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Lex Goudswaard, GP, PhD Kees in ’t Veld, GP Saskia Mol, MD, PhD Netherlands College of GPs (NHG) Guidelines... Guidelines: indispensable for quality assurance / improvement, but... Guidelines do not implement themselves! Kathleen Lohr Close contact between ‘makers’ and ‘users’ is very helpful (if not necessary) for a successful guideline program! Jonathan Lomax What’s old? • 50 GPs (randomly selected) are invited to comment upon the concept of the guideline What’s new? • • 50 GPs… involvement, from the start, of a staffmember with knowledge and experience in implementation What’s new (2)? • Discussion group at University Institute for Vocational Training: • 6-8 GP trainers • 1 GP trainee • 3 staff NHG (chair) Method • • • • • • Spontaneous abortion Problem drinking Lower urinary tract symptoms Urinary tract infection Heart failure Osteoporosis Results (1) Proposed changes • • 70 Items changed Partially changed Total 30 13 43 (43%) (19%) (61%) Results (2) Alcohol • • Definition: abuse, dependancy, problem drinking… …problem drinking • • Making up the vitamin deficiency… …in malnourished people Results (3) LUTS • • • Referral for further investigations and/or treatment linked to a life expectancy of 10 yrs… …72 yrs, co-morbidity emphasis on shared decision making Results (4) Spontaneous abortion • • Neutral stand on wait&see versus D&C… …clear stand on the advantage of wait&see • Workshop Workshop Keyfeatures clinical guideline UTI: 1. 2. UTI without fever in healthy, non pregnant woman = uncomplicated All other UTI are complicated Workshop 3. 4. High risk patients: physical examination (abdomen, VE)! A screening test of leucocyte enzymes can determine treatment Workshop 5. 6. Treatment of choice: nitrofurantoin (5 day course) Treatment complicated UTI: longer, with antibiotics effective against a wide range of bacteria Thank you very much! P.O. Box 3231 3502 GE Utrecht the Netherlands +3130 288 17 00 [email protected]