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1.
Methods Inf Med ; 45(4): 447-54, 2006.
Article in English | MEDLINE | ID: mdl-16964364

ABSTRACT

OBJECTIVE: We developed AsthmaCritic, a non-inquisitive critiquing system integrated with the general practitioners' electronic medical records. The system is based on the guidelines for asthma and chronic obstructive pulmonary disease (COPD) as issued by the Dutch College of General Practitioners. This paper assesses the effect of AsthmaCritic on monitoring and treatment of asthma and COPD by Dutch general practitioners in daily practice. METHODS: A randomized clinical trial in 32 practices (40 Dutch general practitioners) using electronic patient records. An intervention group was given the use of AsthmaCritic, a control group continued working in the usual manner. Both groups had the disposal of the asthma and COPD guidelines routinely distributed by the Dutch College of General Practitioners. We measured the average number of contacts, FEV 1 (forced expiratory volume), and peak-flow measurements per asthma/COPD patient per practice; and, the average number of antihistamine, cromoglycate, deptropine, and oral bronchodilator prescriptions per asthma/COPD patient per practice. RESULTS: The number of contacts increased in the age group of 12-39 years. The number of FEV1 , peak-flow measurements, and the ratio of coded measurements increased, whereas the number of cromoglycate prescriptions decreased in the age group of 12-39 years. CONCLUSIONS: Our study shows that the guideline-based critiquing system AsthmaCritic changed the manner in which the physicians monitored their patients and, to a lesser extent, their treatment behavior. In addition, the physicians changed their data-recording habits.


Subject(s)
Ambulatory Care Information Systems , Asthma/drug therapy , Decision Support Systems, Clinical , Drug Utilization , Family Practice/standards , Guideline Adherence , Practice Patterns, Physicians' , Pulmonary Disease, Chronic Obstructive/drug therapy , Adolescent , Adult , Child , Decision Making , Drug Monitoring , Family Practice/methods , Feedback , Female , Humans , Male , Medical Records Systems, Computerized , Netherlands
2.
Eur Urol ; 47(4): 494-8, 2005 Apr.
Article in English | MEDLINE | ID: mdl-15774248

ABSTRACT

OBJECTIVE: To describe the incidence of acute urinary retention (AUR) in the general male population and in a population of men newly diagnosed with lower urinary tract symptoms suggestive of BPH (LUTS/BPH). METHODS: We performed a retrospective cohort study in the Integrated Primary Care Information (IPCI) database, a GP research database in The Netherlands, during the period 1995-2000. All males, > or =45 years, without a history of AUR or radical cystectomy were included in the study. In addition, we followed a sub-cohort of men, newly diagnosed with LUTS/BPH. AUR was defined as the sudden inability to urinate, requiring catheterization. RESULTS: Amongst 56,958 males with a mean follow-up of 2.8 years, 344 AUR cases occurred (incidence rate 2.2/1000 man-years) of whom more than 40% were precipitated. AUR was the first symptom of LUTS/BPH in 73 (49%) of the 149 AUR cases that occurred in men newly diagnosed with LUTS/BPH. The risk of AUR was 11-fold higher in patients newly diagnosed with LUTS/BPH (RR 11.5; 95%CI: 8.4-15.6) with an overall incidence rate of 18.3/1000 man-years (95%CI: 14.5-22.8). CONCLUSIONS: The incidence rate of AUR is low in the general population but substantial in a population of men newly diagnosed with LUTS/BPH. The incidence rate increases with age and AUR is precipitated in approximately 40% of all cases. Within the LUTS/BPH cohort, AUR is the first presenting symptom of BPH in 50% of all AUR cases.


Subject(s)
Urinary Retention/epidemiology , Acute Disease , Aged , Aged, 80 and over , Cohort Studies , Humans , Incidence , Male , Middle Aged , Retrospective Studies
3.
Stud Health Technol Inform ; 93: 39-46, 2002.
Article in English | MEDLINE | ID: mdl-15058412

ABSTRACT

BACKGROUND: Computerised decision support systems (CDSS) can be categorised as either being inquisitive or non-inquisitive. The non-inquisitive system uses routinely entered electronic patient data, to generate patient specific feedback based on guidelines. The Dutch College of General Practitioners' (DCGP) cholesterol guideline classifies patients into risk groups, eligible for screening. The availability of sufficient routinely recorded electronic patient data to classify patients according to the DCGP cholesterol guideline is unknown. OBJECTIVE: To assess whether it is possible to classify patients according to the screening criteria of the DCGP cholesterol guideline, using data routinely recorded by general practitioners. METHODS: We analysed the DCGP cholesterol guideline to identify selection criteria for screening. These selection criteria were subsequently used to create a cohort of patient records eligible for screening in the Integrated Primary Care Information (IPCI) Database. We calculated incidence and prevalence of risk factors and selected patient records for active management according to the identified screening selection criteria. RESULTS: 145866 valid patient records were selected for classification. In the retrieved records 9741 (13.6%) males and 5756 (7.8%) females were identified for active management according to the selection criteria of the DCGP cholesterol guideline. CONCLUSION: The classification of patients into risk groups, eligible for screening, according to the criteria of the DCGP cholesterol guideline using routinely recorded electronic patient data is feasible. Care should be taken when using only diagnostic codes, as it gives higher than expected incidence and prevalence of risk factors. Based on these findings we are currently building Cholgate, a non-inquisitive decision support system for cholesterol management.


Subject(s)
Hypercholesterolemia/therapy , Mass Screening/methods , Medical Records Systems, Computerized/statistics & numerical data , Patients/classification , Practice Guidelines as Topic , Adolescent , Adult , Aged , Decision Support Systems, Clinical/statistics & numerical data , Feasibility Studies , Female , Humans , Information Storage and Retrieval/methods , Male , Mass Screening/classification , Middle Aged , Netherlands , Risk Assessment/methods
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