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LINH

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  1. LINH

  2. The Netherlands Information Network of General Practice

  3. Overview • position of the GP in the Netherlands • organisation and funding • what data are collected and how • research projects • the future

  4. Organisation and funding A joint project of: • Dutch association of GPs • Dutch College of GPs • Centre for Quality of Care Research (WOK) • NIVEL Basic infrastructure funded by the Dutch Ministry of Health

  5. Aims of LINH: Collect information in GP practices for: • health services research • quality of care research • public health monitoring

  6. Representativeness • 80 computerised general practices (about 350.000 patients) • 6 major GP software packages

  7. Data flow 1. Every day: full morbidity and interventions recording in general practice. 2. Every six months: • extraction software sent to GPs • GPs retrieve data and send it to LINH • storage in central database

  8. Data flow (2) 3. Every week: • extraction and upload of selection of diseases in 45 practices • influenza surveillance

  9. Quality assurance • practice selection procedures • support for ICPC coding • extensive software testing and checking • data-flow procedures, quality checks • feedback reports to practices • practice visits (at least bi-annually)

  10. History of LINH

  11. What data are collected? • contacts + diagnosis + episode typing (new/existing) • referrals + associated diagnosis • prescriptions (ATC codes) + associate diagnosis • diagnoses coded using ICPC • patient characteristics (sex, date of birth, postcode area, type of insurance)

  12. Individual patient records • follow patients in time (care chains) • comorbidity • comedication • linkage to hospital databases • linkage to CBS databases (eg. occupation, ethnicity)

  13. Output: some examples

  14. Mean number of home visits and contacts during consultation hours with the GP per patient per year, classified according to age, 2003 Annual reports on morbidity, contacts, prescription referrals at www.linh.nl

  15. Monthly column in the Journal of the Dutch college of GPs (Huisarts & Wetenschap)

  16. Health effects of firework disaster Enschede (2000)

  17. Prescription studies • off-label prescribing • changes in reimbursed package

  18. Monitoring annual Influenza vaccination campaign

  19. Evaluation electronic prescribing system

  20. Sudden changes in morbidity (bioterrorism)

  21. Towards a European morbidity network?(the eHID project)

  22. Antibiotics prescription in France and Netherlands

  23. GP reimbursement in relation to workload

  24. Information Network out of hours services

  25. Evaluation task delegation

  26. The future (1): Need to adapt to changes in the organisation of GP care • introduction of ‘call centers’ (triage) • introduction of GP co-ops for out of hours services • extending role of practice nurses/nurse practitioners/physician assistants • new referrer: occupational health care • no referral needed for physiotherapy

  27. The future (2):The next step in public health monitoring weekly extraction of data creates opportunities for: • monitoring infectious diseases (influenza) • monitoring rare diseases and sudden changes in morbidity patterns (bioterrorist attacks)

  28. The future (3):Technological innovations • ICPC-triggered pop-up screens • with extra in-depth questions • to investigate morbidity not covered by ICPC

  29. More about LINH at: www.linh.nl Graph and table headings in English