[Collaboration on health in the neighbourhood: role for GPs? Experiences from the 'Prevention in the neighbourhood' project]. / Samenwerken aan gezondheid in de wijk: een rol voor de huisarts?

There are two reasons why general practitioners (GPs) should collaborate with others in their neighbourhood: social problems that translate into physical symptoms and addressing healthy lifestyles and prevention.

Healthy diet in primary care: views of general practitioners and nurses from Europe.

BACKGROUND: Most of the national colleges of general practitioners (GPs) do not have their own dietary/nutritional tools, and GPs and nurses do not have the time, knowledge, or skills to advise their patients about desirable dietary practices. OBJECTIVE: To assess the usefulness of a simple and practical guide on healthy diet to be used by European GPs and nurses. DESIGN: A postal survey was mailed to 171 GPs and nurses from 12 European countries to obtain information about the usefulness of a guide on healthy diet developed by EUROPREV. RESULTS: The perception of health professionals is that the main source of information on healthy diet for the population was the media. In all, 95% of GPs and nurses reported that the guide was useful; 93, 95, and 82% reported that the concepts were concise, easy to understand, and realistic, respectively. Also, 77% reported that the type of counselling recommended was feasible and could be applied, 94% reported that the implementation measures proposed could be effective and 88% reported that the Traditional Mediterranean Diet Pyramid is useful, but some concerns about the content were mentioned. CONCLUSIONS: GPs and nurses from Europe think that a practical guide on healthy diet developed by EUROPREV could be used to advise patients in primary care, although the Traditional Mediterranean Diet Pyramid should be modified.

[The practice guideline: 'Treatment of tobacco dependence']. / Richtlijn 'Behandeling van tabaksverslaving'.

The interdisciplinary guideline 'Treatment of tobacco dependence' discusses the approach to smoking patients. The point of departure is the concept that smoking is an addiction and that its treatment should be based on this fact. The effectiveness of treatment depends on the patient's motivation to stop smoking and on the intensity of the intervention. Pharmacotherapy may be of added value here, particularly for persistent smokers. The guideline aims at reaching as many smoking patients as possible, regardless of whether there is a relationship between their symptoms or ill health and smoking. Practitioners should ask about smoking habits regularly and smokers should be advised at least once to stop. Further treatment and guidance aims in particular to increase the motivation to quit and at those who are prepared to stop on the basis of the stages-of-change model. More intensive possibilities for treatment, by both general practitioners and specialists, are needed for persistent smokers. Such facilities are hardly available at all in The Netherlands at present, but will have to be developed to make the cost-effective treatment of tobacco addiction possible on a large scale.

Challenges to prevention in Dutch general practice.

In the Netherlands the general practitioner (GP) plays an important role in prevention. Every Dutch citizen has to be registered with one GP and GPs know their patients well. Face-to-face contact is a relatively effective means of influencing behavior; if preventive advice is related to a patient's state of health, compliance may be stimulated. However, Dutch GPs have shown reluctance toward preventive work. Curing rather than preventing disease is emphasized in medical school. Many GPs doubt that they are entitled to interfere with a patients' lifestyle unless asked. Some GPs are aware of their limited knowledge of nutrition. Preventive work requires some reorganization of medical practice and can lead to an increased workload, without financial compensation. Then there is the "prevention paradox": preventive actions that have a demonstrable effect on the whole population bring only small benefits for individuals. Since 1989 the Dutch College of General Practitioners has published 60 standards for general practice. Several of these include advice on lifestyle and diet, eg, for non-insulin-dependent diabetes mellitus, hypertension, hypercholesterolemia, peptic ulcer, and heart failure. Prevention work in general practice must use only interventions proved to be effective and they must be feasible in the context of general practice. A trial collaboration of 118 GPs and 5 public health authorities between 1988 and 1990 for screening and lifestyle management of hypertension was a limited success. It brought to light the practical problems of this type of work in general practice. Present government priorities for GP-public health collaboration are influenza vaccination and cervical screening.

[A repeat advice no longer applies for cervical smears without endocervical cells in population studies for cervical cancer]. / Geen herhalingsadvies meer bij een cervixuitstrijk zonder endocervicale cellen in het bevolkingsonderzoek op baarmoederhalskanker.

Recent Dutch and non-Dutch studies have shown that the absence of endocervical cells (ecc-) in an adequate cervical smear does not present an increased risk for the presence or occurrence of cervical cancer or premalignant abnormalities in a later phase. Based on these findings, the Coordination Committee Cervical Cancer Screening of the Dutch Health Insurance Council had advised dropping the repeat advice for non-abnormal ecc- smears by January 1st 2002. The National Health Insurance Council has agreed to this advice. The following measures have been taken: (a) no repeat advice for ecc- smears; in the case of negative findings the woman waits until the next five-yearly invitation from the screening programme; (b) whether the portio cervicis was seen has to be stated on the national request form; (c) the reporting of an ecc- in the cytology report and periodical feedback to general practitioners remains unchanged; (d) in the case of a non-abnormal ecc- smear with an uninspected portio or doubts as to whether the transformation zone was adequately scraped, either the smear will have to be repeated or the patient will have to be referred to the gynaecologist.