Lex Goudswaard, GP, PhD Kees in ’t Veld, GP Saskia Mol, MD, PhD Netherlands College of GPs (NHG)

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Lex Goudswaard, GP, PhD Kees in ’t Veld, GP Saskia Mol, MD, PhD Netherlands College of GPs (NHG)

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Transcript of Lex Goudswaard, GP, PhD Kees in ’t Veld, GP Saskia Mol, MD, PhD Netherlands College of GPs (NHG)

Page 1: Lex Goudswaard, GP, PhD Kees in ’t Veld, GP Saskia Mol, MD, PhD Netherlands College of GPs (NHG)

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

Netherlands College of GPs (NHG)

Page 2: Lex Goudswaard, GP, PhD Kees in ’t Veld, GP Saskia Mol, MD, PhD Netherlands College of GPs (NHG)

Guidelines...

Page 3: Lex Goudswaard, GP, PhD Kees in ’t Veld, GP Saskia Mol, MD, PhD Netherlands College of GPs (NHG)

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

Page 4: Lex Goudswaard, GP, PhD Kees in ’t Veld, GP Saskia Mol, MD, PhD Netherlands College of GPs (NHG)

Guidelines do not implement themselves!

Kathleen Lohr

Page 5: Lex Goudswaard, GP, PhD Kees in ’t Veld, GP Saskia Mol, MD, PhD Netherlands College of GPs (NHG)

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

Jonathan Lomax

Page 6: Lex Goudswaard, GP, PhD Kees in ’t Veld, GP Saskia Mol, MD, PhD Netherlands College of GPs (NHG)

What’s old?

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

concept of the guideline

Page 7: Lex Goudswaard, GP, PhD Kees in ’t Veld, GP Saskia Mol, MD, PhD Netherlands College of GPs (NHG)

What’s new?

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

Page 8: Lex Goudswaard, GP, PhD Kees in ’t Veld, GP Saskia Mol, MD, PhD Netherlands College of GPs (NHG)

What’s new (2)?

• Discussion group at University Institute for Vocational

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

Page 9: Lex Goudswaard, GP, PhD Kees in ’t Veld, GP Saskia Mol, MD, PhD Netherlands College of GPs (NHG)

Method

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

Page 10: Lex Goudswaard, GP, PhD Kees in ’t Veld, GP Saskia Mol, MD, PhD Netherlands College of GPs (NHG)

Results (1)

Proposed changes 70

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

Total 43(61%)

Page 11: Lex Goudswaard, GP, PhD Kees in ’t Veld, GP Saskia Mol, MD, PhD Netherlands College of GPs (NHG)

Results (2) Alcohol

• Definition: abuse, dependancy, problem drinking…

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

Page 12: Lex Goudswaard, GP, PhD Kees in ’t Veld, GP Saskia Mol, MD, PhD Netherlands College of GPs (NHG)

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

Page 13: Lex Goudswaard, GP, PhD Kees in ’t Veld, GP Saskia Mol, MD, PhD Netherlands College of GPs (NHG)

Results (4) Spontaneous abortion

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

Page 14: Lex Goudswaard, GP, PhD Kees in ’t Veld, GP Saskia Mol, MD, PhD Netherlands College of GPs (NHG)

•

Page 15: Lex Goudswaard, GP, PhD Kees in ’t Veld, GP Saskia Mol, MD, PhD Netherlands College of GPs (NHG)

Workshop

Page 16: Lex Goudswaard, GP, PhD Kees in ’t Veld, GP Saskia Mol, MD, PhD Netherlands College of GPs (NHG)

WorkshopKeyfeatures clinical guideline UTI:

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

Page 17: Lex Goudswaard, GP, PhD Kees in ’t Veld, GP Saskia Mol, MD, PhD Netherlands College of GPs (NHG)

Workshop

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

4. A screening test of leucocyte enzymes can determine

treatment

Page 18: Lex Goudswaard, GP, PhD Kees in ’t Veld, GP Saskia Mol, MD, PhD Netherlands College of GPs (NHG)

Workshop

5. Treatment of choice: nitrofurantoin

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

Page 19: Lex Goudswaard, GP, PhD Kees in ’t Veld, GP Saskia Mol, MD, PhD Netherlands College of GPs (NHG)

Thank you very much!

P.O. Box 32313502 GE Utrechtthe Netherlands+3130 288 17 [email protected]


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