The Efficacy of Education with the WHO Dengue Algorithm on Correct Diagnosing and Triaging of Dengue-Suspected Patients; Study in Public Health Centre

Background: Correct diagnosing and triaging dengue fever remains clinical, but is difficult because of unspecific flu-like symptoms. Best tool at the moment is the easy–to-use 2009 WHO guidelines. Objective: To investigate the efficacy of educational intervention with the (adapted and translated) algorithm from the 2009 WHO dengue guideline to healthcare providers in the Indonesian primary health care setting of Central Java. Methods: Quasi-randomized intervention study implemented in two Public Health Centres (PHCs), one being intervention and the other control. Intervention consisted of educational actions on healthcare providers with a presentation, hand-outs and posters. All patients with fever seen in policlinic or emergency department were included. Data were collected with a participatory observation using the WHO algorithm as a guidance. Results: Pre-intervention, a total of 88 patients (n=38 intervention group; n=50 in the control group), and post-intervention, a total of 231 patients (n=105 in the intervention group; n=126 in the control group) were included. Pre-intervention, correct diagnosing and triaging was not significantly different (63.2% vs 64.0% ; p=0.935), while post-intervention, the intervention group scored higher (75.2% vs 62.7% ; p=0.041). However, in both pre- and post-interventional phase, more than 50% of the cases in 19/22 domains were not investigated by the intervention group. Conclusion: Statistical analyses showed a significantly better outcome in correct diagnosis in the intervention group. However, results are considered inconclusive due to incompleteness of relevant information, which most probably leads to many false positive correct diagnoses and triaging

Doctor-patient communication with people with intellectual disability - a qualitative study

<p>Abstract</p> <p>Background</p> <p>People with intellectual disability (ID) expressed dissatisfaction with doctor-patient communication and mentioned certain preferences for this communication (our research). Since many people with ID in the Netherlands have recently moved from residential care facilities to supported accommodations in the community, medical care for them was transferred from ID physicians (IDPs) to general practitioners (GPs) in the vicinity of the new accommodation. We addressed the following research question: 'What are the similarities and differences between the communication preferences of people with ID and the professional criteria for doctor-patient communication by GPs?'</p> <p>Methods</p> <p>A focus group meeting and interviews were used to identify the preferences of 12 persons with ID for good communication with their GP; these were compared with communication criteria used to assess trainee GPs, as described in the MAAS-Global manual.</p> <p>Results</p> <p>Eight preferences for doctor-patient communication were formulated by the people with ID. Six of them matched the criteria used for GPs. Improvements are required as regards the time available for consultation, demonstrating physical examinations before applying them and triadic communication.</p> <p>Conclusions</p> <p>People with ID hold strong views on communication with their doctors during consultations. GPs, people with ID and their support workers can further fine-tune their communication skills.</p

The SMILE study: a study of medical information and lifestyles in Eindhoven, the rationale and contents of a large prospective dynamic cohort study

<p>Abstract</p> <p>Background</p> <p>Health problems, health behavior, and the consequences of bad health are often intertwined. There is a growing need among physicians, researchers and policy makers to obtain a comprehensive insight into the mutual influences of different health related, institutional and environmental concepts and their collective developmental processes over time.</p> <p>Methods/Design</p> <p>SMILE is a large prospective cohort study, focusing on a broad range of aspects of disease, health and lifestyles of people living in Eindhoven, the Netherlands. This study is unique in its kind, because two data collection strategies are combined: first data on morbidity, mortality, medication prescriptions, and use of care facilities are continuously registered using electronic medical records in nine primary health care centers. Data are extracted regularly on an anonymous basis. Secondly, information about lifestyles and the determinants of (ill) health, sociodemographic, psychological and sociological characteristics and consequences of chronic disease are gathered on a regular basis by means of extensive patient questionnaires. The target population consisted of over 30,000 patients aged 12 years and older enrolled in the participating primary health care centers.</p> <p>Discussion</p> <p>Despite our relatively low response rates, we trust that, because of the longitudinal character of the study and the high absolute number of participants, our database contains a valuable set of information.</p> <p>SMILE is a longitudinal cohort with a long follow-up period (15 years). The long follow-up and the unique combination of the two data collection strategies will enable us to disentangle causal relationships. Furthermore, patient-reported characteristics can be related to self-reported health, as well as to more validated physician registered morbidity. Finally, this population can be used as a sampling frame for intervention studies. Sampling can either be based on the presence of certain diseases, or on specific lifestyles or other patient characteristics.</p

Clinical and cost-effectiveness of computerised cognitive behavioural therapy for depression in primary care: Design of a randomised trial

<p>Abstract</p> <p>Background</p> <p>Major depression is a common mental health problem in the general population, associated with a substantial impact on quality of life and societal costs. However, many depressed patients in primary care do not receive the care they need. Reason for this is that pharmacotherapy is only effective in severely depressed patients and psychological treatments in primary care are scarce and costly. A more feasible treatment in primary care might be computerised cognitive behavioural therapy. This can be a self-help computer program based on the principles of cognitive behavioural therapy. Although previous studies suggest that computerised cognitive behavioural therapy is effective, more research is necessary. Therefore, the objective of the current study is to evaluate the (cost-) effectiveness of online computerised cognitive behavioural therapy for depression in primary care.</p> <p>Methods/Design</p> <p>In a randomised trial we will compare (a) computerised cognitive behavioural therapy with (b) treatment as usual by a GP, and (c) computerised cognitive behavioural therapy in combination with usual GP care. Three hundred mild to moderately depressed patients (aged 18–65) will be recruited in the general population by means of a large-scale Internet-based screening (<it>N </it>= 200,000). Patients will be randomly allocated to one of the three treatment groups. Primary outcome measure of the clinical evaluation is the severity of depression. Other outcomes include psychological distress, social functioning, and dysfunctional beliefs. The economic evaluation will be performed from a societal perspective, in which all costs will be related to clinical effectiveness and health-related quality of life. All outcome assessments will take place on the Internet at baseline, two, three, six, nine, and twelve months. Costs are measured on a monthly basis. A time horizon of one year will be used without long-term extrapolation of either costs or quality of life.</p> <p>Discussion</p> <p>Although computerised cognitive behavioural therapy is a promising treatment for depression in primary care, more research is needed. The effectiveness of online computerised cognitive behavioural therapy without support remains to be evaluated as well as the effects of computerised cognitive behavioural therapy in combination with usual GP care. Economic evaluation is also needed. Methodological strengths and weaknesses are discussed.</p> <p>Trial registration</p> <p>The study has been registered at the Netherlands Trial Register, part of the Dutch Cochrane Centre (ISRCTN47481236).</p

Preface

On 25-26 October 2018, the World Health Organisation hosted a Global Conference, in Astana, Kazakhstan. This conference, 40 years after the Alma Ata declaration of Health for All, refocused again on the commitment of governments to Primary Health Care (PHC), in order to ensure that everyone, everywhere, is able to enjoy the highest, possible, attainable standard of health.The Astana Declaration on Health for All has a long list of commitments and goals which can serve as guidance for governments to plan their health policy. Primary Health Care is described as the cornerstone of a sustainable health system for Universal Health Coverage (UHC) and the health-related Sustainable Development Goals. The WHO and governments are convinced that strengthening PHC is the most inclusive, effective and efficient approach to enhance people’s physical and mental health.</jats:p