Robert A Verheij

• PhD
• Project Manager at Nivel – Research for better care

Background Some of those infected with SARS-CoV-2 suffer from post-COVID syndrome (PCS). However, an uniform definition of PCS is lacking, causing uncertainty about the prevalence and nature of this syndrome. We aimed to improve understanding of PCS by operationalizing different classifications and to explore clinical subtypes. Methods We used dat...

Purpose Global prevalence of tinnitus (15%) is rising, indicating an increase in patients seeking help for this common symptom and potentially affecting the accessibility of care. The aim of this retrospective study is twofold; describing the morbidity trends and healthcare utilization among patients with recorded tinnitus at Dutch general practice...

Background The post-COVID syndrome (PCS) has a large impact on an individual’s daily life. The wide variety of symptoms in PCS patients and the fact that it is still relatively new makes it difficult for general practitioners (GPs) to recognize, diagnose and treat patients with PCS, leading to difficulties in assessing and fulfilling healthcare nee...

Background In recent years, eHealth has received much attention as an opportunity to increase efficiency within healthcare organizations. Adoption of eHealth might consequently help to solve perceived health workforce challenges, including labor shortages and increasing workloads among primary care professionals, who serve as the first point of con...

Objective Natural language processing (NLP) can enhance research on activities of daily living (ADL) by extracting structured information from unstructured electronic health records (EHRs) notes. This review aims to give insight into the state-of-the-art, usability, and performance of NLP systems to extract information on ADL from EHRs. Materials...

Objectives This study aimed to assess the impact of on-demand versus continuous prescribing of proton pump inhibitors (PPIs) on symptom burden and health-related quality of life in patients with gastroesophageal reflux disease (GERD) presenting to primary care. Methods Thirty-six primary care centres across Europe enrolled adult GERD patients from...

Background Unplanned admissions to hospital represent a hazardous event for older people. Timely identification of high-risk individuals using a prediction tool may facilitate preventive interventions. Aim To develop and validate an easy-to-use prediction model for unplanned admissions to hospital in community-dwelling older adults using readily a...

Background The deployment of the mental health nurse, an additional healthcare provider for individuals in need of mental healthcare in Dutch general practices, was expected to substitute treatments from general practitioners and providers in basic and specialized mental healthcare (psychologists, psychotherapists, psychiatrists, etc.). The goal of...

Explantation is the proposed treatment for breast implant illness (BII). Little is known about which medical specialists are visited and what diagnoses are made before explantation is provided as the treatment. This study investigated medical specialist care utilization in women with cosmetic breast implants who underwent explantation compared to w...

Background Patient reported experiences (PREMs) are important indices of quality of care. Similarities in demography between patient and doctor, known as social concordance, can facilitate patient-doctor interaction and may be associated with more positive patient experiences. The aim of this research is to study associations between gender concord...

Background A national pay-for-performance (P4P) scheme was introduced in the Netherlands to incentivize appropriate prescribing among general practitioners (GPs) using routine care data of electronic health records (EHRs). The goal of this program was to encourage GPs to choose the most clinically appropriate and cost-effective medication for their...

Introduction This paper provides insight into the development of the Dutch Dementia Care and Support Registry and the lessons that can be learned from it. The aim of this Registry was to contribute to quality improvement in dementia care and support. Methods This paper describes how the Registry was set up in four stages, reflecting the four FAIR...

Background Experiences with organizational changes in daytime general practices and out-of-hours (OOH) services during the COVID-19 pandemic may help to address the challenges in general practice care that were already a concern before the crisis. This study aimed to describe these experiences and the potential usefulness of the organizational chan...

Introduction: Medical guidelines aim to stimulate stepped care for knee and hip osteoarthritis, redirecting treatments from hospitals to primary care. In the Netherlands, this development was supported by changing health insurance coverage for physio/exercise therapy. The aim of this study was to evaluate healthcare utilization patterns before and...

The Cohort Study of Mobile Phone Use and Health (COSMOS) study has repeatedly collected both self-reported and operator-recorded data on mobile phone use. Assessing health effects using self-reported information only is prone to measurement error, but operator data were available prospectively for only part of the study population and did not cover...

Background: Scientific researchers who wish to reuse health data pertaining to individuals can obtain consent through an opt-in procedure or opt-out procedure. The choice of procedure may have consequences for the consent rate and representativeness of the study sample and the quality of the research, but these consequences are not well known. Ob...

Background: In the nursing home sector, reusing routinely recorded data from electronic health records (EHRs) for knowledge development and quality improvement is still in its infancy. Trust in appropriate and responsible reuse is crucial for patients and nursing homes deciding whether to share EHR data for these purposes. A data governance framew...

Background A comprehensive overview of the burden of disease of burns for the full spectrum of care is not available. Therefore, we estimated the burden of disease of burns for the full spectrum in the Netherlands in 2018, and explored whether the burden of disease changed over the past 5 years (2014-2018). Methods Data were collected at four leve...

Importance It is unknown how often breast implant illness (BII) is the indication for revision in women with silicone breast implants. Objective To examine how often women with silicone breast implants have their implants explanted or replaced because of BII compared with local postoperative complications. Design, Setting, and Participants A lega...

BACKGROUND Scientific researchers who wish to reuse health data pertaining to individuals can obtain consent through an opt-in procedure or opt-out procedure. The choice of procedure may have consequences for the consent rate and representativeness of the study sample and the quality of the research, but these consequences are not well known. OBJE...

Background Primary Sjögren’s Syndrome (pSS) is a rare autoimmune disease that is difficult to diagnose due to a variety of clinical presentations, resulting in misdiagnosis and late referral to specialists. To improve early-stage disease recognition, this study aimed to develop an algorithm to identify possible pSS patients in primary care. We buil...

Objectives: To explore available data sources, secondary uses and key considerations for optimising the actionability of primary care prescribing data to improve quality of care in the Dutch context. Design: An exploratory qualitative study was undertaken based on semi-structured interviews. We anchored our investigation around three tracer pres...

Background In the Netherlands, General Practitioners (GP) are usually the first point of contact with a health professional for most health problems. Out-of-hours (OOH) primary care is provided by regional OOH services. Changes in consultation rates at OOH services may be regarded as a warning system for failures elsewhere in the healthcare system....

Background Increased opioid prescribing has raised concern, as the benefits of pain relief not always outweigh the risks. Acute and chronic pain is often treated in a primary care out-of-hours (OOH) setting. This setting may be a driver of opioid use but the extent to which opioids are prescribed OOH is unknown. We aimed to investigate weak and str...

Mensen met een slechte lichamelijke en geestelijke gezondheid zijn oververtegenwoordigd in de gevangenispopulatie. Onduidelijk is of die gezondheidsproblemen er al waren voor de detentie, of juist in de gevangenis zijn ontstaan of verergerd. In een gematcht cohortonderzoek op basis van Nivel Zorgregistraties Eerste Lijn en gevangenisgegevens is de...

Background Real-world data from electronic health records (EHRs) represent a wealth of information for studying the benefits and risks of medical treatment. However, they are limited in scope and should be complemented by information from the patient perspective. Objective The aim of this study is to develop an innovative research infrastructure t...

COVID-19 restrictions have resulted in major changes in healthcare, including the prescribing of antibiotics. We aimed to monitor antibiotic prescribing trends during the COVID-19 pandemic in Dutch general practice, both during daytime and out-of-hours (OOH). Routine care data were used from 379 daytime general practices (DGP) and 28 OOH-services o...

Background Individuals with poor health are largely overrepresented in prison populations. However, it remains unclear whether their poor health status already exists prior to their detention or reflects an effect of detention. We examined the health of detainees in the year before and after their detention and compared this with the health of matc...

BACKGROUND Real-world data from electronic health records (EHRs) represent a wealth of information for studying the benefits and risks of medical treatment. However, they are limited in scope and should be complemented by information from the patient perspective. OBJECTIVE The aim of this study is to develop an innovative research infrastructure t...

Background Telephone triage is used to facilitate efficient and adequate acute care allocation, for instance in out-of-hours primary care services (OPCSs). Remote assessment of health problems is challenging and could be impeded by a patient’s ambiguous formulation of his or her healthcare need. Socioeconomically vulnerable patients may experience...

BACKGROUND There is increasing attention for machine learning based clinical decision support systems (CDSS), but their added value and pitfalls are very rarely evaluated at the frontline of clinical practice. We have implemented a CDSS to aid general practitioners (GP) with the treatment of patients with urinary tract infections (UTI). UTIs are a...

Background: There is increasing attention on machine learning (ML)-based clinical decision support systems (CDSS), but their added value and pitfalls are very rarely evaluated in clinical practice. We implemented a CDSS to aid general practitioners (GPs) in treating patients with urinary tract infections (UTIs), which are a significant health burd...

Background Little is known about the public health impact of chronic exposure to physical and social stressors in the human environment. Objective of this study was to investigate the immediate and long-term health effects of living in an environment with gas-mining induced earthquakes and related stressors in the Netherlands. Methods Data on psyc...

Objectives Patients who present in primary care with chronic functional somatic symptoms (FSS) have reduced quality of life and increased health care costs. Recognising these early is a challenge. The aim is to develop and internally validate a clinical prediction rule for repeated consultations with FSS. Design and setting Records from the longit...

We aimed to obtain reliable reference charts for sleep duration, estimate the prevalence of sleep complaints across the lifespan and identify risk indicators of poor sleep. Studies were identified through systematic literature search in Embase, Medline and Web of Science (9 August 2019) and through personal contacts. Eligible studies had to be publ...

Objectives To evaluate whether the prevalence of health problems in cohabiting partners of people with dementia differs between the year before and the year after three transitions: the diagnosis of dementia, institutionalization and the death of the person with dementia. Methods Individuals with dementia and their partners were identified on the...

Background: Psychotropic drugs are frequently prescribed to people with dementia in nursing homes although severe adverse events and side effects are common. Less is known about the prevalence and types of psychotropic drug prescription in primary care for people with dementia. Objective: This study examined the prevalence of psychotropic drug pres...

Background Low socioeconomic position (SEP) is related to higher healthcare use in out-of-hours primary care services (OPCSs). We aimed to determine whether inequalities persist when taking the generally poorer health status of socioeconomically vulnerable individuals into account. To put OPCS use in perspective, this was compared with healthcare u...

Epidemiological evidence from prospective cohort studies on risk factors of Parkinson’s disease (PD) is limited as case ascertainment is challenging due to a lack of registries and the disease course of PD. The objective of this study was to create a case ascertainment method for PD within two prospective Dutch cohorts based on multiple sources of...

Introduction: Reliable estimates of time from diagnosis until institutionalization and death in people with dementia from routine nationally representative databases are lacking. Methods: We selected 9230 people with dementia and 24,624 matched controls from family physicians' electronic records linked with national administrative databases to a...

Objective Patient‐related outcome measures (PROMs) can guide clinicians in providing evidence‐based treatment and have the potential to empower patients, support clinical decision making, and improve quality of care. In order to make the information coming from PROMs useful, it is important to know to what extent the use of PROMs is biased in any w...

Background: The organizational model of out-of-hours primary care is likely to affect healthcare use. We aimed to examine differences in the use of general practitioner cooperatives for out-of-hours care in the Netherlands and Belgium (Flanders) and explore if these are related to organizational differences. Methods: A cross-sectional observatio...

Background Incidence rates and prevalence proportions are commonly used to express the populations health status. Since there are several methods used to calculate these epidemiological measures, good comparison between studies and countries is difficult. This study investigates the impact of different operational definitions of numerators and deno...

Objectives Major long-term care (LTC) reforms in the Netherlands in 2015 may specifically have disadvantaged socioeconomically deprived groups to acquire LTC, possibly impacting the use of acute care. We aimed to demonstrate whether LTC reforms coincided with changes in the use of out-of-hours (OOH) primary care services (PCSs), and to compare chan...

Inleiding Er zijn aanwijzingen dat gezamenlijke besluitvorming onnodig voorschrijven van antibiotica kan verminderen. De onderzoekers gingen na of in huisartsenpraktijken waar meer gezamenlijke besluitvorming plaatsvindt, minder vaak antibiotica worden voorgeschreven. Methode De onderzoekers maten het niveau van gezamenlijke besluitvorming met een...

Background Routine weight recording in electronic health records (EHRs) could assist general practitioners (GPs) in the identification, prevention, and management of overweight patients. However, the extent to which weight management is embedded in general practice in the Netherlands has not been investigated. The purpose of this study was to evalu...

Background Patient gender as well as doctor gender are known to affect doctor-patient interaction during a medical consultation. It is however not known whether an interaction of gender influences antibiotic prescribing. This study examined GP’s prescribing behavior of antibiotics at the first presentation of patients with sore throat symptoms in p...

Background: Both social and physical neighbourhood factors may affect residents' health, but few studies have considered the combination of several exposures in relation to individual health status. Aim: To assess a range of different potentially relevant physical and social environmental characteristics in a sample of small neighbourhoods in the N...

Objective An important reason why general practitioners (GPs) are less inclined to work in rural areas is a perception of a higher workload. This study assesses the differences in the workloads of GPs in rural and urban areas. We used two definitions of rurality, one based on the number of addresses per square kilometre, and a second defined by the...

Background: Increasing antibiotic resistance is recognized as a major threat to global health and is related to antibiotic prescription rates in primary care. Shared decision-making (SDM), the process in which patients and doctors participate together in making decisions, is argued to possibly promote more appropriate use of antibiotics and reduce...

BACKGROUND Routinely recorded electronic health records (EHRs) from general practitioners (GPs) are increasingly available and provide valuable data for estimating incidence and prevalence rates of diseases in the population. OBJECTIVE This paper describes how we developed an algorithm to construct episodes of illness based on EHR data to calculat...

Background: Low socioeconomic status (SES) is persistently associated with poor health and suboptimal use of healthcare services, and more unplanned healthcare use. Suboptimal use of emergency and acute healthcare services may increase health inequalities, due to late diagnosis or lack of continuity of care. Given that health literacy has been ass...

Background: Enormous amounts of data are recorded routinely in health care as part of the care process, primarily for managing individual patient care. There are significant opportunities to use these data for other purposes, many of which would contribute to establishing a learning health system. This is particularly true for data recorded in pri...

Background: Psychosocial research has shown that perceived exposure can influence symptom reporting, regardless of actual exposure. The impact of this phenomenon on the interpretation of results from epidemiological research on environmental determinants of symptoms is unclear. Objective: Our aim was to compare associations between modeled expos...

Doel In de beleving van huisartsen nemen de contacten op de huisartsenpost (HAP) toe in aantal en de urgentie. We wilden deze ervaringen onderbouwen met landelijke cijfers en onderzochten patiënt- en zorgkenmerken van contacten met HAP’s over de jaren 2013-2016. Methode We voerden een retrospectief crosssectioneel onderzoek uit op routinematig gere...

Purpose LIFEWORK is a large federated prospective cohort established in the Netherlands to quantify the health effects of occupational and environmental exposures. This cohort is also the Dutch contribution to the international Cohort Study of Mobile Phone Use and Health (COSMOS). In this paper, we describe the study design, ongoing data collection...

Objectives It is unclear why the use of email consultation is not more widespread in Dutch general practice, particularly because, since 2006, its costs can be reimbursed. To encourage further implementation, it is needed to understand the current use of email consultations. This study aims to understand the use of email consultation by different p...

The aim of our study was to investigate the association between health enhancing and threatening, and social and physical aspects of the neighbourhood environment and general practitioner (GP) assessed morbidity of the people living there, in order to find out whether the effects of environmental characteristics add up or modify each other. We comb...

Background Adequate record keeping of medication adverse events in electronic health records systems is important for patient safety. Events that remain unrecorded cannot be communicated from one health professional to another. In the absence of a gold standard, we investigate the variation between Dutch general practices in the extent to which the...

Background Since in an ageing society more long-term care (LTC) facilities are needed, it is important to understand the main determinants of first-time utilization of (LTC) services. Methods The Andersen service model, which distinguishes predisposing, enabling and need factors, was used to develop a model for first-time utilization of LTC servic...

Objective Facing challenges to establish a new national syndromicsurveillance system in the Netherlands for infectious diseases amongasylum seekers.IntroductionMost European countries are facing a continuous increased influxof asylum seekers [1]. Poor living conditions in crowded shelters andrefugee camps increase the risk for - outbreaks of - infe...

Lagerugpijn komt frequent voor. Volgens de NHG-Standaard Aspecifieke lagerugpijn overweegt de huisarts verwijzing naar een fysio- of oefentherapeut indien de patiënt er niet in slaagt om binnen drie weken de activiteiten uit te breiden tot normaal en als de patiënt hiertoe gemotiveerd is.

In de periode 2013-2015 is de gemiddelde omvang van de zorgvraag op de huisartsenpost nauwelijks veranderd. Het aantal contacten met een hogere urgentie steeg wel. Omdat ouderen steeds langer thuis blijven wonen en mensen met GGZ-problemen vaker door de huisarts worden behandeld, verwachtten verschillende partijen een toename van de zorgvraag op de...

Purpose: To assess the extent to which clinical rules (CRs) can be implemented for automatic evaluation of quality of care in general practice. Methods: We assessed 81 clinical rules (CRs) adapted from a subset of Assessing Care of Vulnerable Elders (ACOVE) clinical rules, against Dutch College of General Practitioners (NHG) data model. Each CR...

Samenvatting Van Dijk CE, De Jong JD, Verheij RA, Jansen T, Korevaar JC, De Bakker DH. Hoe goed volgen patiënten een verwijzing naar de specialist op? Huisarts Wet 2017;60(1):9-11. Achtergrond Huisarts en patiënt beslissen samen of een verwijzing naar medisch-specialistische zorg nodig is, maar het is de patiënt die de beslissing neemt daadwerkeli...

AimThe Dutch Sentinel General Practice Network (SGPN) was founded in 1970 for disease surveillance in primary care, based on paper questionnaires. Advances in information technology offered new prospects of data collection from electronic health records (EHRs). This study investigates the resulting challenges for the SGPN and its transition towards...

Objective: Electronic health record (EHR) data are used to exchange information among health care providers. For this purpose, the quality of the data is essential. We developed a data quality feedback tool that evaluates differences in EHR data quality among practices and software packages as part of a larger intervention. Methods: The tool was...

Gezondheidstests zijn in opkomst door onder andere technologische ontwikkelingen. Mensen maken steeds meer gebruik van de mogelijkheid om buiten de huisarts om gezondheidstests uit te (laten) voeren en zo meer grip te krijgen op hun eigen gezondheid. Enerzijds helpt dit om mensen meer bewust te laten worden van hun eigen verantwoordelijkheid voor h...

Background In a gatekeeper system, primary care physicians and patients jointly decide whether or not medical specialist care is needed. However, it is the patient who decides to actually use the referral. Referral non-compliance could delay diagnosis and treatment. The objective of this study was to assess patient compliance with a referral to med...

Objective: How do healthcare consumers perceive the use of medical data for scientific research, within the framework of protection of their personal data? Design: Survey among 731 members of the Healthcare Consumer Panel of the Netherlands Institute for Health Services Research (NIVEL). Method: A written and online questionnaire was used, con...

The connection of clinical care with clinical research is the main purpose of the Learning Health System (LHS) integrating scientific information, informatics, and patient care. The LHS generates new medical knowledge as a by-product of the care process. For this purpose, the aggregation of data from Electronic Health Records (EHR), Case Report For...

Objectives: Dutch primary out-of-hours care is provided by general practice cooperatives (GPCs). Although most GPCs use the same standardised triage system, differences between GPCs exist in the urgency assigned to patients' health problems. This cross-sectional study aims to provide insight into factors associated with the variation in assigned u...

The discussion about the European regime for processing personal data is entering a new phase. After the European Commission had proposed a new General Data Protection Regulation (GDPR) in 2012, the European Parliament proposed a different version in May 2014. The proposal of the European Parliament of the GDPR restricts processing personal data by...

Huisartsen hebben een volledig beeld van de gezondheid van de Nederlandse bevolking. Bijna iedereen staat immers bij een huisarts ingeschreven en de huisarts is als poortwachter de eerste zorgprofessional waarmee contact wordt gezocht bij een medisch probleem.

To assess guideline adherence of co-prescribing NSAID and gastroprotective medications for elders in general practice over time, and investigate its potential association with the electronic medical record (EMR) system brand used. We included patients 65 years and older who received NSAIDs between 2005 and 2010. Prescription data were extracted fro...