Tobacco control has been identified as the most urgent and immediate priority intervention to reduce the prevalence of non-communicable disease. Nevertheless, a substantial gap exists between the... Show moreTobacco control has been identified as the most urgent and immediate priority intervention to reduce the prevalence of non-communicable disease. Nevertheless, a substantial gap exists between the evidence-based knowledge on the treatment of tobacco dependence and real-world practices of primary care professionals. The empirical studies in this dissertation provided insight in a variety of methodological approaches that can be used to describe and facilitate the implementation of smoking cessation care in general practice. This resulted in study findings showing that a training programme for GPs including action planning has the potential to facilitate the implementation of smoking cessation care, in particular the degree to which smokers are identified and advised to quit. In addition, full health insurance coverage of stop-smoking programmes increased GP prescription behaviour. Yet, challenges remain to incorporate smoking cessation care as a routine procedure in general practice, with a special focus on arranging follow-up support by GPs. This dissertation provided several new ideas for future research in order to overcome these challenges. Multifaceted strategies, based on a socio-ecological approach to guideline implementation and including behavioural change theories, have the potential to facilitate a successful implementation of smoking cessation care in general practice. Show less
This thesis is about migraine. Three elements are discussed. First element is preventive treatment, second element is attack treatment and the third part focuses on medication overuse headache. The... Show moreThis thesis is about migraine. Three elements are discussed. First element is preventive treatment, second element is attack treatment and the third part focuses on medication overuse headache. The preventive treatment of migraine is a valuable intervention in primary care. If preventive treatment is applied, usually only one attempt with one type of medication is performed. A number of considerations hinder GPs to address preventive treatment of migraine. Also several patient-related aspects cause that the GP differ from national guidelines. The decision to start preventive treatment is based on a complex of considerations from the patient. For example, experienced suffering from migraine and interaction with family, colleagues and general practitioner. Interest in preventive therapy increases with increased concerns about migraine symptoms. In attack treatment of migraine, most patients had a clear preference for one of both treatments. Preference correlated only moderately with the commonly used "two-hour pain-free score." Multi-attack, crossover, 'patient preference' studies are well able to detect clinically relevant differences between existing treatments. Overuse of triptans, resulting in chronic headaches is common and causes unnecessary costs. The common thread through this thesis is what patients want in migraine and which interventions they prefer: patients' preference in migraine. Show less
Room for improvement is present in the treatment of migraine in primary care. However, inviting all patients who receive prescriptions for __2 triptans each month to have an evaluation consultation... Show moreRoom for improvement is present in the treatment of migraine in primary care. However, inviting all patients who receive prescriptions for __2 triptans each month to have an evaluation consultation with their general practitioner (GP), produces insufficient effect on headache outcomes and costs. However, it remains important to stay alert on patients who are candidate for preventive treatment. When discussing the possibility of preventive treatment, GPs should keep in mind possible barriers in patients. Also, GPs have to ask themselves if they do not deny patients a possibly effective treatment because of their own negative ideas towards preventive medication. Also, we learned that when designing pragmatic studies in primary care, there are methodological issues that make it harder to prove the effectiveness of an intervention. First, the outcomes of pragmatic studies in primary care can negatively affected by changes in the behaviour of GPs and patients in the control group. Second, the quality of life outcome measures that are often used in this type of research are harder to validate and to interpret than the more robust outcome measures that are used in clinical trials Show less
