[Contacts outside of office hours: complaints presented to the general practitioner and to the emergency department]. / Contacten buiten de kantooruren: klachten gepresenteerd aan de huisarts en aan de Spoedeisende Hulp.

OBJECTIVE: To determine the differences between the problems presented out-of-hours to general practitioners (GPs) or to the Accident & Emergency (A&E) department of a hospital, and to assess whether the physicians believed the patient was justified in contacting them. DESIGN: Descriptive. METHOD: All the out-of-hours contacts that 33,000 patients on the lists of 22 general practices had with either a duty GP or the A&E department of a nearby hospital (so-called 'self-referrers') were counted during two 3-month periods. In addition, symptoms were classified in both settings using the International Classification of Primary Care (ICPC). RESULTS: The ratio for contacts between general practice and A&E was 2:1 in the evening and 3:1 at night. The majority of problems presented to the GP was dealt with by telephone. At the A&E, trauma was seen most commonly, while GPs were contacted for infections and (complications of) chronic diseases. A&E physicians judged one out of five reasons for encounter as 'unjustified', while this ratio was one in seven in the case of GPs. CONCLUSIONS: There was only a partial overlap in the nature of the problems presented to an A&E department and those presented to GPs; instead, the two settings appeared to complement each other. The results were influenced by the fact that the A&E department lacked the possibility of dealing with patients by telephone. Both the A&E department and the GPs were contacted by patients who did not need (acute) medical care.

Risk of depression in patients with chronic obstructive pulmonary disease and its determinants.

BACKGROUND: Although it has been repeatedly suggested that chronic obstructive pulmonary disease (COPD) is associated with depression, no conclusion has so far been reached. A study was undertaken to investigate whether depression occurs more often in patients with COPD than in controls. The demographic and clinical variables associated with depression were also determined. METHODS: Patients with a registered diagnosis of obstructive airway disease in general practice, aged > or=40 years, forced expiratory volume in 1 second (FEV(1)) <80% predicted, FEV(1) reversibility

Added value of co-morbidity in predicting health-related quality of life in COPD patients.

The extent to which a chronic obstructive pulmonary disease (COPD) patient is impaired in health-related quality of life (HRQoL) is only to a small extent reflected in clinical and demographical measures. As the influence of comorbidity on HRQoL is less clear, we investigated the added value of 23 common diseases in predicting HRQoL in COPD patients with mild to severe airways obstruction. COPD patients from general practice who appeared to have an forced expiratory volume in 1 sec/inspiratory vital capacity (FEV1/IVC) < predicted -1.64 SD, FEV1 <80% predicted, FEV1 reversibility < 12% and a smoking history, were included (n=163). HRQoL was assessed with the short-form-36 (SF-36) and the presence of comorbidity was determined by a questionnaire, which asked for 23 common diseases. All domains of the SF-36 were best predicted by the presence of three or more co-morbid diseases. FEV1 % predicted, dyspnoea and the presence of one or two diseases were second-best predictors. Co-morbidity explained an additional part of the variance in HRQoL, particularly for emotional functioning (delta R2=0.11). When individual diseases were investigated, only insomnia appeared to be related to HRQoL. As HRQoL is still only partly explained, co-morbidity and other patient characteristics do not clearly distinguish between COPD patients with severe impairments in HRQoL and COPD patients with minor or no impairments in HRQoL. Therefore, it remains important to ask for problems in daily functioning and well-being, rather than to rely on patient characteristics alone.

Prevalence of comorbidity in patients with a chronic airway obstruction and controls over the age of 40.

The goal of this study is to determine the prevalence of 23 common diseases in subjects with a chronic airway obstruction and in controls. All subjects with a known diagnosis by their general practitioner of asthma or chronic obstructive pulmonary disease (COPD), and who were 40 years and older were selected (n = 1145). Subjects who were willing to participate (n = 591) and who appeared to have an irreversible airway obstruction (n = 290) were included. To recruit controls, a random sample was taken of 676 individuals who were 40 years and older and who were not diagnosed as having asthma or COPD by their general practitioner. Of these 676 individuals 421 were willing to participate. The presence of diseases was determined by using a questionnaire. One hundred and ninety-four subjects (73%) and 229 controls (63%) were shown to be suffering from one or more (other) diseases. In both groups, locomotive diseases, high blood pressure, insomnia and heart disease were most common. Locomotive diseases, insomnia, sinusitis, migraine, depression, stomach or duodenal ulcers and cancer were significantly more common in the subject group than in the control group. For both clinical and research purposes, it is important to consider the presence of diseases in patients with a chronic airway obstruction.

Identifying relevant diagnostic studies in MEDLINE. The diagnostic value of the erythrocyte sedimentation rate (ESR) and dipstick as an example.

OBJECTIVE: We aimed to examine sensitivity and positive predictive value of MEDLINE searching for diagnostic studies, relevant for the primary health care setting. METHOD: Results of MEDLINE searches were compared with a reference standard collection of studies on two subjects, the diagnostic value of ESR in discriminating between 'pathology' and 'no pathology', and the dipstick method in diagnosing urinary tract infections. The main outcome measures were sensitivity (proportion of the total number of reference standard diagnostic studies that could be identified by the search) and positive predictive value (proportion of the total number of publications retrieved by MEDLINE that were incorporated in the reference standard). RESULTS: The combined MeSH and freetext search was more sensitive than MeSH term searching only, for both the ESR and the dipstick search. With this combined search sensitivities of 0.91 and 0.98 and predictive values of 0.10 and 0.68 were found for ESR and dipstick respectively. By restricting the search with keywords describing the primary health care setting the predictive values increased to 0.72 and 1.00 but sensitivity dropped to 0.10 and 0.07 (ESR and dipstick respectively). CONCLUSION: Combining freetext and MeSH term searching, without restriction to the primary health care setting, is a valuable strategy in systematically searching for available evidence on the value of a diagnostic test in the scope of a specific disease. The predictive value seems to depend on the breadth of the disease area. MEDLINE should provide a term such as 'diagnostic evaluation study' to be used in the limit field Publication Type to specify diagnostic studies.