Titel Rapport

Published by NIVEL. The use of figures and/or texts to explain or support articles, books and theses is allowed provided that the source is stated clearly You can order the report through [email protected] Continuous Morbidity Registration at Dutch Sentinel Stations 2007 Mrs. Dr. G.A. Donker NIVEL, Netherlands Institute for Health Services Research PO box 1568, 3500 BN Utrecht, the Netherlands You can download this report and other NIVEL publications as pdf.formats on: www.nivel.eu ISBN 978-90-6905-9372 http://www.nivel.nl [email protected] Telephone 030 2 729 700 Fax 030 2 729 729 ©2007 NIVEL, PO Box 1568, 3500 BN UTRECHT No part of this report may be reproduced, stored in a retrieval system, or transmitted in any form or by any means without the written consent of the NIVEL at Utrecht, the Netherlands. The use of figures, and/or text as clarification or support in articles is permitted, provided the source is clearly mentioned. Contents Foreword 5 1 Introduction 7 1.1 International cooperation 9 2 Counselling Committee 11 3 Sentinel station staff seminar in 2006 13 4 Distribution of sentinel stations in the Netherlands 15 4.1 Practices 16 4.2 Practice populations 18 4.3 Scale and continuity of reporting 22 4.4 Weekly return 26 4.5 Analyses 27 4.6 Extrapolation of observed frequencies to the Dutch population as a whole 29 4.7 Confidence intervals 31 5 Influenza(-like illness) 33 6 Pneumonia 47 7 Chickenpox 53 8 Whooping cough 61 9 Acute gastro-enteritis 69 10 Fear of AIDS 83 11 Urethritis in men 91 Continuous Morbidity Registration at Dutch Sentinel Stations 2007, NIVEL 2008 3 12 Sports injuries 97 13 Unwanted pregnancy 103 14 Sexual problems and sexual violence 109 15 End-of–Life research 115 16 (Attempted) suicide 121 17 Euthanasia requests 129 18 Palliative Sedation 137 19 Eating disorders 145 20 General comments 151 21 Literature list 153 22 Footnotes 158 Appendix 1: participating doctors in 2007 161 Appendix 2: Weekly return in 2007 163 Appendix 3: topics on the weekly returns 1970-2008 164 Appendix 4: list of incidental studies 167 Appendix 5: age distribution of the population of the Netherlands 168 Appendix 6: annual tables 169 Appendix 7: explanatory notes 176 4 Continuous Morbidity Registration at Dutch Sentinel Stations 2007, NIVEL 2008 Foreword For the CMR Sentinel Stations the year 2007 was characterized predominantly by continuation of the transition from paper to electronic registration of CMR data. At the end of 2007 only six practices still registered data on paper forms. The transition to electronic registration was met by hurdles in the efficient processing of data because the CMR module could not be integrated yet in the Microhis and Medicom registration systems. During the period of transition all practices were asked to register on paper as well as electronically to allow identification of possible flaws in the new system. Many thanks to all GPs for the extra effort. This annual report is based on data gathered both via the old pencil and paper method and electronic registration. The start of the study on the incidence of pneumonia in general practice and its sensitivity to antibiotics has important implications. The surveillance of antibiotic resistance requires regular monitoring of the micro-organisms involved. The study may also serve as a description of the point-zero situation after implementation of pneumococcal vaccination in children in 2006. Three years in succession the Sentinel Stations have registered sport injuries, about 230,000 per year, from which it became apparent that the chance for men to get a sport injury far exceeds the chance of women. Sport injuries occur at all ages, but peak between 15 and 19 years; both for boys and girls. GPs in rural areas treat more sport injuries, most likely because of a greater distance to a hospital, making treatment in the hospital a less attractive option. The increase in the number of registered sport injuries in the past years might be due to the increased availability of primary care during evenings, nights and weekends. Continuous Morbidity Registration at Dutch Sentinel Stations 2007, NIVEL 2008 5 The influenza epidemic only started after the turn of 2007-2008. The epidemic peaked mid February but was less high than in the previous season. The epidemic lasted eight weeks and throughout the season influenza A viruses were predominant. They only differed slightly from the viruses used in the vaccine, which therefore may have provided good protection. Quite unexpected was the finding that 27% of the circulating A strains were resistant to the antivral agent oseltamivir. Although this agent is hardly prescribed by Dutch GPs, this finding may have important consequences for the protection against a possible pandemic. Therefore NIVEL and NIC have started a study to the possible difference in morbidity and mortality invoked by viruses that are resistant or non-resistant to antiviral agents. A difference might point to increased virulence of mutated strains. For this study GPs were asked to fill in extra forms for each patient with proven influenza. Thus far no differences in morbidity and mortality were observed, however further analysis of the data is in progress and will be published separately. The high response rate of GPs to this inquiry, demanding extra time, was highly appreciated by the project management. Professor J. van der Zee Chairman of the Counseling Committee 6 Continuous Morbidity Registration at Dutch Sentinel Stations 2007, NIVEL 2008 1 Introduction Continuous Morbidity Registration is a method of gathering data by means of records kept by general practitioners. A national network of general practices, called Sentinel Stations, covers approximately 1% of the Dutch population. The network structure takes account of the geographical distribution of the population and its distribution over areas with different degrees of urbanisation (see pp 15-18). The GPs in the network, the Sentinel Doctors, submit a weekly form to report certain illnesses, occurrences and procedures. The form is called the ‘weekly return’. A weekly return gives a breakdown by age and, when necessary, by gender (see p. 161). In 2007 this form has in some practices been replaced by ICPC coded electronic registration. A census is held every two years among the practice populations involved to determine the size and make-up of the population to which the gathered data must be related. Frequencies are generally calculated by age group per 10,000 men or women (see p. 27). Each year the Counselling Committee selects the topics to be placed on the weekly return. The Committee also considers requests and suggestions received from other parties. If a decision is made for the inclusion of a new topic a supervisor who is responsible for the registration is assigned. At least five conditions must be met for a disease or occurrence to be placed on the weekly return: 1 The importance of the topic must be described. 2 Strict and unambiguous criteria must be definable for the disease or occurrence to be registered. 3 Application of these criteria must not take too much time and must fit in with the GP's work. 4 A need must exist for representative information at the national level. 5 The CMR Sentinel Stations must be the best source of information. Continuous Morbidity Registration at Dutch Sentinel Stations 2007, NIVEL 2008 7 The recording of data for a topic is discontinued if the topic ‘owner’ feels that data has been collected for a sufficiently long period of time, or if a different registration system is going to gather more or less the same information, or if insurmountable problems have arisen in the recording of data. This report gives background information on each topic included in the weekly return for the first time. Refer to previous reports for information about "old" topics. See pages 164-166 for an overview of the years when topics were first included in the weekly return. An examination of the topics studied over the years leads to the conclusion that the name ‘Continuous Morbidity Registration’ does not actually cover all aspects of the work. After all, some of the topics covered are interventions or occurrences and not illnesses. The name ‘Sentinel Stations’ is more apt because monitoring is performed, sometimes for a year or more and sometimes permanently. Therefore this project is called Continuous Morbidity Registration Dutch Sentinel Stations. Besides completing the weekly returns, sentinel doctors have been providing data for "incidental studies" since 1976. The incidental studies focus on relatively uncommon diseases and occurrences. The appendix 3 lists the subjects covered by the studies. Here we report the data assembled in 2007. The difference with other topics is that the data are requested only once a year, usually immediately after the end of the year. This approach allows data to be gathered retrospectively on subjects for which the need for registration did not become apparent until after the start of the year. One condition is that the subject must be well imprinted on the memory of the doctor. This report contains neither an exhaustive (statistical) analysis nor a detailed discussion of the data. The purpose of the report is to compile and disseminate the basic data that is reported in the year in question. 8 Continuous Morbidity Registration at Dutch Sentinel Stations 2007, NIVEL 2008 1.1 International cooperation The CMR Sentinel Stations have been participating in international projects since 1985. The oldest project at present is the European Influenza Surveillance Scheme (EISS). The networks of spotter GPs at sentinel stations and the national influenza centres of the participating countries cooperate with each other in EISS.

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