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Medische consumptie in de huisartspraktijk op Urk

(2002) Lege, Willem Adrianus de

Low referral rates for a considerable number of years among publicly insured Urk residents were the
reason for setting up this study.
Urk is a former island in the IJsselmeer, a lake in the central part of the Netherlands. Chapter 1 describes
the history of Urk, the population characteristics and mentality and its health care facilities.
Studying literature on the subject (chapter 2) resulted in an analytical model and the conclusion that an
extensive inventory of the health condition (self-reported by the population), care demand (GP consultation),
use of care (number of consultations and subsequent interventions) and factors that influenced the
population and the GPs as for care demand and use of care, was worth doing. The Dutch national survey
of general practice (1987-1988) would provide the tools and could serve as reference.
The consequences are explained in chapter 3: a questionnaire among (a sample of) the population, a
questionnaire among GPs, and registration of all consultations and interventions in the GP practices for a
period of three months. The registration is episode-orientated, an episode being a number of consultations
for the same health problem. Questionnaire data of the population sample about use of care, health condition,
determinants of health and attitude were compared with the figures of the Dutch national survey or
with figures of the Central Bureau for Statistics or with both. Consultation registration data about care
demand and use of care in the GP practice were standardized per practice as for the Dutch population
structure (age and gender). In order to limit the consequences of diagnostic inter-doctor variation for the
comparison between Urk and the Netherlands as much as possible, diagnoses were clustered to an advanced
level. Differences between Urk and the Netherlands were only tested in 20 or more episodes in
Urk. The data collection for the study took place in the autumn of 1991.

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