Development of a research agenda for general practice based on knowledge gaps identified in Dutch guidelines and input from 48 stakeholders.

BACKGROUND: Several funding organizations using different agendas support research in general practice. Topic selection and prioritization are often not coordinated, which may lead to duplication and research waste. OBJECTIVES: To develop systematically a national research agenda for general practice involving general practitioners, researchers, patients and other relevant stakeholders in healthcare. METHODS: We reviewed knowledge gaps from 90 Dutch general practice guidelines and formulated research questions based on these gaps. In addition, we asked 96 healthcare stakeholders to add research questions relevant for general practice. All research questions were prioritized by practising general practitioners in an online survey (n = 232) and by participants of an invitational conference including general practitioners (n = 48) and representatives of other stakeholders in healthcare (n = 16), e.g. patient organizations and medical specialists. RESULTS: We identified 787 research questions. These were categorized in two ways: according to the chapters of the International Classification for Primary Care (ICPC) and in 12 themes such as common conditions, person-centred care and patient education, collaboration and organization of care. The prioritizing procedure resulted in top 10 lists of research questions for each ICPC chapter and each theme. CONCLUSION: The process resulted in a widely supported National Research Agenda for General Practice. We encourage both researchers and funding organizations to use this agenda to focus their research on the most relevant issues in general practice and to generate new evidence for the next generation of guidelines and the future of general practice.

[Chronic kidney damage guidelines revision]. / Herziening richtlijnen 'Chronische nierschade'.

Age has no effect on the diagnosis of 'chronic kidney damage'. Estimated glomerular filtration rate (eGFR) < 60 ml/min per 1.73 m2 is to be considered 'abnormal' for patients of all ages. Albuminuria is classified as 'not abnormal', 'moderately elevated' and 'severely elevated'. Decreased eGFR and elevated albuminuria are independent risk factors for and predictors of cardiovascular and total mortality, progression of chronic kidney damage and end-stage kidney failure. Blood pressure target value is ≤ 130/80 mmHg. In case of an indication for blood pressure-lowering treatment for patients with chronic kidney damage and elevated albuminuria, an ACE inhibitor or angiotensin II receptor blocker is preferred. The general practitioner refers patients with chronic kidney damage and a highly elevated risk of mortality, cardiovascular disease, progression of kidney damage and end-stage kidney failure to the internist-nephrologist. Inform patients about drugs that can cause kidney damage and about the importance of dosage adjustments. When prescribing drugs to patients with eGFR < 50 ml/min per 1.73 m2, the pharmacist should, with the patient's approval, be informed of the eGFR.

[Point-of-care-testing in general practice]. / 'Point-of-care testing' in de huisartsenzorg.

Point-of-care testing (POCT) is being used increasingly in general practice and other healthcare contexts outside the hospital. Recommendations for correct and safe use of POCT in Dutch general practice have been laid down in the guideline 'Point-of-care testing in general practice'. The recommendations in this guideline are based on existing regulations and guidelines, both national and international, and respect the different roles and responsibilities within the healthcare chain.