Robert Verheij, Nottingham, July 20,

2005Slide 1

LINH

Robert Verheij, Nottingham, July 20,

2005Slide 2

The Netherlands Information Network of

General Practice

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2005Slide 3

Overview position of the GP in the Netherlands organisation and funding what data are collected and how research projects the future

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2005Slide 5

Organisation and funding

A joint project of: • Dutch association of GPs • Dutch College of GPs• Centre for Quality of Care Research (WOK) • NIVEL

Basic infrastructure funded by the Dutch Ministry of Health

Robert Verheij, Nottingham, July 20,

2005Slide 6

Aims of LINH:

Collect information in GP practices for:

health services research quality of care research public health monitoring

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Representativeness

80 computerised general practices (about 350.000 patients)

6 major GP software packages

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Data flow

1. Every day: full morbidity and interventions recording in general practice.

2. Every six months: extraction software sent to GPs GPs retrieve data and send it to LINH storage in central database

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Data flow (2)

3. Every week: extraction and upload of selection of

diseases in 45 practices influenza surveillance

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Quality assurance

practice selection procedures support for ICPC coding extensive software testing and checking data-flow procedures, quality checks feedback reports to practices practice visits (at least bi-annually)

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History of LINH

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What data are collected?

contacts + diagnosis + episode typing (new/existing)

referrals + associated diagnosis prescriptions (ATC codes) + associate

diagnosis diagnoses coded using ICPC patient characteristics (sex, date of birth,

postcode area, type of insurance)

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Individual patient records

follow patients in time (care chains) comorbidity comedication linkage to hospital databases linkage to CBS databases (eg.

occupation, ethnicity)

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Output: some examples

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Annual reports on morbidity, contacts, prescription referrals at www.linh.nlwww.linh.nl

Mean number of home visits and contacts during consultation hours with the GP per patient per year, classified according to age, 2003

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2005Slide 16

Monthly column in the Journal of the Dutch college of GPs (Huisarts & Wetenschap)

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Health effects of firework disaster Enschede (2000)

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Prescription studies

• off-label prescribing

• changes in reimbursed package

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Monitoring annual Influenza vaccination campaign

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Evaluation electronic prescribing system

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Sudden changes in morbidity (bioterrorism)

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Towards a European morbidity network?(the eHID project)

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Antibiotics prescription in France and Netherlands

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GP reimbursement in relation to workload

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Information Network out of hours services

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Evaluation task delegation

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The future (1): Need to adapt to changes in the organisation of GP care

introduction of ‘call centers’ (triage) introduction of GP co-ops for out of hours

services extending role of practice nurses/nurse

practitioners/physician assistants new referrer: occupational health care no referral needed for physiotherapy

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The future (2): The next step in public health monitoring

weekly extraction of data creates opportunities for:

monitoring infectious diseases (influenza) monitoring rare diseases and sudden

changes in morbidity patterns (bioterrorist attacks)

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The future (3):Technological innovations

ICPC-triggered pop-up screens with extra in-depth questions to investigate morbidity not

covered by ICPC

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More about LINH at:

www.linh.nlGraph and table headings in English