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Biomedical subjects

J Metsemakers

Publications and source records attributed to J Metsemakers.

8 recordsLinked to original sources
PubMed2001

Predictors of intention to adhere to physiotherapy among women with urinary incontinence.

During the last decade, pelvic floor muscle exercise (PFME) therapy has proved its short-term efficacy among women with urinary incontinence. Long-term success with PFME therapy is hampered by non-adherence. So far, specific knowledge on determinants of adherence behavior has been scarce. A cross-sectional study was conducted to elucidate the relative importance of determinants of the intention to adhere to PFME therapy in women with urinary incontinence. Based on behavioral theories, literature research and interviews, a questionnaire measuring determinants of the intention to adhere to PFME therapy was developed. In total, 129 women, aged 17 years or over, with symptoms of urinary incontinence, completed this questionnaire. Multiple regression analysis with backward elimination was carried out to identify determinants that predict intention. Significant predictors of the intention to adhere to PFME therapy were the amount to urinary loss per wet episode and women's perception of their ability to do the exercises as recommended under various circumstances. Building self-efficacy might be a good starting point for health education interventions aiming to promote adherence to PFME therapy, which can be used by physiotherapists and general practitioners.

Adult↗
PubMed1999

The management of chronic neck pain in general practice. A retrospective study.

OBJECTIVE: To describe the management in patients with chronic non-specific neck pain in general practice. DESIGN: A descriptive, questionnaire-based retrospective study. SETTING: General practices in the Netherlands. PATIENTS: 517 patients with chronic non-specific neck pain. MAIN OUTCOME MEASURES: Nature and frequency of diagnostic procedures, therapeutic interventions and referrals by the general practitioner (GP). RESULTS: Forty-four per cent visited the GP for neck pain in the previous year. Of the patients who did visit the GP in the previous year, 32% did not receive a diagnostic modality, 31% did not receive therapy and 43% were not referred. The most frequently applied diagnostic and therapeutic modalities were physical examination (66%) and pain medication (58%), respectively. The GPs most frequently referred to a physiotherapist (51%). CONCLUSION: Once neck pain has become chronic, the minority (44%) of patients do seek help from their GP on a yearly base. In spite of the fact that the patients' conditions are non-specific and chronic, GPs still find indications for further diagnostics in two-thirds of patients. The GPs were rather consistent in their management, as the nature of the diagnostic/therapeutic modalities and referrals was similar in more than 50% of the patients.

Adolescent↗
PubMed1994

To what extent do clinical notes by general practitioners reflect actual medical performance? A study using simulated patients.

BACKGROUND: Review of clinical notes is used extensively as an indirect method of assessing doctors' performance. However, to be acceptable it must be valid. AIM: This study set out to examine the extent to which clinical notes in medical records of general practice consultations reflected doctors' actual performance during consultations. METHOD: Thirty nine general practitioners in the Netherlands were consulted by four simulated patients who were indistinguishable from real patients and who reported on the consultations. The complaints presented by the simulated patients were tension headache, acute diarrhoea and pain in the shoulder, and one presented for a check up for non-insulin dependent diabetes. Later, the doctors forwarded their medical records of these patients to the researchers. Content of consultations was measured against accepted standards for general practice and then compared with content of clinical notes. An index, or content score, was calculated as the measure of agreement between actions which had actually been recorded and actions which could have been recorded in the clinical notes. A high content score reflected a consultation which had been recorded well in the medical record. The correlation between number of actions across the four complaints recorded in the clinical notes and number of actions taken during the consultations was also calculated. RESULTS: The mean content score (interquartile range) for the four types of complaint was 0.32 (0.27-0.37), indicating that of all actions undertaken, only 32% had been recorded. However, mean content scores for the categories 'medication and therapy' and 'laboratory examination' were much higher than for the categories 'history' and 'guidance and advice' (0.68 and 0.64, respectively versus 0.29 and 0.22, respectively). The correlation between number of actions across the four complaints recorded in the clinical notes and number of actions taken during the consultations was 0.54 (P < 0.05). CONCLUSION: The use of clinical notes to audit doctors' performance in Dutch general practice is invalid. However, the use of clinical notes to rank doctors according to those who perform many or a few actions in a consultation may be justified.

Clinical Competence↗
PubMed1992

Chronic illness in the community and the concept of 'social prevalence'.

General practice is an important source of information on the occurrence and distribution of chronic disease in the population. In this study, the burden of chronic illness was expressed as different indices of prevalence. Data were provided by 42 general practitioners in 15 computerized practices, collaborating in the Registration Network Family Practices of the University of Limburg in the Netherlands. Morbidity data concerning the actual health status of 25,357 subjects, as recorded by their GPs, were classified following the International Classification of Primary Care using the diagnostic criteria of the International Classification of Health Problems in Primary Care-2-Defined. The most frequent single disease was asthma (3.5%), while locomotor problems represented the most prevalent category (8.3%). The overall prevalence of chronic disease was 29.4%, with a clear positive correlation with age and, to a lesser extent, with a lower educational level. The 'social prevalence' of chronic illness (including individuals related to chronically diseased patients via their households) could be measured in a subset of the database (n = 4577), and amounted to 56%. It is concluded that the role of the GP as a family doctor involved with chronic disease concerns the majority of the general population.

Adolescent↗
PubMed1989

The Reason-for-Encounter mode of the ICPC: reliable, adequate, and feasible.

For three consecutive months, eight general practitioners reported and classified all reasons for encounter presented by their patients. They were taking part in an international trial of the WHO-ICPC Committee, utilizing a trial version of the 'Reasons-for-Encounter' (RFE-C)1. This scale has now been integrated with the newly developed 'International Classification of Primary Care' (ICPC)2. Attention was given to reliability, adequacy, and feasibility. Results indicated that the trial version of this classification system is highly reliable; the participating doctors found it both adequate for their purposes and feasible for use in their practices.

Evaluation Studies as Topic↗
PubMed1986

Smoking behaviour of Dutch general practitioners in the period 1977-1983.

Between 1977 and 1983 roughly half of the Dutch general practitioners were smokers. The percentage of smokers was decreasing, both among general practitioners and in the general Dutch population. The number of smoking male general practitioners was higher than for men in general and considerably higher than in the highest socioeconomic bracket. Among general practitioners the daily consumption of manufactured and handrolled cigarettes was lower while the cigar consumption was higher. In most countries physician smoking behaviour antedates that of the general population but in Holland general practitioners' smoking habits are about four years behind that of the general population. It seems that Dutch general practitioners attribute little value to the role of setting an example in health behaviour, especially where it concerns their own smoking habits.

Adult↗