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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 [email protected]