Why does it run in families? Explaining family similarity in help-seeking behaviour by shared circumstances, socialisation and selection

Why do contact frequencies with general practice of family members resemble each other? Many aspects related to the clustering of health-care utilisation within families have been studied, but the underlying mechanisms have not been addressed. This article considers whether family similarity in contact frequency with general practice can be explained as (a) a result of shared circumstances, (b) through socialisation, and (c) through homogeneity of background characteristics. Data from the second Dutch national survey of general practice were used to test these mechanisms empirically. This survey recorded all consultations in 2001 for 104 general practices in the Netherlands, serving 385 461 patients. Information about socio-demographic characteristics was collected by means of a patient survey. In a random sample, an extended health interview took place (n ¼ 12 699). Overall, we were able to show that having determinants in common through socialisation and shared circumstances can explain similarity in contact frequencies within families, but not all hypotheses could be confirmed. In specific terms, this study shows that resemblances in contact frequencies within families can be best explained by spending more time together (socialisation) and parents and children consulting a general practitioner simultaneously (circumstances of the moment). For general practitioners, the mechanisms identified can serve as a framework for a family case history. The importance of the mechanism of socialisation in explaining similarities in help-seeking behaviour between family members points to the significance of knowledge and health beliefs underlying consultation behaviour. An integrated framework including these aspects can help to better explain health behaviour

All in the Family:Headaches and Abdominal Pain as Indicators for Consultation Patterns in Families

PURPOSE Headaches and abdominal pain are examples of minor ailments that are generally self-limiting. We examined the extent to which patterns of visits to family physicians for minor ailments, such as headaches or abdominal pain, cluster within families. METHODS Using information from the Second Dutch National Survey of General Practice for 96 family practices, we analyzed the visits of families with at least 1 child aged 12 years or younger during a period of 12 months. RESULTS Family patterns were clearest in the visits of mothers and children. A large part of the similarity in the frequencies of contact by mothers and daughters could be attributed to shared family factors. This fi nding was especially true for families with a child who had a headache or abdominal pain as the presenting symptom, rather than physical trauma or chronic disease. Within families, we did not fi nd any specific patterns of diagnoses. Diagnoses were recorded by family physicians. In the case of young children, family similarity may have been overestimated because parents initiated the visits and put their child’s health problem into words. CONCLUSIONS Visits to family physicians for headaches or abdominal pain can be seen as indicators of consultation patterns in families. Family patterns related to minor ailments are likely to be a result of socialization. Family consultation patterns might point toward specifi c needs of families and consequently at a different approach to treatment

Measurement Properties of Questionnaires Measuring Continuity of Care: A Systematic Review

Contains fulltext : 108627.pdf (publisher's version ) (Open Access)BACKGROUND: Continuity of care is widely acknowledged as a core value in family medicine. In this systematic review, we aimed to identify the instruments measuring continuity of care and to assess the quality of their measurement properties. METHODS: We did a systematic review using the PubMed, Embase and PsycINFO databases, with an extensive search strategy including 'continuity of care', 'coordination of care', 'integration of care', 'patient centered care', 'case management' and its linguistic variations. We searched from 1995 to October 2011 and included articles describing the development and/or evaluation of the measurement properties of instruments measuring one or more dimensions of continuity of care (1) care from the same provider who knows and follows the patient (personal continuity), (2) communication and cooperation between care providers in one care setting (team continuity), and (3) communication and cooperation between care providers in different care settings (cross-boundary continuity). We assessed the methodological quality of the measurement properties of each instrument using the COSMIN checklist. RESULTS: We included 24 articles describing the development and/or evaluation of 21 instruments. Ten instruments measured all three dimensions of continuity of care. Instruments were developed for different groups of patients or providers. For most instruments, three or four of the six measurement properties were assessed (mostly internal consistency, content validity, structural validity and construct validity). Six instruments scored positive on the quality of at least three of six measurement properties. CONCLUSIONS: Most included instruments have problems with either the number or quality of its assessed measurement properties or the ability to measure all three dimensions of continuity of care. Based on the results of this review, we recommend the use of one of the four most promising instruments, depending on the target population Diabetes Continuity of Care Questionnaire, Alberta Continuity of Services Scale-Mental Health, Heart Continuity of Care Questionnaire, and Nijmegen Continuity Questionnaire

Does the GP treat elderly people differently than is advised in the NHG Standard for Incontinence? If so, why? [Handelt de huisarts bij ouderen anders dan de NHG-Standaard Incontinence voor urine adviseert? En zo ja, waarom?]

Aim: To discover when and why GPs deal with patients differently than is advised in the NHG Standard for Urine Incontinence. Method: The investigation is part of a larger study of urine incontinence (UI) in the elderly. We invited elderly people with uncomplicated UI, who had not previously received treatment for the condition but did wish to be treated, to go to their GP. After each consultation the GP filled in a self-registration form recording the extent to which he had followed the guidelines contained in the NHG Standard for Urine Incontinence. The researcher later discussed with the GPs why they had deviated from the Standard. Results: A total of 19 men and 71 women visited their GP. During the anamnesis, the physical examination and the urine check the GPs kept to the Standard on all points. However the GPs did sometimes deviate from the Standard in the treatment phase. One sixth of the men and women decided not to undergo treatment because they regarded the UI not sufficiently severe to merit the effort they would be required to make in the exercise therapy. When it was possible to identify comorbidity, both the GP and the patient regarded the UI as more complex, also because they had to choose which medical problem was to be preferentially treated. The GPs found mixed incontinence in particular as too complex and time-consuming to treat themselves. Conclusion: The NHG Standard for Urine Incontinence applies well to elderly patient where anamnesis, physical examination and the urine check are concerned, but applies to a lesser extent in the treatment. The three main reasons for this are: the patient finds the treatment not worth the effort; because of comorbidity patient and doctor must choose which condition is given preferential treatment; and the GP finds the treatment of UI in the elderly complex and time-consuming

Why does it run in families? Explaining family similarity in help-seeking behaviour by shared circumstances, socialisation and selection

Why do contact frequencies with general practice of family members resemble each other? Many aspects related to the clustering of health-care utilisation within families have been studied, but the underlying mechanisms have not been addressed. This article considers whether family similarity in contact frequency with general practice can be explained as (a) a result of shared circumstances, (b) through socialisation, and (c) through homogeneity of background characteristics. Data from the second Dutch national survey of general practice were used to test these mechanisms empirically. This survey recorded all consultations in 2001 for 104 general practices in the Netherlands, serving 385 461 patients. Information about socio-demographic characteristics was collected by means of a patient survey. In a random sample, an extended health interview took place (n=12 699). Overall, we were able to show that having determinants in common through socialisation and shared circumstances can explain similarity in contact frequencies within families, but not all hypotheses could be confirmed. In specific terms, this study shows that resemblances in contact frequencies within families can be best explained by spending more time together (socialisation) and parents and children consulting a general practitioner simultaneously (circumstances of the moment). For general practitioners, the mechanisms identified can serve as a framework for a family case history. The importance of the mechanism of socialisation in explaining similarities in help-seeking behaviour between family members points to the significance of knowledge and health beliefs underlying consultation behaviour. An integrated framework including these aspects can help to better explain health behaviour.General practice Help-seeking behaviour Consultation rates Socialisation The Netherlands

Measuring continuity of care: Psychometric properties of the Nijmegen Continuity Questionnaire

Background: Recently, the Nijmegen Continuity Questionnaire (NCQ) was developed. It aims to measure continuity of care from the patient perspective across primary and secondary care settings. Initial pilot testing proved promising. Aim: To further examine the validity, discriminative ability, and reliability of the NCQ. Design: A prospective psychometric instrument validation study in primary and secondary care in the Netherlands. Method: The NCQ was administered to patients with a chronic disease recruited from general practice (n = 145) and hospital outpatient departments (n = 123) (response rate 76%). A principal component analysis was performed to confirm three subscales that had been found previously. Construct validity was tested by correlating the NCQ score to scores of other scales measuring quality of care, continuity, trust, and satisfaction. Discriminative ability was tested by investigating differences in continuity subscores of different subgroups. Test-retest reliability was analysed in 172 patients. Results: Principal factor analysis confirmed the previously found three continuity subscales-personal continuity, care provider knows me; personal continuity, care provider shows commitment; and team/cross-boundary continuity. Construct validity was demonstrated through expected correlations with other variables and discriminative ability through expected differences in continuity subscores of different subgroups. Test-retest reliability was high (the intraclass correlation coefficient varied between 0.71 and 0.82). Conclusion: This study provides evidence for the validity, discriminative ability, and reliability of the NCQ. The NCQ can be of value to identify problems in continuity of care

Description of identified instruments.

<p>Description of identified instruments.</p

Levels of evidence for the overall quality of the measurement property [22].

<p>+  =  positive rating, ?  =  indeterminate rating, −  =  negative rating.</p

Quality of measurement properties and the interpretability per instrument.

<p>+++ or −−−  =  strong evidence positive/negative result, ++ or −  =  moderate evidence positive/negative result, + or −  =  limited evidence positive/negative result, +/−  =  conflicting evidence, ?  =  unknown, due to poor methodological quality.</p><p>na  =  no information available.</p><p>Cross-cultural validity, criterion validity and responsiveness were not evaluated.</p

Description of identified study populations.

<p>Description of identified study populations.</p