Welcome to the 26th WONCA Europe Virtual Conference Programme Scheduling

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Background and purpose: One in five Dutch women experience an unwanted pregnancy (UWP) in their lifetime. Over half of these women consult their general practitioner (GP) regarding the UWP. Despite the prominent role GPs play in the care for women and their partners, they have little experience in UWP-care. Both UWP-women and professionals working in abortion clinics have raised concerns about counselling and aftercare provided by GPs. Partners are underrepresented in literature and policy. The aims is to identify the experiences and needs of UWP-women and –men, to formulate recommendations to improve UWP-care.

Methods: The protocol was registered under PROSPERO number 196461. The search was performed in MEDLINE, PubMed, EMBASE, PsycINFO, CINAHL and Web of Science, using the keywords ‘Unwanted pregnancy’, ‘Decision-making’, ‘Counselling’, ‘Experience’ and ‘Needs’. In total 3,433 articles were screened for eligibility. After methodological quality appraisal 18 studies were included (from 6 countries, published between 2000 and 2019). Thematical analysis was performed.

Results: The results for UWP-women illustrate the need for accurate information, empowerment of decision ownership and sensitivity to their existential experiences. All three factors have been found to influence the mental wellbeing after termination of pregnancy. Influences on the wellbeing after carrying an UWP to term were not found. UWP-partners experiences are coloured by the level of involvement in the decision-making process and signify the need for organized support to aid for UWP-men.

Conclusions: The results indicate areas to improve UWP-care. Focus needs to be on the active support of women and partners by their health care providers, to improve the psychological outcome.

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Background and purpose: Active patient involvement can contribute to improved treatment outcomes and more patient-centered care. Yet, patient involvement remains a challenge in clinical practice. We aimed to develop a new tool, the PREparing Patients for Active Involvement in medication Review (PREPAIR) tool, to enhance systematic patient involvement in conversations about medication optimization in general practice.

Methods: A literature review was conducted and followed by co-producing activities: 1) a workshop with six GPs and 2) pilot testing including observations and interviews with 22 patients, three GPs and three staff members. During this process, continuous adaptations of the PREPAIR were made.

Results: The final tool included five questions: 1) satisfaction with current medications, 2) experience of taking too much medication, 3) major side effects, 4) experience of taking unnecessary medication, and 5) medication-related topics to discuss with the GP (open-ended question). The PREPAIR tool was completed by the patient before the GP consultation to encourage patient reflections on own medications. During the consultation, the GP’s focus changed from the computer towards the patient, questionnaire responses were reviewed, and potential medication-related problems were discussed. The patients were empowered to speak, and the GPs improved their understanding of patient perspectives on medications. Although some GPs suggested a broader scope on health perspectives, the PREPAIR tool was received positively by both patients and GPs.

Conclusions: We developed a brief and useful tool to support systematic patient involvement in general practice. Future research should address whether the PREPAIR tool can contribute to improved patient outcomes and quality of care.

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1. Background and purpose

The Dutch College of General Practitioners (NHG) has a longstanding comprehensive guideline programme including 135 clinical practice guidelines. In recent years, these guidelines are adapted to facilitate shared decision making, including the integration of decision support tools, such as option tables. To guide the development of option tables, we identified preference-sensitive recommendations within the clinical practice guidelines, for which option tables are most needed, as resources are limited.

2. Methods

We systematically analysed all 135 NHGs clinical practice guidelines and selected all preference-sensitive recommendations. Based on several criteria, we then assessed for which recommendations an option table can have added value. Recommendations for which an option table is not yet available or under development, were added to the longlist. In the upcoming months this longlist will undergo prioritization by several stakeholders such as general practitioners and patient(organisation)s.

3. Results

We identified 87 preference-sensitive recommendations for which an option table can have added value according to our criteria. For 10 recommendations, an option table is already available or under development in primary or multidisciplinary care. The remaining 77 recommendations will undergo prioritization. The results of this prioritization will be presented at WONCA, July 2021.

4. Conclusions

We systematically identified and prioritized preference-sensitive recommendations within NHGs clinical practice guidelines, for which an option table can have added value. This will guide us to make sensible choices for a programmatic approach of the development of option tables.

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Background and purpose: Clinicians, researchers, and Alzheimer Societies, stress the importance of an early dementia diagnosis in a mild stage. However, whether this is an improvement in patients’ health and well-being is still debated. Ideally, shared-decision making (SDM) is implemented to discuss the potential benefits and harms of an early diagnosis and disclosure with patients. This study explores experiences and considerations of GPs regarding an (early) diagnostic trajectory for dementia and implementation of SDM therein.

Methods: In this qualitative study, GPs and practice-based nurses were interviewed. Topics included views concerning early dementia diagnosis, the decision-making process for starting a diagnostic trajectory, and views on the implementation of SDM in this regard.

Results: 16 GPs and practice-based nurses in the Netherlands were interviewed. Several considerations concerning the timing of a dementia diagnosis were identified including; (1) decrease in patients’ quality of life (QoL) due to an (early) diagnosis, (2) potential advantages of an early diagnosis for patients and their significant others (3) the possibility of a misdiagnosis (4) experiences related to a dementia diagnosis in a late disease stage.

Several patient and dyad related factors were identified that could hinder or facilitate the implementation of SDM in general practice.

Conclusions: Most GPs were in favour of a timely (instead of an early) diagnostic trajectory (i.e. initiated at the right time for patients and significant others to meet their needs and expectations) and emphasized the importance of their patients’ QoL. GPs favour patient involvement in deciding on an (early) diagnostic trajectory, but several barriers and facilitators (e.g. patients’ expectations regarding treatment) affect SDM.

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Background and purpose

OPEN, the Dutch national program to help general practitioners with online access to medical records for patients, is two years into its 4 year duration. With an enrolment of 97% of GPs and a potential reach of the entire population, the impact on patient doctor relations, patient empowerment and shared decision making is substantial.

Closely monitoring the progress and course of OPEN via a data cockpit, the authors present first-hand information ‘from the flight deck’.

Methods

Data on implementation by GPs and usage of online access by patients was collected in all 57 regions and 4745 GP-practices (of 4887) via quarterly measurements. A survey among staff enrolled in an eLearning (n = 24.994) measured attitude towards online access. Social Return on Investment Analysis provided insight in costs and benefits. Scientific research is conducted with the Universities of Nijmegen and Maastricht and the Netherlands Institute for Health Services Research.

Results

During the second half of 2020 almost 80% of practices implemented and 5% of the population aged over 15 used online access (0% to 24% of regional population). Significant regional (65-89%) and inter-staff (55-85%) variability in positive attitude towards online access were found prior to implementation in 2020. Positive attitude was higher than the 35% found by the national e-health monitor in 2018. As quarterly data-sets accumulate, insight is gained in the cause and background of these differences.

Conclusions

Monitoring and internationally comparing data of a national program for ‘open notes’ offers unprecedented insight in this major change in patient doctor relations and changing attitude of medical staff in the Netherlands.

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Background and purpose

Foreign-born persons unfamiliar with Dutch health practices have less confidence in the Dutch healthcare system and the GP. Cultural and language barriers can impede good delivery of care. Thuisarts.nl, the patient information website of the Dutch College of General Practitioners, offers reliable and easy-accessible health information. Thuisarts.nl supports GPs with patient education and improves patient empowerment. We evaluated the usage and perceived usefulness of an English pilot-version (GPinfo.nl) among internationals (i.e., foreign-born persons living in the Netherlands for work or study) and GPs in the Netherlands.

Methods

GPinfo.nl offers a selection of medical (n=19) and Dutch-healthcare topics (n=15), 1:1 translated from Thuisarts.nl. Newsletters and the Healthcare for internationals (H4i.nl) network promoted GPinfo.nl among GPs. A limited-budget social-media and Google-Adwords campaign was setup to reach internationals. The website was monitored from September-December 2020 using web-statistics, an online exit-survey (n=148), interviews (n=6) among internationals, an online survey (n=68) and interviews (n=6) among GPs.

Results

GPinfo.nl had 20,342 visits. 79% (95%CI=72-85%) and 78% (95%CI=72-85%) of internationals perceived GPinfo.nl to be reliable and relevant, respectively. 70% (95%CI=59-81%) and 77% (95%CI=67-87%) of GPs indicated that GPinfo.nl improved their interaction with international patients and the efficiency of their consultations, respectively. Internationals and GPs encouraged the initiative. Their suggested improvements for more impact were: more healthcare-system-related information and explanation of Dutch medical practices, greater coverage of medical subjects, and incorporation of cross-cultural sensitivity.

Conclusions

This pilot confirmed the need for and potential impact of health(care) information in English for internationals and GPs. However, a 1:1 translation of Thuisarts.nl seems yet insufficient and adaptation is required.