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P J E Bindels

Publications and source records attributed to P J E Bindels.

12 recordsLinked to original sources
PubMed2006

'Under pressure': How Ghanaian, African-Surinamese and Dutch patients explain hypertension.

The aim of this study was to explore and compare explanatory models (EMs) of hypertension in native-Dutch, first-generation Ghanaian and African-Surinamese (Surinamese) hypertensives in Amsterdam, the Netherlands. Through semi-structured interviews, we elicited accounts of the nature, causes and consequences of hypertension in a purposive sample of 46 patients (aged 35-65 years, treated for hypertension in general practice >1 year). All three groups had difficulty in describing hypertension. All groups mentioned culturally specific nutritional habits as possible causes of hypertension (Dutch liquorice; Ghanaians fufu; Surinamese salty diet). Most respondents, particularly those of Ghanaian and Surinamese background, perceived stress as the main cause of hypertension and experienced symptoms of hypertension. Many Ghanaian and Surinamese respondents attributed hypertension to migration-related factors: changes in diet or climate, stress owing to adaptation to the Dutch society or obligations towards family in their homelands. Many immigrants felt a return to their homeland could cure hypertension and were concerned about the consequences of hypertension. Half of the Dutch and almost all Ghanaian and Surinamese respondents believed uncontrolled hypertension could cause immediate damage. Some Ghanaians expressed reservations sharing their concerns with community members because it might cause social stigma. Few respondents associated hypertension with obesity, even though many were overweight. Confirming findings from UK and US studies, this study reveals that EMs of hypertension in patients from three ethnic groups differ from the common medical perspective. These differences are greater for patients from migrant groups. Our findings can be useful in developing patient-centred hypertension interventions, particularly in new migrant populations.

Adult↗
PubMed2006

Predictors of asthma control in children from different ethnic origins living in Amsterdam.

To identify factors associated with asthma control in a multi-ethnic paediatric population. We interviewed 278 children with paediatrician diagnosed asthma (aged 7-17 years) and one of their parents. Asthma control was assessed with the Asthma Control Questionnaire (ACQ). Detailed information about sociodemographic variables, asthma medication, knowledge of asthma, inhalation technique and environmental factors were collected. Turkish and Moroccan parents were interviewed in their language of choice. Logistic regression analyses were used to identify correlates of asthma control. Of the 278 children, 85 (30.6%) were Dutch, 84 (30.2%) were Moroccan, 58 (20.9%) were Turkish and 51 (18.3%) were Surinamese. Overall, almost 60% had a status of well-controlled asthma, as indicated by the ACQ. Only 51 of the 142 (35.9%) Moroccan and Turkish parents had a good comprehension of the Dutch language. In logistic regression analyses the risk of having uncontrolled asthma was significantly higher among Surinamese children (OR 2.3; 95% CI 1.06-4.83), respondents with insufficient comprehension of the Dutch language (OR 2.3; 95% CI 1.08-4.78), children using woollen blankets (OR 9.8; 95% CI 1.52-63.42), and significantly lower among male (OR 0.5; 95% CI 0.31-0.91) and non-daily users of inhaled corticosteroids (OR 0.6; 95% CI 0.38-1.07). In conclusion, ethnicity as well as insufficient comprehension of the Dutch language appeared to be independent risk factors for uncontrolled asthma. Special attention should be given to children from immigrants groups for example by calling in an interpreter by physicians when comprehension is insufficient.

Administration, Inhalation↗
PubMed2006

Data quality improvement in general practice.

BACKGROUND: The importance of routine data generated by GPs has grown extensively in the last decade. These data have found many applications other than patient care. More attention has therefore been given to the issue of data quality. Several systematic reviews have detected ample space for improvement of data quality. A new review was conducted in order to find out which methods of improvement are effective. METHOD: The Medline database was searched using an iteratively composed set of terms and MeSH (Medical Subject Headings) headings. Only papers that focused on explicit attempts at improving data quality of medical records in general practice were included. RESULTS: Twelve studies met the inclusion criteria. No study used patient-based comparison of records with external sources as the method to assess data quality improvement. Ten studies used internal indicators or markers of data quality instead. Attempts at data quality improvement often involve some sort of individualized feedback, and nearly all attempts seem to have some positive effect. Only one of the included studies fulfilled the basic methodological requirements of an intervention study. The most recent studies used a simple before-after design. CONCLUSION: No intervention to improve data quality has been put to a rigorous enough test. We still lack empirical knowledge as to how improvement can be brought about.

Data Collection↗
PubMed2004

A cost study of a general practitioner hospital in the Netherlands.

OBJECTIVE: To perform a cost study of the first general practitioner (GP) hospital in the Netherlands. METHODS: We conducted a cost study in a GP hospital in the Netherlands. Data on healthcare utilisation from 218 patients were collected for a period of one year. The costs of admission to the GP hospital were compared with the expected costs of the alternative mode of care. In the GP hospital three types of bed categories were distinguished: GP beds (admission and discharge by GPs, n=131), rehabilitation beds (recovery from hospital surgery, n=62) and nursing home beds (hospital patients awaiting a vacancy in a nursing home, n=25). GPs were interviewed to indicate the best alternative form of healthcare for the GP bed patients in the absence of a GP hospital (dichotomised for this study into "hospital" or "home care"). For the "rehabilitation" and "nursing home" patients the alternative care mode was admission to a hospital. RESULTS: The mean length of stay was 15 days for the GP beds, 31 days for the rehabilitation beds and 90 days for the nursing home beds. For the GP bed patients the costs were 2533 euros per admission compared with 3792 euros for hospital stay. For the group of GP bed patients for whom "home care" was the best alternative, the costs were 2494 euros for GP hospital days compared with 2814euros , the average cost for home care of patients of 65 years and older. For rehabilitation patients the costs per patient were 4744 euros compared with 8041 euros in a hospital. For patients waiting for admission to a nursing home, these costs were 13,143 euros and 22,670 euros respectively. CONCLUSION: The GP hospital might be a cost-saving alternative for elderly patients in need of intermediate medical and nursing care between hospital and home care. Further research on the cost-effectiveness of the GP hospital compared with home care and nursing home care is needed.

Aged↗
PubMed2003

QUOTE-HIV: an instrument for assessing quality of HIV care from the patients' perspective.

BACKGROUND: An HIV-specific version of the QUOTE questionnaire was developed to measure the quality of care of patients infected with HIV from the patients' perspective. The consistency and validity of the questionnaire was assessed. METHODS: Focus group discussions were held to select aspects for inclusion in the questionnaire that are important to patients with HIV. Item and inter-item analysis, factor analysis, and reliability analysis were performed to test the internal consistency and validity of the questionnaire. RESULTS: Twenty seven items (13 generic and 14 HIV specific) were used in the QUOTE-HIV questionnaire. Separate factor analyses of the generic and HIV specific aspects indicated that each loaded onto a single factor. The internal consistency of the total questionnaire was good (Cronbach's alpha >/=0.80). Feasibility of the questionnaire was shown by the diversity of importance and performance scores for general practitioners as well as for HIV specialists and AIDS nursing consultants. CONCLUSION: The QUOTE-HIV questionnaire is a useful instrument for measuring the quality of care from the perspective of HIV infected patients.

Adult↗
PubMed2002

[Contacts outside of office hours: complaints presented to the general practitioner and to the emergency department].

OBJECTIVE: To determine the differences between the problems presented out-of-hours to general practitioners (GPs) or to the Accident & Emergency (A&E) department of a hospital, and to assess whether the physicians believed the patient was justified in contacting them. DESIGN: Descriptive. METHOD: All the out-of-hours contacts that 33,000 patients on the lists of 22 general practices had with either a duty GP or the A&E department of a nearby hospital (so-called 'self-referrers') were counted during two 3-month periods. In addition, symptoms were classified in both settings using the International Classification of Primary Care (ICPC). RESULTS: The ratio for contacts between general practice and A&E was 2:1 in the evening and 3:1 at night. The majority of problems presented to the GP was dealt with by telephone. At the A&E, trauma was seen most commonly, while GPs were contacted for infections and (complications of) chronic diseases. A&E physicians judged one out of five reasons for encounter as 'unjustified', while this ratio was one in seven in the case of GPs. CONCLUSIONS: There was only a partial overlap in the nature of the problems presented to an A&E department and those presented to GPs; instead, the two settings appeared to complement each other. The results were influenced by the fact that the A&E department lacked the possibility of dealing with patients by telephone. Both the A&E department and the GPs were contacted by patients who did not need (acute) medical care.

Accidents↗
PubMed2002

Do levels of immunoglobulin G antibodies to foods predict the development of immunoglobulin E antibodies to cat, dog and/or mite?

BACKGROUND: In children at high risk of inhalation allergy, food sensitization is associated with an increased risk for sensitization to inhalant allergens. Furthermore, this association was also found in a cross-sectional study. OBJECTIVE: To examine in a prospective study, whether levels of IgG to foods (i.e. mixture of wheat and rice, mixture of soy bean and peanut, egg white, cow's milk, meat, orange and potato) indicate an increased risk for the future development of IgE antibodies to inhalant allergens in a low-risk population and whether they can be used as predictors of the subsequent development of IgE antibodies in young, initially IgE-negative children. METHODS: Coughing children, aged 1-5, visiting their GPs, were tested for IgE antibodies to mite, dog and cat (RAST) and IgG (ELISA) to foods. All IgE-negative children were retested for IgE antibodies after two years. The IgG results (66 percentiles) of the first blood sample were compared to the RAST-scores of the second blood sample. RESULTS: After two years, 51 out of 397 (12.8%) originally IgE-negative children, had become IgE-positive for cat, dog and/or mite. An increased IgG antibody level to wheat-rice (OR = 2.2) and to orange (OR = 2.0) indicated an increased risk of developing IgE to cat, dog or mite allergens. In addition to IgG to a mixture of wheat-rice and orange; total IgE, breastfeeding, eczema as a baby and age were the most important predictors for the subsequent development of IgE to inhalant allergens. DISCUSSION: An increased IgG antibody level to a mixture of wheat-rice or orange, indicates an increased risk of developing IgE to cat, dog or mite allergens. This indicates that excessive activity of the mucosal immune system is present before IgE antibodies to airborne allergens can be demonstrated. Nevertheless, IgG to foods is not very helpful (with a positive predictive value of 16.5%, and negative predictive value of 90.6%) in identifying individual children at risk in clinical practice. However, besides other risk factors, IgG to wheat-rice and to orange could be useful as a screening test for studies in the early identification, i.e. before IgE antibodies can be detected, of children with an increased risk of developing IgE antibodies in the future.

Animals↗
PubMed2002

The patient as a source to improve the medical record.

BACKGROUND: The problem list is an important tool in general practice for care as well as research purposes. As the central part of the problem-oriented medical record, it lists the main medical problems which the GP wants to have knowledge of during any patient encounter. The assessment of its quality is usually made by comparing with other sources of information on the patient's problems. OBJECTIVE: This study addresses the question of to what extent the problem list can be improved by asking the patient about their own medical problems. METHODS: During 7 weeks, all patients who visited three GPs in a health care centre in an Amsterdam suburb were interviewed. During the interview, they were confronted with the problem list made by their own GP and stimulated to make suggestions for addition or removal of problems. RESULTS: All in all, patients were in agreement with 88% of all listed problems. The completeness of the problem list could be increased by 28%, while 4% ultimately were removed: a net gain of 24%. CONCLUSION: The patient can be used as a sourcetool for improvement of the quality of the problem list when its prime function is patient care. It becomes more complicated when the problem list also serves a research purpose. Clear inclusion rules will then have to be formulated.

Chi-Square Distribution↗
PubMed2002

Risk of depression in patients with chronic obstructive pulmonary disease and its determinants.

BACKGROUND: Although it has been repeatedly suggested that chronic obstructive pulmonary disease (COPD) is associated with depression, no conclusion has so far been reached. A study was undertaken to investigate whether depression occurs more often in patients with COPD than in controls. The demographic and clinical variables associated with depression were also determined. METHODS: Patients with a registered diagnosis of obstructive airway disease in general practice, aged > or=40 years, forced expiratory volume in 1 second (FEV(1)) <80% predicted, FEV(1) reversibility <or =12%, FEV(1)/VC < or = predicted - 1.64 x SD, and a history of smoking were selected. A random sample of subjects without a registered diagnosis of asthma or COPD aged 40 years or older acted as controls. Depression was assessed using the Centers for Epidemiologic Studies Depression (CES-D) scale. RESULTS: In patients with severe COPD (FEV(1) <50% predicted), the prevalence of depression was 25.0% compared with 17.5% in controls and 19.6% in patients with mild to moderate COPD. When the results were adjusted for demographic variables and comorbidity, the risk for depression was 2.5 times greater for patients with severe COPD than for controls (OR 2.5, 95% CI 1.2 to 5.4). In patients with mild to moderate COPD this increased risk of depression was not seen. Living alone, reversibility of FEV(1) % predicted, respiratory symptoms and physical impairment were significantly associated with the scores on the CES-D scale. CONCLUSION: Patients with severe COPD are at increased risk of developing depression. The results of this study underscore the importance of reducing symptoms and improving physical functioning in patients with COPD.

Adult↗
PubMed2002

How do primary care physicians use long-term acid suppressant drugs? A population-based analysis of Dutch general practices.

OBJECTIVES: A considerable proportion of the medication budget of Dutch general practitioners is spent on prescribed long-term acid suppressant drugs. We investigated the magnitude of long-term prescription of acid suppressant drugs in general practice and the frequency and means of confirming the primary working diagnosis. STUDY DESIGN: We used a retrospective descriptive study of 24 general practices in the Amsterdam region. POPULATION: We identified those receiving long-term acid suppressant therapy (12 or more weeks/year) from a total of 46,813 patients by extracting data from pharmacy databases. OUTCOMES MEASURED: We measured the amount and duration of prescriptions for each medication, indications for prescription, and investigations performed by general practitioners. RESULTS: Of the 46,813 patients, 922 (2%) received long-term acid suppressant therapy. The duration of prescription varied from 12 weeks in 8% of patients to &gt 52 weeks in 23% of patients (mean = 33 weeks). In 25% of patients, no investigations were performed; 75% of patients underwent endoscopy or ingested a barium meal. The predominant diagnoses in investigated patients were ulcer disease (39%), gastroesophageal reflux disease (49%), and functional dyspepsia (gastritis, normal aspect; 18%). Helicobacter pylori status was available in 29% of patients with ulcer disease. Eradication therapy was reported in 44% of these patients. CONCLUSIONS: Among patients of physicians in general practice in the Amsterdam region, 2% used long-term acid suppressants. Patients with ulcer disease may stop taking acid suppressants after apparent successful H pylori eradication. Tapering strategies must be developed for patients with mild reflux disease or functional dyspepsia.

Adolescent↗
PubMedDate not supplied

Validation of a single concentration methacholine inhalation provocation test (SCIPT) in children.

A new method to assess bronchial hyperresponsiveness (BHR) using a single concentration methacholine has already been validated in adults with asthma. Because the geometrical dimensions of the airways in children are different, the results from studies in adults cannot be extrapolated to children. In this study, we validated the single concentration methacholine inhalation provocation test (SCIPT) in children. Twenty-two children performed three methacholine inhalation challenge tests in random order. Two challenges were performed according to the SCIPT: doubling doses (0.03-1.8 mg; maximal cumulated dose 3.6 mg) were administered with an Aerosol Provocation System (Masterscope, Jaeger). The third challenge was performed according to a standard dosimeter method (SDM): doubling doses (0.002-1.8 mg; maximal cumulative dose 3.5 mg) were administered with a DeVillbiss 646 nebulizer. The degree of BHR is expressed as a PD20. A difference of < 1.5 dose step was assumed to be due to intraindividual variation. We found an intraclass correlation of 0.91 between both tests according to the SCIPT and of 0.80 between the SCIPT and SDM. We found, according to the method of Bland and Altman, good agreement when comparing these two challenge tests. The single concentration inhalation provocation test is reproducible and shows good agreement with a standard dosimeter method to test bronchial responsiveness in children.

Administration, Inhalation↗