Primary care and public health a natural alliance? The introduction of the guidelines for obesity and undernutrition of the Dutch College of General Practitioners.

The prevalence of obesity and overweight is increasing globally and forms a huge public health problem. On the other hand, the prevalence of malnutrition or undernutrition is substantial, especially in nursing homes or in the elderly at home. Primary care and public health are separate disciplines. But in the field of nutrition and other lifestyle-related interventions, there are many direct and indirect interfaces for over- as well as undernutrition. The Dutch College of General Practitioners (NHG) published the Practice Guideline Obesity in adults and children to lead GPs in this process and to bridge the gap with public health. The same applies for the recently published National Primary Care Cooperation Agreement Undernutrition on the collaboration of primary care workers to enhance awareness and early intervention in case of nutritional impairment. This article goes into the background as well as the content of these two NHG products and the implications for daily practice. An attempt is made to connect primary care and public health in this matter. Particularly in the case of obesity, a close relationship with public health is of vital importance.

The development of a minimal intervention strategy to address overweight and obesity in adult primary care patients in The Netherlands.

BACKGROUND: Currently, overweight and obesity do not receive the attention they deserve from the Dutch GPs, mostly because of a lack of an effective intervention strategy to tackle this difficult health problem. OBJECTIVE: To develop a minimal intervention strategy (MIS) addressing overweight and obesity among adult primary care patients, resulting in a prototype. METHODS: Following the intervention mapping protocol, the MIS is based on literature study, existing interventions, psychosocial theories, stakeholder interviews and a questionnaire study among stakeholders. This led to the development of a prototype of the MIS materials: a screening flow chart and a treatment flow chart, a manual and patient education materials. A pre-test among 42 general practitioners and practice nurses was conducted to investigate the usefulness of the MIS materials at first sight. RESULTS: The stakeholder interviews and the questionnaire study resulted in insight on what the MIS should look like. For instance, the stakeholders indicated that the treatment needs to focus on helping patients to eat more healthy and exercise more, using techniques like motivational interviewing. The pre-test showed that most participants were enthusiastic about the materials, although they made some suggestions on improvements. CONCLUSION: The MIS materials seem to be useful and promising. A future pilot test is needed to investigate its usefulness in daily practice and to further improve the materials in preparation for a process and effect evaluation.

Nutrition guidance in The Netherlands: the role of the GP in the translation from population strategy to individual approach.

An important pitfall of nutritional guidance in medical practice is how to deal with the prevention paradox: a nutritional advice that is good for the population as a whole is not necessarily proven effective for the individual patient. Evidence-based guidelines are needed to support GPs to translate these advices to the individual patient. We illustrate this with two examples: obesity and undernutrition. The Dutch Ministry of Health started a national partnership on overweight. The role of the Dutch College of GPs (NHG) in this process is to insert the GP's perspective and to 'translate' the multidisciplinary guideline into a practice guideline for GPs. A systematic review on nutritional deficiency in general practice in The Netherlands showed a prevalence ranging from 0% to 13%. The 'National Steering Committee Undernutrition' stimulates GPs to pay more attention to undernutrition, in collaboration with the Dutch College of GPs. The Cochrane Primary Health Care Field (Nijmegen) accommodates the Cochrane Diet and Nutrition Sub Field involving the inclusion of evidence from non-randomized studies, which are generally not included in Cochrane Reviews, but which form an important part of the evidence for the role of nutrition. From this international initiative, a national collaboration in The Netherlands between universities, researchers and the Dutch College was founded, which aims to support the foundation of practice-based nutrition counselling in the consulting room.

ICPC-code approach of nutritional questions in general practice: a look at the future.

The Dutch College of General Practitioners is developing a computerised consult supporting system on nutrition that is integrated in the widely used GP Information System. Connected to every ICPC-code (International Code of Primary Care) for diagnosis relevant nutritional information is available. Short items simple sentences with respect to the content-provide the main nutritional information, needed to inform the patient within the limited consultation time. Background information is the second level and is reachable by clicking on the coloured items in the first part. After all the patients' practical advice is the last part of this so-called: 'P-module of nutrition'.

[Folic acid use for women desiring offspring: the family physician's response]. / Foliumzuurgebruik bij zwangerschapswens: de reactie van de huisarts.

OBJECTIVE: To establish to what extent general practitioners (GP's) are familiar with the folic acid campaign of the Netherlands Bureau for Food and Nutrition Education, display a positive attitude regarding use of folic acid tablets by women who would like to become pregnant and factually provide information on folic acid. DESIGN: Cross-sectional, descriptive. SETTING: Regions: Central Brabant, Achterhoek, Randstad and Northern Netherlands. METHOD: In 1996 a printed questionnaire was sent to 300 GP's selected at random. It contained questions about knowledge, attitude and management regarding the use of folic acid by women who would like to become pregnant and with a normal risk to have a child with a neural tube defect. RESULTS: The response was high (81%). Most GP's were familiar with the national campaign on folic acid (87%), but 18% considered themselves insufficiently informed about the education campaign and/or the folic acid recommendations. Half the GP's considered use of folic acid tablets by women who would like to become pregnant as important, while two-thirds were of the opinion that it contributed to medicalization of the pregnancy. Most GP's (82%) thought that pregnant women who had not used folic acid tablets might develop feelings of guilt. Nevertheless, 64% recommended use of folic acid tablets and 63% were willing to write a prescription if the woman asked for it. Seventy-five per cent of the GP's reported that they themselves suggested use of folic acid tablets to women who they assumed would like to become pregnant, although most stated they sometimes forgot (58%). The percentages of GP's who sometimes or always suggested folic acid tablets during a contraception advice after delivery or who advised women who would like to become pregnant to switch to a diet rich in folic acid, were much smaller (29 and 37%, respectively). CONCLUSION: Although a large number of the GP's mentioned potential problems, the majority actively cooperated in promoting use of folic acid by women who would like to become pregnant.