Wim de Grauw - Academia.edu (original) (raw)

Papers by Wim de Grauw

Research Square (Research Square), Jul 23, 2020

Background: Patients with serious mental illness (SMI) and patients on antipsychotics (AP) have a... more Background: Patients with serious mental illness (SMI) and patients on antipsychotics (AP) have an elevated risk for cardiovascular diseases. In the Netherlands, the mental healthcare for these patients is increasingly taken care of by family practitioners (FP) as a result of a shift from secondary to primary care. Therefore, it is essential to increase our knowledge regarding the characteristics of this patient group and the (somatic) care provided by their FPs. The aim was to examine the rate of cardiovascular risk screening in patients with SMI or the use of AP in family practice. Methods: We performed a retrospective cohort study of 151.238 patients listed in 24 family practices in the Netherlands. From electronic medical records we extracted data concerning diagnoses, measurement values of CVR factors, medication and frequency of visits over a 2 year period. Primary outcome was the rate of patients who were screened for CVR factors. We compared three groups: patients with SMI/AP without diabetes or CVD (SMI/AP-only), patients with SMI/AP and diabetes mellitus (SMI/AP+DM), patients with SMI/AP and a history of cardiovascular disease (SMI/AP+CVD). We explored factors associated with adequate screening using multilevel logistic regression. Results: We identi ed 1705 patients with SMI/AP, 834 with a SMI diagnosis, 1150 using AP. The screening rate for CVR in the SMI/AP-only group (n=1383) was adequate in 8.5%. Screening was higher in the SMI/AP-+DM (n=206, 68.4% adequate, OR 24.6 (95%CI, 17.3-35.1) and SMI/AP+CVD (n=116, 26.7% adequate, OR 4.2 (95%CI, 2.7-6.6). A high frequency of visits, age, the use of AP and a diagnosis of COPD were associated with a higher screening rate. In addition we also examined differences between patients with SMI and patients using AP without SMI. Conclusion: CVR screening in patients with SMI/AP is performed poorly in Dutch family practices. Acceptable screening rates were found only among SMI/AP patients with diabetes mellitus as comorbidity. The nding of a large group of AP users without a SMI diagnosis may indicate that FPs often prescribe AP off-label, lack information about the diagnosis, or use the wrong code. Background Both a diagnosis of serious mental illness (SMI) and the use of antipsychotics (AP) are associated with an elevated cardiovascular risk. SMI incorporates schizophrenia, bipolar disorder and other psychotic disorders.(1) People with SMI have an 8-20 years shorter life expectancy compared to the general population,(2, 3) which is mainly caused by CVD.(4-6) The etiology of the increased risk for CVD in patients with SMI is multifactorial, including high levels of smoking and other substance misuse, poor dietary intake, inadequate amount of exercise, less access to medical care, obesity, diabetes and adverse effects of AP.(6-16) The use of AP increases the risk of CVD via metabolic pathways involving weight gain, glucose intolerance, dyslipidemia and can cause cardiac toxicity.(4, 17-19) Patients get AP

Family Practice, Oct 18, 2006

Background. Guidelines for type 2 diabetes care in general practice are well known and accepted, ... more Background. Guidelines for type 2 diabetes care in general practice are well known and accepted, but the implementation falls short. Objective. To implement these guidelines by introducing a diabetes support service (DSS) to support the care delivered by the GP. Methods. A controlled, non-randomised study with delayed intervention in the control group; 78 GPs (n = 51 for the intervention and n = 21 for the control group) in the south of the Netherlands and 613 of their type 2 diabetic patients participated. Data were collected on the frequency, content and results of the checkups (fasting blood glucose, HbA1c, cholesterol, cholesterol/HDL ratio, triglycerides, creatinine, blood pressure, fundus photography, foot examination, body mass index and smoking status) for 3 years. The year before signing up with the DSS was taken for the pre-measurements and after 2 years of DSS the postmeasurements took place. The effect of the DSS was analysed in a mixed model with repeated measurement covariance structure. Results. At baseline the intervention and control group did not differ in control frequency and outcome (HbA1c). After the intervention the percentage of patients that attended four or more quarterly checkups (with at least testing of fasting blood glucose or HbA1c) increased from 59 to 78%. In contrast, the frequency of checkups in the control group remained constant. This effect was significant. The HbA1c remained the same in the intervention group while there was a significant deterioration in the HbA1c in the control group. Conclusion. Simple logistic support by the DSS proved to have the capacity to implement type 2 diabetes guidelines in general practice.

Background Patients with a serious mental illness (SMI) and those using antipsychotics (AP) have ... more Background Patients with a serious mental illness (SMI) and those using antipsychotics (AP) have an elevated risk for cardiovascular disease (CVD). In the Netherlands, the mental healthcare for these patients is increasingly provided by family practitioners (FPs), following a shift from secondary to primary care. It is therefore essential to better understand the characteristics of this patient group and the (somatic) care provided by their FPs. The aim of this study was to examine the rate of cardiovascular risk (CVR) screening in patients with SMI or those using APs in family practice. Methods We performed a retrospective cohort study of 151,238 patients registered with 24 family practices in the Netherlands. From electronic medical records, we extracted data concerning diagnoses, the measurement of CVR factors, medication, and the frequency of visits over a two-year year period. The primary outcome was the proportion of patients who were screened for CVR factors. We compared three groups: patients

Research Square (Research Square), Jul 9, 2020

Huisarts en Wetenschap, 2003

Driemaandelijkse controles De driemaandelijkse controles voeren de huisartsen over het algemeen v... more Driemaandelijkse controles De driemaandelijkse controles voeren de huisartsen over het algemeen volgens de standaard uit (tabel). Bij het merendeel van de patiënten controleerde men bloedglucose en gewicht. Ook bloeddrukmetingen vinden tijdens de driemaandelijkse controles zeer regelmatig plaats. Van de patiënten bij wie de bloeddruk gemeten werd, was minder dan de helft bekend met hypertensie. Bij 92% van de met hypertensie bekende patiënten werd tijdens de driemaandelijkse controle de bloeddruk gemeten. Bij 40% van de voor voetonderzoek geïndiceerde patiënten (ulcus, standafwijkingen of ernstige neuropathie) voerde men dit onderzoek volgens de meest recente standaard driemaandelijks uit.

Quality and Safety in Health Care, 2008

Logistic support to general practitioners improves the care processes for patients with diabetes ... more Logistic support to general practitioners improves the care processes for patients with diabetes but is not sufficient to meet all criteria. To introduce patient-oriented interventions by a practice nurse in general practices which already use logistic support to improve the care processes for patients with diabetes. A controlled before-after study with delayed intervention in the control group. 51 practices (n = 23 for the intervention and n = 28 for the control group) in the south of The Netherlands and 900 of their patients with type 2 diabetes. Data were collected on the results of the checkups (fasting blood glucose, glycosylated haemoglobin (HbA1C), cholesterol, cholesterol/high-density lipoprotein ratio, triglycerides, creatinine, blood pressure, fundus photo, foot exam and body mass index), smoking status, physical activity and medication use. The effect of the patient-oriented intervention was analysed in a mixed model with repeated measurement covariance structure. The HbA1C improved in the intervention group (from 7.3 to 7.1), while that of the control group deteriorated (from 7.2 to 7.3). The percentage of patients with an HbA1C &amp;amp;amp;amp;amp;gt;or=8.5 was halved after the intervention (from 13 to 6). Patients in the intervention group started to exercise more besides their daily activities compared with the control group. The need for medication increased more in the control group than in the intervention group (more changes to insulin and more defined daily dose (DDD) oral medication). Patient-oriented interventions in addition to logistic support have a positive effect on diabetic patient outcomes.

British Journal of General Practice

BackgroundGPs frequently use 10-year-risk estimations of cardiovascular disease (CVD) to identify... more BackgroundGPs frequently use 10-year-risk estimations of cardiovascular disease (CVD) to identify high- risk patients.AimTo assess the performance of four models for predicting the 10-year risk of CVD in Dutch general practice.Design and settingProspective cohort study. Routine data (2009– 2019) was used from 46 Dutch general practices linked to cause of death statistics.MethodThe outcome measures were fatal CVD for SCORE and first diagnosis of fatal or non- fatal CVD for SCORE fatal and non-fatal (SCORE- FNF), Globorisk-laboratory, and Globorisk-office. Model performance was assessed by examining discrimination and calibration.ResultsThe final number of patients for risk prediction was 1981 for SCORE and SCORE-FNF, 3588 for Globorisk-laboratory, and 4399 for Globorisk- office. The observed percentage of events was 18.6% (n= 353) for SCORE- FNF, 6.9% (n= 230) for Globorisk-laboratory, 7.9% (n= 323) for Globorisk-office, and 0.3% (n= 5) for SCORE. The models showed poor discriminatio...

Codes, Categories and Themes. A detailed table with codes and their description, from which categ... more Codes, Categories and Themes. A detailed table with codes and their description, from which categories and themes originated. (DOCX 37 kb)

Topic list. A list of relevant topics concerning CKD management which was constructed before star... more Topic list. A list of relevant topics concerning CKD management which was constructed before start of the study to ensure all research items were covered and discussed in the focus groups. (DOCX 19 kb)

BJGP Open, 2022

Backgroundcare for patients with chronic kidney disease (CKD) necessitates tailored pathways betw... more Backgroundcare for patients with chronic kidney disease (CKD) necessitates tailored pathways between primary and secondary care. It is unknown if back referring CKD patients is safe and effective.Aimto study the feasibility of discharging patients with stable moderate-to-advanced CKD from secondary to primary care, and to evaluate Quality of Care (QoC) and patients’ and General Practitioners’ (GPs) experiences.Design & settinga monocentre prospective mixed-method study.Methodwe included patients who met pre-determined back referral criteria. Patients were discharged with personalised information guides and transfer letters. GPs had the option of consulting a nephrologist by Telenephrology. Renal outcomes, QoC and experiences were collected after one year.Results18 patients were included. The mean age was 73 years old; the mean estimated Glomerular Filtration Rate (eGFR) was 34.3 mL/min/1.73 m2 at baseline. After one year, three patients had received either no or incomplete monitorin...

BJGP Open, 2022

Scandinavian Journal of Primary Health Care, 2014

Objective. Randomized trials showed that changes in healthcare organization improved diabetes car... more Objective. Randomized trials showed that changes in healthcare organization improved diabetes care. This study aimed to identify which organizational determinants were associated with patient outcomes in routine diabetes care. Design. Observational study, in which multilevel regression analyses were applied to examine the impact of 12 organizational determinants on diabetes care as separate measures and as a composite score. Setting. Primary care practices in the Netherlands. Subjects. 11,751 patients with diabetes in 354 practices. Main outcome measures. Patients ' recorded glycated hemoglobin (HbA1c), systolic blood pressure, and serum cholesterol levels. Results. A higher score on the composite measure of organizational determinants was associated with better control of systolic blood pressure (p ϭ 0.017). No effects on HbA1C or cholesterol levels were found. Exploration of specifi c organizational factors found signifi cant impact of use of an electronic patient registry on HbA1c (OR ϭ 1.80, 95% CI 1.12-2.88), availability of patient leafl ets on systolic blood pressure control (OR ϭ 2.59, 95% CI 1.06-6.35), and number of hours ' nurse education on cholesterol control (OR ϭ 2.51, 95% CI 1.02-6.15). Conclusion. In routine primary care, it was found that favorable healthcare organization was associated with a number of intermediate outcomes in diabetes care. This fi nding lends support to the fi ndings of trials on organizational changes in diabetes care. Notably, the composite measure of organizational determinants had most impact.

NHG-Standaarden voor de huisarts 2011, 2011

... Om dit te bereiken richt de behandeling zich zowel op goede regulering van de bloedglucose-wa... more ... Om dit te bereiken richt de behandeling zich zowel op goede regulering van de bloedglucose-waarden en periodieke controle van nieren, ogen en voeten, als op maatregelen om de cardiovasculaire risicofactoren gunstig te beïnvloeden. ...

Journal of the American Medical Informatics Association, 2013

Objective Quality indicators for the treatment of type 2 diabetes are often retrieved from a chro... more Objective Quality indicators for the treatment of type 2 diabetes are often retrieved from a chronic disease registry (CDR). This study investigates the quality of recording in a general practitioner's (GP) electronic medical record (EMR) compared to a simple, web-based CDR. Methods The GPs entered data directly in the CDR and in their own EMR during the study period (2011). We extracted data from 58 general practices (8235 patients) with type 2 diabetes and compared the occurrence and value of seven process indicators and 12 outcome indicators in both systems. The CDR, specifically designed for monitoring type 2 diabetes and reporting to health insurers, was used as the reference standard. For process indicators we examined the presence or absence of recordings on the patient level in both systems, for outcome indicators we examined the number of compliant or non-compliant values of recordings present in both systems. The diagnostic OR (DOR) was calculated for all indicators. Results We found less concordance for process indicators than for outcome indicators. HbA1c testing was the process indicator with the highest DOR. Blood pressure measurement, urine albumin test, BMI recorded and eye assessment showed low DOR. For outcome indicators, the highest DOR was creatinine clearance <30 mL/min or mL/min/1.73 m 2 and the lowest DOR was systolic blood pressure <140 mm Hg. Conclusions Clinical items are not always adequately recorded in an EMR for retrieving indicators, but there is good concordance for the values of these items. If the quality of recording improves, indicators can be reported from the EMR, which will reduce the workload of GPs and enable GPs to maintain a good patient overview.

Analysis details. A detailed description of the iterative process of data collection and analysis... more Analysis details. A detailed description of the iterative process of data collection and analysis. (DOCX 14 kb)

British Journal of General Practice, 2013

Background Chronic kidney disease (CKD) is highly prevalent in patients with diabetes or hyperten... more Background Chronic kidney disease (CKD) is highly prevalent in patients with diabetes or hypertension in primary care. A shared care model could improve quality of care in these patients Aim To assess the effect of a shared care model in managing patients with CKD who also have diabetes or hypertension. Design and setting A cluster randomised controlled trial in nine general practices in The Netherlands. Method Five practices were allocated to the shared care model and four practices to usual care for 1 year. Primary outcome was the achievement of blood pressure targets (130/80 mmHg) and lowering of blood pressure in patients with diabetes mellitus or hypertension and an estimated glomerular filtration rate (eGFR)<60ml/min/1.73m 2. Results Data of 90 intervention and 74 control patients could be analysed. Blood pressure in the intervention group decreased with 8.1 (95% CI = 4.8 to 11.3)/1.1 (95% CI = −1.0 to 3.2) compared to −0.2 (95% CI = −3.8 to 3.3)/−0.5 (95% CI = −2.9 to 1.8) in the control group. Use of lipid-lowering drugs, angiotensin-system inhibitors and vitamin D was higher in the intervention group than in the control group (73% versus 51%, 81% versus 64%, and 15% versus 1%, respectively, [P = 0.004, P = 0.01, and P = 0.002]). Conclusion A shared care model between GP, nurse practitioner and nephrologist is beneficial in reducing systolic blood pressure in patients with CKD in primary care.

Background. In type 2 diabetes, educational interventions that target differences between patient... more Background. In type 2 diabetes, educational interventions that target differences between patients' and partners' illness perceptions have been advocated. Objective. To investigate how the route to diagnosis of type 2 diabetes (through screening versus clinical symptoms) affects illness perceptions of patients and their partners. Methods. In a cross-sectional study, we enrolled patients aged 40-75 years from general practices in the Netherlands with a new diagnosis of type 2 diabetes (≤3 years), detected by either screening (n = 77) or clinical symptoms (n = 32). Patients and their partners each completed a postal Brief Illness Perception Questionnaire (Brief IPQ), and up-to-date clinical data were obtained from their GP. The Brief IPQ scores of the screening and clinical diagnosis groups were compared for both patients and partners, and multiple variable linear regression models with Brief IPQ scores as outcomes were developed. Results. The route to diagnosis did not appear to have a strong influence on patients' illness perceptions but did influence illness perceptions of their partners. Partners of patients diagnosed through screening perceived greater consequences for their own life, had a stronger feeling that their patient-partners had control over their diabetes, were more concerned about their partners' diabetes, and believed that their patient-partners experienced more diabetes symptoms, compared with partners of patients who were diagnosed through clinical symptoms. Conclusions. The route to diagnosis of type 2 diabetes has a greater impact on the illness perceptions of partners than that of patients. Professionals in diabetes education and treatment should consider these differences in their approach to patient care.

Family …, 1999

Background. Traditionally, health and the outcomes of medical treatment have been measured in ter... more Background. Traditionally, health and the outcomes of medical treatment have been measured in terms of morbidity, incidence or prevalence of disease, or even mortality. This disease model provides an adequate framework for acute illnesses, but for chronic diseases, severity and their effect on everyday functioning are paramount. For chronic diseases, functional health status, as a vital part of quality of life, is now recognized as an important outcome measure of the GP's care. Objective. We aimed to assess the impact of type 2 diabetes mellitus on functional health status in Dutch general practice. Method. We conducted a cross-sectional study of the functional health status of all patients with type 2 diabetes mellitus under 85 in two general practices, using the Sickness Impact Profile (SIP) and the COOP/WONCA charts. A control group of non-diabetic patients was selected, matched for practice, sex and age. Results. In total, 127 type 2 diabetes mellitus patients and 127 controls participated in the study, the responses being 78 and 70%, respectively. Between these groups the following were significantly different: the SIP subscore Physical, the SIP sum score and the COOP/WONCA scores for physical fitness and overall health. Type 2 diabetes mellitus patients were 2.46 (95% CI 1.5-4.1) times more likely to experience functional impairment. Cardiovascular morbidity (odds ratio 2.5, 95% CI 1.3-4.7), locomotory morbidity (odds ratio 2.6, 95% CI 1.4-5.1) and diabetes itself (odds ratio 1.4, 95% CI 1.1-1.9) were significantly associated with the presence of functional impairment. Conclusion. This study demonstrates the impact of type 2 diabetes mellitus on functional status, particularly in relation to cardiovascular morbidity.

Research Square (Research Square), Jul 23, 2020

Family Practice, Oct 18, 2006

Research Square (Research Square), Jul 9, 2020

Huisarts en Wetenschap, 2003

Quality and Safety in Health Care, 2008

British Journal of General Practice

BJGP Open, 2022

Scandinavian Journal of Primary Health Care, 2014

NHG-Standaarden voor de huisarts 2011, 2011

Journal of the American Medical Informatics Association, 2013

British Journal of General Practice, 2013

Family …, 1999