LINH-cijfers: taakopvatting van huisartsen omtrent psychosociale zorgverlening versmald.

De taakopvatting van huisartsen ten aanzien van psychosociale zorgverlening is aanzienlijk versmald. Vergeleken met 1987 vinden minder huisartsen dat ze zich bezig zouden moeten houden met het bespreken van bijvoorbeeld de relatieproblemen van hun patiënten, hun opvoedingsmoeilijkheden of de langdurige problemen op hun werk. Psychosociale zorgverlening maakt een wezenlijk onderdeel uit van de door Nederlandse huisartsen verleende zorg. Toch is bijvoorbeeld het percentage huisartsen dat het bespreken van langdurige problemen op het werk volledig of grotendeels tot het eigen takenpakket rekent, afgenomen van 70% tot iets minder dan de helft (46%). De verschuiving in taakopvatting is minder groot bij psychiatrische problemen, zoals het behandelen van wanen. Juist méér huisartsen dan vroeger geven aan dat zij het bieden van hulp bij het bedwingen van suïcidale neigingen wél tot hun taak rekenen. Hoe dat komt is onbekend. De veranderingen in taakopvatting gaan hand in hand met het minder vaak door huisartsen zelf behandelen van psychosociale problemen in de dagelijkse praktijk.Dit blijkt uit een schriftelijke enquête onder Nederlandse huisartsen in 1987 en 2001 (in het kader van respectievelijk de Eerste en Tweede Nationale Studie naar ziekten en verrichtingen in de huisartspraktijk)

Professionalisation of the practice assistant enables task delegation:1987-2001.

In times of a rising shortage of GPs, task delegation is in the centre of attention. We have investigated the role of practice assistants nowadays and how this role has been changing since the late 1980s. In addition, we studied the relationship between delegation to practice assistants and workload. Results indicated that the occupation of practice assistants has professionalised since 1987. Practice assistants are better educated and carry out more medical tasks. General practitioners (GPs) regard their practice assistants as competent and would prefer to delegate more to them. There appears to be room for expansion of the tasks of practice assistants: the GPs and the assistants are in favour of it, the assistants are sufficienlty competent, and according to GPs , patients find delegation acceptable. However, according to the GPs, task delegation is hampered by lack of time for the practice assistant, room and funds. (aut. ref.

Meldingsbereid door tip- en beloningsgelden?

Het doel van dit verkennende onderzoek is om meer inzicht te verkrijgen in de meldingsbereidheid van burgers in relatie tot (de hoogte van) tip- en beloningsgelden. Het voorgaande mondt dan ook uit in de volgende hoofdvraag: Wat is er, op basis van (inter)nationale literatuur en interviews met een aantal deskundigen, bekend over de invloed van tip- en beloningsgelden op de bereidheid van burgers tot het geven van tips aan opsporingsdiensten in Nederland en in (enkele) andere landen (Australië, België en Duitsland)? Welke zijn de meest relevante onderwerpen om te bespreken in een expertmeeting en met wie? INHOUD: 1. Inleiding 2. Tip- en beloningsgelden; procedures en praktijken 3. Meldingsbereidheid in Nederland: gedragswetenschappelij ke literatuur, interviews en expertmeeting 4. Bevindingen verkennend onderzoek Australië, België en Duitsland 5. Conclusie

The workload of general practitioners in the Netherlands: 1987 and 2001.

Like in many other countries, it has often been stated that the workload of general practitioners (GPs) in the Netherlands has increased in the past few years. However, empirical evidence for this statement is lacking. Additionally, most previous research has focused on only one or a few aspects of workload, e.g. the number of working hours or the consultation frequency. In this study we describe changes in objective and subjective workload using a range of workload measures. Compared to 1987, GPs have to deal with an increasing number of medical problems within a shorter time frame. This is mainly due to a 10% increase in demand for care, combined with a shorter working week on average for GPs, i.e. a decline of nine hours per week. Approximately threequarter of the GPs were satisfied or very satisfied with their work in 2001. In comparison with 14 years ago, this represents a distinct decline. Although workload is partly determined by care demand, it can be influenced by the GP. An increasing workload requires creative solutions and can often be managed by organisational measures, e.g. task delegation. (aut. ref.

Effects of intensive trauma-focused treatment of individuals with both post-traumatic stress disorder and borderline personality disorder

Background: Research indicates that intensive trauma-focused therapy can be effective in alleviating symptoms of post-traumatic stress disorder (PTSD) and borderline personality disorder (BPD). However, these studies have relied on self-report of BPD symptoms and follow-up data are scarce. Objective: The purpose of this feasibility study was to determine the effects of an intensive trauma-focused treatment programme on the severity of PTSD and BPD symptoms and the diagnostic status up to a 12-month follow-up. Methods: A total of 45 (60% female) individuals meeting the diagnostic criteria of both PTSD and BPD participated in an intensive eight-day trauma-focused treatment programme which combined prolonged exposure and EMDR therapy in an inpatient treatment setting. Severity of PTSD and BPD symptoms were assessed at pre-treatment, post-treatment, 6 months, and 12 months after treatment (CAPS-5, BPDSI-IV). Diagnostic status was determined using clinical interviews (CAPS-5 and SCID-5-P) at pre-treatment and 12-month follow-up. Results: Of all participants, 93.3% had been exposed to physical abuse, and 71.1% to sexual abuse prior to the age of 12 years. PTSD and BPD symptom severity significantly decreased from pre- to post-treatment (Cohen's ds: 1.58 and 0.98, respectively), and these results were maintained at 6- (ds: 1.20 and 1.01) and 12-month follow-up (ds: 1.53 and 1.36). Based upon CAPS-5, 69.2% no longer met the diagnostic criteria of PTSD at 12-month follow-up, while according to the SCID-5-P 73.1% no longer fulfilled the diagnostic criteria of BPD at that time. No significant worsening of symptoms occurred. Conclusion: The findings of this study, which is the first to examine the effects of psychotherapeutic treatment of PTSD on the presence of a borderline personality disorder one year after treatment, add support to the notion that a brief intensive trauma-focused treatment can be a valuable option for individuals suffering from both PTSD and BPD

Predictors of influenza in the adult population during seasonal and A(H1N1)pdm09 pandemic influenza periods.

We aimed to assess whether the characteristics of influenza-like illness (ILI) cases in the general population were similar during the seasonal and pandemic A(H1N1)pdm09 influenza periods. We conducted a study using a general population database, which included demographic (sex, age) and clinical (underlying medical conditions, influenza vaccination status) information on more than 80 000 subjects. We assessed the most important predictors of ILI during each season by using multiple logistic regression. We descriptively compared whether they were similar during different seasons. The model, including all demographic and clinical characteristics, showed that age ⩾60 years decreased the odds for ILI by 52% and 81% during the seasonal and A(H1N1)pdm09 pandemic periods, respectively. Being vaccinated decreased the odds of ILI for seasonal influenza by 32%, while suffering from the comorbidities other than lung or cardiovascular diseases doubled the odds of ILI during the A(H1N1)pdm09 pandemic. (aut. ref.