Patient satisfaction with out-of-hours primary care in the Netherlands

BACKGROUND: In recent years out-of-hours primary care in the Netherlands has changed from practice-based to large-scale cooperatives. The purpose of this study is to determine patient satisfaction with current out-of-hours care organised in general practitioner (GP) cooperatives, and gain insight in factors associated with this satisfaction. METHODS: From March to June 2003, 2805 questionnaires were sent to patients within three weeks after they had contacted the GP cooperative in their region. The study was conducted in the province of Limburg in the South of the Netherlands. One-third of these questionnaires was sent to patients who had only received telephone advice, one-third to patients who attended the GP cooperative for consultation, and one-third to patients who received a home visit. Four weeks after the first reminder, a non-respondents telephone interview was performed among a random sample of 100 patients. Analyses were performed with respect to the type of consultation. RESULTS: The total response was 42.4% (1160/2733). Sixty-seven percent of patients who received telephone advice only reported to be satisfied with out-of-hours care. About 80% of patients who went to the GP cooperative for consultation or those receiving a home visit, reported to be satisfied. Factors that were strongly associated with overall satisfaction included, the doctor's assistant's attitude on the phone, opinion on GP's treatment, and waiting time. CONCLUSION: Patients seem generally satisfied with out-of-hours primary care as organised in GP cooperatives. However, patients who received telephone advice only are less satisfied compared to those who attended the GP cooperative or those who received a home visit

De ziektelast, zorg en de kosten van CVA in Nederland

Stroke is a major chronic disease with a high morbidity and mortality. In the Netherlands about 30,000 people a year suffer a stroke for the first time. One third of these stroke patients dies within the first year after stroke, and 41% of the survivors experience limitations in their daily activities. The aim of this report is to give an overview of the disease impact, health care management, and costs of stroke in the Netherlands. First, we present the epidemiological trends of stroke in recent years, by describing the incidence, prevalence and mortality of stroke, and the relationship with its major risk factors. Then, we describe the Dutch health care system, its recent developments, and its bottlenecks and limitations of the Dutch health care system. Finally, an overview is presented of the use of health care resources due to stroke in the Netherlands, the supply of physicians, stroke units, and the total drug expenditure and consumption by defined daily dosage. Special attention is given to the costs of stroke in 1993, the lifetime costs, and the future costs of stroke.Beroerte is een belangrijke ziekte zowel qua morbiditeit als mortaliteit. In Nederland ondergaan ongeveer 30.000 mensen per jaar een beroerte. Drieendertig procent van deze patienten overlijdt in het eerste jaar na het ontstaan van de beroerte en 41% van de overlevenden ondervindt beperkingen in zijn dagelijks leven als gevolg van de beroerte. Het doel van het rapport is een overzicht te geven van de huidige ziektelast, de organisatie van de zorg en de kosten van de zorg van patienten met een beroerte in Nederland. In het rapport wordt allereerst de epidemiologie en de risicofactoren voor het krijgen van een beroerte beschreven. Vervolgens wordt de Nederlandse gezondheidszorg, in relatie tot de zorg voor patienten met een beroerte besproken. Nieuwe ontwikkelingen in de zorg van patienten met een beroerte, zoals 'stroke units', 'stroke services' en TIA-poli's, komen aan de orde. Daarnaast wordt in dit rapport informatie over het gebruik van voorzieningen ten gevolge van beroerte in Nederland gepresenteerd. Tot slot wordt ingegaan op de kosten van de zorg van patienten met een beroerte. Het rapport is een bijdrage aan het Ageing-Related Disease project van de Organisation for Economic Co-operation and Development (OECD) getiteld "Cross-national difference in the treatment, costs and outcomes of stroke"