[The practice guideline 'The STD consultation' from the Dutch College of General Practitioners; a response from the perspective of general practice]. / De standaard 'Het soa-consult' van het Nederlands Huisartsen Genootschap; reactie vanuit de huisartsgeneeskunde.

The new guidelines from the Dutch College of General Practitioners on sexually transmitted diseases (STDs) replace three existing practice guidelines covering a number of sexually transmitted diseases. In the Netherlands the general practitioner treats almost 75% of all patients with an STD. These include patients with symptoms, patients who are worried or anxious, and patients at high risk of an STD. STD-risk assessment should be regarded as a high priority. Chlamydia-infection remains the most prevalent STD. It is easily diagnosed by DNA-diagnostic amplification techniques. The new guidelines recommend more proactive and wider testing. There is much emphasis on counselling, prevention and notifying partners. General practice is the ideal setting for this.

Adverse drug reactions and polypharmacy in the elderly in general practice.

OBJECTIVES: The risk of adverse drug reactions (ADRs) increases with the number of drugs used. Most studies refer to potential interactions; the results regarding the severity of occurring and registered ADRs are inconsistent. Therefore, we examined the relevance of drug-induced problems in the elderly in general practice and their association with polypharmacy. DESIGN: Retrospective cross-sectional analysis of prospectively collected data. SETTING: Three family practices participating in the medication and morbidity Registration Network Groningen (RNG). METHODS: From 2185 elderly patients (>64 years) medication and morbidity data were collected over the period of 2 years (1994 and 1995). Polypharmacy was defined as the long-term simultaneous use of two or more drugs. Adverse reactions recognised as such were coded as a separate 'diagnosis' A85. The most risky drug groups and the most prevalent diseases in relation to ADRs were studied. RESULTS: The incidence of ADRs in general practice was 5.7 per 100 elderly patients and the prevalence 6.1 per 100. Moderate polypharmacy was more frequent in the elderly who experienced adverse effects; no other differences in degree of polypharmacy could be found. The elderly who experienced adverse reactions used overall more different drugs (14.4 +/- 7.6, of which 1.5 +/- 1.5 were used long term) than the other elderly patients (8.1 +/- 5.7, of which 1.0 +/- 1.5 were long term). The incidence of ADRs increased non-significantly with the number of drugs used long term. Antibiotics, antihypertensives and non-steroidal anti-inflammatory drugs were mainly responsible for gastrointestinal complaints (nausea, diarrhoea and stomach pain) and rash. In the cases of treating urinary tract infections and sleeping disorders, there was a significantly high risk of ADRs. Slightly more at risk for adverse drug reactions were older patients with coronary heart disease or asthma/chronic obstructive pulmonary disease. CONCLUSION: Most of the ADRs observed in general practice turn out to be rather harmless. This is in agreement with outpatient studies, though not with hospital studies. An increased risk of adverse effects with the number of drugs used simultaneously, as reported in other studies, was not confirmed in our study. This study however is limited to actually registered effects.

[Chronic polypharmacy in one-third of the elderly in family practice]. / Chronische polyfarmacie bij eenderde van de ouderen in de huisartspraktijk.

OBJECTIVE: Description of the extent and nature of polypharmacy in the elderly in general practice. DESIGN: Retrospective cross-sectional study. METHOD: Medication and morbidity data were collected over July-December 1994 on all 2197 patients > or = 65 years registered in 3 family practices connected with the Medication and Morbidity Registration Network Groningen, the Netherlands. Special attention was paid to the simultaneous use of > or = 2 drugs during > or = 120 days in the study period ('chronic use'). Three categories of polypharmacy were distinguished: mild (2-3 drugs), moderate (4-5) and extensive (> 5). RESULTS: Forty per cent of the study group were males; 54% were 65-74 years, 34% were 75-84 years and 12% were > or = 85 years. The mean number of drugs used was 3.9 per person (SD: 3.6), of which 1.4 (SD: 1.8) chronically. Polypharmacy occurred in 35%: mild in 23%, moderate in 8% and extensive in 4%. All occurred mostly in the group between 75 and 84 years old. Cardiovascular drugs, in particular diuretics, and psycholeptics were mostly prescribed concomitantly with each other and with other drugs. The prevalence of concomitant use of drugs with potential interactions was low (< 3%). The indications for psycholeptic drugs were quite often not clear. Congestive heart failure, chronic obstructive pulmonary disease (COPD)/asthma and diabetes mellitus were mainly responsible for extensive polypharmacy.

[Polypharmacy in the elderly with chronic diseases: conflicting interests]. / Polyfarmacie bij ouderen met chronische ziekten: tegenstrijdige belangen.

Polypharmacy patients are elderly people with multiple chronic diseases, such as hypertension, heart failure, atrial fibrillation, diabetes mellitus and chronic obstructive pulmonary disease. Many specialists are involved, each of them trying to optimise the function of a particular organ system. The general practitioner has the overall picture and assesses the consequences for the quality of life of the patient. Specialists and pharmacists should consult with the general practitioner, who ought to be in charge of treatment.