Jacob Mohrs - Academia.edu (original) (raw)
Papers by Jacob Mohrs
Background: Patients who visit their General Practitioner (GP) very frequently over extended peri... more Background: Patients who visit their General Practitioner (GP) very frequently over extended periods of time
often have multimorbidity and are costly in primary and specialist healthcare. We investigated the impact of
patient-level psychosocial and GP-level factors on the persistence of frequent attendance (FA) in primary care.
Methods: Two-year prospective cohort study in 623 incident adult frequent attenders (N90th attendance centile;
age and sex-adjusted) in 2009. Informationwas collected through questionnaires (patients, GPs) andGPs' patient
data.We usedmultilevel, ordinal logistic regression analysis, controlling for somatic illness and demographic factors
with FA in 2010 and/or 2011 as the outcome.
Results: Other anxiety (odds ratio (OR) 2.00; 95% confidence interval from 1.29 to 3.10) over 3 years and the
number of life events in 3 years (OR 1.06; 1.01–1.10 per event; range of 0 to 12) and, at baseline, panic disorder
(OR 5.40; 1.67–17.48), other anxiety (OR 2.78; 1.04–7.46), illness behavior (OR 1.13; 1.05–1.20 per point; 28-
point scale) and lack of mastery (OR 1.08; 1.01–1.15 per point; 28-point scale)were associated with persistence
of FA. We found no evidence of synergistic effects of somatic, psychological and social problems. We found no
strong evidence of effects of GP characteristics.
Conclusion: Panic disorder, other anxiety, negative life events, illness behavior and lack of mastery are independently
associatedwith persistence of frequent attendance. Effective intervention at these factors, apart fromtheir
intrinsic benefits to these patients, may reduce attendance rates, and healthcare expenditures in primary and
specialist care.
Abstract Background: Frequently attending patients to primary care (FA) are likely to cost more i... more Abstract
Background: Frequently attending patients to primary care (FA) are likely to cost more in primary care than their
non-frequently attending counterparts. But how much is spent on specialist care of FAs? We describe the
healthcare expenditures of frequently attending patients during 1, 2 or 3 years and test the hypothesis that
additional costs can be explained by FAs’ combined morbidity and primary care physicians’ characteristics.
Methods: Record linkage study. Pseudonymised clinical data from the medical records of 16 531 patients from 39
general practices were linked to healthcare insurer’s reimbursements data. Main outcome measures were all
reimbursed primary and specialist healthcare costs between 2007 and 2009. Multilevel linear regression analysis was
used to quantify the effects of the different durations of frequent attendance on three-year total healthcare
expenditures in primary and specialist care, while adjusting for age, sex, morbidities and for primary care physicians
characteristics. Primary care physicians’ characteristics were collected through administrative data and a
questionnaire.
Results: Unadjusted mean 3-year expenditures were 5044 and 15 824 Euros for non-FAs and three-year-FAs,
respectively. After adjustment for all other included confounders, costs both in primary and specialist care remained
substantially higher and increased with longer duration of frequent attendance. As compared to non-FAs, adjusted
mean expenditures were 1723 and 5293 Euros higher for one-year and three-year FAs, respectively.
Conclusions: FAs of primary care give rise to substantial costs not only in primary, but also in specialist care that
cannot be explained by their multimorbidity. Primary care physicians’ working styles appear not to explain these
excess costs. The mechanisms behind this excess expenditure remain to be elucidated.
Primary Care Respiratory Journal, 2014
PLoS ONE, 2014
Objectives: To evaluate the effect of a practice-based, culturally appropriate patient education ... more Objectives: To evaluate the effect of a practice-based, culturally appropriate patient education intervention on blood pressure (BP) and treatment adherence among patients of African origin with uncontrolled hypertension.
Family Practice, 2002
The problem list is an important tool in general practice for care as well as research purposes. ... more 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. This study addresses the question of to what extent the problem list can be improved by asking the patient about their own medical problems. 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. 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%. 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.
Journal of Psychosomatic Research, 2014
Background: Patients who visit their General Practitioner (GP) very frequently over extended peri... more Background: Patients who visit their General Practitioner (GP) very frequently over extended periods of time often have multimorbidity and are costly in primary and specialist healthcare. We investigated the impact of patient-level psychosocial and GP-level factors on the persistence of frequent attendance (FA) in primary care. Methods: Two-year prospective cohort study in 623 incident adult frequent attenders (N90th attendance centile; age and sex-adjusted) in 2009. Information was collected through questionnaires (patients, GPs) and GPs' patient data. We used multilevel, ordinal logistic regression analysis, controlling for somatic illness and demographic factors with FA in 2010 and/or 2011 as the outcome. Results: Other anxiety (odds ratio (OR) 2.00; 95% confidence interval from 1.29 to 3.10) over 3 years and the number of life events in 3 years (OR 1.06; 1.01-1.10 per event; range of 0 to 12) and, at baseline, panic disorder (OR 5.40; 1.67-17.48), other anxiety (OR 2.78; 1.04-7.46), illness behavior (OR 1.13; 1.05-1.20 per point; 28point scale) and lack of mastery (OR 1.08; 1.01-1.15 per point; 28-point scale) were associated with persistence of FA. We found no evidence of synergistic effects of somatic, psychological and social problems. We found no strong evidence of effects of GP characteristics. Conclusion: Panic disorder, other anxiety, negative life events, illness behavior and lack of mastery are independently associated with persistence of frequent attendance. Effective intervention at these factors, apart from their intrinsic benefits to these patients, may reduce attendance rates, and healthcare expenditures in primary and specialist care.
Implementation Science, 2010
Background: To improve hypertension care for ethnic minority patients of African descent in the N... more Background: To improve hypertension care for ethnic minority patients of African descent in the Netherlands, we developed a provider intervention to facilitate the delivery of culturally appropriate hypertension education. This pilot study evaluates how the intervention affected the attitudes and perceived competence of hypertension care providers with regard to culturally appropriate care.
British Journal of General Practice, 2009
Few patients who attend GP consultations frequently continue to do so long term. While transient ... more Few patients who attend GP consultations frequently continue to do so long term. While transient frequent attendance may be readily explicable, persistent frequent attendance often is not. It increases GPs' workload while reducing work satisfaction. It is neither reasonable, nor efficient to target diagnostic assessment and intervention at transient frequent attenders.
BMC Pulmonary Medicine, 2009
Background: Asthma is a difficult diagnosis to establish in preschool children. A few years ago, ... more Background: Asthma is a difficult diagnosis to establish in preschool children. A few years ago, our group presented a prediction rule for young children at risk for asthma in general practice. Before this prediction rule can safely be used in practice, cross-validation is required. In addition, general practitioners face many therapeutic management decisions in children at risk for asthma. The objectives of the study are: (1) identification of predictors for asthma in preschool children at risk for asthma with the aim of cross-validating an earlier derived prediction rule; (2) compare the effects of different treatment strategies in preschool children.
BMC Medical Research Methodology, 2012
Background: In research with long-term follow-up and repeated measurements, quick and complete re... more Background: In research with long-term follow-up and repeated measurements, quick and complete response to questionnaires helps ensure a study's validity, precision and efficiency. Evidence on the effect of non-monetary incentives on response rates in observational longitudinal research is scarce.
BMC Family Practice, 2008
Background: Patients who visit their General Practitioner (GP) very frequently over extended peri... more Background: Patients who visit their General Practitioner (GP) very frequently over extended periods of time
often have multimorbidity and are costly in primary and specialist healthcare. We investigated the impact of
patient-level psychosocial and GP-level factors on the persistence of frequent attendance (FA) in primary care.
Methods: Two-year prospective cohort study in 623 incident adult frequent attenders (N90th attendance centile;
age and sex-adjusted) in 2009. Informationwas collected through questionnaires (patients, GPs) andGPs' patient
data.We usedmultilevel, ordinal logistic regression analysis, controlling for somatic illness and demographic factors
with FA in 2010 and/or 2011 as the outcome.
Results: Other anxiety (odds ratio (OR) 2.00; 95% confidence interval from 1.29 to 3.10) over 3 years and the
number of life events in 3 years (OR 1.06; 1.01–1.10 per event; range of 0 to 12) and, at baseline, panic disorder
(OR 5.40; 1.67–17.48), other anxiety (OR 2.78; 1.04–7.46), illness behavior (OR 1.13; 1.05–1.20 per point; 28-
point scale) and lack of mastery (OR 1.08; 1.01–1.15 per point; 28-point scale)were associated with persistence
of FA. We found no evidence of synergistic effects of somatic, psychological and social problems. We found no
strong evidence of effects of GP characteristics.
Conclusion: Panic disorder, other anxiety, negative life events, illness behavior and lack of mastery are independently
associatedwith persistence of frequent attendance. Effective intervention at these factors, apart fromtheir
intrinsic benefits to these patients, may reduce attendance rates, and healthcare expenditures in primary and
specialist care.
Abstract Background: Frequently attending patients to primary care (FA) are likely to cost more i... more Abstract
Background: Frequently attending patients to primary care (FA) are likely to cost more in primary care than their
non-frequently attending counterparts. But how much is spent on specialist care of FAs? We describe the
healthcare expenditures of frequently attending patients during 1, 2 or 3 years and test the hypothesis that
additional costs can be explained by FAs’ combined morbidity and primary care physicians’ characteristics.
Methods: Record linkage study. Pseudonymised clinical data from the medical records of 16 531 patients from 39
general practices were linked to healthcare insurer’s reimbursements data. Main outcome measures were all
reimbursed primary and specialist healthcare costs between 2007 and 2009. Multilevel linear regression analysis was
used to quantify the effects of the different durations of frequent attendance on three-year total healthcare
expenditures in primary and specialist care, while adjusting for age, sex, morbidities and for primary care physicians
characteristics. Primary care physicians’ characteristics were collected through administrative data and a
questionnaire.
Results: Unadjusted mean 3-year expenditures were 5044 and 15 824 Euros for non-FAs and three-year-FAs,
respectively. After adjustment for all other included confounders, costs both in primary and specialist care remained
substantially higher and increased with longer duration of frequent attendance. As compared to non-FAs, adjusted
mean expenditures were 1723 and 5293 Euros higher for one-year and three-year FAs, respectively.
Conclusions: FAs of primary care give rise to substantial costs not only in primary, but also in specialist care that
cannot be explained by their multimorbidity. Primary care physicians’ working styles appear not to explain these
excess costs. The mechanisms behind this excess expenditure remain to be elucidated.
Primary Care Respiratory Journal, 2014
PLoS ONE, 2014
Objectives: To evaluate the effect of a practice-based, culturally appropriate patient education ... more Objectives: To evaluate the effect of a practice-based, culturally appropriate patient education intervention on blood pressure (BP) and treatment adherence among patients of African origin with uncontrolled hypertension.
Family Practice, 2002
The problem list is an important tool in general practice for care as well as research purposes. ... more 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. This study addresses the question of to what extent the problem list can be improved by asking the patient about their own medical problems. 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. 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%. 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.
Journal of Psychosomatic Research, 2014
Background: Patients who visit their General Practitioner (GP) very frequently over extended peri... more Background: Patients who visit their General Practitioner (GP) very frequently over extended periods of time often have multimorbidity and are costly in primary and specialist healthcare. We investigated the impact of patient-level psychosocial and GP-level factors on the persistence of frequent attendance (FA) in primary care. Methods: Two-year prospective cohort study in 623 incident adult frequent attenders (N90th attendance centile; age and sex-adjusted) in 2009. Information was collected through questionnaires (patients, GPs) and GPs' patient data. We used multilevel, ordinal logistic regression analysis, controlling for somatic illness and demographic factors with FA in 2010 and/or 2011 as the outcome. Results: Other anxiety (odds ratio (OR) 2.00; 95% confidence interval from 1.29 to 3.10) over 3 years and the number of life events in 3 years (OR 1.06; 1.01-1.10 per event; range of 0 to 12) and, at baseline, panic disorder (OR 5.40; 1.67-17.48), other anxiety (OR 2.78; 1.04-7.46), illness behavior (OR 1.13; 1.05-1.20 per point; 28point scale) and lack of mastery (OR 1.08; 1.01-1.15 per point; 28-point scale) were associated with persistence of FA. We found no evidence of synergistic effects of somatic, psychological and social problems. We found no strong evidence of effects of GP characteristics. Conclusion: Panic disorder, other anxiety, negative life events, illness behavior and lack of mastery are independently associated with persistence of frequent attendance. Effective intervention at these factors, apart from their intrinsic benefits to these patients, may reduce attendance rates, and healthcare expenditures in primary and specialist care.
Implementation Science, 2010
Background: To improve hypertension care for ethnic minority patients of African descent in the N... more Background: To improve hypertension care for ethnic minority patients of African descent in the Netherlands, we developed a provider intervention to facilitate the delivery of culturally appropriate hypertension education. This pilot study evaluates how the intervention affected the attitudes and perceived competence of hypertension care providers with regard to culturally appropriate care.
British Journal of General Practice, 2009
Few patients who attend GP consultations frequently continue to do so long term. While transient ... more Few patients who attend GP consultations frequently continue to do so long term. While transient frequent attendance may be readily explicable, persistent frequent attendance often is not. It increases GPs' workload while reducing work satisfaction. It is neither reasonable, nor efficient to target diagnostic assessment and intervention at transient frequent attenders.
BMC Pulmonary Medicine, 2009
Background: Asthma is a difficult diagnosis to establish in preschool children. A few years ago, ... more Background: Asthma is a difficult diagnosis to establish in preschool children. A few years ago, our group presented a prediction rule for young children at risk for asthma in general practice. Before this prediction rule can safely be used in practice, cross-validation is required. In addition, general practitioners face many therapeutic management decisions in children at risk for asthma. The objectives of the study are: (1) identification of predictors for asthma in preschool children at risk for asthma with the aim of cross-validating an earlier derived prediction rule; (2) compare the effects of different treatment strategies in preschool children.
BMC Medical Research Methodology, 2012
Background: In research with long-term follow-up and repeated measurements, quick and complete re... more Background: In research with long-term follow-up and repeated measurements, quick and complete response to questionnaires helps ensure a study's validity, precision and efficiency. Evidence on the effect of non-monetary incentives on response rates in observational longitudinal research is scarce.
BMC Family Practice, 2008