Lex Goudswaard, GP, PhDKees in ’t Veld, GPSaskia Mol, MD, PhD

Netherlands College of GPs (NHG)

Guidelines...

Guidelines: indispensable for quality assurance / improvement, but...

Guidelines do not implement themselves!

Kathleen Lohr

Close contact between ‘makers’ and ‘users’ is very helpful (if not necessary) for a successful guideline program!

Jonathan Lomax

What’s old?

• 50 GPs (randomly selected) are invited to comment upon the

concept of the guideline

What’s new?

• 50 GPs…• involvement, from the start, of a staffmember with knowledge and experience in implementation

What’s new (2)?

• Discussion group at University Institute for Vocational

Training:• 6-8 GP trainers• 1 GP trainee• 3 staff NHG (chair)

Method

• Spontaneous abortion• Problem drinking • Lower urinary tract symptoms • Urinary tract infection• Heart failure • Osteoporosis

Results (1)

Proposed changes 70

• Items changed 30(43%) • Partially changed 13 (19%)

Total 43(61%)

Results (2) Alcohol

• Definition: abuse, dependancy, problem drinking…

• …problem drinking • Making up the vitamin deficiency…• …in malnourished people

Results (3) LUTS

• Referral for further investigations and/or treatment linked to a life expectancy of 10 yrs…• …72 yrs, co-morbidity• emphasis on shared decision making

Results (4) Spontaneous abortion

• Neutral stand on wait&see versus D&C…• …clear stand on the advantage of wait&see

•

Workshop

WorkshopKeyfeatures clinical guideline UTI:

1. UTI without fever in healthy, non pregnant woman = uncomplicated2. All other UTI are complicated

Workshop

3. High risk patients: physical examination (abdomen, VE)!

4. A screening test of leucocyte enzymes can determine

treatment

Workshop

5. Treatment of choice: nitrofurantoin

(5 day course) 6. Treatment complicated UTI: longer, with antibiotics effective against a wide range of bacteria

Thank you very much!

P.O. Box 32313502 GE Utrechtthe Netherlands+3130 288 17 00c.intveld@nhg-nl.org