Patients' experiences with continuum of care across hospitals:A multilevel analysis of Consumer Quality Index Continuum of Care

Objective: Communication between professionals is essential because it contributes to an optimal continuum of care. Whether patients experience adequate continuum of care is uncertain. To address this, a questionnaire was developed to elucidate this care process from a patients' perspective. In this study, the instrument's ability to measure differences in "Consumer Quality Index Continuum of Care" scores between hospitals was investigated. Methods: The questionnaire was mailed to a random sample of 2159 patients and comprised of 22 items divided over four domains, GP approach, GP referral, specialist and collaboration. Multilevel analysis was conducted to identify case-mix and determine this questionnaire's ability to measure differences in domain scores between hospitals. Results: Based on a 65% response rate, 1404 questionnaires were available for analysis. Case-mix of patient characteristics across hospitals could not be demonstrated. Some differences in scores between hospitals were observed. At most two in eight hospitals showed different domain scores. Conclusion: The ability of this questionnaire to measure differences in continuum of care scores between hospitals is limited. The outcome of this survey suggests that hospitals provide a similar level of continuum of care from a patient's perspective. Practical implications: This questionnaire is especially useful for measuring differences between patients. (C) 2010 Elsevier Ireland Ltd. All rights reserved

Maak van je verwijsbrief geen troebele SOEP

Veel huisartsen en specialisten zijn niet tevreden over de kwaliteit van de onderlinge (verwijs)brieven. Volgens hen bevatten deze vaak irrelevante informatie of staan er afortingen in die ze niet begrijpen. Geregeld ontbreken gegevens over de prognose, de intentie van de behandeling en de verschillende behandelopties. Wat kunnen huisartsen doen om de schrifelijke communicatie met specialisten teverbeteren

Follow-up of curatively treated cancer in primary care:a qualitative study of the views of Dutch GPs

BACKGROUND: Follow-up for cancer typically occurs in secondary care, and improved survival has increased demands on these services. Other care models may alleviate this burden, such as moving (parts of) follow-up care for curatively treated patients from secondary to primary care (care substitution). AIM: To explore the opinions of GPs regarding the potential benefits, barriers, and requirements of care substitution for breast and colorectal cancer. DESIGN AND SETTING: A qualitative study of the opinions of purposively sampled GPs in Dutch primary care. METHOD: Focus group sessions and individual semi-structured interviews were recorded and transcribed verbatim. Data were analysed by two independent researchers using thematic analysis. RESULTS: Two focus groups (n = 14) were conducted followed by nine individual interviews. Three main themes were identified: perceived benefits, perceived barriers, and perceived requirements. Perceived benefits included better accessibility and continuity of care, and care closer to patients' homes. Uncertainty about cancer-related competences and practical objections were perceived as barriers. Requirements included close specialist collaboration, support from patients for this change, and stepwise implementation to avoid loss of existing care quality. CONCLUSION: Most GPs reported that they were not in favour of complete care substitution, but that primary care could have greater formal involvement in oncological follow-up if there is close collaboration with secondary care (that is, shared care), support from patients, sufficient resource allocation, stepwise implementation with clear guidelines, and monitoring of quality. Clear and broadly supported protocols need to be developed and tested before implementing follow-up in primary care

Long-term psychological distress in breast cancer survivors and their matched controls:A cross-sectional study

Introduction: Breast cancer survivors often experience psychological distress shortly after diagnosis. Long-term psychological effects, however, have not been clearly demonstrated. Methods: This cross-sectional cohort study included 350 breast cancer survivors and 350 age-matched and general-practitioner-matched women. The median follow-up was 10 years. Using logistic regression we compared breast cancer survivors with controls on having (severe) symptoms of depression and/or anxiety, as measured with the Hospital Anxiety and Depression Scale. In multivariable logistic regression, we adjusted the results for a history of depression or prescription of antidepressants. Results: Larger proportions of breast cancer survivors experienced symptoms of depression (10.6%) compared with controls (4.9%) and symptoms of anxiety (18.6%) compared with controls (16.3%). The odds of symptoms of depression (OR 2.3, 95%CI 1.3-4.2), severe symptoms of depression (OR 3.3, 95%CI 1.1-10.3) and severe symptoms of anxiety (OR 2.1, 95%CI, 1.1-4.0) were significantly higher for breast cancer survivors than for controls, even after adjusting for history of depression or prescription of antidepressants. No significant difference was seen for mild symptoms of anxiety. Conclusions: Breast cancer survivors have an increased risk of symptoms of depression, including severe symptoms, and severe symptoms of anxiety compared with controls, for up to at least 10 years after diagnosis

Increased primary health care use in the first year after colorectal cancer diagnosis

OBJECTIVE: The view that the general practitioner (GP) should be more involved during the curative treatment of cancer is gaining support. This study aimed to assess the current role of the GP during treatment of patients with colorectal cancer (CRC). DESIGN: Historical prospective study, using primary care data from two cohorts. SETTING: Registration Network Groningen (RNG) consisting of 18 GPs in three group practices with a dynamic population of about 30,000 patients. SUBJECTS: Patients who underwent curative treatment for CRC (n = 124) and matched primary care patients without CRC (reference population; n = 358). MAIN OUTCOME MEASURES: Primary healthcare use in the period 1998-2009. FINDINGS: Patients with CRC had higher primary healthcare use in the year after diagnosis compared with the reference population. After correction for age, gender, and consultation behaviour, CRC patients had 54% (range 23-92%) more face-to-face contacts, 68% (range 36-108%) more drug prescriptions, and 35% (range -4-90%) more referrals compared with reference patients. Patients consulted their GP more often for reasons related to anaemia, abdominal pain, constipation, skin problems, and urinary infections. GPs also prescribed more acid reflux drugs, laxatives, anti-anaemic preparations, analgesics, and psycholeptics for CRC patients. CONCLUSIONS: The GP plays a significant role in the year after CRC diagnosis. This role may be associated with treatment-related side effects and psychological problems. Formal guidelines on the involvement of the GP during CRC treatment might ensure more effective allocation and communication of care between primary and secondary healthcare services

Skin tumours underexposed in general practice

Huisartsen worden frequent geconsulteerd om huidtumoren te beoordelen. Zij spelen dus een belangrijke rol bij de vroegtijdige detectie van huidkanker zoals het basaalcelcarcinoom, het plaveiselcelcarcinoom, het melanoom en detectie van premaligne huidafwijkingen. Door de spectaculaire toename van de incidentie van alle vormen van huidkanker, wordt de groep patiënten die diagnostiek en behandeling behoeft steeds groter. Daarom is het voor de huisarts, maar ook voor de dermatoloog, van groot belang om deze toename met betere transmurale zorg in goede banen te leiden.Met huidtumoren worden al dan niet gepigmenteerde afwijkingen bedoeld zoals naevi, papels of wratten, die klinisch zowel benigne als maligne kunnen imponeren. De grote meerderheid van de huidtumoren die de huisarts beoordeelt, is echter benigne.1Het is bekend dat in de praktijk een aantal huidafwijkingen die op klinische gronden als ‘benigne’ worden beoordeeld, wordt behandeld met cryotherapie, curettage, ‘shaven’ of excisie zonder histopathologisch onderzoek.General practitioners (GPs) in the Netherlands frequently assess skin tumours such as moles. However, the training of medical students, GP trainees and postgraduate training of GPs in evaluating these skin lesions is limited. Furthermore, literature is scarce and no guidelines are available. It is still unclear when histopathological evaluation of an excised skin lesion should be performed. Additional research in primary care populations and the development of a guideline would promote a more unambiguous approach. More (postgraduate) education is needed on this topic. Dermatoscopy and teledermatology might also play a role in improving care.</p

Late effects of cancer treatment:shared care

Many adverse effects of cancer treatment develop years after treatment completion. Late effects such as cardiotoxicity, metabolic syndrome, and osteoporosis can sometimes be prevented or reduced if they are detected early. This makes it important to continue to monitor patients after they have been discharged from secondary care. Shared care means that patients, general practitioners, and oncologists are jointly involved in the management of these late effects. To this end, a personalized care plan should be prepared that clearly describes each person's role and which provides recommendations for screening and, if necessary, interventions. It would seem logical that general practitioners have a pivotal role in this because of their broad background and experience with multimorbidity and chronic illnesses. A precondition for successful shared care is the availability of better and more consistent aftercare protocols for various types of cancer treatment and better scientific support for the relevance of screening for late effects