Huug J van Duijn

University Medical Center Utrecht, Utrecht, Provincie Utrecht, Netherlands

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Publications (20)19.51 Total impact

  • Huug van Duijn
    Huisarts en wetenschap 09/2010; 53(12).
  • Huug van Duijn
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    ABSTRACT: Samenvatting Diffuse haaruitval is verlies van hoofdhaar volgens een bepaald patroon. Patiënten komen bij de huisarts omdat ze ongerust zijn over het dunner worden van hun haar of de plotseling opgetreden kale plek. Meestal vrezen ze dat dit een voorteken is van geheel kaal worden. Uiteraard spelen ook esthetische bezwaren een grote rol.
    Huisarts en wetenschap 01/2009; 52(7):360-360.
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    ABSTRACT: GPs are often consulted for respiratory tract symptoms in children. To explore characteristics of children, their parents, and their GPs that are correlated with consulting a GP for cough, sore throat, or earache. Second Dutch National Survey of General Practice (DNSGP-2) with a health interview and an additional questionnaire. Children aged 0-17 years registered with 122 GPs in Dutch general practice. Characteristics of patients and their GPs were derived from the DNSGP-2 health interview and a questionnaire, respectively. Characteristics of the illness symptoms and GP consultation were acquired by means of an additional questionnaire. Data were analysed using multivariate logistic regression. Of all children who completed the questionnaire, 550 reported cough, sore throat, or earache in the 2 weeks preceding the interview with 147 of them consulting their GP. Young children more frequently consulted the GP for respiratory symptoms, as did children with fever, longer duration of symptoms, those reporting their health to be 'poor to good', and living in an urban area. When parents were worried, and when a child or their parents were cued by someone else, the GP was also consulted more often. GP-related determinants were not associated with GP consultation by children. This study emphasises the importance of establishing the reasons behind children with respiratory tract symptoms consulting their GP. When GPs are aware of possible determinants of the decision to consult a GP, more appropriate advice and reassurance can be given regarding these respiratory symptoms, which are generally self-limiting.
    British Journal of General Practice 05/2008; 58(549):248-54. · 2.03 Impact Factor
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    ABSTRACT: Although the vast majority of respiratory tract symptoms are self-limiting, many patients visit their GP for these symptoms and antibiotics are over-prescribed. To explore determinants of patients visiting GPs for recent cough, sore throat, or earache; for being prescribed antibiotics; and for patients' satisfaction with visiting the GP. Design of the study: Second Dutch National Survey of General Practice (DNSGP-2) with a health interview and an additional questionnaire. A total of 7057 adult patients of 163 GPs in the Netherlands. Characteristics of patients and GPs as well as morbidity data were derived from the DNSGP-2 and a health interview. Characteristics of the symptoms, GPs' management and patients' satisfaction were measured by an additional written questionnaire. Data were analysed by means of multivariate logistic regression. About 40% of the responders (n = 1083) reported cough, sore throat, or earache in the 2 weeks preceding the interview and, of them, 250 visited their GP. Of this latter group, 97 patients were prescribed antibiotics. Apart from non-medical reasons, relevant medical factors played an important role in deciding to visit the GP. Smokers and patients with cardiac disease or diabetes mellitus were not especially inclined to see their GP. Smoking behaviour, fever, and views on respiratory tract symptoms and antibiotics of patients and GPs were associated with being prescribed antibiotics. Patients' perception of having been carefully examined was associated with their satisfaction, while receiving antibiotics was not. GPs should inform patients with clear elevated risk when to visit their GP in cases of cough, sore throat, or earache. There is still a need for GPs and patients to be better informed about the limited significance of single inflammation signs (for example, fever and green phlegm) as an indication for antibiotics. Careful examination of the patient contributes to patient satisfaction.
    British Journal of General Practice 08/2007; 57(540):561-8. · 2.03 Impact Factor
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    ABSTRACT: Next to other GP characteristics, diagnostic labelling (the proportion of acute respiratory tract (RT) episodes to be labelled as infections) probably contributes to a higher volume of antibiotic prescriptions for acute RT episodes. However, it is unknown whether there is an independent association between diagnostic labelling and the volume of prescribed antibiotics, or whether diagnostic labelling is associated with the number of presented acute RT episodes and consequently with the number of antibiotics prescribed per patient per year. Data were used from the Second Dutch National Survey of General Practice (DNSGP-2) with 163 GPs from 85 Dutch practices, serving a population of 359,625 patients. Data over a 12 month period were analysed by means of multiple linear regression analysis. Main outcome measure was the volume of antibiotic prescriptions for acute RT episodes per 1,000 patients. The incidence was 236.9 acute RT episodes/1,000 patients. GPs labelled about 70% of acute RT episodes as infections, and antibiotics were prescribed in 41% of all acute RT episodes. A higher incidence of acute RT episodes (beta 0.67), a stronger inclination to label episodes as infections (beta 0.24), a stronger endorsement of the need of antibiotics in case of white spots in the throat (beta 0.11) and being male (beta 0.11) were independent determinants of the prescribed volume of antibiotics for acute RT episodes, whereas diagnostic labelling was not correlated with the incidence of acute RT episodes. Diagnostic labelling is a relevant factor in GPs' antibiotic prescribing independent from the incidence of acute RT episodes. Therefore, quality assurance programs and postgraduate courses should emphasise to use evidence based prognostic criteria (e.g. chronic respiratory co-morbidity and old age) as an indication to prescribe antibiotics in stead of single inflammation signs or diagnostic labels.
    BMC Family Practice 02/2007; 8:55. · 1.61 Impact Factor
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    ABSTRACT: Van Duijn HJ, Kuyvenhoven MM, Schellevis FG, Verheij ThJM. Groen slijm, witte stippen en antibiotica. Opvattingen van patiënten en huisartsen en het beleid bij luchtweginfecties. Huisarts Wet 2007;50(4):150-5. Luchtwegklachten gaan meestal vanzelf over en antibiotica zijn dan ook zelden nodig. Toch schrijven huisartsen veelvuldig antibiotica voor bij deze klachten. Tegen deze achtergrond wilden wij nagaan in hoeverre de opvattingen van huisartsen en patiënten over luchtwegklachten en antibiotica van elkaar verschillen, en of die opvattingen een rol spelen bij het ziektegedrag van patiënten en bij de beslissing van de huisarts om antibiotica voor te schrijven. De resultaten van het onderzoek zijn gebaseerd op gegevens van de Tweede Nationale Studie van het NIVEL. De opvattingen van patiënten en huisartsen over luchtwegklachten en antibiotica blijken inderdaad van elkaar te verschillen. Om misverstanden te voorkomen en gemakkelijker overeenstemming over de behandeling te bereiken, zou de huisarts tijdens het consult de verwachtingen en opvattingen van de patiënt meer moeten exploreren. Zowel patiënten als huisartsen gaven aan dat zij ontstekingsverschijnselen als groen sputum en witte stippen in de keel een belangrijke reden vinden voor antibiotica. Wellicht kunnen gerichte publiekscampagnes en nascholing dit beeld bijstellen. Patiënten die aangaven dat de huisarts hen zorgvuldig had onderzocht, waren vaker tevreden over het consult. Of zij al dan niet antibiotica kregen, was niet van invloed op die tevredenheid. Huisartsen die aangaven dat zij snel geneigd zijn nieuwe medicijnen voor te schrijven, schreven relatief meer tweedekeusantibiotica voor bij luchtwegepisodes. De neiging om snel nieuwe geneesmiddelen voor te schrijven hangt sterk samen met het ontvangen van artsenbezoekers. Het verdient daarom aanbeveling dat de huisarts de verwerving van nieuwe farmacotherapeutische informatie bewust beperkt tot FTO en nascholing. Van Duijn HJ, Kuyvenhoven MM, Schellevis FG, Verheij ThJM. Green sputum, white spots and antibiotics: Role of patients’ and doctors’ views and the management of respiratory tract infections. Huisarts Wet 2007;50(4):150-5. Although the vast majority of respiratory tract symptoms are self-limiting and antibiotics are seldom needed, general practitioners (GPs) frequently prescribe antibiotics for these symptoms. Therefore this study aimed to explore differences in views on respiratory tract symptoms and antibiotics and to explore the role of these views on the management of respiratory tract symptoms of both patients and GPs. The results of the study are based on data derived from the Second Dutch National Survey of General Practice of NIVEL (DNSGP-2). Patients’ views differ from those of GPs. To avoid misperceptions and to enhance shared decision-making, GPs should better explore patients’ expectations and views during consultation. Both patients and GPs reported signs of inflammation such as green sputum and white spots in the throat to be important reasons for prescribing antibiotics. Public campaigns and postgraduate training will probably be able to provide a more appropriate opinion on the prognostic value of these inflammation signs. Patients who reported having been carefully examined by the GP were more often satisfied with the visit, while being prescribed antibiotics was not associated with patients’ satisfaction. GPs who reported a greater inclination to prescribe new drugs prescribed relatively more second-choice antibiotics for respiratory tract episodes. The number of visits by pharmaceutical company representatives was strongly associated with this inclination. Therefore information on pharmacotherapy should be obtained by participating in pharmacotherapy peer review groups or postgraduate training programs. antibiotica-beschouwing-luchtweginfecties (bovenste)-patiënten-ziektegedrag
    Huisarts en wetenschap 01/2007; 50(4):254-261.
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    ABSTRACT: To explore views on respiratory tract symptoms (cough, sore throat and earache) and antibiotics of GPs, practice staff, and patients. In a nationwide study, 181 GPs, 204 practice staff members and 1250 patients from 90 practices participated by answering 14 items relating to views on respiratory tract symptoms and antibiotics in a written questionnaire. Differences in means were compared. Patients more than GPs endorsed the seriousness of respiratory tract symptoms, the need to consult a GP, the need to prescribe antibiotics, and the ability of antibiotics to speed up recovery. GPs were more than patients convinced of the self-limiting character of respiratory tract symptoms and of the fact that antibiotics have side effects. Practice staff took a middle ground in most of these views. Differences between GPs, practice staff and patients must be taken into account when exploring patients' complaints and advising on treatment. Education and knowledge programmes for practice staff might be advocated.
    Patient Education and Counseling 07/2006; 61(3):342-7. · 2.60 Impact Factor
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    ABSTRACT: The aim of this study was to assess the association between general practitioners' (GPs') characteristics and the volume of second-choice antibiotics for acute respiratory tract (RT) episodes by GPs. Morbidity and antibiotic prescription data originated from the Second Dutch National Survey of General Practice (DNSGP-2). GPs' characteristics, including professional activities and views on RT symptoms and antibiotics, were measured by a written questionnaire. Multiple regression was carried out to assess associations between possible determinants and volume of second-choice antibiotic prescriptions. In approximately 39% of acute RT episodes antibiotics were prescribed, with one-quarter being second-choice antibiotics, relatively more frequently in lower than in upper RT episodes: 30 versus 19%. GPs who were more frequently consulted by patients with RT episodes (beta = 0.29; 95% CI 0.13-0.41), who labelled RT episodes more as diagnoses than as symptoms (beta = 0.27; 95% CI 0.15-0.42), who less frequently used national GP guidelines (beta = -0.17; 95% CI -0.31 to -0.03) and who were more inclined to prescribe new drugs (beta = 0.26; 95% CI 0.13-0.40), prescribed more second-choice antibiotics. Given the growing number of prescriptions of second-choice antibiotics, it is important to implement professional guidelines in daily practice, while training in being reluctant to prescribe new drugs and being alert to the marketing activities of pharmaceutical companies should be started in the medical curriculum.
    Journal of Antimicrobial Chemotherapy 09/2005; 56(2):420-2. · 5.34 Impact Factor
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    The European Journal of General Practice 01/2005; 11(3-4):139-40. · 0.74 Impact Factor
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    British Journal of General Practice 07/2003; 53(491):491-2. · 2.03 Impact Factor
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    ABSTRACT: To explore the views of patients and doctors on respiratory tract symptoms. Transversal survey among patients and general practitioners. Primary health care and community. 51 patients attending a general practitioner, 38 patients in the community, 7 general practitioners. Patients' and doctors' views on respiratory tract symptoms and differences between them: agreement with statements rated on a 5-point scale, ranging from "strongly disagree" to "strongly agree." Patients less than doctors endorsed the self-limiting character of cough, sore throat and earache (mean 3.1, 3.4 and 2.9 versus 4.1, 4.1 and 3.7) and patients--much more than doctors--rated antibiotics as being necessary for cough and sore throat (mean 2.7 and 2.9 versus 1.7 and 17) and believed that antibiotics speed recovery (mean 3.7 versus 2.0). However, there was little difference relating to the necessity to see a doctor after some time period. Patients appeared to differ from doctors in views on respiratory tract symptoms. The results stress the importance of exploring patients' views when being confronted by patients suffering from respiratory tract symptoms.
    Scandinavian Journal of Primary Health Care 01/2003; 20(4):201-2. · 1.91 Impact Factor
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    British Journal of General Practice 53(491):491-492. · 2.03 Impact Factor
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    ABSTRACT: Uijen JHJM, Van Duijn HJ, Kuyvenhoven MM, Schellevis FG, Van der Wouden JC. Kinderen met hoesten, keelpijn en oorpijn: wie raadpleegt de huisarts? Huisarts Wet 2008;51(13):663-8. Inleiding Luchtwegklachten als hoesten, keelpijn en oorpijn komen bij kinderen vaak voor en gaan meestal vanzelf over. Toch raadplegen veel (ouders van) patiënten hiervoor de huisarts. We onderzochten welke kenmerken van kinderen, hun ouders en hun huisartsen samenhangen met het besluit om voor deze klachten naar de huisarts te gaan. Methode We gebruikten de Tweede Nationale Studie naar ziekten en verrichtingen in de huisartspraktijk om kenmerken van kinderen van nul tot zeventien jaar en hun huisartsen in kaart te brengen. We stuurden een vragenlijst naar patiënten om de aanwezigheid van luchtwegklachten te achterhalen en na te gaan of ze er hun huisarts voor hadden bezocht. We analyseerden de gegevens aan de hand van een multivariate logistische regressieanalyse. Resultaten Van de 550 kinderen die in de twee weken voorafgaande aan het interview hoestten, of keelpijn of oorpijn hadden, bezochten er 147 hun huisarts. Jonge kinderen gingen vaker naar de huisarts voor respiratoire symptomen dan oudere kinderen. Dit gold tevens voor kinderen bij wie sprake was van koorts, langere ziekteduur, en voor kinderen die hun gezondheid als ‘slecht’ tot ‘goed’ beoordeelden of die in een stedelijk gebied woonden. Ook gingen kinderen vaker naar de huisarts als de ouders ongerust waren en als de kinderen of de ouders door iemand anders waren geadviseerd om naar de huisarts te gaan. Huisartskenmerken hingen niet samen met de mate van consultatie.
    Huisarts en wetenschap 51(13):663-668.
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    ABSTRACT: Achtergrond: Huisartsen worden vaak geconsulteerd voor luchtwegklachten bij kinderen. Doel: Exploratie of kenmerken van kinderen, hun ouders en hun huisartsen zijn geassocieerd met contact met de huisarts voor hoest, keelpijn en oorpijn. Studieopzet: Tweede Nationale Studie naar Ziekten en Verrichtingen in de Huisartsenpraktijk (NS2) met een gezondheidsinterview en een additionele vragenlijst. Setting: Kinderen van 0-17 jaar ingeschreven bij 122 Nederlandse huisartsen. Methoden: Kenmerken van de kinderen en hun huisartsen werden uit het gezondheidsinterview en de vragenlijst van de NS2 vastgesteld. Aanwezigheid van luchtwegklachten en een eventueel contact met de huisarts werden verkregen met een additionele vragenlijst. Data werden geanalyseerd met multivariate logistische regressie. Resultaten: Van alle kinderen rapporteerden er 550 hoest, keelpijn of oorpijn in de twee weken voorafgaande aan het interview en 147 van hen consulteerden hun huisarts. Jonge kinderen consulteerden meer frequent de huisarts voor respiratoire symptomen; dit gold tevens voor kinderen met koorts, langere zieketeduur, kinderen die hun gezondheid als "slecht tot goed" rapporteerden en kinderen die in een stedelijk gebied woonden. Wanneer de ouders ongerust waren, en als het kind/de ouders naar de huisarts waren gestuurd door iemand anders, werd de huisarts vaker geraadpleegd. Huisartsgerelateerde factoren waren niet geassocieerd met de consultatie van de huisarts door kinderen. Conclusie: Deze studie benadrukt hoe belangrijk het is om de consultredenen voor kinderen met luchtwegklachten te exploreren. Wanneer de huisarts zich bewust is van de mogelijke determinanten van het besluit om de huisarts te raadplegen, zal meer passend advies en geruststelling gegeven kunnen worden voor deze luchtwegklachten, die meestal zelf-limiting zijn.