General practices' experiences with patients' web-based access to medical records:Survey study

Background: Patients’ web-based access to their medical records is expected to promote their role and responsibility in managingtheir own health and treatments and supporting shared decision-making. As of July 2020, general practices in the Netherlandsare legally obliged to provide their patients access to their electronic medical records. Web-based access provision is facilitatedand stimulated through a national support program named OPEN.Objective: We aimed to investigate general practice staff experiences with providing web-based access; investigate its impacton patient consultations, administrative actions, and patient inquiries; and investigate how it affects routine general practiceworkflow processes.Methods: In October 2021, a total of 3813 general practices in the Netherlands were invited to complete a web-based surveythat included questions regarding their experiences with the provision of web-based access to medical records and how it affectsroutine general practice workflow. Responses of general practices that started providing web-based access before 2020, in 2020,or in 2021 were analyzed to identify trends.Results: Of 3813 invited general practices, 523 (13.72%) completed the survey. Approximately all responding general practices(487/523, 93.1%) indicated that they provide web-based access. Experiences with patients’ web-based access were diverse, with36.9% (178/482) primarily positive, 8.1% (39/482) primarily negative, 42.3% (204/482) neutral, and 12.7% (61/482) could not(yet) indicate how they experienced web-based access. Of the total, two-thirds (311/473, 65.8%) reported an increase ine-consultations and a similar percentage (302/474, 63.7%) indicated an increase in administrative actions associated with web-basedaccess provision. A small proportion of the practices (≤10%) experienced a decrease in patient contacts. Earlier adoption ofweb-based access was associated with a more positive attitude toward web-based access and more positive experienced effectsrelated to patient contacts and general practice workflow.Conclusions: The surveyed general practices mainly experienced providing web-based access as either neutral or mostly positive,despite an increased number of patient contacts and administrative burden that were associated with its adoption. Periodicmonitoring of experiences is needed to understand the temporal or structural nature of both the intended and unintended effectsof patients’ web-based access to medical records for general practices and their staff

Use of E-health in Dutch general practice during the COVID-19 pandemic

The COVID-19 pandemic has forced general practices to search for possibilities to provide healthcare remotely (e.g., e-health). In this study, the impact of the pandemic on the use of e-health in general practices in the Netherlands was investigated. In addition, the intention of practices to continue using e-health more intensively and differences in the use of e-health between practice types were investigated. For this purpose, web surveys were sent to general practices in April and July 2020. Descriptive data analysis was performed and differences in the use of e-health between practice types were tested using one-way ANOVA. Response rates were 34% (n = 1433) in April and 17% (n = 719) in July. The pandemic invoked an increased use of several (new) e-health applications. A minority of practices indicated the intention to maintain this increased use. In addition, small differences in the use of e-health between the different practice types were found. This study showed that although there was an increased uptake of e-health in Dutch general practice during the COVID-19 pandemic, only a minority of practices intends to maintain this increased use in the future. This may point towards a temporary uptake of digital healthcare delivery rather than accelerated implementation of digital processes

Mental and physical health problems before and after detention:A matched cohort study

BACKGROUND: Individuals with poor health are largely overrepresented in prison populations. However, it remains unclear whether their poor health status already exists prior to their detention or reflects an effect of detention. We examined the health of detainees in the year before and after their detention and compared this with the health of matched non-detainees. METHODS: In this matched cohort study, we linked national data on all persons detained in the Netherlands in 2014/2015 to electronic health records (EHR's) of a representative sample of general practitioners in the Netherlands. Participants include 952 detained persons and 4760 matched non-detained persons (matched on age, sex and general practice). Prevalence rates of health problems in the year before and after detention and odds ratios with 95% confidence intervals were calculated. Rates for a variety of physical and mental health problems are presented. FINDINGS: Detainees and matched controls differed statistically significant in their pre-detention health status. Compared with controls, male detainees were more likely to report psychological (odds ratio [OR] 3·64 [95% CI 3·11–4·26]), social (1·96 [1·46–2·64]), neurological (1·34 [1·02–1·76]), digestive (1·23 [1·02–1·49]), genital system-related (1·36 [1·07–1·72]), and unspecified health problems (1·32 [1·10–1·59]) in the year before their detention. For example, 43·7% of detainees and 17·6% of controls reported psychological problems in this pre-detention year. To some extent these pre-detention health differences were related to socioeconomic differences. Nevertheless, after taking these characteristics into account, a number of pre-detention health differences between detainees and controls remained statistically significant. No statistically significant changes in prevalence rates from pre- to post-detention and no differences in the levels of change across detainees and controls were observed. For female detainees a similar pattern was found. INTERPRETATION: People who experience detention have high and complex health needs both pre- and post-detention. While this study did not show a health deteriorating effect of detention, it also did not show a health improving effect. This latter finding may indicate a missed opportunity for health care services to address detainees’ health, especially since persons entering detention have elevated health problems. Knowledge on detainees’ specific health problems may help health care providers in prisons and in the community to adequately address the health care needs of this vulnerable group. FUNDING: None

Possible Sources of Bias in Primary Care Electronic Health Record Data Use and Reuse

Background - Enormous amounts of data are recorded routinely in health care as part of the care process, primarily for managing individual patient care. There are significant opportunities to use this data for other purposes, many of which would contribute to establishing a learning health system. This is particularly true for data recorded in primary care settings, as in many countries, these are the first place patients turn to for most health problems. Objective - In this paper, we discuss whether data that is recorded routinely as part of the health care process in primary care is actually fit to use for these other purposes, how the original purpose may affect the extent to which the data is fit for another purpose and the mechanisms behind these effects. In doing so, we want to identify possible sources of bias that are relevant for the (re-)use of this type of data. Methods –This discussion paper is based on the authors’ experience as users of electronic health records data, as a general practitioner, health informatics experts, and health services researchers. It is a product of the discussions they had during the TRANSFoRm project, which was funded by the EU and sought to develop, pilot and evaluate a core information architecture for the Learning Health System (LHS) in Europe, based on primary care electronic health records. Results – We first describe the different stages in the processing of EHR data, as well as the different purposes for which this data is used. Given the different data processing steps and purposes, we then discuss the possible mechanisms for each individual data processing step, that can generate biased outcomes. We identified thirteen possible sources of bias. Four of them are related to the organization of a health care system, some are of a more technical nature. Conclusions - There are a substantial number of possible sources of bias, and very little is known about the size and direction of their impact. However, any (re-)user of data that was recorded as part of the health care process (such as researchers and clinicians) should be aware of the associated data collection process and environmental influences that can affect the quality of the data. Our stepwise, actor and purpose oriented approach may help to identify these possible sources of bias. Unless data quality issues are better understood and unless adequate controls are embedded throughout the data lifecycle, data-driven healthcare will not live up to its expectations. We need a data quality research agenda to devise the appropriate instruments needed to assess the magnitude of each of the possible sources of bias, and then start measuring their impact. The possible sources of bias described in this paper serve as a starting point for this research agenda

Results of a survey among GP practices on how they manage patient safety aspects related to point-of-care testing in every day practice

Background Point-of-care (POC) tests are devices or test strips that can be used near or at the site where care is delivered to patients, enabling a relatively fast diagnosis. Although many general practitioners (GPs) in the Netherlands are using POC tests in their practice, little is known on how they manage the corresponding patient safety aspects. Methods To obtain information on this aspect, an invitation to participate in a web-based questionnaire was sent to a random sample of 750 GP practices. Of this sample 111 GP practices returned a complete questionnaire. Data was analysed by using descriptive statistics. Results Results show that there is not always attention for quality control measures such as checking storage conditions, executing calibration, and maintenance. In addition, universal hygienic measures, such as washing hands before taking a blood sample, are not always followed. Refresher courses on the use of POC tests are hardly organized. Only a few of the GPs contact the manufacturer of the device when a device failure occurs. Well-controlled aspects include patient identification and actions taken when ambiguous test results are obtained. Conclusions We observed a number of risks for errors with POC tests in GP practices that may be reduced by proper training of personnel, introduction of standard operating procedures and measures for quality control and improved hygiene. To encourage proper use of POCT in general practices, a national POCT guideline, dedicated to primary care and in line with ISO standards, should be introduce

The use of out-of-hours primary care during the first year of the COVID-19 pandemic

BACKGROUND: In the Netherlands, General Practitioners (GP) are usually the first point of contact with a health professional for most health problems. Out-of-hours (OOH) primary care is provided by regional OOH services. Changes in consultation rates at OOH services may be regarded as a warning system for failures elsewhere in the healthcare system. Therefore in this study, we investigated how the COVID-19 pandemic changed the use of primary care OOH services during the first year of the pandemic. METHODS: Routine electronic health records data were used from 60% of OOH services in the Netherlands, collected by the Nivel Primary Care Database. We compared consultation rates per week (2020) for COVID-19-like symptoms and other health problems (e.g. small traumas, urinary tract infections), for different age groups, the proportion of remote consultations, and different levels of urgency during the pandemic compared to the same period in 2019. RESULTS: The number of consultations for COVID-19-like symptoms peaked at the start of the COVID-19 pandemic, while consultations for other health problems decreased. These changes in consultation rates differed between age groups. Remote consultations took place more frequently for all health problems, while the proportion of non-urgent health problems increased. CONCLUSION: There were significant changes in the number of consultations and the proportion that were remote for COVID-19-like symptoms and other health problems. Especially care for babies and young children decreased, while the number of consultations for older adults remained stable. The continued use of OOH services by older adults suggests there were unmet care needs elsewhere in our healthcare system. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-022-08096-x

Immediate and long-term health impact of exposure to gas-mining induced earthquakes and related environmental stressors

BACKGROUND: Little is known about the public health impact of chronic exposure to physical and social stressors in the human environment. Objective of this study was to investigate the immediate and long-term health effects of living in an environment with gas-mining induced earthquakes and related stressors in the Netherlands. METHODS: Data on psychological, somatic and social problems recorded routinely in electronic health records by general practitioners during a 6-year period (2010–2015) were combined with socioeconomic status and seismicity data. To assess immediate health effects of exposure to M(L)≥1.5 earthquakes, relative risk ratios were calculated for patients in the week of an earthquake and the week afterwards, and compared to the week before the earthquake. To analyse long-term health effects, relative risks of different groups, adjusted for age, sex and socioeconomic status, were computed per year and compared. RESULTS: Apart from an increase in suicidality, few immediate health changes were found in an earthquake week or week afterwards. Generally, the prevalence of health problems was higher in the mining province in the first years, but dropped to levels equal to or even below the control group in subsequent years, with lower relative risks observed in more frequently exposed patients. CONCLUSIONS: From a public health perspective, the findings are fascinating. Contrary to our expectation, health problems presented in general practice in the earthquake province decreased during the study period. More frequently exposed populations reported fewer health issues to general practitioners, which might point at health adaptation to chronic exposure to stressors

Face and emotion recognition in MCDD versus PDD-NOS

Previous studies indicate that Multiple Complex Developmental Disorder (MCDD) children differ from PDD-NOS and autistic children on a symptom level and on psychophysiological functioning. Children with MCDD (n = 21) and PDD-NOS (n = 62) were compared on two facets of social-cognitive functioning: identification of neutral faces and facial expressions. Few significant group differences emerged. Children with PDD-NOS demonstrated a more attention-demanding strategy of face processing, and processed neutral faces more similarly to complex patterns whereas children with MCDD showed an advantage for face recognition compared to complex patterns. Results further suggested that any disadvantage in face recognition was related more to the autistic features of the PDD-NOS group rather than characteristics specific to MCDD. No significant group differences emerged for identifying facial expressions

Congenital Short Bowel Syndrome: from clinical and genetic diagnosis to the molecular mechanisms involved in intestinal elongation

AbstractCongenital Short Bowel Syndrome (CSBS) is a rare gastrointestinal disorder in which the mean length of the small intestine is substantially reduced when compared to its normal counterpart. Families with several affected members have been described and CSBS has been suggested to have a genetic basis. Recently, our group found mutations in CLMP as the cause of the recessive form of CSBS, and mutations in FLNA as the cause of the X-linked form of the disease. These findings have improved the quality of genetic counselling for CSBS patients and made prenatal diagnostics possible. Moreover, they provided a reliable starting point to further investigate the pathogenesis of CSBS, and to better understand the development of the small intestine. In this review, we present our current knowledge on CSBS and discuss hypotheses on how the recent genetic findings can help understand the cause of CSBS