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Verschillen in preventieve zorg door huisartsen verklaren sociaal-economische verschillen in de incidentie van CVA niet

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Huisarts en Wetenschap Aims and scope

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Samenvatting

Avendano M, Boshuizen HC, Schellevis FG, Mackenbach JP, Van Lenthe FJ, Van den Bos GAM. Verschillen in preventieve zorg door huisartsen verklaren sociaal-economische verschillen in de incidentie van CVA niet. Huisarts Wet 2007;50(5):186-93.

Vraagstelling Bestaan er in Nederland sociaal-economische verschillen in de incidentie van een cerebrovasculair accident (CVA) en in de kwaliteit van de preventieve zorg van huisartsen met betrekking tot CVA?

Onderzoeksopzet Wij volgden gedurende 12 maanden 190.664 patiënten uit 96 verschillende huisartsenpraktijken. Gegevens over alle gestelde diagnosen, verwijzingen naar de tweede lijn, voorgeschreven geneesmiddelen en diagnostische procedures ontleenden we aan het elektronisch medisch dossier. De kwaliteit van de preventieve zorg, gedefinieerd als de zorg door de huisarts voor aandoeningen die een verhoogd risico op CVA met zich meebrengen, bepaalden we aan de hand van 8 kwaliteitsindicatoren op basis van de NHG-Standaarden.

Resultaten Een lager opleidingsniveau was bij mannen, maar niet bij vrouwen geassocieerd met een hogere incidentie van CVA (RR voor mannen 1,36, 95%-BI 1,06-1,74). Zowel onder mannen als vrouwen werden sociaal-economische verschillen waargenomen in het vóórkomen van hypertensie, hypercholesterolemie, diabetes mellitus, angina pectoris, hartfalen en perifeer arterieel vaatlijden. Wanneer lager opgeleide patiënten met hypercholesterolemie cholesterolverlagende medicatie kregen voorgeschreven, was dat minder vaak een statine. Er konden geen duidelijke verschillen in de kwaliteit van zorg worden aangetoond voor andere aandoeningen die een verhoogd risico op CVA met zich meebrengen.

Conclusie De algemene toegankelijkheid van huisartsenzorg en de implementatie van richtlijnen in de huisartsenpraktijk hebben er waarschijnlijk aan bijgedragen dat er aan alle sociaal-economische groepen gelijke en gestandaardiseerde zorg geboden wordt voor aandoeningen die een verhoogd risico op CVA geven. Dit heeft er echter niet toe geleid dat er geen sociaal-economische verschillen in de incidentie van CVA meer bestaan.

Abstract

Avendano M, Boshuizen HC, Schellevis FG, Mackenbach JP, Van Lenthe FJ, Van den Bos GAM. Disparities in stroke preventive care in general practice did not explain socioeconomic disparities in stroke. Huisarts Wet 2007;50(5):186-93.

Objective To assess socioeconomic disparities in stroke incidence and in the quality of preventive care in general practice for stroke in the Netherlands.

Study design and setting A total of 190,664 patients who registered in 96 general practices were followed up for 12 months. Data were collected on diagnoses, referrals, prescriptions, and diagnostic procedures. Hazard ratios (HR) were calculated to assess the association between educational level and stroke incidence. We developed quality indicators based on evidence based guidelines for stroke prevention at general practice, and assessed deviations from these guidelines. Multilevel logistic regression was used to assess socioeconomic disparities in the quality of preventive care for stroke precursors.

Results Lower educational level was associated with higher incidence of stroke in men (HR 1.36, 95% CI 1.06-1.74) but not in women. Among both men and women, there were socioeconomic disparities in the prevalence of hypertension, hypercholesterolemia, diabetes, angina pectoris, heart failure, and peripheral artery disease. Lower educated hypercholesterolemia patients under medication were less likely to be prescribed statins (odds ratio 0.62, 95% CI 0.42-0.91). However, for other precursors of stroke, there were no major disparities in the quality of preventive care.

Conclusion There are socioeconomic disparities in stroke incidence among men but not among women. Socioeconomic differences in factors such as hypertension and diabetes are likely to contribute to stroke disparities. Universal access to general practice and the implementation of general practice guidelines in the Netherlands are likely to have promoted the provision of equal and standardised care for stroke precursors across socioeconomic groups.

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  1. www.bsl.nl/shop/huisarts-en-wetenschap-0018-7070.html

    M Avendano

Authors
  1. M Avendano
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  2. HC Boshuizen
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  3. FG Schellevis
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  4. JP Mackenbach
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  5. FJ van Lenthe
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  6. GAM van den Bos
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Corresponding author

Correspondence to M Avendano.

Additional information

Erasmus MC, Instituut voor Maatschappelijke Gezondheidszorg, Postbus 2040, 3000 CA Rotterdam: dr. M. Avendano: onderzoeker; prof. dr. J.P. Mackenbach, hoogleraar; dr. F.J. van Lenthe, universitair docent; NIVEL, Utrecht: prof.dr. F.G. Schellevis, programmaleider huisartsgeneeskundige zorg; RIVM, Bilthoven: dr. H.C. Boshuizen, onderzoeker; AMC, afdeling Sociale Geneeskunde: prof.dr. G.A.M. van den Bos, hoogleraar.

Mogelijke belangenverstrengeling: niets aangegeven.

Dit artikel is een bewerkte vertaling van: Avendano M, Boshuizen HC, Schellevis FG, Mackenbach JP, Van Lenthe FJ, Van den Bos GA.Disparities in stroke preventive care in general practice did not explain socioeconomic disparities in stroke. J Clin Epidemiol 2006;59:1285-94. Publicatie gebeurt met toestemming van de uitgever.

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Avendano, M., Boshuizen, H., Schellevis, F. et al. Verschillen in preventieve zorg door huisartsen verklaren sociaal-economische verschillen in de incidentie van CVA niet. HUWE 50, 313–321 (2007). https://doi.org/10.1007/BF03085158

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