The multifaceted intervention strategy modestly improved implementation (for parts of the recommendations in) the Dutch low back pain guideline by general practitioners and produced small concomitant changes in patient management. The implementation strategy produced fewer referrals to therapists during follow-up consultations.

This article analyzes Dutch experiences of health care reform-in particular in primary care-with emphasis on lessons for current United States health care reforms. Recent major innovations were the introduction of private insurance based on the principles of primary care-led health care and including all citizens irrespective of their financial, employment, or health status; introduction of primary care collaboratives for out-of-hour services and chronic disease management; and primary care team building, including practice nurses. These innovations were introduced on top of a strong primary care tradition of family practices with defined populations based on patient panels, practice-based research, evidence-based medicine, large-scale computerization, and strong primary care health informatics. Dutch health reform redirected payment to support introduction of innovative health plans and strengthening of primary care to respond to public health objectives.Five recommendations for US primary care follow from this Dutch experience: (1) a private insurance model is compatible with thriving primary care, but it must include all people, especially the most vulnerable in society, and espouse a primary care-led health care system; (2) patient panels or practice lists strengthen continuity of care and community orientation to focus on and respond to local needs; (3) reward collaboration within primary care and between primary care, hospital care, and public health; (4) stimulate primary care professionals to exert their passion and expertise through participation in primary care research and development; and (5) health informatics should be primary care based, preferably adopting the International Classification of Primary Care. With these recommendations, it will be possible for the United States to obtain better population health for its population. (J Am Board Fam Med 2012;25:S12-17.)

Observational, point-prevalence, and cross-sectional study. SettingGPs attending the annual conference of the Dutch College of General Practitioners in 2006. MethodNasal swabs were randomly taken from 395 GPs and analysed for the presence of S. aureus. Antimicrobial susceptibility was determined by a microbroth dilution method and the genotypes by spa typing, which was associated with multilocus sequence typing. ResultsOf the GPs, 129/395 (33%; 95% confidence interval [CI] = 28 to 37%) were carriers of S. aureus. No meticillin-resistant S. aureus (MRSA) was found. Resistance was observed to penicillin (71%; 95% CI = 63 to 79%), fusidic acid (7%; 95% CI = 3 to 13%), and clarithromycin (6%; 95% CI = 3 to 12%). In 72% of the isolates, an MRSA-related genotype of S. aureus was found. ConclusionThe low antibiotic resistance found among S. aureus of GPs suggests that GPs are not a reservoir of antibioticresistant S. aureus strains. The relatively high resistance to fusidic acid, which has not previously been described in the Netherlands and is mostly because of antibiotic use, suggests that patients infect GPs and not the other way round. GPs may be at risk for nasal carriage of S. aureus with an MRSA-related genotype.

Background: Personal continuity in general practice is considered to be a prerequisite of high quality patient care based on shared knowledge and mutual understanding. Not much is known about how personal continuity is reflected in the content of GP -patient communication. We explored whether personal continuity of care influences the content of communication during the consultation.

Er wordt heel wat geı¨nformeerd in Nederland. Dat is niet erg, want goed geı¨nformeerde patie¨nten zijn een zegen: zij komen met gerichte vragen en staan meer open voor de deskundigheid en informatie van de huisarts. Maar geı¨n-formeerde patie¨nten blijken helaas niet altijd goed geı¨nformeerd.Zo is er de laatste tijd opvallend veel geı¨nformeerd over schimmelnagels. Pedicures zijn vast en zeker goed geı¨nformeerd, want buitengewoon vaak komen patie¨n-ten rechtstreeks bij hen vandaan met vragen om pillen voor de behandeling van schimmelnagels.Deze zomer werd de bevolking via televisiereclame nog eens extra geı¨nformeerd: 'Raadpleeg uw huisarts; die kan u helpen de nagel weer gezond te maken.' Wakkere collega's hebben bij de Reclame Code Commissie gelukkig bezwaar gemaakt tegen deze vorm van informatievoorziening. De gedaagde partij blijkt toevallig een producent van antimycotica. Zou het misschien dezelfde organisatie zijn die de pedicures zo goed heeft geı¨nfor-meerd? Informatie over gezondheidsproblemen onderscheidt zich van reclame als de voorlichtende instantie een zekere onafhankelijkheid heeft. Opportunistische motieven als omzetvergroting horen in ieder geval geen rol te spelen.De huisarts mag het allemaal uitleggen, en de boodschap dat het meestal vooral een cosmetisch probleem is, is voor de patie¨nt vaak een teleurstelling. Dat vraagt dus weer veel tijd en aandacht, en hoe dan ook betekent het meer werk voor de huisarts. Die tijd kan wel beter besteed worden. Bijvoorbeeld aan echte gezondheidsproblemen.Uit welk budget zou de betreffende organisatie die reclamespotjes eigenlijk betalen? Marketing misschien? Huisarts en Wetenschap (december 2001) 44:237