Comorbidity was associated with neurologic and psychiatric diseases: a general practice-based controlled study

BACKGROUND AND OBJECTIVE: To comprehensively examine comorbidity in unselected cohorts of patients with depression, stroke, multiple sclerosis (MS), Parkinson's disease/parkinsonism (PD/PKM), dementia, migraine, and epilepsy. METHODS: This cross-sectional study used morbidity data recorded by Dutch general practitioners. Index disease cohort sizes ranged from 241 patients with MS to 6,641 patients with lifetime depression. Thirty somatic and seven psychiatric disease categories were examined to determine whether they were comorbid with the index diseases by performing comparisons with age- and gender-matched control cohorts. Identified comorbidities were classified as either "possible" or "highly probable" comorbidity. RESULTS: An extensive range of 26 disease categories was found to be comorbid with lifetime depression. The comorbidity profile of stroke was also wide, including 21 disease categories. The comorbidity patterns of migraine and epilepsy comprised each 11 disease categories. Those concerning MS, PD/PKM, and dementia included a small number of disease categories. CONCLUSION: This study provides comprehensive knowledge of the occurrence of somatic and psychiatric comorbidity in general populations of patients with depression, stroke, MS, PD/PKM, dementia, migraine, and epilepsy. The implications of the findings for clinical practice and research are discussed.     

European primary care surveillance networks: their structure and operation

BACKGROUND: In many European countries, primary care surveillance networks play a role in public health surveillance. OBJECTIVES: To update an inventory of surveillance networks, to describe them and to report on their organization and function in a standardized way. To investigate whether and under what conditions their information can contribute to surveillance at a European level. METHODS: Surveillance networks were defined as 'A network of practices or community based primary care physicians who monitor one or more specific illness problems on a regular and continuing basis'. For the inventory questionnaires were sent out, followed by site visits to seven networks using a standardized audit checklist. RESULTS: We sent out 75 questionnaires and received 57 back (73% response rate), with 33 (58% of responders) fitting our selection criteria. National surveillance networks were identified in 11 countries. Many had an infectious disease surveillance component, particularly for influenza. Most were funded by the Ministry of Health, some by research funds. The median number of general practitioners was 120, comprising a stable group of general practitioners and covering a representative sample of the general population. The frequency of reporting varied from daily to annually, depending on the purpose of the network. CONCLUSIONS: A large number of primary care surveillance networks exist in Europe. Their value has been shown with the surveillance of influenza, but the challenge is now to extend their use to other diseases. When fulfilling identical minimal criteria they can provide comparable estimates of morbidity, ultimately leading to improved national and European surveillance.     

Increased risk of infection in patients with diabetes mellitus type 1 or 2

OBJECTIVE: To determine the risk of common infections in patients with diabetes mellitus type 1 (DM1) or type 2 (DM2). DESIGN: Prospective controlled study. METHODS: In a 12-month prospective cohort study as part of the Second Dutch National Survey of General Practice, 705 adult DM1 and 6,712 DM2 patients were compared with 18,911 control patients who had hypertension without diabetes. Outcome measures were medically-attended episodes of infections of the respiratory tract, urinary tract, skin and mucous membranes. Multivariate and multinomial logistic regression analysis was applied to determine independent risks of infections and their recurrence in patients with diabetes compared to controls. RESULTS: Upper respiratory-tract infections were as common in diabetes patients as in controls. Diabetes patients had a higher risk of lower respiratory-tract infections (DM2: odds ratio (OR): 1.30; 95% CI: 1.11-1.52), urinary-tract infections (DM1: OR: 1.56; 95% CI: 1.13-2.15; DM2: OR: 1.21; 95% CI: 1.07-1.38), bacterial skin or mucous-membrane infections (DM1: OR: 1.48; 95% CI: 1.01-2.15; DM2: OR: 1.32; 95% CI: 1.13-1.55) and mycotic skin or mucous-membrane infections (DM2: OR: 1.41; 95% CI: 1.24-1.61). The risk of recurrence of these common infections was seen to be increased. CONCLUSIONS: Patients with type-1 and type-2 diabetes are at increased risk of lower respiratory-tract infections, urinary-tract infections and skin or mucous-membrane infections.     

Views on respiratory tract symptoms and antibiotics of Dutch general practitioners, practice staff and patients

OBJECTIVES: To explore views on respiratory tract symptoms (cough, sore throat and earache) and antibiotics of GPs, practice staff, and patients. METHODS: In a nationwide study, 181 GPs, 204 practice staff members and 1250 patients from 90 practices participated by answering 14 items relating to views on respiratory tract symptoms and antibiotics in a written questionnaire. Differences in means were compared. RESULTS: Patients more than GPs endorsed the seriousness of respiratory tract symptoms, the need to consult a GP, the need to prescribe antibiotics, and the ability of antibiotics to speed up recovery. GPs were more than patients convinced of the self-limiting character of respiratory tract symptoms and of the fact that antibiotics have side effects. Practice staff took a middle ground in most of these views. CONCLUSIONS: Differences between GPs, practice staff and patients must be taken into account when exploring patients' complaints and advising on treatment. Education and knowledge programmes for practice staff might be advocated.     

The incidences of and consultation rate for lower extremity complaints in general practice

OBJECTIVE: To estimate the incidence and consultation rate of lower extremity complaints in general practice. METHODS: Data were obtained from the Second Dutch National Survey of General Practice, in which 195 general practitioners (GPs) in 104 practices recorded all contacts with patients during 12 consecutive months in computerised patient records. GPs classified the symptoms and diagnosis for each patient at each consultation according to the International Classification of Primary Care (ICPC). Incidence densities and consultation rates for different complaints were calculated. RESULTS: During the registration period 63.2 GP consultations per 1000 person-years were attributable to a new complaint of the lower extremities. Highest incidence densities were seen for knee complaints: 21.4 per 1000 person-years for women and 22.8 per 1000 person-years for men. The incidence of most lower extremity complaints was higher for women than for men and higher in older age. CONCLUSIONS: Both incidences of and consultation rates for lower extremity complaints are substantial in general practice. This implies a considerable impact on the workload of the GP.     

UBQLN2 in familial amyotrophic lateral sclerosis in The Netherlands

Recently it was discovered that mutations in the UBQLN2 gene were a cause of an X-linked dominant type of familial amyotrophic lateral sclerosis (ALS). We investigated the frequency of mutations in this gene in a cohort of 92 families with ALS in the Netherlands. Eight families were excluded because of male-to-male transmission. In the remaining 84 familial ALS cases no mutations were discovered in UBQLN2. Hence, UBQLN2 was not found to be a cause of familial ALS in the Netherlands.     

Continuity in different care modes and its relationship to quality of life: a randomised controlled trial in patients with COPD

Background

New care modes in primary care may affect patients’ experienced continuity of care.

Aim

To analyse whether experienced continuity for patients with chronic obstructive pulmonary disease (COPD) changes after different care modes are introduced, and to analyse the relationship between continuity of care and patients’ quality of life.

Design and setting

Randomised controlled trial with 2-year follow-up in general practice in the Netherlands.

Method

A total of 180 patients with COPD were randomly assigned to three different care modes: self-management, regular monitoring by a practice nurse, and care provided by the GP at the patient''s own initiative (usual care). Experienced continuity of care as personal continuity (proportion of visits with patient''s own GP) and team continuity (continuity by the primary healthcare team) was measured using a self-administered patient questionnaire. Quality of life was measured using the Chronic Respiratory Questionnaire.

Results

Of the final sample (n = 148), those patients receiving usual care experienced the highest personal continuity, although the chance of not contacting any care provider was also highest in this group (29% versus 2% receiving self-management, and 5% receiving regular monitoring). There were no differences in experienced team continuity in the three care modes. No relationship was found between continuity and changes in quality of life.

Conclusion

Although personal continuity decreases when new care modes are introduced, no evidence that this affects patients’ experienced team continuity or patients’ quality of life was found. Patients still experienced smooth, ongoing care, and considered care to be connected. Overall, no evidence was found indicating that the introduction of new care modes in primary care for patients with COPD should be discouraged.