Adoption of new medicines in primary care: a comparison between the uptake of new oral anticoagulants and diabetes medicines

Direct-acting oral anticoagulants (DOACs) were introduced in 2008 for the treatment of thrombo-embolic diseases. Dipeptidyl peptidase-4 inhibitors (DPP4-inhibitors) and glucagon-like peptide-1 receptor agonists (GLP1-agonists), both incretin-based therapies, were introduced in 2007 and (late) 2006 respectively, for the treatment of type 2 diabetes mellitus (T2DM). This study aimed to gain insight in the uptake, practice variation and correlation in the adoption of DOACs and incretin-based therapies Prescription data from general practices in the Dutch Nivel Primary Care Database from 2007-2019 were used. Per year 46 to 424 general practices and 179,933 to 1,654,376 patients were included. In 2019, the mean percentage of patients per practice using DOACs or incretin-based therapies was 54.9% and 9.7%, respectively. The intraclass correlation coefficient (ICC) decreased from 0.75 to 0.024 for DOACs and from 0.33 to 0.074 for incretin-based medicines during the study period. No clear correlation was found between the prescription of DOACs and incretin-based therapies

Newer insulins in primary care

Newer long-acting insulins (insulin glargin 300 U/ml and insulin degludec) are not recommended for the treatment of patients with type 2 diabetes mellitus (T2DM) according to the Dutch guideline ‘NHG-Standaard diabetes mellitus type 2'. Although adherence to guidelines is generally high among Dutch GPs, the popularity of insulin glargine 300 U/ml and insulin degludec in Dutch practice is rapidly increasing. This study therefore aimed to identify practice variation in, and practice and patient characteristics associated with, the prescription of newer insulins to patients with T2DM in primary care, 3–5 years after their introduction. We performed a retrospective cohort study in Dutch general practices using data of the Nivel Primary Care Database. We found that a median percentage of 21.2% of all patients prescribed intermediate or long-acting insulins per practice received a prescription for newer insulins. The inter-practice variation in the prescription of newer insulins was large and could only be partially explained by patient- and practice-related differences. This indicates substantial opportunities for improvement

Nivel Corona Cohort: a description of the cohort and methodology used for combining general practice electronic records with patient reported outcomes to study impact of a COVID-19 infection

A population-based COVID-19 cohort was set up in the Netherlands to gain comprehensive insight in the short- and long-term effects of COVID-19 in the general population. A subset of this data, deposited and described here, was used for the aims to describe the methodology and infrastructure used to recruit individuals with COVID-19 and the representativeness of the population-based cohort and to characterize the population by description of their symptoms and health care usage during the acute COVID-19 phase. The starting point of the set-up of the cohort was to recruit participants in routinely recorded, general practice electronic health records (EHR) data, which are sent to the Netherlands Institute for Health Services Research Primary Care Database (Nivel-PCD) on a weekly basis. Patients registered with COVID-19 were flagged in the Nivel-PCD based on their COVID-19 diagnoses. Flagged patients were invited for participation by their general practitioner via a trusted third party. Participating patients received a series of four questionnaires over the duration of one year allowing for a combination of data from patient reported outcomes and EHRs. The Nivel Corona Cohort consists of 442 participants and here a subset of the data from the first questionnaire is shown. The Nivel Corona Cohort is population-based, containing a complete image of severity of symptoms from patients with none or hardly any symptoms to those who were hospitalized due to the COVID-19. The five most prevalent symptoms during the acute COVID-19 phase were fatigue (90.5%), reduced condition (88.2%), coughing/sneezing/stuffy nose (79.3%), headache (75.4%), and myalgia (66.7%). The population-based Nivel Corona Cohort provides ample opportunities for future studies to gain comprehensive insight in the short- and long-term effects of COVID-19 by combining patients’ perspectives and clinical parameters via the EHRs within a long-term follow-up of the cohort