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Biomedical subjects

P F Verhaak

Publications and source records attributed to P F Verhaak.

At least 19 recordsLinked to original sources
PubMed2000

Electronic diary assessment of pain, disability and psychological adaptation in patients differing in duration of pain.

Computerized diary measurement of pain, disability and psychological adaptation was performed four times a day for 4 weeks in 80 patients with various duration of unexplained pain. Reported are (1) the temporal characteristics and stability of pain report during the 4-week measurement period, (2) the association between pain duration and pain report, disability and general psychopathology, and (3) the accordance between diary assessment versus questionnaire assessment of pain, disability and psychological adaptation. No evidence of instrument reactivity was found: pain report was stable across the 4-week period. However, pain report appeared to be highly variable both between and within days. About half the patients showed a clear increasing trend in pain during the day. Several differences were found between subgroups of patients varying in pain duration. Patients with less than 6 months of pain reported significantly less pain intensity, disability and fatigue than patients whose pain persisted for more than 6 months. Pain coping and responses to pain behaviors by the spouse also differed for the subgroups: longer pain duration was associated with increased catastrophizing and solicitous responses from the spouse. Comparison of scores obtained with diary versus questionnaire assessment indicated moderate correlations for most variables. Retrospective (questionnaire) assessment of pain intensity yielded significantly higher pain scores than diary assessment.

Adaptation, Psychological↗
PubMed2000

Doctor-patient communication in different European health care systems: relevance and performance from the patients' perspective.

Our aim is to investigate differences between European health care systems in the importance attached by patients to different aspects of doctor-patient communication and the GPs' performance of these aspects, both being from the patients' perspective. 3658 patients of 190 GPs in six European countries (Netherlands, Spain, United Kingdom, Belgium, Germany, Switzerland) completed pre- and post-visit questionnaires about relevance and performance of doctor-patient communication. Data were analyzed by variance analysis and by multilevel analysis. In the non-gatekeeping countries, patients considered both biomedical and psychosocial communication aspects to be more important than the patients in the gatekeeping countries. Similarly, in the patients' perception, the non-gatekeeping GPs dealt with these aspects more often. Patient characteristics (gender, age, education, psychosocial problems, bad health, depressive feelings, GPs' assessment of psychosocial background) showed many relationships. Of the GP characteristics, only the GPs' psychosocial diagnosis was associated with patient-reported psychosocial relevance and performance. Talking about biomedical issues was more important for the patients than talking about psychosocial issues, unless the patients presented psychosocial problems to the GP. Discrepancies between relevance and performance were apparent, especially with respect to biomedical aspects. The implications for health policy and for general practitioners are discussed.

Adolescent↗
PubMed2000

GPs' referral to mental health care during the past 25 years.

Previous research has shown that mental disorder in the community has remained fairly constant over the past 30 years. As a result there has been a shift in mental health care from primary care to specialised mental health care. This shift should be visible in higher referral figures from general practice. In this longitudinal analysis of mental health referrals (1971 to 1997), the authors aimed to answer whether these higher referral rates have occurred, whether there are increases in referral for specific groups, and whether the referral pattern has changed. The results demonstrate an increase in referral rate with a factor of 4.5. It is concluded that we are witnessing a pull from mental health care together with a push from general practice, thus reinforcing each other.

Adolescent↗
PubMed1999

Educating patient educators: enhancing instructional effectiveness in physical therapy for low back pain patients.

The objective of this research project was to study the effectiveness of a training program for the enhancement of patient education skills in physical therapy. In this paper the improvement of five of these skills is tested. These skills are aimed at a better monitoring of adherence problems during the treatment and at enhancing self-efficacy of the patient after treatment. In order to test the effectiveness of the program, complete treatments of 19 physiotherapists have been assessed before (1142 sessions, 130 patients) and after (775 sessions, 88 patients) the training program. Information on the instructions and solutions given to the patients was obtained with a registration form, completed after each session by the physiotherapist. The patient's perception of the effectiveness and feasibility of instructions was obtained from questionnaires, completed by the patient on three occasions. After the training only a minority of the trained skills appeared to be improved. All in all, the training program was not very effective. More effort is needed to develop training programs aimed at promoting patients' self-efficacy as well as measurement instruments to assess the effects of such programs.

Attitude of Health Personnel↗
PubMed1999

The general practitioner as the first contacted health professional by patients with psychosocial problems: a European study.

BACKGROUND: There are considerable differences between and within countries in the involvement of general practitioners (GPs) in psychosocial care. This study aimed to describe the self-perceived role of GPs in 30 European countries as the first contacted professional for patients with psychosocial problems. and to examine the relationship with characteristics of the health care system, practice organization and doctors. METHODS: Data collected in the European Study of GP Task Profiles were analysed in relation to the self-perceived involvement of GPs in psychosocial care. In 30 countries 7233 GPs answered standardized questionnaires in their own languages about seven brief case scenarios. The questions focused on care given as the first health care professional contacted, and were answered in a scored scale (1-4) ranging from 'never' to 'almost always'. Independent variables examined were both on a national level and on an individual level, including: listed practice population, referral system, employment status of GPs, workload, measures of practice organization, contacts with social workers and urbanization of practice area. Data were analysed using multi-level techniques. RESULTS: Self-perceived involvement in psychosocial care was much higher in Western than in Eastern Europe and also in countries with a referral system. Cooperation with social workers, rural practice, keeping medical records, presence of an appointment system and high workload were positively associated with this perceived involvement. CONCLUSIONS: In countries with self-employed doctors and a referral system, GPs are in a better position to provide psychosocial care. GPs should be encouraged to cooperate with social workers and to keep medical records of their patient contacts routinely.

Adolescent↗
PubMed1999

Back care instructions in physical therapy: a trend analysis of individualized back care programs.

BACKGROUND AND PURPOSE: The treatment of people with low back pain often includes giving a variety of instructions about back care. The objective of our study was to explore the content and sequence of these instructions. SUBJECTS: Our database contained information on 1,151 therapy sessions for 132 patients who were treated by 21 therapists. METHODS: Hierarchical linear modeling was used to establish trends in instructions during the course of treatment. Instructions were measured by means of a registration form. RESULTS: Pain management instructions were given at the start of treatment and then decreased in later sessions. Instructions about taking care of the back in daily activities followed the same course. Exercise instructions were introduced after the start of treatment and were spread evenly across the visits. The number of recommendations about general fitness decreased during treatment. CONCLUSION AND DISCUSSION: The majority of back care instructions were spread evenly across therapy visits. Relatively little variation in instructions among patients was seen, which may indicate a lack of individualization of the back care programs.

Activities of Daily Living↗
PubMed1998

Communication in general practice: recognition and treatment of mental illness.

From previous studies there is a lot of evidence that in primary care settings, many patients tend to express their mental problems in terms of physical symptoms. Therefore, the general practitioner (GP) needs to recognize mental problems at an early stage. Early recognition allows for adequate treatment that might speed up recovery. The present article reports on a study exploring the GP's ability to recognize mental illness, the communication style that is supposed to support this ability, the subsequent treatment of mental problems, and the patient's recovery. Two databases were used. First, an observation study, involving 351 videotaped consultations held by 15 GPs, yielded information on communication style and recognition abilities. Patients in this study were selected randomly. The second database obtained treatment data and measures of patient recovery from a 1-year follow-up study dealing with the treatment and course of mental illness. Patients in this study were selected because their GPs considered their problems "mainly psychosocial by nature". Half of them were categorized within psychological and social diagnostic categories of the International Classification for Primary Care (ICPC), the other half were categorized within physical disease categories, with an assessment by the GP that the complaints were mainly psychosocial. Results showed no significant relationships between the recognition of mental illness and nine communication features supposed to induce these abilities. There was a tendency however, for a positive association between recommended communicative behaviour of the GP and his or her tendency to give frequently psychosocial evaluations of the patient's complaints. Also, there was a negative tendency between this recommended behaviour and the degree of agreement between the GP's evaluation and the score on a psychiatric screening questionnaire. This agreement is called "accuracy". Frequent psychosocial evaluations were related to exploring behaviour and mental health referral in case of psychosocial complaints. Further, relationships between the GPs' recognition ability and various measures of patients' recovery did not prove univocal. Both positive, negative and absent relationships were found.

Communication↗
PubMed1997

Somatic disease and psychological disorder.

The association between physical and psychological disorders has been demonstrated repeatedly. There are a number of explanations for this association, each of them pointing to specific diseases and operationalizations of mental distress. In this article, the relationship between various somatic diseases and a number of indices for psychological distress was investigated. Within one study population, patients with different somatic diseases were identified, and their experience with mental distress, their requests for help from their GP during consultations, and their GPs' diagnoses were registered and compared with the total study population: It appears that relationships could be demonstrated between experience of distress and presentation of psychological symptoms during consultations, on the one hand, and common physical disorders, on the other. Patients with neurological diseases (Parkinson's, epilepsy, multiple sclerosis) and gastric ulcers showed the same relationships, but were also more frequently diagnosed by the GP as having psychological disorders. Patients with a number of other serious somatic diseases, such as diabetes, cancer, and arthritis, did not distinguish themselves in a positive way on one of indices for psychological distress.

Adolescent↗
PubMed1996

Psychiatric consultation for somatizing patients in the family practice setting: a feasibility study.

OBJECTIVE: The purpose of the study was to assess the feasibility of a psychiatric consultation intervention for somatizing patients in the family practice setting in terms of 1) patient compliance, 2) patient satisfaction, and 3) compliance and satisfaction of general practitioners (GPs). METHOD: In a period of nine months, forty-six patients were selected for psychiatric consultation in six solo family practices in a semi-urban area in the Netherlands. The consultation included an interview with the consulting psychiatrist, the patient, and the GP. A written summary of the consultation was provided to the GP and the patient. A booster session with a GP and psychiatrist was included to evaluate and reinforce the recommendations. RESULTS: The majority of the selected patients agreed to participate after informed consent. An intervention was implemented containing interpersonal techniques, reattribution, clarification, and structuring. GP compliance with recommendations was 100 percent, patient compliance 75 percent. CONCLUSION: A standardized psychiatric consultation for somatizing patients in a family practice setting can be implemented. Several levels of implementation can be distinguished.

Family Practice↗
PubMed1995

Determinants of the help-seeking process: Goldberg and Huxley's first level and first filter.

This paper discusses minor psychiatric morbidity in the community and its relation to help-seeking. The research is aimed at identifying the demographic and social characteristics that enhance the likelihood of minor psychiatric morbidity, as measured by the General Health Questionnaire, and to reveal how these determinants relate to health status. In the second stage of the study, the same characteristics are related to their effect on the decision to decision to consult a general practitioner and, specifically, on presenting psycho-social problems to the GP. At the population level, the likelihood of a high GHQ score was greater for women, divorced persons and the unemployed, other variables remaining equal. However, GHQ score was contaminated by poor subjective health perception, especially for unemployed persons. Chronic physical illness did not have an independent effect on the GHQ score. Chronic physical illness did influence help-seeking. In addition, several socio-demographic characteristics showed an independent effect on consulting behaviour for both GHQ-positive and GHQ-negative patients. Women, unemployed persons and publicly insured patients with a minor psychiatric disturbance were more apt to visit their GP, regardless of their physical health status. However, no socio-demographic characteristics increased the likelihood that a GHQ-positive patient would present unambiguous psycho-social complaints as a reason to see their doctor.

Adolescent↗
PubMed1994

[Mental problems in family practice more variable and diffuse that in psychiatry].

OBJECTIVE: To describe the epidemiology of mental problems in general practice, from the viewpoint of the general practitioner (GP). DESIGN: Descriptive population survey. SETTING: Data were collected from the National Study of Morbidity and Interventions in General Practice. METHOD: In 1987-1988 we used an interview to assess health status and medical consumption of 10,350 persons, aged 15 and over. At the same time they were screened for mental illness using the General Health Questionnaire (GHQ). For three months, all doctor-patient contacts, the reason for contact (classified in ICPC) and the GP's assessment of possible psychological factors in the reason for contact were recorded. RESULTS: Of the patients with a high GHQ score only one third explicitly mentioned his psychological problems to the GP, 70 were recognized by the GP as having psychological problems in the three month period and besides psychological problems this group showed much more acute and chronic physical illness. Patients scoring high on the GHQ have more symptoms, but in general not other symptoms than mentally 'healthy' people have. CONCLUSION: Screening-programmes on mental illness are not recommended because of the impossible of determining the groups at risk. Prevention might be possible in patients with a high frequency in doctor-patient contacts and many physical complaints. A public health approach, encouraging patients to discuss psychological problems directly with their GP, might be sensible.

Adolescent↗
PubMed1994

The somatizing patient in general practice.

OBJECTIVE: The exploratory study described in this article followed two groups of patients over a twelve-month period. Subjects were drawn from a pool of patients who had consulted their general practitioner during the three-month selection period. One group consisted of patients who had consulted their general practitioner at least once about a physical complaint that the GP regarded as predominantly psychosocial; these patients did not articulate complaints of an explicitly mental or social nature. The second group was characterized by the fact that its members voiced precisely such mental or social complaints. METHOD: The study investigated the extent to which the two groups (which were comparable in the severity of their complaints) differ with respect to patient characteristics such as the severity of their possible respect to patient characteristics such as the severity of their possible psychological problems, the frequency with which they visited their GPs, and the types of complaints--e.g. mental, psychosomatic and purely physical--they presented. RESULTS: It was found that patients in the first group, whose somatic complaints were seen to have a psychosocial basis, are not the dependent types generally mentioned in theories about somatization. In fact, they adopt a more independent attitude to the GP than do patients voicing mental complaints. There are indications that for "somatizing" patients, underlying mental problems are less important than for "psychologizing" patients. CONCLUSIONS: Both the somatizing patients and the psychologizing patients continued very frequent visits to their GP during the 12-month research period, although chiefly to address physical complaints that the GP also assessed as such.

Adolescent↗
PubMed1993

Analysis of referrals of mental health problems by general practitioners.

The majority of people in the community who have a psychiatric disorder will consult their general practitioner. Referrals from general practice to specialist services are, however, relatively rare. The filter between primary care and specialist care has been characterized by Goldberg and Huxley as the least permeable of the filters separating psychiatrists and other specialists from the populations they serve. These referrals form the subject of this study in the Netherlands. Using a large database of doctor-patient contacts, the proportion of mental health disorders resulting in a referral and the characteristics of the patient and general practitioner that are involved in such a referral have been determined. In addition, the type of mental health institution or specialist to which referrals were directed and the characteristics influencing this choice were examined. Only 6% of patients presenting with a psychiatric disorder during surgery hours were referred to specialist care. Younger patients, male patients and patients with severe diagnoses had a greater probability of being referred. The percentage of patients referred was higher in urban areas than in rural areas. Doctors with a limited task perception regarding mental treatment tended to refer more often. Although the diagnosis did have some relationship with the institutions to which patients were referred (psychotic conditions to psychiatric services and social/material problems to social workers), the most prevalent diagnoses (neurotic conditions and relationship problems) seemed to be more or less randomly distributed over the various possibilities. Preferences appeared to be related to the existence of regular meetings between general practitioners and specialists and a positive evaluation by general practitioners of the institution concerned.

Adult↗
PubMed1992

Psychosocial problems in primary care: some results from the Dutch National Study of Morbidity and Interventions in General Practice.

According to standardized screening instruments, mental distress is a common phenomenon among many patients who visit their general practitioner. However, a number of patients who seem to be in need of mental help do not put forward such a demand for help, whereas other patients who express psychosocial problems to their GP are not considered to be in need, according to a standardized measure. In this paper, a distinction has been made between the objectified needs of the patient as expressed by a standardized assessment, and the demands of the patient, expressed by the Reason for Encounter, stated during their visit at the GP. Results of a follow-up study of two cohorts of patients have been presented: one cohort presented during a 3 month period at least one articulated demand for psychosocial help, a second cohort presented at least one somatic complaint, considered by the GP as being psychological by character, without presenting any psychosocial complaint in that period. Objective needs for mental help of patients in both cohorts were assessed by means of the General Health Questionnaire. During one year all consultations of these two cohorts were registered. The following questions have been put forward: what demands for help have been put forward by the patients, what treatment have these patients got, and what has been the course of the problems during one year of patients with different needs and demands. From the results the following conclusions may be drawn: many patients with a probable mental illness (according to their objective need) present only physical symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

The importance of the GHQ in general practice.

The relationship between General Health Questionnaire (GHQ) score and complaints presented at the general practitioners office was examined, and showed that the correlation between them is not as high as might be expected. Many patients who present psychosocial problems to their GP appear to have a low GHQ score; many patients with a high GHQ score exclusively present somatic complaints, which are also assessed by the GP as being purely somatic. Implications of the results are discussed.

Family Practice↗
PubMed1990

What does a doctor do with psychosocial problems in primary care?

Though a lot has been published on the prevalence of psychosocial disorders in primary care, less is known about the actual treatment, given by primary care providers. This article describes treatment given to complaints which are considered by the physician as being psychosocial by nature. Treatment has been assessed by means of observation. A database of approximately 1500 videotaped consultations, sampled from thirty general practitioners has been used for this purpose. The possibilities and limitations of (generalist) psychosocial treatment in primary care are discussed.

Counseling↗