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P Spreeuwenberg

Publications and source records attributed to P Spreeuwenberg.

13 recordsLinked to original sources
PubMed2005

Shared help seeking behaviour within families: a retrospective cohort study.

OBJECTIVE: To examine the extent to which the family influences individual use of general practitioner care. DESIGN: Retrospective cohort study of all consultations in one calendar year. Multilevel modelling was used to analyse contact frequencies of individuals within families within practices. SETTING: General practice in the Netherlands. PARTICIPANTS: 42 262 families with children aged 2-21 years registered in 96 practices. MAIN OUTCOME MEASURES: Family influence on individual frequency of contact with general practice and correlation in frequency of contacts between parents and children. RESULTS: After correction for patients' age and sex, analysis of siblings indicates that 22% of the variance in frequencies of contact can be ascribed to influence of the family. This means that contact frequencies of family members within families resemble each other, whereas differences in contact frequencies exist between families. Almost 6% of the variance refers to differences between practices and 73% of the variance refers to individual differences. The strongest correlations were found between mothers and children and between children. CONCLUSIONS: The extent of shared help seeking behaviour within families has considerable implications in the context of the practice.

Adolescent↗
PubMed2002

Symptom attribution after a plane crash: comparison between self-reported symptoms and GP records.

BACKGROUND: On 4 October 1992, an El Al Boeing 747-F cargo aeroplane crashed on two apartment buildings in Amsterdam. Thirty-nine residents on the ground and the four crew members of the plane died. In the years after, a gradually increasing number of people attributed physical signs and symptoms to their presence at the disaster scene. AIM: To investigate the consistency between patients' symptoms attributed to the crash and GPs' diagnoses and perception of the association with the crash. DESIGN OF STUDY: Comparison between self-reported symptoms to a call centre and GPs' medical records on onset and type of symptoms, diagnoses, and GPs' perception of association with the disaster, assessed by questionnaire. SETTING: Consenting patients (n = 621) contacting the call centre and their GPs. METHOD: Patients were interviewed by the call centre staff and interview data were recorded on a database. Questionnaires were sent to the consenting patients' GPs, requesting their opinions on whether or not their patients' symptoms were attributable to the effects of disaster. Baseline differences and differences in reported symptoms between interviewed patients and their GP records were tested using the chi2 test. RESULTS: The 553 responders reported on average 4.3 symptoms to the call centre. The majority of these symptoms (74%) were reported to the GP. Of the ten most commonly reported symptoms, fatigue, skin complaints, feeling anxious or nervous, dyspnoea, and backache featured in 80% of symptoms reported to the GP. One out of four symptoms was either reported to the GP before the disaster took place, or six or more years after (1998/1999, during a period of much media attention). Depression (7%), post-traumatic stress disorder (PTSD) (5%) and eczema (5%) were most frequently diagnosed by GPs. They related 6% of all reported symptoms to the disaster. CONCLUSIONS: Most of the symptoms attributed to a disaster by patients have been reported to their GP, who related only a small proportion of these to the disaster.

Accidents, Aviation↗
PubMed2001

Content and outcomes of Dutch nurse clinics for children with asthma.

Dutch specialist asthma nurses run extramural and transmural nurse clinics for children with asthma. Extramural clinics are run under the responsibility and in the premises of a home care organization. Transmural clinics are run in an outpatient clinic in close collaboration and joint responsibility between home care organizations and hospitals. Effects of and differences between these clinics were determined by using a quasiexperimental design. Visiting a nurse clinic appears to result in a reduced information need and reduced use of health care services. Parents of asthmatic children visiting transmural nurse clinics appeared to have a lower information need than those attending extramural nurse clinics.

Asthma↗
PubMed2001

Motives for seeking a second opinion in orthopaedic surgery.

OBJECTIVES: The number of second opinions in orthopaedic surgery is increasing rapidly, yet the grounds on which patients and their doctors decide to seek a second opinion have been little studied. The goal of the study was to identify patient and consultant factors that appeared to contribute to a second opinion being sought. METHODS: Two thousand and seventy-nine consecutive new patients visiting an orthopaedic surgical outpatient clinic in 1996-1997 participated in the study. Patients were self-defined as seeking a second opinion if they had visited at least one other consultant for the same condition within the previous two years. Each of these patients completed a questionnaire before seeing the orthopaedic surgeon; this included details about the physician-patient relationship, reasons for seeking a second opinion and perceived health status. The first-opinion consultants were contacted by mail; their practice characteristics and the motives for seeking a second opinion were also obtained. RESULTS: Thirty per cent of the study population (n = 625) had sought a second opinion. Patients sought a second opinion because of disappointment concerning their original treatment, or because they wanted more information about their condition and/or its treatment. First-opinion consultants were usually unaware of these communication issues. Patients' inclination to initiate a second opinion was best predicted by their evaluation of their relationship with their first-opinion consultant. The propensity to initiate referrals for a second opinion varied widely among the first-opinion consultants (10-70%) and was inversely proportional to the size of the group they worked in and their distance from the referral centre. CONCLUSIONS: Patients did not seek a second opinion because they had doubts about the competence of their treating consultant, but because they were dissatisfied about the level of communication or about the results of their treatment. Medical educators should continue to increase their efforts to improve specialists' communication and relationship skills since these seem to generate referrals for second opinions, which occupy clinic space that could be used by other patients.

Humans↗
PubMed2000

Hormone replacement therapy: changes in frequency and type of prescription by Dutch GPs during the last decade of the millennium.

OBJECTIVE: The present study was conducted in order to determine the change of frequency and type of hormone replacement therapy (HRT) regimen newly prescribed by Dutch GPs. METHODS: A comparison was made of two data sets (multi-stage random samples) collected in 1987/88 and from 1995 to 1998 concerning women 40 years and older who were newly prescribed HRT. RESULTS: Compared with 1987/88, 50% more patients were newly prescribed HRT in 1998 (2.0 in 1987/88 and 3.0 in 1998 per 1000 registered women, P < 0.01). The age distribution remained about the same, with a peak between 50 and 54 years in each year of registration. Unopposed oestrogens (including plasters) were prescribed less frequently (1.3 per thousand in 1987/88 versus 0.7 per thousand in 1998, P < 0.001), and combinations of oestrogen and progestogen more frequently in 1998 (0. 2 per thousand in 1987/88 versus 1.8 per thousand in 1998, P < 0. 01). Sequential therapy was prescribed slightly more frequently than continuous therapy (65% sequential therapy in 1995; 55% in 1998). The most frequent reason for starting HRT in 1995-1998 was climacteric symptoms (89-98%), followed by osteoporosis prevention (16-28%) and early menopause (13-25%). Rarely were preventive goals the only reason (6%) for prescribing HRT. CONCLUSIONS: The number of HRT prescriptions increased by 50% over the last decade of the millennium. The age distribution remained the same. There was a tendency to shift from prescribing unopposed oestrogens to combinations of oestrogens and progestogens. Alleviation of climacteric symptoms was the main reason for prescribing HRT throughout the registration period. Prescription of HRT for prevention of osteoporosis and/or cardiovascular disease has so far not been adopted on a large scale by Dutch GPs.

Adult↗
PubMed1999

Neighbourhood characteristics and use of benzodiazepines in The Netherlands.

This paper analyses the relationship between individual and neighbourhood characteristics and the use of benzodiazepines within a Dutch city. It is hypothesized that the proportion of users is lower in more socially integrated and less deprived neighbourhoods. Hypotheses have been tested by using multi-level analysis to distinguish between composition and context effects. Age and gender have a clear relation to the use of benzodiazepines and neighbourhood differences in the proportion of users are partly the effect of population composition by age and gender. The proportion of users is higher in neighbourhoods with a higher percentage of one-parent families, with a lower percentage of social rented housing and with a larger number of rooms per person. The strength of the relation between age and use is influenced by neighbourhood characteristics. Neighbourhood variation in the amount used only depends on population composition.

Age Factors↗
PubMed1999

Patients with irritable bowel syndrome: health status and use of health care services.

BACKGROUND: The reason for consulting a physician is more related to illness behaviour than to the severity of complaints. Yet, little is known about the course of complaints, the health care seeking behaviour, and psychosocial factors influencing these items in patients with irritable bowel syndrome (IBS) attending the general practitioner (GP). AIM: To study health status, lifestyle, and use of health care services of patients with IBS in order to indicate problem areas accessible for intervention strategies. METHOD: Structured interviews of 53 patients with IBS aged 15 years and older compared with a general population of 12,975 in the same age range, all drawn from the Dutch National survey of Morbidity and Intervention in General Practice. RESULTS: Patients with IBS revealed a lower grade of education (P < 0.001), poorer health (P < 0.001), a higher mean complaint score (8.3 versus 4.0, P < 0.001), a higher score on the General Health Questionnaire (P < 0.001), a higher score on the biographic problem list (BIOPRO, 2.3 versus 1.4, P < 0.001), and more absence from work (32% versus 18% in two months, P < 0.01). Patients with IBS consulted the family physician (1.6 versus 0.8 in three months, P < 0.001), the physical therapist (30% versus 15% in one year, P < 0.001), and the alternative therapist (32% versus 15% in five years, P < 0.001) more often than those without. CONCLUSIONS: The study shows an excess of comorbidity, psychosocial problems, use of health care services, and absence owing to disease in patients with IBS. Special guidelines and training of GPs to apply a more integral approach may reduce the cost of health care and may lead to a more favourable course in patients with IBS.

Adolescent↗
PubMed1998

[Management of psoriasis in family practice is now in closer agreement with the guidelines of the Netherlands Society of Family Physicians].

OBJECTIVE: To assess changes in incidence of psoriasis and to study changes in the management of psoriasis in general practice after the sending of guidelines on management of psoriasis to general practitioners (GPs) by the NHG. DESIGN: Secondary data analysis. SETTING: Netherlands Institute for Health Care Research (NIVEL), Utrecht, the Netherlands. METHOD: Data on the incidence of psoriasis and its management by general practitioners were collected from a file predating the publication of the NHG guideline 'Psoriasis' in 1994, namely the 'Dutch National Survey of General Practice' (NS; 1987/'88), and from a subsequent file, the 'Registration Network Groningen' (RNG; 1995). RESULTS: In the NS there were 106 new patients with psoriasis (incidence: 1.3/1000/year; 95% confidence interval (95% CI): 1.2-1.4) while in the RNG there were 24 (incidence: 1.2/1000/year; 95% CI: 0.7-1.9). In all, there were 466 psoriasis patients in the NS and 125 in the RNG. The number of referrals to dermatologists was halved in 1995 (7.2%) compared with 1987/'88 (14.4%; p < 0.05). The most frequently prescribed dermatologica in psoriasis was in 1995 corticosteroid group 3 (32.8%; in 1987/'88: 28.5%), but the rise was stronger in corticosteroid group 2 (29.6%; in 1987/'88: 16.0%; p < 0.001) and group 4 (16.0%; in 1987/'88: 8.8%; p < 0.05). CONCLUSION: The incidence of psoriasis in general practice had not changed between 1987/'88 en 1995. Referral pattern and prescription shifted towards the guidelines issued by the NHG.

Adrenal Cortex Hormones↗
PubMed1997

Epilepsy patients: health status and medical consumption.

OBJECTIVE: To study the health status and medical consumption of outpatients with active epilepsy in comparison with the general population. DESIGN: Descriptive population study (multi-stage random sample). SETTING: Structured questionnaire. PATIENTS: Thirty-nine epilepsy patients compared with a general population of 12,975. RESULTS: Epilepsy patients revealed poorer health, a higher mean complaint score (5.3 versus 3.7, P < 0.05), a higher score on the General Health Questionnaire (P < 0.05), a somewhat higher score on the bio-logical problem list (BIOPRO) (1.8 versus 1.4, P > 0.05), less active sports engagement (16% versus 39%, P < 0.01), more fatigue (46 vs 29%, P < 0.05), dizziness (33 vs 10%, P < 0.01), nervousness (28 vs 18%, P > 0.05), sleep disturbance (23 vs 15%, P > 0.05) and excitability (33 vs 15%, P < 0.01) when compared with the general population. The BIOPRO showed problems in epilepsy patients on specific items related to self-confidence (P < 0.001) Epileptic patients do not show more absence due to illness, from work, school or at home (15 vs 18%, P > 0.05) and/or more problems at work or in the family when compared with the general population. Almost half of epilepsy patients had consulted a specialist in the past 2 months (46 vs 23% of the general population, P < 0.001). Epilepsy patients consulted the family physician slightly more often than other responders (3.0 versus 2.3, P > 0.05) and contacted the family physician's assistant considerably more often (2.3 versus 0.7, P < 0.001). One-third of epilepsy patients consulted an alternative healer in the past 5 years versus 14% in the general population (P < 0.001). CONCLUSIONS: The study shows an excess of psychosocial problems and medical consumption in epilepsy patients, but not more absence from work or problems at work or in the family. Further development of a quality of life instrument specific to epilepsy is advised.

Adaptation, Psychological↗
PubMed1996

[Little recognition of mental problems in children by parents and family physicians].

OBJECTIVE: To determine the prevalence of psychic problems in children in the Dutch GP-practice and to determine how often parents and general practitioners (GPs) recognize psychic problems in children. DESIGN: Descriptive. SETTING: World Health Organisation Collaborating Centre for Primary Health Care (NIVEL) and Academic Hospital, Department of Child and Adolescent Psychiatry, Utrecht, the Netherlands. METHOD: In 810 children presence or absence of emotional and behavioural problems was studied by means of the Child Behaviour Checklist (CBCL) filled out by a parent at the moment of contact with a GP. The GPs findings in these were also recorded. RESULTS: 7.7% of all children obtained a total CBCL score indicating presence of emotional and behavioural problems (> P90). These children had problems at school, had repeated a school year, and followed special education more often. Nevertheless most of their parents (86%) did not experience problems with their children and 40% of the parents did not report any psychic problem in the preceding 2 weeks. Only 15% of these children were completely free of signs and symptoms, however, as against 40% of children with low scores. The percentages of children with high scores consulting a GP, social work or mental health care agency were somewhat higher than the percentages of children without these problems, but only the last-mentioned difference was significant. Children saw the GP rarely because of psychosocial problems (n = 7; less than 1%; 1 had a high CBCL score). Regardless of the presence of emotional and behavioural problems, as assessed by the CBCL, the GP seldom diagnosed psychological or social problems in children (n = 11; 1.4%; 2 had a high CBCL score) and rarely suspected the complaints had a psychosocial background. CONCLUSION: Children with a high CBCL score did not visit their GPs more often. The perception by the parent appears to be crucial in the help-seeking process. In many children in whom the screening instrument indicated the presence of emotional and behavioural problems, parents did not consider their children as problematic and did not seek the help of a GP.

Adolescent↗
PubMed1996

[Multiple sclerosis in family practice].

OBJECTIVE: To study the family physician's role in the diagnosis and treatment of multiple sclerosis (MS) patients. DESIGN: Descriptive. SETTING: Nederlands Instituut voor Onderzoek van de Gezondheidszorg, Utrecht, The Netherlands. METHOD: In the Dutch National survey of morbidity and intervention in general practice, data were collected by 161 general practices throughout the Netherlands (161 family physicians) regarding contacts with patients during three months. These data were examined for contacts which resulted in the diagnosis of MS and for comorbidity. RESULTS: MS patients (n = 118) had 4.3 encounters per 3 months with their family physician and (or) the practice assistant. In 5 patients MS was diagnosed for the first time. Apart from neurological complaints characteristic of MS the family physician was consulted most frequently for sleeping disorders, urinary tract infections and urine incontinence. One-third of patients depended on social security and 26% had a paid job. CONCLUSION: The family physician was consulted relatively frequently by MS patients. Apart from sleeping disorders remarkably few psychic complaints were noted.

Adult↗
PubMed1996

Multiple sclerosis: management in Dutch general practice.

BACKGROUND AND OBJECTIVES: A descriptive study on 118 MS patients in general practice, to describe the family physician's role in diagnosis, treatment and follow-up of patients. METHOD: Random sample of 103 general practices (161 family physicians) throughout The Netherlands with a total list of 335,000 patients. RESULTS: MS patients had on average 5.7 encounters with general practice in 3 months compared to 2.3 in all other patients (P < 0.001). Home visits counted for 38.7% of all family physician's encounters in MS patients compared to 16.6% in all other patients (P < 0.01). The average encounter lasted 12.9 minutes per MS patient compared to 7.8 in all other patients (P < 0.01). Counselling by the family physician took place in all new patients and in 53% of known patients. Follow-up appointments were made with all new patients and 65.9% of all MS patients. Fifteen patients (12.7%) were newly referred to a specialist and 28 patients (24%) were still treated by specialists. No medication was prescribed to almost 40% of patients. Vitamin B, benzodiazepines, laxatives, antibiotics for treatment of urinary tract infections and muscle relaxants are the most frequently prescribed drugs. The average dose of vitamin B complex was 1.94 times the defined daily dose. CONCLUSIONS: The family physician spends more time than average on MS patients, carries out more home visits and takes care of treatment of symptoms and complications of MS. Counselling and follow-up of patients takes an important place in family physician's management of MS. Vitamin B complex is being prescribed (too) frequently in a (too) high dose.

Adult↗