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The European Journal of Public Health Advance Access originally published online on January 12, 2009
The European Journal of Public Health 2009 19(3):290-296; doi:10.1093/eurpub/ckn130
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© The Author 2009. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Health Services Research

Striking trends in the incidence of health problems in the Netherlands (2002–05). Findings from a new strategy for surveillance in general practice

Marion C. J. Biermans1, Peter Spreeuwenberg2, Robert A. Verheij2, Dinny H. de Bakker2, Pieter F. de Vries Robbé1 and Gerhard A. Zielhuis3

1 Department of Medical Informatics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
2 Netherlands Institute for Health Services Research, Utrecht, The Netherlands
3 Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

Correspondence: Marion Biermans, Department of Medical Informatics, Radboud University Nijmegen Medical Centre, 152 MI, PO Box 9101, 6500 HB Nijmegen, The Netherlands, tel: +31 24 361 54 30, fax: +31 24 361 35 04, e-mail: m.biermans{at}mi.umcn.nl

Received April 9, 2008 , accepted December 4, 2008

Background: This study aimed to detect striking trends based on a new strategy for monitoring public health. Methods: We used data over 4 years from electronic medical records of a large, nationally representative network of general practices. Episodes were either directly recorded by general practitioners (GPs) or were constructed using a new record linkage method (EPICON). The episodes were used to estimate raw morbidity rates for all codes of the International Classification of Primary Care (ICPC). Multilevel Poisson regression models were used to analyse the trend over time for 15 health problems that showed an obvious change over time. Based on these models, we calculated adjusted incidence rates corrected for clustering, sex and age. Results: During 2002–05, both men and women increasingly consulted the GP because of concern about a drug reaction, a change in faeces/bowel movements and urination problems. Men showed an increase in consultations for prostate problems and venereal diseases. The incidence of chronic internal knee derangement decreased for both sexes. Women consulted their GP less frequently about sterilization and fear of being pregnant. Conclusion: The strategy developed proved to be useful to detect trends across a short period of time. Changes in the health care market, such as the increasing availability of over-the-counter drugs and various large advertising campaigns for medications may explain some of the findings. The increasing incidence of health problems in the urogenital area deserves attention as it could reflect increases in the incidence of sexually transmitted diseases (STDs) and urinary tract infections.

Keywords: computerized medical record, family practice, health policy, incidence, trends


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