Time trends in the incidence of eating disorders: A primary care study in The Netherlands

BackgroundWhether the incidence of eating disorders in Western, industrialized countries has changed over time has been the subject of much debate. The purpose of this primary-care study was to examine changes in the incidence of eating disorders in The Netherlands during the 1980s, 1990s and 2000s.MethodA nationwide network of general practitioners (GPs), serving a representative sample (~1%) of the total Dutch population, recorded newly diagnosed patients with anorexia nervosa (AN) and bulimia nervosa (BN) in their practice during 1985–1989, 1995–1999, and 2005–2009. GPs are key players in the Dutch healthcare system, as their written referral is mandatory in order to get access to specialized (mental) healthcare, covered by health insurance. Health insurance is virtually universal in The Netherlands (99% of the population). A substantial number of GPs participated in all three study periods, during which the same case identification criteria were used and the same psychiatrist was responsible for making the final diagnoses. Incidence rates were calculated and for comparison between periods, incidence rate ratios.ResultsThe overall incidence rate of BN decreased significantly in the past three decades (from 8.6 per 100 000 person-years in 1985–1989 to 6.1 in 1995–1999, and 3.2 in 2005–2009). The overall incidence of AN remained fairly stable during three decades, i.e. 7.4 per 1 00 000 person-years in 1985–1989, 7.8 in 1995–1999, and 6.0 in 2005–2009.ConclusionsThe incidence rate of BN decreased significantly over the past three decades, while the overall incidence rate of AN remained stable.

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Is the beck anxiety inventory a good tool to assess the severity of anxiety? A primary care study in The Netherlands study of depression and anxiety (NESDA)

BMC Family Practice ◽

10.1186/1471-2296-12-66 ◽

2011 ◽

Vol 12 (1) ◽

Cited By ~ 57

Author(s):

Anna DT Muntingh ◽

Christina M van der Feltz-Cornelis ◽

Harm WJ van Marwijk ◽

Philip Spinhoven ◽

Brenda WJH Penninx ◽

...

Keyword(s):

Primary Care ◽

The Netherlands ◽

Beck Anxiety Inventory ◽

Depression And Anxiety ◽

Good Tool ◽

Care Study

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Evidence-Based Treatment for the Eating Disorders

The Oxford Handbook of Eating Disorders ◽

10.1093/oxfordhb/9780195373622.013.0025_update_001 ◽

2010 ◽

pp. 451-451

Author(s):

Phillipa J. Hay ◽

Angélica de M. Claudino

Keyword(s):

Primary Care ◽

Eating Disorders ◽

Evidence Base ◽

Good Evidence ◽

Distinct Advantage ◽

Specialist Care ◽

Feeding And Eating Disorders ◽

Online Therapies ◽

Primary Care Practitioners

This chapter comprises a focused review of the best available evidence for psychological and pharmacological treatments of choice for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified and unspecified feeding and eating disorders (OSFED and UFED), discusses the role of primary care and online therapies, and presents treatment algorithms. In AN, although there is consensus on the need for specialist care that includes nutritional rehabilitation in addition to psychological therapy, no single approach has yet been found to offer a distinct advantage. In contrast, manualized cognitive behavior therapy (CBT) for BN has attained “first-line” treatment status with a stronger evidence base than other psychotherapies. Similarly, CBT has a good evidence base in treatment of BED and for BN, and BED has been successfully adapted into less intensive and non-specialist forms. Behavioral and pharmacological weight loss management in treatment of co-morbid obesity/overweight and BED may be helpful in the short term, but long-term maintenance of effects is unclear. Primary care practitioners are in a key role, both with regard to providing care and with coordination and initiation of specialist care. There is an emerging evidence base for online therapies in BN and BED where access to care is delayed or problematic.

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Evidence-Based Treatment for the Eating Disorders

10.1093/oxfordhb/9780195373622.013.0025 ◽

2012 ◽

Cited By ~ 1

Author(s):

Phillipa J. Hay ◽

Angélica de M. Claudino

Keyword(s):

Primary Care ◽

Eating Disorders ◽

Evidence Base ◽

Good Evidence ◽

Distinct Advantage ◽

Specialist Care ◽

Feeding And Eating Disorders ◽

Online Therapies ◽

Primary Care Practitioners

This chapter comprises a focused review of the best available evidence for psychological and pharmacological treatments of choice for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified and unspecified feeding and eating disorders (OSFED and UFED), discusses the role of primary care and online therapies, and presents treatment algorithms. In AN, although there is consensus on the need for specialist care that includes nutritional rehabilitation in addition to psychological therapy, no single approach has yet been found to offer a distinct advantage. In contrast, manualized cognitive behavior therapy (CBT) for BN has attained “first-line” treatment status with a stronger evidence base than other psychotherapies. Similarly, CBT has a good evidence base in treatment of BED and for BN, and BED has been successfully adapted into less intensive and non-specialist forms. Behavioral and pharmacological weight loss management in treatment of co-morbid obesity/overweight and BED may be helpful in the short term, but long-term maintenance of effects is unclear. Primary care practitioners are in a key role, both with regard to providing care and with coordination and initiation of specialist care. There is an emerging evidence base for online therapies in BN and BED where access to care is delayed or problematic.

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Identifying and managing eating disorders in type 1 diabetes mellitus: An all-Wales study

Clinical Child Psychology and Psychiatry ◽

10.1177/13591045211009591 ◽

2021 ◽

pp. 135910452110095

Author(s):

Jacinta O A Tan ◽

Imogen Spector-Hill

Keyword(s):

Diabetes Mellitus ◽

Primary Care ◽

Eating Disorders ◽

Type 1 Diabetes ◽

Eating Disorder ◽

Type 1 Diabetes Mellitus ◽

Healthcare Professionals ◽

Health And Wellbeing ◽

Level Of Knowledge

Background: Co-morbid diabetes and eating disorders have a particularly high mortality, significant in numbers and highly dangerous in terms of impact on health and wellbeing. However, not much is known about the level of awareness, knowledge and confidence amongst healthcare professionals regarding co-morbid Type 1 Diabetes Mellitus (T1DM) and eating disorders. Aim: To understand the level of knowledge and confidence amongst healthcare professionals in Wales regarding co-morbid T1DM and eating disorder presentations, identification and treatment. Results: We conducted a survey of 102 Welsh clinicians in primary care, diabetes services and eating disorder services. 60.8% expressed low confidence in identification of co-morbid T1DM and eating disorders. Respondents reported fewer cases seen than would be expected. There was poor understanding of co-morbid T1DM and eating disorders: 44.6% identified weight loss as a main symptom, 78.4% used no screening instruments, and 80.3% consulted no relevant guidance. The respondents expressed an awareness of their lack of knowledge and the majority expressed willingness to accept training and education. Conclusion: We suggest that priority must be given to education and training of all healthcare professionals in primary care, diabetes services and mental health services who may see patients with co-morbid T1DM and eating disorders.

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Engaging primary care providers in managing pediatric eating disorders: a mixed methods study

Journal of Eating Disorders ◽

10.1186/s40337-020-00363-8 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Jocelyn Lebow ◽

Cassandra Narr ◽

Angela Mattke ◽

Janna R. Gewirtz O’Brien ◽

Marcie Billings ◽

...

Keyword(s):

Primary Care ◽

Eating Disorders ◽

Mixed Methods ◽

Care Setting ◽

Primary Care Setting ◽

Primary Care Providers ◽

Mixed Methods Study ◽

Evidence Based ◽

Care Providers ◽

Evidence Based Treatment

Abstract Background The primary care setting offers an attractive opportunity for, not only the identification of pediatric eating disorders, but also the delivery of evidence-based treatment. However, constraints of this setting pose barriers for implementing treatment. For interventions to be successful, they need to take into consideration the perspectives of stakeholders. As such, the purpose of this study was to examine in-depth primary care providers’ perspective of challenges to identifying and managing eating disorders in the primary care setting. Methods This mixed methods study surveyed 60 Pediatric and Family Medicine providers across 6 primary care practices. Sixteen of these providers were further interviewed using a qualitative, semi-structured interview. Results Providers (n = 60, response rate of 45%) acknowledged the potential of primary care as a point of contact for early identification and treatment of pediatric eating disorders. They also expressed that this was an area of need in their practices. They identified numerous barriers to successful implementation of evidence-based treatment in this setting including scarcity of time, knowledge, and resources. Conclusions Investigations seeking to build capacities in primary care settings to address eating disorders must address these barriers.

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CHARGE-AF in a national routine primary care electronic health records database in the Netherlands: validation for 5-year risk of atrial fibrillation and implications for patient selection in atrial fibrillation screening

Open Heart ◽

10.1136/openhrt-2020-001459 ◽

2021 ◽

Vol 8 (1) ◽

pp. e001459

Author(s):

Jelle C L Himmelreich ◽

Wim A M Lucassen ◽

Ralf E Harskamp ◽

Claire Aussems ◽

Henk C P M van Weert ◽

...

Keyword(s):

Atrial Fibrillation ◽

Primary Care ◽

High Risk ◽

The Netherlands ◽

Patient Selection ◽

Low Cost ◽

Calibration Plot ◽

Primary Care Data ◽

C Statistic ◽

Kaplan Meier

AimsTo validate a multivariable risk prediction model (Cohorts for Heart and Aging Research in Genomic Epidemiology model for atrial fibrillation (CHARGE-AF)) for 5-year risk of atrial fibrillation (AF) in routinely collected primary care data and to assess CHARGE-AF’s potential for automated, low-cost selection of patients at high risk for AF based on routine primary care data.MethodsWe included patients aged ≥40 years, free of AF and with complete CHARGE-AF variables at baseline, 1 January 2014, in a representative, nationwide routine primary care database in the Netherlands (Nivel-PCD). We validated CHARGE-AF for 5-year observed AF incidence using the C-statistic for discrimination, and calibration plot and stratified Kaplan-Meier plot for calibration. We compared CHARGE-AF with other predictors and assessed implications of using different CHARGE-AF cut-offs to select high-risk patients.ResultsAmong 111 475 patients free of AF and with complete CHARGE-AF variables at baseline (17.2% of all patients aged ≥40 years and free of AF), mean age was 65.5 years, and 53% were female. Complete CHARGE-AF cases were older and had higher AF incidence and cardiovascular comorbidity rate than incomplete cases. There were 5264 (4.7%) new AF cases during 5-year follow-up among complete cases. CHARGE-AF’s C-statistic for new AF was 0.74 (95% CI 0.73 to 0.74). The calibration plot showed slight risk underestimation in low-risk deciles and overestimation of absolute AF risk in those with highest predicted risk. The Kaplan-Meier plot with categories <2.5%, 2.5%–5% and >5% predicted 5-year risk was highly accurate. CHARGE-AF outperformed CHA2DS2-VASc (Cardiac failure or dysfunction, Hypertension, Age >=75 [Doubled], Diabetes, Stroke [Doubled]-Vascular disease, Age 65-74, and Sex category [Female]) and age alone as predictors for AF. Dichotomisation at cut-offs of 2.5%, 5% and 10% baseline CHARGE-AF risk all showed merits for patient selection in AF screening efforts.ConclusionIn patients with complete baseline CHARGE-AF data through routine Dutch primary care, CHARGE-AF accurately assessed AF risk among older primary care patients, outperformed both CHA2DS2-VASc and age alone as predictors for AF and showed potential for automated, low-cost patient selection in AF screening.

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Consultations for Influenza-like Illness in Primary Care in The Netherlands: A Regression Approach

Value in Health ◽

10.1016/j.jval.2020.10.013 ◽

2020 ◽

Author(s):

F. Christiaan K. Dolk ◽

Pieter T. de Boer ◽

Lisa Nagy ◽

Gé A. Donker ◽

Adam Meijer ◽

...

Keyword(s):

Primary Care ◽

The Netherlands ◽

Influenza Like Illness ◽

Regression Approach

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Platelet aggregation inhibitor prescription for newly diagnosed peripheral arterial disease in the Netherlands: a cohort study

BMJ Open ◽

10.1136/bmjopen-2020-041715 ◽

2021 ◽

Vol 11 (1) ◽

pp. e041715

Author(s):

Aarent RT Brand ◽

Eline Houben ◽

Irene D Bezemer ◽

Frank L J Visseren ◽

Michiel L Bots ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

The Netherlands ◽

Peripheral Arterial Disease ◽

Arterial Disease ◽

Free Text ◽

Newly Diagnosed ◽

Patient Journey ◽

P2y12 Inhibitors ◽

Peripheral Arterial

ObjectivesPharmacological treatment of peripheral arterial disease (PAD) comprises of antiplatelet therapy (APT), blood pressure control and cholesterol optimisation. Guidelines provide class-I recommendations on the prescription, but there are little data on the actual prescription practices. Our study provides insight into the prescription of medication among patients with PAD in the Netherlands and reports a ‘real-world’ patient journey through primary and secondary care.DesignWe conducted a cohort study among patients newly diagnosed with PAD between 2010 and 2014.SettingData were obtained from the PHARMO Database Network, a population-based network of electronic pharmacy, primary and secondary healthcare setting records in the Netherlands. The source population for this study comprised almost 1 million individuals.Participants‘Newly diagnosed’ was defined as a recorded International Classification of Primary Care code for PAD, a PAD-specific WCIA examination code or a diagnosis recorded as free text episode in the general practitioner records with no previous PAD diagnosis record and no prescription of P2Y12 inhibitors or aspirin the preceding year. The patient journey was defined by at least 1 year of database history and follow-up relative to the index date.ResultsBetween 2010 and 2014, we identified 3677 newly diagnosed patients with PAD. Most patients (91%) were diagnosed in primary care. Almost half of all patients (49%) had no APT dispensing record. Within this group, 33% received other anticoagulant therapy (vitamin K antagonist or direct oral anticoagulant). Mono-APT was dispensed as aspirin (40% of patients) or P2Y12 inhibitors (2.5% of patients). Dual APT combining aspirin with a P2Y12 inhibitor was dispensed to 8.5% of the study population.ConclusionHalf of all patients with newly diagnosed PAD are not treated conforming to (international) guideline recommendations on thromboembolism prevention through APT. At least 33% of all patients with newly diagnosed PAD do not receive any antithrombotic therapy. Evaluation and improvement of APT prescription and thereby improved prevention of (secondary) cardiovascular events is warranted.

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The daily self-weighing for obesity management in primary care study: Rationale, design and methodology

Contemporary Clinical Trials ◽

10.1016/j.cct.2021.106463 ◽

2021 ◽

pp. 106463

Author(s):

Gareth R. Dutton ◽

Amber W. Kinsey ◽

Carrie R. Howell ◽

Maria Pisu ◽

Amy E. Dobelstein ◽

...

Keyword(s):

Primary Care ◽

Obesity Management ◽

Care Study

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