Substitution scenario in follow-up of chronic cancer patients in primary care: prevalence, disease duration and estimated extra consultation time.

BACKGROUND: The incidence of cancer as well as survival rates for it are increasing. It is debated whether care in the chronic phase of cancer can be positioned in primary care due to doubts about capacity and workload. OBJECTIVE: To estimate GPs' extra consultation time if they assume responsibility for the care in the chronic phase of cancer. METHOD: Retrospective cohort study. Estimation of extra consultation time by quantifying prevalence, incidence, survival, number of chronic cancer patients, current practice contacts and registration of risk factors in patients with all types of cancers. RESULTS: The most prevalent types of cancer (with 5-year survival rates) are as follows: breast cancer (91.5%), colorectal cancer (63.8%), prostate cancer (78.3%), melanoma (91.9%) and bladder and urinary tract cancer (77.3%). Primary care practices include ~32 chronic cancer patients, with a potential extra consultation time of ~19 hours per year per 1000 patients. One-third (35%) are already in a chronic disease management programme and 57% were diagnosed >5 years ago. Registration of risk factors for cancer is incomplete, but of better quality when comorbidity is present. CONCLUSION: Numbers of chronic cancer patients and possible time investment by primary care professionals in the case of a substitution scenario should not be a limiting factor for transition of follow-up from secondary to primary care, as most of the patients were diagnosed >5 years ago and a large proportion of these patients are already monitored in an existing chronic care programme.

Do practice characteristics explain differences in morbidity estimates between electronic health record based general practice registration networks?

BACKGROUND: General practice based registration networks (GPRNs) provide information on population health derived from electronic health records (EHR). Morbidity estimates from different GPRNs reveal considerable, unexplained differences. Previous research showed that population characteristics could not explain this variation. In this study we investigate the influence of practice characteristics on the variation in incidence and prevalence figures between general practices and between GPRNs. METHODS: We analyzed the influence of eight practice characteristics, such as type of practice, percentage female general practitioners, and employment of a practice nurse, on the variation in morbidity estimates of twelve diseases between six Dutch GPRNs. We used multilevel logistic regression analysis and expressed the variation between practices and GPRNs in median odds ratios (MOR). Furthermore, we analyzed the influence of type of EHR software package and province within one large national GPRN. RESULTS: Hardly any practice characteristic showed an effect on morbidity estimates. Adjusting for the practice characteristics did also not alter the variation between practices or between GPRNs, as MORs remained stable. The EHR software package 'Medicom' and the province 'Groningen' showed significant effects on the prevalence figures of several diseases, but this hardly diminished the variation between practices. CONCLUSION: Practice characteristics do not explain the differences in morbidity estimates between GPRNs.

The influence of population characteristics on variation in general practice based morbidity estimations.

BACKGROUND: General practice based registration networks (GPRNs) provide information on morbidity rates in the population. Morbidity rate estimates from different GPRNs, however, reveal considerable, unexplained differences. We studied the range and variation in morbidity estimates, as well as the extent to which the differences in morbidity rates between general practices and networks change if socio-demographic characteristics of the listed patient populations are taken into account. METHODS: The variation in incidence and prevalence rates of thirteen diseases among six Dutch GPRNs and the influence of age, gender, socio economic status (SES), urbanization level, and ethnicity are analyzed using multilevel logistic regression analysis. Results are expressed in median odds ratios (MOR). RESULTS: We observed large differences in morbidity rate estimates both on the level of general practices as on the level of networks. The differences in SES, urbanization level and ethnicity distribution among the networks' practice populations are substantial. The variation in morbidity rate estimates among networks did not decrease after adjusting for these socio-demographic characteristics. CONCLUSION: Socio-demographic characteristics of populations do not explain the differences in morbidity estimations among GPRNs.

Estimating morbidity rates from electronic medical records in general practice. Evaluation of a grouping system.

OBJECTIVES: In this study, we evaluated the internal validity of EPICON, an application for grouping ICPC-coded diagnoses from electronic medical records into episodes of care. These episodes are used to estimate morbidity rates in general practice. METHODS: Morbidity rates based on EPICON were compared to a gold standard; i.e. the rates from the second Dutch National Survey of General Practice. We calculated the deviation from the gold standard for 677 prevalence and 681 incidence rates, based on the full dataset. Additionally, we examined the effect of case-based reasoning within EPICON using a comparison to a simple, not case-based method (EPI-0). Finally, we used a split sample procedure to evaluate the performance of EPICON. RESULTS: Morbidity rates that are based on EPICON deviate only slightly from the gold standard and show no systematic bias. The effect of case-based reasoning within EPICON is evident. The addition of case-based reasoning to the grouping system reduced both systematic and random error. Although the morbidity rates that are based on the split sample procedure show no systematic bias, they do deviate more from the gold standard than morbidity rates for the full dataset. CONCLUSIONS: Results from this study indicate that the internal validity of EPICON is adequate. Assuming that the standard is gold, EPICON provides valid outcomes for this study population. EPICON seems useful for registries in general practice for the purpose of estimating morbidity rates.

Prescription of technical aids by general practitioners in the Netherlands.

This study focused on the allocation of technical aids, in particular which technical aids general practitioners (GPs) prescribe for what patients. Data was collected by 64 Dutch GPs participating in a nationwide representative sentinel practice network. The GPs gathered information on type of technical aid prescribed, patient characteristics, and diagnosis (coded according to the International Classification of Primary Care (ICPC)). The most frequently prescribed technical aids include incontinence supplies, anti-oedema stockings, and rollators. The number of prescribed technical aids increased strongly with the age of the patients and almost all technical aids were prescribed more often for women than for men. Most technical aids were prescribed based on the initiative of the patients. The GPs made a wide range of diagnoses in the prescription of technical aids. Diagnoses involving the musculoskeletal system, the circulatory system, and the urinary system were the most frequently made. Implications of these findings for policy and further research are discussed.

The influence of prenatal screening and termination of pregnancy on perinatal mortality rates.

OBJECTIVES: This study concerns the possible effect of practice of prenatal screening of congenital anomalies followed by termination of pregnancy on the perinatal mortality between European countries. METHODS: Data of nine region-specific EUROCAT registries from five European countries were used to compare the pregnancy termination rate and perinatal mortality due to congenital anomalies between the registries. The impact of pregnancy terminations on the perinatal mortality rate was estimated using a calculated lethality for each congenital anomaly in the hypothetical case that no pregnancy terminations had been performed and was expressed in the 'natural' perinatal mortality rate. RESULTS: There are large differences between the EUROCAT registries in the number of pregnancy terminations for congenital anomalies. The difference between the 'natural' and regular perinatal mortality rate vary between 3.7 and 14.1 per 10 000 live births and stillbirths. The difference is greater in regions where prenatal screening is more common than in regions where this is not common. CONCLUSION: Differences in practice of prenatal screening and termination of pregnancy of congenital anomalies contribute to the variations in the overall perinatal mortality rate between European regions and countries.