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Engels Jaarverslag 2008 Dit rapport is een uitgave van het NIVEL. De gegevens mogen worden gebruikt met bronvermelding. Continuous Morbidity Registration at Dutch Sentinel Stations 2008 Mrs. Dr. G.A. Donker U vindt dit rapport en andere publicaties van het NIVEL in PDF-format op: www.nivel.nl ISBN 978-94-6122-0097 http://www.nivel.nl [email protected] Telephone 030 2 729 700 Fax 030 2 729 729 ©2010 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 2008 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 Surveillance topics and incidental studies 26 4.5 Analyses 27 4.6 Extrapolation of observed frequencies to the Dutch population as a whole 29 4.7 Confidence intervals 30 5 Influenza(-like illness) 33 6 Pneumonia 45 7 Chickenpox 51 8 Whooping cough 58 9 Acute gastro-enteritis 65 10 STD 81 11 Unwanted pregnancy 87 Continuous Morbidity Registration at Dutch Sentinel Stations 2008, NIVEL 2010 3 12 Sexual problems and sexual violence 93 13 End-of–Life research 99 14 (Attempted) suicide 107 15 Diabetes mellitus 115 16 Euthanasia requests 118 17 Palliative Sedation 127 18 Eating disorders 135 19 General comments 143 20 Literature list 145 21 Footnotes 149 Appendix 1: participating doctors in 2008 153 Appendix 2: registered topics in the sentinel surveillance 1970-2009 (alphabetical) 155 Appendix 3: list of incidental studies 158 Appendix 4: age distribution of the population of the Netherlands 159 Appendix 5: annual tables 160 4 Continuous Morbidity Registration at Dutch Sentinel Stations 2008, NIVEL 2010 Foreword For the CMR Sentinel Stations the year 2008 was characterized predominantly by continuation of the transition from paper to electronic registration of CMR data. At the end of 2008 no data were be delivered on paper anymore. The transition to electronic registration was met by hurdles in the efficient processing of data. This annual report is still based on data collected by paper registration and registration via the so called sentinel software module. In substance, the start of gathering data on (fear of) sexually transmitted diseases and/of AIDS is worth mentioning. This category, started in collaboration with the RIVM, replaces the existing categories ‘urethritis in men’ and ‘fear of AIDS’. The first results are presented in this annual report and show, as expected, that the highest incidence does occur in the big cities. In collaboration with VU Medical Centre in Amsterdam the sentinel practices participated voluntarily in a study on the effects of integrated care in diabetes. In this study patients with diabetes participate by completing questionnaires and by keeping a diary on disease specific costs for three months. Seventeen sentinel practices function as controls for this study. The first results are presented in this annual report. They show that patients respond satisfactorily to the questionnaires and the registration of costs. The follow-up study in patients with eating disorders was continued and provided results that were published in Dutch and international journals. The results suggest that an early diagnosis may result in a better prognosis. The influenza epidemic of the past season (2008/2009) started shortly after the turn of the year. It peaked by the end of January 2009 and was higher than the peak in the previous three seasons. The epidemic lasted seven weeks, the viruses that circulated was predominantly of type A. At the end of the season the distribution between type A and B viruses was about fifty- fifty. The virus strains differed only slightly from the strains used for the vaccines, suggesting that vaccination provided a good protection. The resistance of influenza A(H1N1) against neuramidase inhibitors, as observed in the previous season, did not play a role this year because the dominant Continuous Morbidity Registration at Dutch Sentinel Stations 2008, NIVEL 2010 5 circulating virus was A(H3N2). The study on the possible difference between the clinical symptoms of patients infected with either neuramidase resistant or nonresistant A(H1N1) viruses was terminated. No differences were found, neither in the Dutch nor the European study. However, there was misfortune at the end of the season. By the end of April 2009 a new variant of influenza A(H1N1) was discovered in Mexico. At the time of this writing three inhabitants of the Netherlands were infected with this virus, all had traveled to Mexico. Because of the uncertainty with regard to virulence and contagiousness of the new virus it was made mandatory that health authorities were informed of any suspected infection. The collection of samples, tracing of contacts (fellow travelers) and treatment was coordinated by the Municipal Health Services (GGD). For the sentinel practices the emergence of the Mexican flu implied that intensive surveillance and sampling was continued longer than normal. This was highly appreciated by the health authorities and indicates that the CMR sentinel stations play a pivotal role in the surveillance of influenza, especially when it looms to become pandemic. Prof. dr. F.G. Schellevis Chairman of the Counseling Committee 6 Continuous Morbidity Registration at Dutch Sentinel Stations 2008, NIVEL 2010 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 with the patients registered in these practices about 0,8% 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 weekly data with regard to certain illnesses, events and procedures in general practice. In 2008 most practices provided these data electronically and ICPC-coded. The composition of the practice populations is updated yearly, in order to know precisely how the data relate to the whole population. Generally, the data are extrapolated to frequencies per 10,000 men or women and per age group (see p. 27). Each year the Counselling Committee selects the topics to be registered. 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 working at Nivel or from outside who is responsible for the registration is assigned. At least five conditions must be met for a disease or occurrence to be registered: 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 2008, NIVEL 2010 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 provides background information on each topic included in the registration for the first time. Refer to previous reports for information about "old" topics. See pages 155-158 for an overview of the years when topics were first included in the registration. 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 data collected by EMR, 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 2009. 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 in 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 2008, NIVEL 2010 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). In august 2008 this international collaborative program of, among others, all EU-countries has been incorporated into the European Center of Disease Control (ECDC) in Stockholm. In ECDC sentinel networks of GPs and national influenza centers of participating countries collaborate.
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