Primary Care Respiratory Journal最新文献

{"title":"Are we misleading users of respiratory spacer devices?","authors":"Mark J Sanders, Ronald Bruin","doi":"10.4104/pcrj.2013.00103","DOIUrl":"https://doi.org/10.4104/pcrj.2013.00103","url":null,"abstract":"VHC whistles would be activated if the patient goes beyond a flow rate of 60 L/min (the top end of the ideal inspiratory flow rate). However, our research with three whistle-containing VHCs suggests that this appears to be an erroneous assumption and, unwittingly, we may be misleading patients and therefore contributing to reduced patient care. We measured the whistle-activation flow rates for three different makes of VHCs: Able Spacer (Clement Clarke), AeroChamber Plus (GSK), and Optichamber Diamond (Philips Respironics). A calibrated waveform generator (Pulmonary Waveform Generator System, MH Custom Design & Mfg L.C., Utah, USA) was used to create a standardised vacuum force similar to a human inhalation. The performance of three samples of each device was assessed when used with a range of popular drug pMDIs (see Table). The vacuum force was repeated at 1 L/min incremental amounts until the VHCwhistle sounded. Two operatives agreed the whistle sounding. Three recordings of each VHC-drug pMDI combination were carried out (n=54 tests) and the flow rates recorded. The data show that there is a wide variation in the performance of a VHC-whistle as a function of the inhaler to which it is attached. In many instances the whistle first activates at a flow rate well beyond what would be considered acceptable in order to promote effective drug deposition. This phenomenon can be explained. When the patient inhales from the VHC, air will be drawn in through a combination of two routes – the whistle, and the channels surrounding the canister of Dear Sirs, The UK Drug Tariff lists a number of spacer and valved holding chamber (VHC) products for use with pressurised metered dose inhalers (pMDIs). These add-on devices have the double objective of improving the delivery of drug, and making the inhalation procedure easier for the patient. VHCs, in particular, help the user by eliminating the requirement that the slow deep inspiration coincides with the actuation of the pMDI – a manoeuvre which can be particularly tricky for children and the elderly, although poor coordination is worryingly common in pMDI users irrespective of age. VHC users should inhale gently, using either tidal breathing or an approximate 30 L/min inspiratory flow, which facilitates lung deposition of the drug particles. Some VHC products include an alert whistle designed to sound “when the patient is breathing in too quickly”, as this type of forceful inspiratory manoeuvre increases the likelihood of oral/pharyngeal drug deposition. It is known that healthcare trainers use the whistle-alert as a tool to titrate the Prim Care Respir J 2013; 22(4): 466-467","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 4","pages":"466-7"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4104/pcrj.2013.00103","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31897435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Asthma patients' inability to use a pressurised metered-dose inhaler (pMDI) correctly correlates with poor asthma control as defined by the global initiative for asthma (GINA) strategy: a retrospective analysis.","authors":"Mark L Levy,&nbsp;Alison Hardwell,&nbsp;Eddie McKnight,&nbsp;John Holmes","doi":"10.4104/pcrj.2013.00084","DOIUrl":"https://doi.org/10.4104/pcrj.2013.00084","url":null,"abstract":"<p><strong>Background: </strong>In practice it is logical that inhalers are prescribed only after patients have received training and demonstrated their ability to use the device. However, many patients are unable to use their pressurised metered-dose inhaler devices (pMDIs) correctly. We assessed the relationship between asthma control and patients' ability to use their prescribed pMDIs.</p><p><strong>Methods: </strong>Evaluation of 3,981 (46% male) primary care asthma patient reviews, which included inhaler technique and asthma control, by specialist nurses in primary care in 2009. The paper focuses on people currently prescribed pMDI devices.</p><p><strong>Results: </strong>Accurate data on reliever and preventer inhaler prescriptions were available for 3,686 and 2,887 patients, respectively. In patients prescribed reliever inhalers, 2,375 (64%) and 525 (14%) were on pMDI alone or pMDI plus spacer, respectively. For those prescribed preventers, 1,976 (68%) and 171 (6%) were using a pMDI without and with a spacer, respectively. Asthma was controlled in 50% of patients reviewed. The majority of patients (60% of 3,686) were using reliever pMDIs, 13% with spacers. Incorrect pMDI use was associated with poor asthma control (p<0.0001) and more short burst systemic steroid prescriptions in the last year (p=0.038). Of patients using beclometasone (the most frequently prescribed preventer drug in our sample), significantly more of those using a breath-actuated pMDI device (p<0.0001) and a spacer (p<0.0001) were controlled compared with those on pMDIs alone.</p><p><strong>Conclusions: </strong>Patients who are able to use pMDIs correctly have better asthma control as defined by the GINA strategy document. Beclometasone via a spacer or breath-actuated device resulted in better asthma control than via a pMDI alone. Patients prescribed pMDIs should be carefully instructed in technique and have their ability to use these devices tested; those unable to use the device should be prescribed a spacer or an alternative device such as one that is breath-actuated.</p>","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 4","pages":"406-11"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4104/pcrj.2013.00084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31737975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The quality of reporting of randomised controlled trials in asthma: a systematic review.","authors":"Chara Ntala, Panagiota Birmpili, Allison Worth, Niall H Anderson, Aziz Sheikh","doi":"10.4104/pcrj.2013.00089","DOIUrl":"10.4104/pcrj.2013.00089","url":null,"abstract":"<p><strong>Background: </strong>There are concerns about the reporting quality of asthma trials.</p><p><strong>Aims: </strong>To describe the reporting of contemporary asthma trials and to identify factors associated with better reporting quality.</p><p><strong>Methods: </strong>Two reviewers independently searched MEDLINE for randomised controlled trials (RCTs) of asthma published between January 2010 and July 2012 in leading generalist and specialist journals. We calculated the proportion of trials that adequately reported each Consolidated Standards of Reporting Trials (CONSORT) checklist item and an overall quality score for each trial. Factors associated with better reporting quality were investigated.</p><p><strong>Results: </strong>Thirty-five RCTs satisfied our eligibility criteria. Four trials adequately reported <50% of the items, 15 adequately reported 50-60% of items, and 16 adequately reported >60% of items. Seventeen of the 38 CONSORT items were consistently well reported in more than two-thirds of the articles. In contrast, nine items were poorly reported in more than half the trials - namely, identification as a randomised trial in the title (40.0%), an adequate structured summary/abstract (48.6%), details of eligibility criteria (34.3%), recruitment (48.6%), randomisation procedures (22.9%), intervention (38.5%), harms (34.3%), the funding source (45.7%), and access to the full trial protocol (17.1%). Studies led by teams in high-income country settings were associated with better quality of reporting (relative risk=1.33, 95% CI 1.09 to 1.64).</p><p><strong>Conclusions: </strong>The quality of reporting in contemporary asthma literature remains suboptimal. We have identified important areas in which reporting quality needs to be improved.</p>","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 4","pages":"417-24"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31879047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acceptance and practicability of a visual communication tool in smoking cessation counselling: a randomised controlled trial.","authors":"Stefan Neuner-Jehle,&nbsp;Marianne I Knecht,&nbsp;Claudia Stey-Steurer,&nbsp;Oliver Senn","doi":"10.4104/pcrj.2013.00086","DOIUrl":"10.4104/pcrj.2013.00086","url":null,"abstract":"<p><strong>Background: </strong>Smoking cessation advice is important for reducing the worldwide burden of disease resulting from tobacco smoking. Appropriate risk communication formats improve the success of counselling interventions in primary care.</p><p><strong>Aims: </strong>To test the feasibility and acceptance of a smoking cessation counselling tool with different cardiovascular risk communication formats including graphs, in comparison with the International Primary Care Respiratory Group (IPCRG) 'quit smoking assistance' tool.</p><p><strong>Methods: </strong>GPs were randomised into an intervention group (using our communication tool in addition to the IPCRG sheet) and a control group (using the IPCRG sheet only). We asked participants for socioeconomic data, smoking patterns, understanding of information, motivation, acceptance and feasibility, and measured the duration and frequency of counselling sessions.</p><p><strong>Results: </strong>Twenty-five GPs performed 2.8 counselling sessions per month in the intervention group and 1.7 in the control group (p=0.3) with 114 patients. The median duration of a session was 10 mins (control group 11 mins, p=0.09 for difference). Median patients' motivation for smoking cessation was 7 on a 10-point visual analogue scale with no significant difference before and after the intervention (p=0.2) or between groups (p=0.73 before and p=0.15 after the intervention). Median patients' ratings of motivation, selfconfidence, understanding of information, and satisfaction with the counselling were 3-5 on a 5-point Likert scale, similar to GPs' ratings of acceptance and feasibility, with no significant difference between groups.</p><p><strong>Conclusions: </strong>Among Swiss GPs and patients, both our innovative communication tool and the IPCRG tool were well accepted and both merit further dissemination and application in research.</p>","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 4","pages":"412-6"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4104/pcrj.2013.00086","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31790394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A woman with breathlessness: a practical approach to diagnosis and management.","authors":"Alan Kaplan, Kevin Gruffydd-Jones, Frederik van Gemert, Bruce J Kirenga, Andrew R L Medford","doi":"10.4104/pcrj.2013.00100","DOIUrl":"10.4104/pcrj.2013.00100","url":null,"abstract":"<p><p>Worsening breathless in a patient with severe chronic obstructive pulmonary disease (COPD) is a common diagnostic and management challenge in primary care. A systematic approach to history-taking and examination combined with targeted investigation of pulmonary, cardiovascular, thromboembolic and systemic causes is essential if co-morbidities are to be identified and managed. Distinguishing between heart failure and COPD is a particular challenge as symptoms and signs overlap. In low and middle income countries additional priorities are the detection of infections such as tuberculosis and human immunodeficiency virus (HIV). Clinicians need to be alert to the possibility of atypical presentations (such as pain-free variants of angina) and less common conditions (including chronic thromboembolic pulmonary hypertension) in order not to overlook important potentially treatable conditions. </p>","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 4","pages":"468-76"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31897436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuing discrepancy between patient perception of asthma control and real-world symptoms: a quantitative online survey of 1,083 adults with asthma from the UK.","authors":"Monica Fletcher,&nbsp;David Hiles","doi":"10.4104/pcrj.2013.00091","DOIUrl":"https://doi.org/10.4104/pcrj.2013.00091","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have identified a discrepancy between patient perception of asthma control and real-world symptoms; despite several hypotheses, the reasons remain unclear.</p><p><strong>Aims: </strong>To explore patients' experiences of asthma symptoms and disease management and their educational needs in the UK; to assess recent progress in asthma control and management.</p><p><strong>Methods: </strong>A quantitative questionnaire-based online survey of UK patients aged >18 years with self-reported asthma.</p><p><strong>Results: </strong>Of the 1,083 individuals (55% female, 49% aged >55 years) who completed the survey, 79% described their asthma control as 'good' or 'very good'. Despite this, in the previous 2 years, 65% had experienced 'frequent' day-time symptoms, 37% had 'frequent' night-time symptoms, and 25% had used oral steroids for asthma; 41% of those prescribed a reliever inhaler used it >1 a day. Overall, 76% had a 'good' or 'very good' relationship with their healthcare professional (HCP); 32% had not attended regular asthma reviews and only 12% were using a personal asthma action plan. Moreover, 70% of respondents felt that they had the 'main responsibility' for managing their asthma; 29% believed this responsibility to be shared with their HCP.</p><p><strong>Conclusions: </strong>This survey indicates a continuing discrepancy between patient perception of asthma control and real-world symptoms, with little change from previous studies. Many patients accept symptoms as the norm. The diversity among respondents' attitudes demonstrates a need to help patients change some of their beliefs and understanding about asthma, and to improve asthma management with better education about the understanding of control for patients and HCPs.</p>","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 4","pages":"431-8"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4104/pcrj.2013.00091","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31853681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correct inhalation technique is critical in achieving good asthma control.","authors":"Federico Lavorini,&nbsp;Omar S Usmani","doi":"10.4104/pcrj.2013.00097","DOIUrl":"https://doi.org/10.4104/pcrj.2013.00097","url":null,"abstract":"the Canadian Infectious Diseases Society and the Canadian Thoracic Society. Clin Infect Dis 2000;31:383-421. http://dx.doi.org/10.1086/313959 14. Menéndez R, Torres A, Aspa J, Capelastegui A, Prat C, Rodríguez de Castro F. Community-Acquired Pneumonia. New Guidelines of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR). Arch Bronconeumol 2010;46(10):543-58. http://dx.doi.org/10.1016/j.arbres.2010.06.014 15. Woodhead M, Blasi F, Ewig S, et al. Joint Taskforce of the European Respiratory Society and European Society for Clinical Microbiology and Infectious Diseases. Guidelines for the management of adult lower respiratory tract infections. Clinical Microbiology and Infection 2011;17:(Suppl 6)","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 4","pages":"385-6"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4104/pcrj.2013.00097","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31897440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using your bullets most wisely for the smoking gun.","authors":"Keir Lewis","doi":"10.4104/pcrj.2013.00098","DOIUrl":"https://doi.org/10.4104/pcrj.2013.00098","url":null,"abstract":"Everyone knows smoking is bad for you. It is the leading cause of preventable death and disability in developed and developing countries. Moreover, quitting smoking generates considerable benefits in both quantity and quality of life, almost irrespective of age at quitting. What is the role of doctors? As well as primary prevention, secondary and tertiary prevention to ease smoking-related suffering are increasingly important roles. As Schroeder points out, “Clinicians in general, and especially those who care for patients with smokingrelated illnesses (e.g., oncologists, cardiologists, pulmonologists, emergency physicians, psychiatrists and primary care physicians), should do more to stimulate quit attempts.” Calls for increased clinician efforts to reduce smoking are based on excellent evidence that doctor interventions really do help. Where, when, and how much intervention is most cost-effective, are all issues that need to be established. In developed countries, most people see their general practitioner (GP) every year, so primary care has a central role in population health. Pooled data from 17 trials of brief anti-smoking advice versus no advice (or usual care) confirms a significant increase in the rate of quitting (relative risk 1.66, 95% CI 1.42 to 1.94). Further metaanalysis of 35,000 smokers also shows a clear dose-dependent effect, with more quits following more intense intervention. However, (and crucially), these more successful intense interventions were defined as lasting longer than 10 minutes. Therefore the work reported by Neuner-Jehle et al. in this issue of the PCRJ, introducing an individualised counselling tool as a short intervention as ‘time sparingly as possible’, opens up good opportunities to increase both GP and patient awareness. During their 6-month study, 25 GPs randomised to the intervention of an additional visual, cardiac risk communication tool as well as the standard Opinion Sheet for smoking cessation from the IPCRG, performed on average 2.8 counselling sessions per month compared with 1.7 sessions per month by those GPs randomised to the standard IPCRG sheet alone. Although this was a 64% higher rate, the small numbers meant it was not statistically significant (p=0.3) despite their borderline non-inferiority power calculation. As things stand, it does not translate into clinically meaningful benefits, with no differences in patients’ motivation or satisfaction ratings between the two groups. Of course, also translating any increased motivation into quitting is the next hurdle. Their tool applied the concept of risk, and it is commendable that this risk was based on real-life clinical data from their own country, making it much more pertinent to their patients. Although applying Swiss cardiac risk could limit generalisability, their cardiac risk increase from smoking is similar to the international trials they quoted. In terms of limitations of their study, we would like to know more about the characteristi","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 4","pages":"387-8"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4104/pcrj.2013.00098","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31924932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discrepancy between functional exercise capacity and daily physical activity: a cross-sectional study in patients with mild to moderate COPD.","authors":"Annemieke Fastenau, Onno C P van Schayck, Rik Gosselink, Karin C P M Aretz, Jean W M Muris","doi":"10.4104/pcrj.2013.00090","DOIUrl":"10.4104/pcrj.2013.00090","url":null,"abstract":"<p><strong>Background: </strong>In patients with moderate to severe chronic obstructive pulmonary disease (COPD) the six-minute walk distance reflects the functional exercise level for daily physical activity. It is unknown if this also applies to patients with mild to moderate COPD in primary care.</p><p><strong>Aims: </strong>To assess the relationship between functional exercise capacity and physical activity in patients with mild to moderate COPD.</p><p><strong>Methods: </strong>A cross-sectional study was performed in 51 patients with mild to moderate COPD in primary care. Functional exercise capacity was assessed by the six-minute walk test and physical activity was measured with an accelerometer-based activity monitor.</p><p><strong>Results: </strong>Functional exercise capacity was close to normal values. However, the daily physical activity of the patients could be classified as 'sedentary' and 'low active'. No significant correlations were observed between six-minute walk distance (% predicted) and any of the physical activity variables (steps per day, movement intensity during walking, total active time, total walking time, physical activity level, and time spent in moderate physical activity).</p><p><strong>Conclusions: </strong>A discrepancy was found between functional exercise capacity and daily physical activity in patients with mild to moderate COPD recruited and assessed in primary care. We conclude that these variables represent two different concepts. Our results reinforce the importance of measuring daily physical activity in order to fine-tune treatment (i.e. focusing on enhancement of exercise capacity or behavioural change, or both).</p>","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 4","pages":"425-30"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31853682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General practitioners' contribution to the management of community-acquired pneumonia in the Netherlands: a retrospective analysis of primary care, hospital, and national mortality databases with individual data linkage.","authors":"Bianca Snijders,&nbsp;Wim van der Hoek,&nbsp;Irina Stirbu,&nbsp;Marianne A B van der Sande,&nbsp;Arianne B van Gageldonk-Lafeber","doi":"10.4104/pcrj.2013.00085","DOIUrl":"10.4104/pcrj.2013.00085","url":null,"abstract":"<p><strong>Background: </strong>Community-acquired pneumonia (CAP) is an important cause of hospital admission and death, but the extent of the problem of CAP at the primary healthcare level is largely unknown.</p><p><strong>Aims: </strong>To investigate the contribution of general practitioners (GPs) to the management of patients with CAP in the Netherlands.</p><p><strong>Methods: </strong>The study population consisted of all people enlisted in a GP network. We obtained information on CAP episodes from GP electronic records (using ICPC code R81) during the years 2002-2009. CAP registrations were also obtained from national hospital discharge data (ICD-9 codes) and cause of death statistics (ICD-10 codes). The three registration systems were linked at the individual level. We used descriptive analyses to estimate the annual number of CAP episodes (i.e. defined as a CAP diagnosis within 30 days).</p><p><strong>Results: </strong>From 2002 to 2009 the mean annual size of the study population was 395,039. For this population, 3,700 (0.9%) CAP episodes per year were registered in at least one of the registration systems, 2,933 (79%) of which were in the GP system only. Recovery within 30 days occurred on average in 95% (2,791/2,933) of the CAP episodes annually registered by a GP, while 2.3% (67/2,933) of patients with a GP-registered CAP episode were admitted to hospital within 30 days and 1% (26/2,933) had a fatal outcome within 30 days.</p><p><strong>Conclusions: </strong>The vast majority of CAP episodes registered in the Netherlands are managed successfully at the GP level without hospitalisation.</p>","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 4","pages":"400-5"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4104/pcrj.2013.00085","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31737976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}