Office-Based Minor Surgery: An Ever-Increasing Challenge Not Only for the Dutch General Practitioner.

BACKGROUND AND OBJECTIVES: Office-based minor surgery (OBMS) refers to all surgical procedures performed under local anesthetic in the office setting. It is cost effective for the health economy, safe, and appreciated by patients. It is not yet fully understood why some general practitioners (GPs) perform OBMS and others do not, while there is a growing demand for OBMS. Therefore, we explored factors that influence the performance of OBMS by GPs. The aim of this study is to explore the facilitators and barriers that influence GPs in deciding whether to perform OBMS. METHODS: We performed a qualitative study using focus groups consisting of GPs and GP trainers. Two researchers analyzed the data independently. RESULTS: The analysis resulted in a comprehensive list of facilitators and barriers. Besides already known factors such as financial consequences and geographic location, the most important factors influencing the decision to perform OBMS were training and the role of the GP trainer; fear of having to work alone and having to solve unexpected complications; and the influence of collaboration, organization, and facilities in the GP's own practice. CONCLUSIONS: The increasing demand for OBMS in primary care centers requires more attention to training aspects, the existing fear, adequate reimbursement for special accreditation, and collaboration and organization. We expect that addressing these factors will result in the strengthening of primary care, improving patient safety, lower referral rates, and a reduction in health care costs.

Lemierre's syndrome: three cases and a review.

Postanginal sepsis, also called Lemierre's syndrome, is a rare but acute medical condition complicating oropharyngeal infection. The pathogenesis consists of the development of internal jugular vein septic thrombophlebitis leading to metastatic infections in the lung and other sites. The causative microorganism is most often Fusobacterium necrophorum. We present three patients with Lemierre's syndrome who presented to the Leiden University Medical Center and give a review of the literature.