Transcript Geen diatitel

Lex Goudswaard, GP, PhD
Kees in ’t Veld, GP
Saskia 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?
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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
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Spontaneous abortion
Problem drinking
Lower urinary tract symptoms
Urinary tract infection
Heart failure
Osteoporosis
Results (1)
Proposed changes
•
•
70
Items changed
Partially changed
Total
30
13
43
(43%)
(19%)
(61%)
Results (2) Alcohol
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Definition: abuse, dependancy,
problem drinking…
…problem drinking
•
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Making up the vitamin deficiency…
…in malnourished people
Results (3) LUTS
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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
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Neutral stand on wait&see versus
D&C…
…clear stand on the advantage of
wait&see
•
Workshop
Workshop
Keyfeatures clinical guideline UTI:
1.
2.
UTI without fever in healthy, non
pregnant woman = uncomplicated
All other UTI are complicated
Workshop
3.
4.
High risk patients: physical
examination (abdomen, VE)!
A screening test of leucocyte
enzymes can determine treatment
Workshop
5.
6.
Treatment of choice: nitrofurantoin
(5 day course)
Treatment complicated UTI: longer,
with antibiotics effective against a
wide range of bacteria
Thank you very much!
P.O. Box 3231
3502 GE Utrecht
the Netherlands
+3130 288 17 00
[email protected]