[Benchmarking using different measurement instruments and the management of measurement variability]. / Meetvariatie als bron van bias bij het benchmarken met verschillende ROM-instrumenten.

BACKGROUND: In mental health care centres in the Netherlands outcome data are collected using a variety of outcome instruments. This may have implications for the comparability of outcome results between different centres. AIM: To discuss recent findings regarding the extent to which the eight instruments currently used in clinical practice report comparable results. METHOD: Our study is based on a combination of literature review and empirical research. RESULTS: The results obtained with the eight instruments are not equivalent. Patients symptom reductions appear larger with some instruments than with others. CONCLUSION: The current practice of benchmarking in the Dutch mental health system would have greater validity if the number of different instruments would be reduced. State-of-the-art calibration studies are necessary to validate the comparability of the remaining instruments. Ideally, all mental health centres will soon use one instrument per care domain to measure treatment outcome.

[Benchmarking and other functions of ROM: back to basics]. / Benchmarken en andere functies van ROM: back to basics.

BACKGROUND: Since 2011 outcome data in the Dutch mental health care have been collected on a national scale. This has led to confusion about the position of benchmarking in the system known as routine outcome monitoring (rom). AIM: To provide insight into the various objectives and uses of aggregated outcome data. METHOD: A qualitative review was performed and the findings were analysed. RESULTS: Benchmarking is a strategy for finding best practices and for improving efficacy and it belongs to the domain of quality management. Benchmarking involves comparing outcome data by means of instrumentation and is relatively tolerant with regard to the validity of the data. Although benchmarking is a function of rom, it must be differentiated form other functions from rom. Clinical management, public accountability, research, payment for performance and information for patients are all functions of rom which require different ways of data feedback and which make different demands on the validity of the underlying data. CONCLUSION: Benchmarking is often wrongly regarded as being simply a synonym for 'comparing institutions'. It is, however, a method which includes many more factors; it can be used to improve quality and has a more flexible approach to the validity of outcome data and is less concerned than other rom functions about funding and the amount of information given to patients. Benchmarking can make good use of currently available outcome data.

[Ethnic differences between pre-trial suspected offenders]. / Etnische verschillen tussen pro Justitia gerapporteerde verdachten.

BACKGROUND: Black and minority ethnic (BME) patients with a severe psychiatric disorder are compulsory admitted to psychiatric hospitals more often than Dutch native patients. AIM: To describe ethnic differences with regard to (1) the prevalence of psychiatric disorders, (2) the degree to which 'suspects' are considered to be accountable for their actions and (3) recommended treatment for reported pre-trial suspects. METHOD: 14,540 pre-trial reports in the Netherlands between 2000 and 2006 with a known ethnicity were assessed. Dutch native, Western, Turkish, Moroccan, Surinamese, Antillean, and other non-Western defendants were compared with chi-square tests and logistic regression models. RESULTS: Psychotic and behavioural disorders were more prevalent among bme suspects, whereas all other psychiatric disorders occurred less frequently in the BME group. Compared to Dutch native suspects, BME suspects were more often deemed to be fully accountable for their actions. Antillean, Moroccan, Surinamese, and other non-Western suspects were more often recommended for compulsory admission to a psychiatric hospital or received no treatment and much less out-patient treatment. There were no ethnic differences with regard to the frequency with which suspects were recommended for compulsory admission to a penitentiary hospital or with regard to medication. CONCLUSION: Compared to Dutch native suspects, BME suspects are, on one hand, more often deemed accountable for their actions but, on the other hand, are more often recommended for compulsory admission to a psychiatric hospital.

Ad hoc tracing of a cohort of patients exposed to acitretine (Neotigason) on a nation-wide scale.

Etretinate has been detected in the blood of women taking acitretine. Because of the proven teratogenic effects of etretinate it was decided to try to trace all users of acitretine in The Netherlands via all drug dispensing outlets (1450 community pharmacies, 95 hospital pharmacies and 636 general practitioners). A request for information on the date of birth, sex, type of prescriber, and the number of capsules dispensed yielded a response rate of 87%. In 61% of all the responding dispensing outlets a prescription for acitretine had been filled. Of these 1153 outlets, 40% had dispensed acitretine to one patient and 52% had dispensed it to 2-5 patients. The 2717 patients comprised 1500 men (55%) and 1217 women, with mean ages of 48 and 53 y, respectively. As against 45% of all the male users, 31% of all the women were in the child-bearing age (15-45 y). The average numbers of dispensed capsules was 167 to users of 10 mg capsules, and 107 to users of the 25 mg capsules. In more than 80% of cases acitretine had been prescribed by dermatologists. Because the large majority of inhabitants in The Netherlands use one community pharmacy, and because most of them have automated records, it is possible to trace a cohort of users quickly and almost completely. Because most large-scale problems with adverse reactions are discovered within the first 2 years of marketing, at a time when exposure and morbidity registries are still collecting information, ad hoc formation of a cohort in this way may be a useful resource for postmarketing surveillance.

[Acitretin; an example of ad-hoc tracing of users in acute problems with drugs]. / Acitretine; een voorbeeld van ad hoc-opsporing van gebruikers bij acute problemen met geneesmiddelen.

Recently etretinate was demonstrated in the blood of women on acitretin. Because of the proven teratogenic effects of etretinate we tried to trace all users of acitretin in the Netherlands via all drug dispensing outlets (1450 community pharmacies, 95 hospital pharmacies and 636 general practitioners). A request for information as regards date of birth, sex, type of prescriber, and number of dispensed capsules was followed by a response rate of 87%. In 61% of all responding outlets a prescription of acitretin had been filled. Of these 1153 outlets 40% had dispensed the drug to one user, whereas 52% had dispensed acitretin to 2-5 patients. The 2717 patients consisted of 1500 men (55%) and 1217 women with mean ages of 48 and 53 years, respectively. Of the women 31% were in the age-group of 15-45 years and of the male users, 45% (p less than 0.0001), whereas in other age groups there was no difference. In 80% of cases acitretin had been prescribed by dermatologists. This study demonstrated that it is possible to trace a cohort of users quickly and almost completely. As most large-scale problems with adverse reactions are discovered in the first 2 years of marketing when exposure and morbidity registries are still collecting information, ad hoc cohort formation may be a useful resource for postmarketing surveillance.