M.A.J.B. Tacken

Urban–rural health differences: primary care data and self reported data render different results

AIM Assessing the usefulness of GP electronic medical records for assessing the health of rural populations by comparing these data with data from health interview surveys. DATA Data from electronic medical records routinely recorded in general practices in 2000-2002. Data on self-reported health problems were obtained through questionnaires in a subset of the same patient population. RESULTS According to GP-records, acute somatic and chronic diseases were more frequently presented in rural areas. At the same time self reported health problems point to a better health in rural areas. CONCLUSION GP electronic medical records may be used to monitor the health of rural populations. These data can be obtained relatively quickly and easily and against acceptable cost. However, they do not give the same outcomes as health interview surveys. Reasons for this discrepancy may be; differences in the accessibility of specialist services and help seeking behaviour between urban and rural populations.

Design of the Dutch prevention of influenza, surveillance and management (PRISMA) study

Rationale and design of a study on the cost-effectiveness of the Dutch influenza vaccination campaign are described. During two influenza epidemics, about 75,000 primary care patients recommended for influenza vaccination are included. Cases have fatal or non-fatal influenza, pneumonia, otitis media, acute respiratory disease (ARD), heart failure, myocardial infarction, depression or diabetes dysregulation. Per case four controls are sampled, frequency matched on age and high-risk co-morbidity (<18 years, 18-64, >/=65 healthy, >/=65 with co-morbidity). Baseline and outcome data are retrieved from patient records. During the 1999-2000 influenza A epidemic 5891 (7.9%) high-risk children, 24,848 (33.2%) high-risk adults aged 18-64 years, 18,484 (24.7%) elderly with co-morbidity and 25,527 (34.1%) healthy elderly had been included. The mortality rate was 5.2 per 1000 and 2035 non-fatal outcome events were recorded (incidence rate 27.2/1000).

Context effects of facial appearance on attitudes toward mentally handicapped persons.

The influence of facial appearance on social attitudes was examined by exposing participants to the faces of three target persons with or without deviant facial features, posing happy, angry or sad facial expressions, or a mixture of these expressions. When they displayed negative emotional expressions, facially deviant targets were judged more negatively than non-deviant targets. Irrespective of emotional expression and level of personal experience, participants expressed more negative attitudes toward mentally handicapped persons in general after exposure to deviant faces than after exposure to non-deviant faces, or in the absence of exposure. However, correlational analyses suggested that only at low levels of personal experience were attitudes influenced by previously formed impressions of deviant exemplars. Results are discussed in terms of the motivational relevance of physical features in stigmatization, and context and exemplar effects in stereotyping and attitude measurement. Practical implications are also discussed.

Prescription of antiviral drugs during the 2009 influenza pandemic: an observational study using electronic medical files of general practitioners in the Netherlands

BackgroundAfter the clinical impact of the A(H1N1) pdm09 virus was considered to be mild, treatment with antiviral drugs was recommended only to patients who were at risk for severe disease or who had a complicated course of influenza. We investigated to what extent antiviral prescriptions in primary care practices were in accordance with the recommendations, what proportion of patients diagnosed with influenza had been prescribed antiviral drugs, and to what extent prescriptions related to the stated indications for antiviral treatment.MethodsWe used data from routine electronic medical records of practices participating in the Netherlands Information Network of General Practice LINH in the period August - December 2009. We considered patient and practice characteristics, clinical diagnoses and drug prescriptions of all patients who contacted their general practitioner in the given period and who had been prescribed antiviral medication (n = 351) or were diagnosed with influenza (n = 3293).ResultsOf all antiviral prescriptions, 69% were in accordance with the recommendations. Only 5% of patients diagnosed with influenza were prescribed antiviral drugs. This percentage increased to 12% among influenza patients belonging to the designated high risk groups. On the other hand, 2.5% of influenza patients not at high risk of complications received antiviral treatment. In addition to the established high risk factors, the total number of drug prescriptions for a patient in this year was a determinant of antiviral prescriptions. Information on time since onset of symptoms and the clinical presentation of patients was not available.ConclusionsGeneral practitioners in the Netherlands have been restrictive in prescribing antiviral drugs during the influenza pandemic, even when patients met the criteria for antiviral treatment.

Seasonal flu vaccination in Dutch at-risk populations was not affected by A(H1N1) 2009 pandemic vaccination.

We read with interest the recent paper by Maurer and colleagues describing the attitudes toward seasonal and H1N1 vaccination and vaccination uptake among US adults (Maurer et al., 2010). They found the 2009 influenza A(H1N1) vaccine uptake as considerably lower than seasonal vaccine uptake, which is not consistent with vaccination rates of patients at-risk we found in the Netherlands.(aut. ref.)

Multimorbiditeit: een groeiend probleem voor de huisarts

SamenvattingIn de gezondheidszorg bekleden huisartsen een centrale positie. Zij beschikken over het volledige medische dossier van hun patiënten en zijn vaak goed op de hoogte van hun sociale omstandigheden. Daarnaast coördineren huisartsen de medische zorg van andere bij de patiënt betrokken zorgverleners

Veranderde indicatiestelling voor influenzavaccinatie: weinig extra werk

SamenvattingVanaf najaar 2008 verandert de indicatiestelling voor influenzavaccinatie: de leeftijdsgrens wordt verlaagd van 65 naar 60 jaar, terwijl voor mensen met recidiverende stafylokokkeninfecties de griepprik niet meer geïndiceerd is. Deze verandering heeft consequenties voor huisartsenpraktijken, aangezien daar veruit de meeste influenzavaccinaties plaatsvinden.