1. Robert Verheij, Nottingham, July 20, 2005 Slide 1 LINH

2. Robert Verheij, Nottingham, July 20, 2005 Slide 2 The Netherlands Information Network of General Practice

3. Robert Verheij, Nottingham, July 20, 2005 Slide 3 Overview n position of the GP in the Netherlands n organisation and funding n what data are collected and how n research projects n the future

4. Robert Verheij, Nottingham, July 20, 2005 Slide 4 Position of GP in the Netherlands n first point of contact with the health care system n gatekeeper for secondary care n fixed patient list n all Dutch citizens are listed with one GP n mixed reimbursement system: capitation fee (publicly insured) fee for service (privately insured)

5. Robert Verheij, Nottingham, July 20, 2005 Slide 5 Organisation and funding A joint project of: Dutch association of GPs Dutch College of GPs Centre for Quality of Care Research (WOK) NIVEL Basic infrastructure funded by the Dutch Ministry of Health

6. Robert Verheij, Nottingham, July 20, 2005 Slide 6 Aims of LINH: Collect information in GP practices for: n health services research n quality of care research n public health monitoring

7. Robert Verheij, Nottingham, July 20, 2005 Slide 7 Representativeness n 80 computerised general practices (about 350.000 patients) n 6 major GP software packages

8. Robert Verheij, Nottingham, July 20, 2005 Slide 8 Data flow 1. Every day: full morbidity and interventions recording in general practice. 2. Every six months: n extraction software sent to GPs n GPs retrieve data and send it to LINH n storage in central database

9. Robert Verheij, Nottingham, July 20, 2005 Slide 9 Data flow (2) 3. Every week: n extraction and upload of selection of diseases in 45 practices n influenza surveillance

10. Robert Verheij, Nottingham, July 20, 2005 Slide 10 Quality assurance n practice selection procedures n support for ICPC coding n extensive software testing and checking n data-flow procedures, quality checks n feedback reports to practices n practice visits (at least bi-annually)

11. Robert Verheij, Nottingham, July 20, 2005 Slide 11 History of LINH

12. Robert Verheij, Nottingham, July 20, 2005 Slide 12 What data are collected? n contacts + diagnosis + episode typing (new/existing) n referrals + associated diagnosis n prescriptions (ATC codes) + associate diagnosis n diagnoses coded using ICPC n patient characteristics (sex, date of birth, postcode area, type of insurance)

13. Robert Verheij, Nottingham, July 20, 2005 Slide 13 Individual patient records n follow patients in time (care chains) n comorbidity n comedication n linkage to hospital databases n linkage to CBS databases (eg. occupation, ethnicity)

14. Robert Verheij, Nottingham, July 20, 2005 Slide 14 Output: some examples

15. Robert Verheij, Nottingham, July 20, 2005 Slide 15 www.linh.nl Annual reports on morbidity, contacts, prescription referrals at www.linh.nl Mean number of home visits and contacts during consultation hours with the GP per patient per year, classified according to age, 2003

16. Robert Verheij, Nottingham, July 20, 2005 Slide 16 Monthly column in the Journal of the Dutch college of GPs (Huisarts & Wetenschap)

17. Robert Verheij, Nottingham, July 20, 2005 Slide 17 Health effects of firework disaster Enschede (2000)

18. Robert Verheij, Nottingham, July 20, 2005 Slide 18 Prescription studies off-label prescribing changes in reimbursed package

19. Robert Verheij, Nottingham, July 20, 2005 Slide 19 Monitoring annual Influenza vaccination campaign

20. Robert Verheij, Nottingham, July 20, 2005 Slide 20 Evaluation electronic prescribing system

21. Robert Verheij, Nottingham, July 20, 2005 Slide 21 Sudden changes in morbidity (bioterrorism)

22. Robert Verheij, Nottingham, July 20, 2005 Slide 22 Towards a European morbidity network? (the eHID project)

23. Robert Verheij, Nottingham, July 20, 2005 Slide 23 Antibiotics prescription in France and Netherlands

24. Robert Verheij, Nottingham, July 20, 2005 Slide 24 GP reimbursement in relation to workload

25. Robert Verheij, Nottingham, July 20, 2005 Slide 25 Information Network out of hours services

26. Robert Verheij, Nottingham, July 20, 2005 Slide 26 Evaluation task delegation

27. Robert Verheij, Nottingham, July 20, 2005 Slide 27 The future (1): Need to adapt to changes in the organisation of GP care n introduction of ‘call centers’ (triage) n introduction of GP co-ops for out of hours services n extending role of practice nurses/nurse practitioners/physician assistants n new referrer: occupational health care n no referral needed for physiotherapy

28. Robert Verheij, Nottingham, July 20, 2005 Slide 28 The future (2): The next step in public health monitoring weekly extraction of data creates opportunities for:  monitoring infectious diseases (influenza)  monitoring rare diseases and sudden changes in morbidity patterns (bioterrorist attacks)

29. Robert Verheij, Nottingham, July 20, 2005 Slide 29 The future (3): Technological innovations n ICPC-triggered pop-up screens u with extra in-depth questions u to investigate morbidity not covered by ICPC

30. Robert Verheij, Nottingham, July 20, 2005 Slide 30 More about LINH at: www.linh.nl Graph and table headings in English