F.G. Schellevis

Primary prevention of cardio-metabolic diseases in general practice: A Dutch survey of attitudes and working methods of general practitioners

Abstract Background: To study the attitudes and working methods of general practitioners (GPs) in primary prevention of cardiovascular diseases, diabetes mellitus and chronic kidney diseases. Methods: A questionnaire with questions about attitude and working methods in the primary prevention of cardiovascular diseases, diabetes mellitus and chronic kidney diseases in general practice was sent to a representative sample of 1,100 Dutch GPs. The questionnaire was developed in collaboration with experts in general practice, cardiovascular disease, diabetes and kidney disease. Results: A total of 330 GPs completed and returned the questionnaire (30% response). Only a quarter of the GPs actively invite patients for preventive measurements. Preventive measures are mainly performed by the GP when a patient asks for it or when patients visit a GP for other complaints. The main reasons for performing preventive tests were a positive family history, obesity and smoking. Most GPs consider detection of these diseases as worthwhile, but detection should particularly focus on the group of patients with the highest risk on these diseases. Conclusion: GPs have a positive attitude towards primary prevention of cardiovascular diseases, diabetes mellitus and chronic kidney diseases, but primary prevention should be focused on patients at risk.

Impetigo: incidence and treatment in Dutch general practice in 1987 and 2001—results from two national surveys

Backgroundu2002 Impetigo is a common skin infection in children. The epidemiology is relatively unknown, and the choice of treatment is subject to debate.

Asthma prescription patterns for children: can GPs do better?

Abstract Background: Assessing prescription patterns of asthma medication for children is helpful to optimize prescribing by general practitioners (GPs). The aim was to explore prescription patterns in children with physician-diagnosed asthma and its determinants in general practice. Methods: We used the Second Dutch National Survey of General Practice (DNSGP-2) with children aged 0–17 years registered in 87 general practices. All children with at least one asthma prescription were included (n = 2993). Prescription rates and prescription of continuous (≥3 prescriptions/year) versus intermittent asthma medication were calculated. Data, including several GP characteristics, were analysed using multivariate logistic regression accounting for clustering within practices. Results: During one year, 16% of the children with physician-diagnosed asthma (n = 3562) received no asthma medication. Of the 2993 children with asthma receiving asthma medication (on average 2.9 prescriptions/year), 61% received one or two prescriptions, 39% received three or more. Continuous medication with a bronchodilator and/or a corticosteroid was prescribed in 22% of these children. One out of 5 children receiving continuous medication was prescribed a bronchodilator only. In 7.5% of the prescriptions, asthma medications other than bronchodilators or corticosteroids were prescribed. Prescribing asthma medication varied widely between practices, but none of the children and GP determinants had an independent effect on prescribing continuous versus intermittent medication. Conclusion: In general practice, the annual number of asthma prescriptions per child with asthma is relatively low. One in 20 children is prescribed bronchodilators only continuously, indicating room for improvement. Child and GP characteristics cannot be used for targeting educational efforts.

Reported incidence and treatment of dermatophytosis in children in general practice: a comparison between 1987 and 2001.

IntroductionDermatophytosis is a common skin infection in children. Although the epidemiology is relatively unknown it is becoming a major health problem in some countries. We determine the incidence and management of dermatophytosis in Dutch general practice in 1987 and 2001.MethodsWe used data of all children aged 0–17xa0years derived from two national surveys performed in Dutch general practice in 1987 and 2001 respectively. All diagnoses, prescriptions and referrals were registered over a 12xa0months period by the participating general practitioners (GPs), 161 and 195 respectively. Data were stratified for socio-demographic characteristics.ResultsCompared to 1987, in 2001 the total reported incidence rate of dermatophytosis in children in general practice increased from 20.8 [95%CI 18.9–22.8] to 24.6 [95%CI 23.5–25.7] per 1,000 person years. Infants (<1xa0year), girls, children in rural areas and children of non-western immigrants more often consulted the GP for dermatophytosis in 2001.In both surveys GPs treated the majority of children with dermatophytosis with topical drugs, especially with azoles.ConclusionsThe reported incidence rate of dermatophytosis in children in general practice increased; however it is unclear whether this is a consequence of an increasing prevalence in the population or a changing help seeking behaviour. GPs generally follow the national guideline for the treatment of dermatophytosis in children.

Tonsillitis acuta bij kinderen in de huisartsenpraktijk: verandering van incidentie en beleid?

SamenvattingDiepenhorst HIJ, Otters HBM, Van Suijlekom-Smit LWA, Schellevis FG, Van der Wouden JC. Tonsillitis acuta bij kinderen in de huisartsenpraktijk: verandering van incidentie en beleid? Huisarts Wet 2004;47(9):399-404.Vraagstelling Welke veranderingen zijn opgetreden in incidentie en beleid van tonsillitis acuta bij kinderen van 0-17 jaar in de huisartsenpraktijk in 2001 ten opzichte van 1987?Methoden Een vergelijking tussen twee Nationale Studies naar ziekten en verrichtingen in de huisartsenpraktijk (in 1987 en 2001) bij kinderen van 0 tot en met 17 jaar. De incidentie werd vergeleken naar leeftijd, geslacht, urbanisatiegraad en sociaal-economische klasse. Voor het beleid werd een onderscheid gemaakt in afwachtend beleid, prescriptie en verwijzing.Resultaten De incidentie per 1000 persoonsjaren bedroeg 44,9 in 1987 tegenover 19,1 in 2001. In 2001 werd vaker een afwachtend beleid gevoerd dan in 1987 (34% respectievelijk 20%) en werden er minder breedspectrumantibiotica voorgeschreven.Conclusie De incidentie van tonsillitis acuta bij kinderen in de huisartsenpraktijk is gedaald. Het beleid van de huisarts bij deze aandoening is veranderd en is in 2001 meer in overeenstemming met de NHG-Standaard.AbstractDiepenhorst HIJ, Otters HBM, Van Suijlekom-Smit LWA, Schellevis FG, Van der Wouden JC. Acute tonsillitis in children in the GPs practice: changes in incidence and policy? Huisarts Wet 2004;47(9):399-404.Objective To assess whether changes have occurred in incidence rates and management of acute tonsillitis among children between the ages of 0 and 17 years in Dutch general practice.Design A comparison was made between two Dutch general practice National Surveys (1987 and 2001) of children 0-17 years of age. Incidence rates were compared by age, sex, degree of urbanisation and socio-economic status. To assess the management of the general practitioner, we distinguished between three strategies: wait and see, drug prescription and hospital referral.Results The incidence rate per 1000 person-years was 44.9 in 1987 against 19.1 in 2001. In 2001 a wait-and-see policy was found more often compared to 1987 (34% versus 20% respectively) and fewer broad-spectrum antibiotics were prescribed.Conclusions We found a decreasing incidence of acute tonsillitis among children in Dutch general practice. General practitioners’ management of this disease has changed and is now more in accordance with the Dutch guideline for general practice.