European Journal of General Practice

Stoffers, Jelle

doi: 10.3109/13814780903452176pmid: 19958236

Karademir, Melek; Koseoglu, Ismail Hakan; Vatansever, Kevser; Van Den Akker, Marjan

doi: 10.3109/13814780903452150pmid: 20055720

AbstractObjectives: To assess the validity and reliability of the Turkish version of the Hill–Bone compliance to high blood pressure therapy scale for use in primary care in Turkey. Methods: To develop a Turkish version of the scale, it was translated into Turkish then back-translated into English. The final version was used in a survey in two urban primary health care centers in Izmir, Turkey. For assessing the validity of Turkish scale, we performed factor analysis to test construct validity. Reliability was assessed by calculating the Cronbach's alpha as a measure of internal consistency. Results: Factor analysis revealed a three–factor structure representing unintentional medication non-adherence; intentional medication non-adherence; and salt intake adherence. Percentages of explained variance were 33.3%, 14.6% and 11.2% respectively. When forcing a two-factor structure we found salt intake and medication adherence clusters. Cronbach's alpha was 0.72 and 0.83 for medication adherence and whole scale, respectively.Conclusion: The Turkish Hill–Bone scale presented a factor structure consistent with the original scale, had a high level of internal consistency. It can be used for assessing hypertension patients’ compliance in Turkish primary care settings.

Spigt, Mark; Stefens, Caroline; Passage, Danique; Van Amelsvoort, Ludovic; Zwietering, Paul

doi: 10.3109/13814780903390814pmid: 20001222

AbstractBackground: Despite many quality improvement trials, diabetes care often remains suboptimal. Few studies in a primary care setting have investigated the ‘real life’ association between organizational differences and quality of diabetes care. Methods: Observational study among ten health care centres with a total of 45 general practitioners (GP). We investigated health care organization and related this to quality of care in a total of 1849 electronic patient records. Results: There were large differences among health care centres in the percentage of patients receiving optimal care (range: 8–67%). The odds to receive good quality of care was higher if the health care centre had a diabetes education program (OR: 4.3; CI: 3.4–5.4), when yearly medical check-ups were done by both the GP and nurse practitioner (NP) (OR: 5.5; CI: 4.2–7.3), planned that after the patient visited the NP the patient is discussed with the GP (OR: 1.8; CI: 1.6–2.0), and had structured follow-up measures for compliance to check-ups (OR: 0.7; CI: 0.5–0.9 and OR: 0.59; CI: 0.5–0.7 for respectively one and two active measures compared to three active measures).Conclusion: Also in real life, quality of care for type 2 diabetic patients is related to health care organization.

Smeets, Hugo M.; De Wit, Niek J.; Delnoij, Diana M. J.; Hoes, Arno W.

doi: 10.3109/13814780903452168pmid: 20055721

AbstractObjective: Many patients are using acid-suppressing drugs (ASD) unnecessary. An insurance company initiated intervention programme aiming at reduction of chronic ASD use, was introduced in primary care-practices. We evaluated the attitude and experiences of the participating patients. Methods: A survey was conducted among a random sample of 2376 long-term ASD users using a validated questionnaire that combined CAHPS and QUOTE methodology. Using a psychometric principal component analysis we assessed the role of GPs in three scales: quality of support; communication and conduct; involvement in decisions. Both the importance of and experiences with quality items, transformed into quality impact indices, were measured. Results: Of 2376 questionnaires distributed, 1808 (76%) were returned, 1270 (54%) were valid. 188 were of patients that participated in the programme. The majority was dissatisfied with the GPs’ support: no information about rebound side effects (76%), lifestyle habits (68%), and reasons to stop (50%). Compared to the non-participants 9% more participants stopped ASD use (P = 0.04).Conclusion: A majority of patients on chronic ASD was prepared to participate in the drug-reduction programme. Although 16% succeeded in stopping ASD use, the majority was dissatisfied with the role of the GP. Improved GP support might have make more patients stop using ASD.

Jung, Stanislaw; Borland, Steven; Matewski, Dariusz

doi: 10.3109/13814780903447564pmid: 19958235

AbstractObjectives: To evaluate the current practice in the approach to the painful hip in children. To determine the superiority of ultrasonographic techniques over plain X-ray and to provide guidance to primary care. Methods: We carried out a prospective cohort study of 55 patients with a painful hip. The management leading up to admission and diagnostic procedures were examined. We carried out ultrasound of all affected hips and repeated the scan every three days. Effusion on ultrasound was noted and was correlated to the symptoms. Results: In total 29/55 patients had plain X-rays taken before or at the initial presentation. No abnormalities were found. Ultrasound showed effusion in 48/55 children. The reduction of the effusion correlated with the improvement in symptoms. An effusion persisting longer than 26 days correlated well to those patients who went on to be diagnosed with a chronic condition (3/4 patients).Conclusions: At present many practitioners use plain X-ray in the initial diagnosis. Ultrasound should be the initial diagnostic tool of choice. Repeat ultrasound at one month may be of use to determine if the child is likely to develop a chronic condition.

Plat, Arian W.; Kroon, Abraham A.; Van Schayck, Constant P.; De Leeuw, Peter W.; Stoffers, Henri E.J.H.

doi: 10.3109/13814780903447572pmid: 20055722

AbstractObjective: To summarize the knowledge on the use of comprehensive family history taking for common, multifactorial diseases in primary health care. Design and data sources: Systematic review of MEDLINE (1966–2008), EMBASE (1986–2008) and Cochrane Library. Methods: Search terms reflected ‘primary care’, ‘family history’ and ‘genetics’. Included were original studies, published in the English language, from a primary care setting, investigating family history taking for multifactorial disorders. Methodological criteria (design, size, response rate) were not used to exclude papers. Out of 116 potentially eligible papers, 27 papers were selected: nine studies on opinions, eight studies on actual practice, seven studies on family history tools, and three studies on the patient perspective. Two authors independently extracted the data, and consequently discussed and summarized them. Given the heterogeneity of the studies, outcomes were presented in a qualitative way. Results: Among family physicians, the general opinion was that taking a family history is the task of the primary care physician. However, observational studies of consultations and analyses of medical records showed wide variability and low regular updating. There are no family history tools yet, that are sufficiently feasible and reproducible. Patients and doctors may perceive a positive family history differently, which may cause miscommunication.Conclusion: There is a need for research into feasible and high quality tools for detailed family history taking for multifactorial disorders.

Hummers-Pradier, Eva; Beyer, Martin; Chevallier, Patrick; Eilat-Tsanani, Sophia; Lionis, Christos; Peremans, Lieve; Petek, Davorina; Rurik, Imre; Soler, Jean Karl; Stoffers, Henri Ejh; Topsever, Pinar; Ungan, Mehmet; Royen, Paul Van

doi: 10.3109/13814780903452184pmid: 20055723

AbstractAt the WONCA Europe conference 2009 the recently published ‘Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe’ was presented. The Research Agenda is a background paper and reference manual for GPs/ family doctors, researchers and policy makers, providing advocacy of general practice/family medicine GP/FM in Europe. The Research Agenda summarizes the evidence relating to the core competencies and characteristics of the WONCA Europe definition of GP/FM, and its meaning for researchers and policy makers. Evidence gaps and research needs are pointed out to provide a basis for planning research for which there is a need and for action that may influence health and research policy, i.e. applying/lobbying for research funds. WONCA Europe and its associated networks and special interest groups could consider the agenda's research priorities when planning future conferences, courses, or projects, and for funding purposes. The European Journal of General Practice will publish a series of articles based on this document. In this first article, background, objectives, methodology and relevant literature are discussed. In subsequent articles, the results will be presented.