring of interventions to gender-specific needs and better results in improving adherence.
Collapse
Affiliation(s)
- Marcia Vervloet
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
- Correspondence: Marcia Vervloet Nivel, Netherlands Institute for Health Services Research, P.O. Box 1568, Utrecht3500 BN, the NetherlandsTel +31 30 2729713 Email
| | - Joke C Korevaar
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Chantal J Leemrijse
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - John Paget
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Leah L Zullig
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Liset van Dijk
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
- University of Groningen, Groningen Research Institute of Pharmacy, Department of Pharmacotherapy, -Epidemiology and -Economics, Groningen, the Netherlands
| |
Collapse
|
34
|
Oosterveld-Vlug MG, Custers B, Hofstede J, Donker GA, Rijken PM, Korevaar JC, Francke AL. What are essential elements of high-quality palliative care at home? An interview study among patients and relatives faced with advanced cancer. BMC Palliat Care 2019; 18:96. [PMID: 31694715 PMCID: PMC6836458 DOI: 10.1186/s12904-019-0485-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 10/31/2019] [Indexed: 11/13/2022] Open
Abstract
Background In the Netherlands, general practitioners (GPs) and community nurses play a central role in the palliative care for home-dwelling patients with advanced cancer and their relatives. To optimize the palliative care provision at home, it is important to have insight in the elements that patients and relatives consider essential for high-quality palliative care, and whether these essentials are present in the actual care they receive. Methods Qualitative semi-structured interviews were conducted with 13 patients with advanced cancer and 14 relatives. The participants discussed their experiences with the care and support they received from the GP and community nurses, and their views on met and unmet needs. Interview data were analysed according to the principles of thematic analysis. Results Patients as well as relatives considered it important that their GP and community nursing staff are medically proficient, available, person-focused and proactive. Also, proper information transfer between care professionals and clear procedures when asking for certain resources or services were considered essential for good palliative care at home. Most interviewees indicated that these essential elements were generally present in the care they received. However, the requirements of ‘proper information transfer between professionals’ and ‘clear and rapid procedures’ were mentioned as more difficult to meet in actual practice. Patients and relatives also emphasized that an alert and assertive attitude on their own part was vital in ensuring they received the care they need. They expressed worries about other people who are less vigilant regarding the care they receive, or who have no family to support them in this. Conclusions Medical proficiency, availability, a focus on the person, proper information transfer between professionals, clear procedures and proactivity on the part of GPs and community nursing staff are considered essential for good palliative care at home. Improvements are particularly warranted with regard to collaboration and information transfer between professionals, and current bureaucratic procedures. It is important for care professionals to ensure that the identified essential elements for high-quality palliative care at home are met, particularly for patients and relatives who are not so alert and assertive.
Collapse
Affiliation(s)
- M G Oosterveld-Vlug
- Nivel, Netherlands institute for health services research, P.O. Box 1568, 3500, BN, Utrecht, The Netherlands.
| | - B Custers
- Nivel, Netherlands institute for health services research, P.O. Box 1568, 3500, BN, Utrecht, The Netherlands
| | - J Hofstede
- Nivel, Netherlands institute for health services research, P.O. Box 1568, 3500, BN, Utrecht, The Netherlands
| | - G A Donker
- Nivel, Netherlands institute for health services research, P.O. Box 1568, 3500, BN, Utrecht, The Netherlands
| | - P M Rijken
- Nivel, Netherlands institute for health services research, P.O. Box 1568, 3500, BN, Utrecht, The Netherlands
| | - J C Korevaar
- Nivel, Netherlands institute for health services research, P.O. Box 1568, 3500, BN, Utrecht, The Netherlands
| | - A L Francke
- Nivel, Netherlands institute for health services research, P.O. Box 1568, 3500, BN, Utrecht, The Netherlands.,Expertise Center Palliative Care VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| |
Collapse
|
35
|
Král N, de Waard AKM, Schellevis FG, Korevaar JC, Lionis C, Carlsson AC, Sønderlund AL, Søndergaard J, Larsen LB, Hollander M, Thilsing T, Angelaki A, de Wit NJ, Seifert B. What should selective cardiometabolic prevention programmes in European primary care look like? A consensus-based design by the SPIMEU group. Eur J Gen Pract 2019; 25:101-108. [PMID: 31411091 PMCID: PMC6713135 DOI: 10.1080/13814788.2019.1641195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Selective prevention of cardiometabolic diseases (CMD)—that is, preventive measures specifically targeting the high-risk population—may represent the most effective approach for mitigating rising CMD rates. Objectives: To develop a universal concept of selective CMD prevention that can guide implementation within European primary care. Methods: Initially, 32 statements covering different aspects of selective CMD prevention programmes were identified based on a synthesis of evidence from two systematic literature reviews and surveys conducted within the SPIMEU project. The Rand/UCLA appropriateness method (RAM) was used to find consensus on these statements among an international panel consisting of 14 experts. Before the consensus meeting, statements were rated by the experts in a first round. In the next step, during a face-to-face meeting, experts were provided with the results of the first rating and were then invited to discuss and rescore the statements in a second round. Results: In the outcome of the RAM procedure, 28 of 31 statements were considered appropriate and three were rated uncertain. The panel deleted one statement. Selective CMD prevention was considered an effective approach for preventing CMD and a proactive approach was regarded as more effective compared to case-finding alone. The most efficient method to implement selective CMD prevention systematically in primary care relies on a stepwise approach: initial risk assessment followed by interventions if indicated. Conclusion: The final set of statements represents the key characteristics of selective CMD prevention and can serve as a guide for implementing selective prevention actions in European primary care.
Collapse
Affiliation(s)
- Norbert Král
- a Institute of General Practice, First Faculty of Medicine, Charles University , Prague , Czech Republic
| | - Anne-Karien M de Waard
- b Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht , Utrecht , the Netherlands
| | - François G Schellevis
- c Nivel (Netherlands Institute for Health Services Research) , Utrecht , the Netherlands.,d Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers , Amsterdam , the Netherlands
| | - Joke C Korevaar
- c Nivel (Netherlands Institute for Health Services Research) , Utrecht , the Netherlands
| | - Christos Lionis
- e Clinic of Social and Family Medicine, School of Medicine, University of Crete , Greece
| | - Axel C Carlsson
- f Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute , Stockholm , Sweden.,g Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University , Uppsala , Sweden
| | - Anders Larrabee Sønderlund
- h Research unit of General Practice, Department of Public Health, University of Southern Denmark Odense , Denmark
| | - Jens Søndergaard
- h Research unit of General Practice, Department of Public Health, University of Southern Denmark Odense , Denmark
| | - Lars Bruun Larsen
- h Research unit of General Practice, Department of Public Health, University of Southern Denmark Odense , Denmark
| | - Monika Hollander
- b Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht , Utrecht , the Netherlands
| | - Trine Thilsing
- h Research unit of General Practice, Department of Public Health, University of Southern Denmark Odense , Denmark
| | - Agapi Angelaki
- e Clinic of Social and Family Medicine, School of Medicine, University of Crete , Greece
| | - Niek J de Wit
- b Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht , Utrecht , the Netherlands
| | - Bohumil Seifert
- a Institute of General Practice, First Faculty of Medicine, Charles University , Prague , Czech Republic
| |
Collapse
|
36
|
Streefkerk N, Heins MJ, Teepen JC, Feijen EAM, Bresters D, van Dulmen-den Broeder E, van der Heiden-van der Loo M, van den Heuvel-Eibrink MM, van Leeuwen FE, Loonen JJ, van der Pal HJH, Ronckers CM, Versluys AB, Tissing WJE, Korevaar JC, Kremer LCM. The involvement of primary care physicians in care for childhood cancer survivors. Pediatr Blood Cancer 2019; 66:e27774. [PMID: 31033160 DOI: 10.1002/pbc.27774] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/20/2019] [Accepted: 04/03/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Childhood cancer survivors (CCS) are at risk of developing long-term morbidity, which is likely to be presented to a primary care physician (PCP). Therefore, insight into CCS's PCP-based health care use is needed. We investigated the volume and underlying health problems of PCP-based health care use and the determinants for PCP-based health care use in CCS. PROCEDURE Data from a Dutch cohort of 6018 eligible five-year CCS were linked to the Nivel Primary Care database, which contains detailed data from a representative sample of 10% of all Dutch PCPs. Per CCS, two matched controls were selected. Negative binomial regression was performed to compare the annual number of contacts between CCS and controls, and to identify determinants for PCP-based care use among CCS. RESULTS This study included 602 CCS and 1204 controls. CCS were 1.3 times more likely to contact their PCP than controls (95% CI, 1.2-1.5), up to 1.5 times at attained age over 40 years (95% CI, 1.2-1.8). CCS were 4.9 times more likely to contact their PCP for new malignancies, 3.1 for hematological conditions, and 2.8 for endocrine conditions. Female sex, higher attained age, and treatment with radiotherapy were determinants for having more PCP contacts. CONCLUSIONS PCPs play an important role in care for CCS. CCS use more PCP-based care than matched controls, mainly for severe conditions such as malignancies, hematological, and endocrine conditions. Our results emphasize the importance of disseminating the current knowledge on long-term morbidity in CCS and on their optimal follow-up care among PCPs.
Collapse
Affiliation(s)
- Nina Streefkerk
- Department Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Marianne J Heins
- Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Jop C Teepen
- Department Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Elizabeth A M Feijen
- Department Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Eline van Dulmen-den Broeder
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatric Oncology/Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatric Oncology/Hematology, Sophia Children's Hospital/Erasmus Medical Center, Rotterdam, the Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jacqueline J Loonen
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Cécile M Ronckers
- Department Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - A Birgitta Versluys
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatric Oncology and Hematology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen, the Netherlands
| | - Joke C Korevaar
- Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Leontien C M Kremer
- Department Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | |
Collapse
|
37
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
38
|
de Waard AKM, Hollander M, Korevaar JC, Nielen MMJ, Carlsson AC, Lionis C, Seifert B, Thilsing T, de Wit NJ, Schellevis FG. Selective prevention of cardiometabolic diseases: activities and attitudes of general practitioners across Europe. Eur J Public Health 2019; 29:88-93. [PMID: 30016426 PMCID: PMC6345147 DOI: 10.1093/eurpub/cky112] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Cardiometabolic diseases (CMDs) are the number one cause of death. Selective prevention of CMDs by general practitioners (GPs) could help reduce the burden of CMDs. This measure would entail the identification of individuals at high risk of CMDs—but currently asymptomatic—followed by interventions to reduce their risk. No data were available on the attitude and the extent to which European GPs have incorporated selective CMD prevention into daily practice. Methods A survey among 575 GPs from the Czech Republic, Denmark, Greece, the Netherlands and Sweden was conducted between September 2016 and January 2017, within the framework of the SPIMEU-project. Results On average, 71% of GPs invited their patients to attend for CMD risk assessment. Some used an active approach (47%) while others used an opportunistic approach (53%), but these values differed between countries. Most GPs considered selective CMD prevention as useful (82%) and saw it as part of their normal duties (84%). GPs who did find selective prevention useful were more likely to actively invite individuals compared with their counterparts who did not find prevention useful. Most GPs had a disease management programme for individuals with risk factor(s) for cardiovascular disease (71%) or diabetes (86%). Conclusions Although most GPs considered selective CMD prevention as useful, it was not universally implemented. The biggest challenge was the process of inviting individuals for risk assessment. It is important to tailor the implementation of selective CMD prevention in primary care to the national context, involving stakeholders at different levels.
Collapse
Affiliation(s)
- Anne-Karien M de Waard
- Department of General Practice, Julius Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Monika Hollander
- Department of General Practice, Julius Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Joke C Korevaar
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Mark M J Nielen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Axel C Carlsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden.,Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Greece
| | - Bohumil Seifert
- Institute of General Practice, First Faculty of Medicine, Charles University, Prague, The Czech Republic
| | - Trine Thilsing
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Niek J de Wit
- Department of General Practice, Julius Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - François G Schellevis
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | | |
Collapse
|
39
|
Kleipool EEF, Nielen MMJ, Korevaar JC, Harskamp RE, Smulders YM, Serné E, Thijs A, Peters MJL, Muller M. Prescription patterns of lipid lowering agents among older patients in general practice: an analysis from a national database in the Netherlands. Age Ageing 2019; 48:577-582. [PMID: 31074492 DOI: 10.1093/ageing/afz034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/10/2019] [Accepted: 03/25/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Dutch cardiovascular risk management guidelines state almost every older adult (≥70 years) is eligible for a lipid lowering drug (LLD). However, life expectancy, frailty or comorbidities may influence this treatment decision. OBJECTIVE investigate how many older adults, according to age, frailty (Drubbel-frailty index) and comorbidities were prescribed LLDs. METHODS data of 244,328 adults ≥70 years from electronic health records of 415 Dutch general practices from 2011-15 were used. Number of LLD prescriptions in patients with (n = 55,309) and without (n = 189,019) cardiovascular disease (CVD) was evaluated according to age, frailty and comorbidities. RESULTS about 69% of adults ≥70 years with CVD and 36% without CVD were prescribed a LLD. LLD prescriptions decreased with age; with CVD: 78% aged 70-74 years and 29% aged ≥90 years were prescribed a LLD, without CVD: 37% aged 70-74 years and 12% aged ≥90 years. In patients with CVD and within each age group, percentage of LLD prescriptions was 20% point(pp) higher in frail compared with non-frail. In patients without CVD, percentage of LLD prescriptions in frail patients was 11pp higher in adults aged 70-74 years and 40pp higher in adults aged ≥90 years compared to non-frail. Similar trends were seen in the analyses with number of comorbidities. CONCLUSION in an older population, LLD prescriptions decreased with age but-contrary to our expectations-LLD prescriptions increased with higher frailty levels.
Collapse
Affiliation(s)
- E E F Kleipool
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - M M J Nielen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - J C Korevaar
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - R E Harskamp
- Amsterdam UMC, University of Amsterdam, Department of General Practice, Amsterdam, The Netherlands
| | - Y M Smulders
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - E Serné
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - A Thijs
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - M J L Peters
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - M Muller
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| |
Collapse
|
40
|
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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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.
Collapse
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
| |
Collapse
|
41
|
Heins MJ, Hooiveld M, Korevaar JC. Healthy elderly and influenza vaccination. Hum Vaccin Immunother 2018; 14:2987-2989. [PMID: 30118635 PMCID: PMC6343621 DOI: 10.1080/21645515.2018.1504525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
In many countries, those at risk for complications due to influenza are invited for influenza vaccination, to prevent serious consequences for themselves and those around them. However, vaccination rates are decreasing. The first invitation for vaccination may provide an opportunity to convey ample information about the (dis)advantages of vaccination. We aimed to identify subgroups less likely to be vaccinated after their first invitation. Using data from 87 general practices participating in NIVEL Primary Care Database, we selected persons invited for vaccination for the first time because of their 60th birthday. Of 3.238 included persons, 78% were not vaccinated after their first invitation and in the vast majority (84%) this decision remained consistent over the next years. Men and those with fewer GP contacts were less likely to be vaccinated. This latter group is not easily reached by the GP, so maybe other ways should be considered to convey information about influenza vaccination.
Collapse
Affiliation(s)
- Marianne J Heins
- a Nivel (Netherlands Institute for Health Services Research) , Utrecht , The Netherlands
| | - Mariëtte Hooiveld
- a Nivel (Netherlands Institute for Health Services Research) , Utrecht , The Netherlands
| | - Joke C Korevaar
- a Nivel (Netherlands Institute for Health Services Research) , Utrecht , The Netherlands
| |
Collapse
|
42
|
Wändell PE, de Waard AKM, Holzmann MJ, Gornitzki C, Lionis C, de Wit N, Søndergaard J, Sønderlund AL, Kral N, Seifert B, Korevaar JC, Schellevis FG, Carlsson AC. Barriers and facilitators among health professionals in primary care to prevention of cardiometabolic diseases: A systematic review. Fam Pract 2018; 35:383-398. [PMID: 29385438 DOI: 10.1093/fampra/cmx137] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aim of this study is to identify potential facilitators and barriers for health care professionals to undertake selective prevention of cardiometabolic diseases (CMD) in primary health care. We developed a search string for Medline, Embase, Cinahl and PubMed. We also screened reference lists of relevant articles to retain barriers and facilitators for prevention of CMD. We found 19 qualitative studies, 7 quantitative studies and 2 mixed qualitative and quantitative studies. In terms of five overarching categories, the most frequently reported barriers and facilitators were as follows: Structural (barriers: time restraints, ineffective counselling and interventions, insufficient reimbursement and problems with guidelines; facilitators: feasible and effective counselling and interventions, sufficient assistance and support, adequate referral, and identification of obstacles), Organizational (barriers: general organizational problems, role of practice, insufficient IT support, communication problems within health teams and lack of support services, role of staff, lack of suitable appointment times; facilitators: structured practice, IT support, flexibility of counselling, sufficient logistic/practical support and cooperation with allied health staff/community resources, responsibility to offer and importance of prevention), Professional (barriers: insufficient counselling skills, lack of knowledge and of experience; facilitators: sufficient training, effective in motivating patients), Patient-related factors (barriers: low adherence, causes problems for patients; facilitators: strong GP-patient relationship, appreciation from patients), and Attitudinal (barriers: negative attitudes to prevention; facilitators: positive attitudes of importance of prevention). We identified several frequently reported barriers and facilitators for prevention of CMD, which may be used in designing future implementation and intervention studies.
Collapse
Affiliation(s)
- Per E Wändell
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden
| | - Anne-Karien M de Waard
- Julius Center for Health Sciences and Primary Care, University medical Center, Utrecht, The Netherlands
| | - Martin J Holzmann
- Functional Area of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Internal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Carl Gornitzki
- University Library, Karolinska Institutet, Stockholm, Sweden
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Crete, Greece
| | - Niek de Wit
- Julius Center for Health Sciences and Primary Care, University medical Center, Utrecht, The Netherlands
| | - Jens Søndergaard
- Research Unit for General Practice, Institute of Public Health, University of Southern, Odense, Denmark
| | - Anders L Sønderlund
- Research Unit for General Practice, Institute of Public Health, University of Southern, Odense, Denmark
| | - Norbert Kral
- Department of General Practice, Charles University, First Faculty of Medicine, Prague, Czech Republic
| | - Bohumil Seifert
- Department of General Practice, Charles University, First Faculty of Medicine, Prague, Czech Republic
| | - Joke C Korevaar
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - François G Schellevis
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Axel C Carlsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden.,Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
43
|
de Waard AKM, Wändell PE, Holzmann MJ, Korevaar JC, Hollander M, Gornitzki C, de Wit NJ, Schellevis FG, Lionis C, Søndergaard J, Seifert B, Carlsson AC. Barriers and facilitators to participation in a health check for cardiometabolic diseases in primary care: A systematic review. Eur J Prev Cardiol 2018; 25:1326-1340. [PMID: 29916723 PMCID: PMC6097107 DOI: 10.1177/2047487318780751] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
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.
Collapse
Affiliation(s)
- Anne-Karien M de Waard
- 1 Julius Center for Health Sciences and Primary Care, University Medical Center, the Netherlands
| | - Per E Wändell
- 2 Department of Neurobiology, Care Science and Society, Karolinska Institutet, Sweden
| | - Martin J Holzmann
- 3 Functional Area of Emergency Medicine, Karolinska University Hospital, Sweden.,4 Department of Internal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joke C Korevaar
- 5 NIVEL (Netherlands Institute for Health Services Research), the Netherlands
| | - Monika Hollander
- 1 Julius Center for Health Sciences and Primary Care, University Medical Center, the Netherlands
| | | | - Niek J de Wit
- 1 Julius Center for Health Sciences and Primary Care, University Medical Center, the Netherlands
| | - François G Schellevis
- 5 NIVEL (Netherlands Institute for Health Services Research), the Netherlands.,7 Department of General Practice and Elderly Care Medicine, VU University Medical Center, the Netherlands
| | - Christos Lionis
- 8 Clinic of Social and Family Medicine, University of Crete, Greece
| | - Jens Søndergaard
- 9 Research Unit for General Practice, University of Southern Denmark, Denmark
| | - Bohumil Seifert
- 10 Department of General Practice, Charles University, Czech Republic
| | - Axel C Carlsson
- 2 Department of Neurobiology, Care Science and Society, Karolinska Institutet, Sweden.,11 Department of Medical Sciences, Uppsala University, Sweden
| | | |
Collapse
|
44
|
Heins MJ, de Jong JD, Spronk I, Ho VKY, Brink M, Korevaar JC. Adherence to cancer treatment guidelines: influence of general and cancer-specific guideline characteristics. Eur J Public Health 2018; 27:616-620. [PMID: 28013246 DOI: 10.1093/eurpub/ckw234] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Guideline adherence remains a challenge in clinical practice, despite guidelines' ascribed potential to improve patient outcomes. We studied the level of adherence to recommendations from Dutch national cancer treatment guidelines, and the influence of general and cancer-specific guideline characteristics on adherence. Methods Based on data from a national cancer registry, adherence was evaluated for 15 treatment recommendations for breast, colorectal, prostate and lung cancer, and melanoma. Recommendations were selected by representatives of the medical specialist associations responsible for developing and implementing the guidelines. We used multivariable multilevel analysis to calculate mean adherence and variation between individual hospitals. Results Mean adherence to the different treatment recommendations ranged from 40 to 99%. Adherence differed only slightly between older and newer guidelines and between recommendations with low, moderate or high levels of evidence (range 79-84% and 77-91%, respectively), while adherence differed more between recommendations for different cancer types (range 54-99%), different treatment modalities (adherence ranged from 40 to 92%) or recommendations that advised against or recommended in favour of particular treatment (adherence ranged from 75 to 98%). Conclusion We found significant variation in adherence between different cancer treatment guidelines. While some guideline characteristics that seem to explain this variation may be considered difficult to modify, the potential for variance across cancer types and treatment modalities suggests that adherence could be further improved. At the same time, these results warrant tailored strategies for the improvement of adherence to clinical practice guidelines.
Collapse
Affiliation(s)
- Marianne J Heins
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Judith D de Jong
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Inge Spronk
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Vincent K Y Ho
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Mirian Brink
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Joke C Korevaar
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| |
Collapse
|
45
|
Spronk I, Burgers JS, Schellevis FG, van Vliet LM, Korevaar JC. The availability and effectiveness of tools supporting shared decision making in metastatic breast cancer care: a review. BMC Palliat Care 2018; 17:74. [PMID: 29747628 PMCID: PMC5946394 DOI: 10.1186/s12904-018-0330-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 05/02/2018] [Indexed: 11/13/2022] Open
Abstract
Background Shared decision-making (SDM) in the management of metastatic breast cancer care is associated with positive patient outcomes. In daily clinical practice, however, SDM is not fully integrated yet. Initiatives to improve the implementation of SDM would be helpful. The aim of this review was to assess the availability and effectiveness of tools supporting SDM in metastatic breast cancer care. Methods Literature databases were systematically searched for articles published since 2006 focusing on the development or evaluation of tools to improve information-provision and to support decision-making in metastatic breast cancer care. Internet searches and experts identified additional tools. Data from included tools were extracted and the evaluation of tools was appraised using the GRADE grading system. Results The literature search yielded five instruments. In addition, two tools were identified via internet searches and consultation of experts. Four tools were specifically developed for supporting SDM in metastatic breast cancer, the other three tools focused on metastatic cancer in general. Tools were mainly applicable across the care process, and usable for decisions on supportive care with or without chemotherapy. All tools were designed for patients to be used before a consultation with the physician. Effects on patient outcomes were generally weakly positive although most tools were not studied in well-designed studies. Conclusions Despite its recognized importance, only two tools were positively evaluated on effectiveness and are available to support patients with metastatic breast cancer in SDM. These tools show promising results in pilot studies and focus on different aspects of care. However, their effectiveness should be confirmed in well-designed studies before implementation in clinical practice. Innovation and development of SDM tools targeting clinicians as well as patients during a clinical encounter is recommended.
Collapse
Affiliation(s)
- Inge Spronk
- NIVEL (Netherlands Institute for Health Services Research), P.O. Box 1568, 3500BN, Utrecht, The Netherlands.
| | - Jako S Burgers
- Dutch College of General Practitioners, Utrecht, The Netherlands. School CAPHRI, Department Family Medicine, Maastricht University, Maastricht, 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/ Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Liesbeth M van Vliet
- NIVEL (Netherlands Institute for Health Services Research), P.O. Box 1568, 3500BN, Utrecht, The Netherlands
| | - Joke C Korevaar
- NIVEL (Netherlands Institute for Health Services Research), P.O. Box 1568, 3500BN, Utrecht, The Netherlands
| |
Collapse
|
46
|
Spronk I, Schellevis FG, Burgers JS, de Bock GH, Korevaar JC. Incidence of isolated local breast cancer recurrence and contralateral breast cancer: A systematic review. Breast 2018; 39:70-79. [PMID: 29621695 DOI: 10.1016/j.breast.2018.03.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/23/2018] [Accepted: 03/26/2018] [Indexed: 12/21/2022] Open
Abstract
An increasing number of women is surviving breast cancer and due to that at risk of developing an isolated ipsilateral breast tumor recurrence (IBTR) or a contralateral breast cancer (CBC). Patients' main concern is cancer recurrence. Patient counseling on breast cancer recurrence is challenging. In order to provide healthcare professionals and patients more guidance, a systematic literature review of the incidence of isolated IBTR and CBC in women diagnosed with early invasive breast cancer was performed. Medline, EMBASE and the Cochrane Library were searched from 2000 until October 2015. Multicenter studies reporting an IBTR or CBC rate in curatively treated adult females diagnosed with invasive breast cancer were included. The initial search yielded 6998 potentially relevant articles. Twenty were eligible for inclusion, representing 25 recurrence incidence rates. Both isolated IBTR and CBC incidence rates steadily increased with the length of follow-up, indicating that IBTR and CBC occur even more than 15 years after diagnosis. The annual incidence rate of isolated IBTR and CBC in women diagnosed with an early invasive breast cancer was 0.6% (range: 0.4-1.1%) and 0.5% (range: 0.2-0.7%), respectively. Analyzed data were lacking information about important risk factors and given treatment with regard to the incidence of recurrence, which hampers the prediction of patient tailored recurrence risks. The presented rates are therefore the best available estimates of isolated IBTR and CBC annual incidence rates based on the current literature. Healthcare professionals could use these rates in their communication with patients diagnosed with early invasive breast cancer.
Collapse
Affiliation(s)
- Inge Spronk
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500BN, Utrecht, 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/ Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
| | - Jako S Burgers
- Dutch College of General Practitioners, P.O. Box 3231, 3502 GE, Utrecht, The Netherlands; School CAPHRI, Department Family Medicine, Universiteitssingel 40, 6229 ER, Maastricht University, Maastricht, The Netherlands.
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Joke C Korevaar
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500BN, Utrecht, The Netherlands.
| |
Collapse
|
47
|
Flinterman LE, Hek K, Korevaar JC, van Dijk L. Impact of a Restriction in Reimbursement on Proton Pump Inhibitors in Patients with an Increased Risk of Gastric Complications. Front Public Health 2018. [PMID: 29536002 PMCID: PMC5835029 DOI: 10.3389/fpubh.2018.00051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Governments have several options to reduce the increasing costs of health care, including restrictions for the reimbursement of medicines. Next to the intended effect of reduced costs for medicines, reimbursement restriction can have unintended effects such as patients refraining from their treatment which may lead to health problems and increased use of health care. An example of a reimbursement restriction is the one for proton pump inhibitors (PPIs) that became effective in the Netherlands in January 2012. A major unintended effect of this measure could be that high-risk patients who start with non-steroidal anti-inflammatory drugs (NSAIDs) or low-dose aspirin (aspirin) and who have an increased risk of gastric complications for which they are prescribed PPIs refrain from this PPI treatment. The aim of this study was to evaluate the effect of the reimbursement restriction among high-risk users of NSAIDs or aspirin. Do these patients refrain from their PPI treatment and if so do they have an increased risk of gastric complications? Part of the patients starting with NSAIDs or aspirin have an increased risk of gastric complications due to their age, comorbidities, or co-medication. The incidence of PPI use during the 2 years before the reimbursement restriction (2010 and 2011) and 2 years after the introduction of the reimbursement restriction was compared for patients on NSAIDs or aspirin with an increased risk of developing gastric complications. Impact of age, sex, and social economic status (SES) was taken into account. Hospital admissions due to gastric complications were studied over the same period (2010–2013). Data were obtained from a large population-based primary care database and a hospital database. The use of PPIs in patients with an increased risk of gastric complications who started NSAID/aspirin increased from 40% in 2010 to 55% in 2013. No impact was found of age, sex, or SES. There was no increase in hospital admissions due to gastric complications after the reimbursement restriction. The reimbursement restriction on PPIs was not associated with any detectable unintended effects for patients with an increased risk of gastric complications.
Collapse
Affiliation(s)
- Linda E Flinterman
- NIVEL Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Karin Hek
- NIVEL Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Joke C Korevaar
- NIVEL Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Liset van Dijk
- NIVEL Netherlands Institute for Health Services Research, Utrecht, Netherlands
| |
Collapse
|
48
|
Reedijk M, Lenters V, Slottje P, Pijpe A, Peeters PH, Korevaar JC, Bueno-de-Mesquita B, Verschuren WMM, Verheij RA, Pieterson I, van Leeuwen FE, Rookus MA, Kromhout H, Vermeulen RCH. Cohort profile: LIFEWORK, a prospective cohort study on occupational and environmental risk factors and health in the Netherlands. BMJ Open 2018; 8:e018504. [PMID: 29431129 PMCID: PMC5829595 DOI: 10.1136/bmjopen-2017-018504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE LIFEWORK is a large federated prospective cohort established in the Netherlands to quantify the health effects of occupational and environmental exposures. This cohort is also the Dutch contribution to the international Cohort Study of Mobile Phone Use and Health (COSMOS). In this paper, we describe the study design, ongoing data collection, baseline characteristics of participants and the repeatability of key questionnaire items. PARTICIPANTS 88 466 participants were enrolled in three cohort studies in 2011-2012. Exposure information was collected by a harmonised core questionnaire, or modelled based on occupational and residential histories; domains include air pollution (eg, nitrogen dioxide (NO2), particulate matter with diameter ≤2.5 µm (PM2.5)), noise, electromagnetic fields (EMF), mobile phone use, shift work and occupational chemical exposures. Chronic and subacute health outcomes are assessed by self-report and through linkage with health registries. FINDINGS TO DATE Participants had a median age of 51 years at baseline (range 19-87), and the majority are female (90%), with nurses being over-represented. Median exposure levels of NO2, PM2.5, EMF from base stations and noise at the participants' home addresses at baseline were 22.9 µg/m3, 16.6 µg/m3, 0.003 mWm2 and 53.1 dB, respectively. Twenty-two per cent of participants reported to have started using a mobile phone more than 10 years prior to baseline. Repeatability for self-reported exposures was moderate to high (weighted kappa range: 0.69-1) for a subset of participants (n=237) who completed the questionnaire twice. FUTURE PLANS We are actively and passively observing participants; we plan to administer a follow-up questionnaire every 4-5 years-the first follow-up will be completed in 2018-and linkage to cause-of-death and cancer registries occurs on a (bi)annual basis. This prospective cohort offers a unique, large and rich resource for research on contemporary occupational and environmental health risks and will contribute to the large international COSMOS study on mobile phone use and health.
Collapse
Affiliation(s)
- Marije Reedijk
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Virissa Lenters
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Pauline Slottje
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Utrecht, The Netherlands
| | - Anouk Pijpe
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Petra H Peeters
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Biostatistics and Epidemiology, Imperial College London, London, UK
| | - Joke C Korevaar
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Bas Bueno-de-Mesquita
- Department of Biostatistics and Epidemiology, Imperial College London, London, UK
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - W M Monique Verschuren
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Robert A Verheij
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Inka Pieterson
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Flora E van Leeuwen
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Matti A Rookus
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Hans Kromhout
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Roel C H Vermeulen
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Biostatistics and Epidemiology, Imperial College London, London, UK
| |
Collapse
|
49
|
Spronk I, Korevaar JC, Schellevis FG, Albreht T, Burgers JS. Evidence-based recommendations on care for breast cancer survivors for primary care providers: a review of evidence-based breast cancer guidelines. BMJ Open 2017; 7:e015118. [PMID: 29237652 PMCID: PMC5728293 DOI: 10.1136/bmjopen-2016-015118] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To review evidence-based (EB) recommendations on survivorship care for primary care providers (PCPs) in EB breast cancer guidelines. DESIGN AND SETTING Guidelines were collected via experts and via literature database, guideline database and cancer agency websites searches. METHOD EB guidelines in any language published between 2012 and 2017 were collected. EB recommendations on survivorship care relevant for PCPs were extracted and grouped into three categories (recurrence detection, long-term effects and recurrence prevention). The content of the recommendations was analysed and summarised in the number and type of clinical topics addressed. The Appraisal of Guidelines for Research and Evaluation II instrument was used to evaluate the methodological quality of the guidelines. RESULTS Six guidelines, of which two were of acceptable methodological quality, were included. One was specifically made for general practitioners. Fifteen clinical topics were identified. Guidelines differed in the clinical topics addressed and for some identical topics in the content of the recommendations. Many recommendations were based on low-quality evidence. Recurrence detection received most attention, physical examination and mammography were often highlighted. Potential complications largely varied in number and type. Intimacy concerns, vaginal dryness, dyspareunia, fatigue, menopausal symptoms, peripheral neuropathy and lymphedema were reported in more than one guideline. Recurrence prevention was mentioned in four guidelines; all recommended physical activity. CONCLUSION The number of EB recommendations in guidelines is limited. Moreover, recommendations differ between guidelines and most are based on low-quality evidence. More high-quality research is needed to develop and adapt guidelines to support PCPs in providing optimal breast cancer survivorship care.
Collapse
Affiliation(s)
- Inge Spronk
- General Practice, NIVEL Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Joke C Korevaar
- General Practice, NIVEL Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Francois G Schellevis
- General Practice, NIVEL Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Tit Albreht
- Centre for Health System Analyses, National Institute of Public Health, Ljubljana, Slovenia
| | - Jako S Burgers
- Dutch College of General Practitioners, Utrecht, The Netherlands
- Department Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
50
|
Abstract
OBJECTIVE This study aimed to investigate both atopic and non-atopic comorbid symptoms and diseases in children with physician-diagnosed atopic disorders (atopic eczema, asthma and allergic rhinitis). METHODS All children aged 0-18 years listed in a nationwide primary care database (the Netherlands Institute for Health Services Research-Primary Care Database) with routinely collected healthcare data in 2014 were selected. Children with atopic disorders were matched on age and gender with non-atopic controls within the same general practice. A total of 404 International Classification of Primary Care codes were examined. Logistic regression analyses were performed to examine the associations between the presence of atopic disorders and (non-)atopic symptoms and diseases by calculating ORs. RESULTS Having one of the atopic disorders significantly increased the risk of having other atopic-related symptoms, even if the child was not registered as having the related atopic disorder. Regarding non-atopic comorbidity, children with atopic eczema (n=15 530) were at significantly increased risk for (infectious) skin diseases (OR: 1.2-3.4). Airway symptoms or (infectious) diseases (OR: 2.1-10.3) were observed significantly more frequently in children with asthma (n=7887). Children with allergic rhinitis (n=6835) had a significantly distinctive risk of ear-nose-throat-related symptoms and diseases (OR: 1.5-3.9). Neither age nor gender explained these increased risks. CONCLUSION General practitioners are not always fully aware of relevant atopic and non-atopic comorbidity. In children known to have at least one atopic disorder, specific attention is required to avoid possible insufficient treatment and unnecessary loss of quality of life.
Collapse
Affiliation(s)
- David H J Pols
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Arthur M Bohnen
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Mark M J Nielen
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Joke C Korevaar
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Patrick J E Bindels
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|