Multiple sclerosis: management in Dutch general practice.
OBJECTIVE
A descriptive study on 118 MS patients in general practice, to describe the family physician's role in diagnosis, treatment and follow-up of patients.


METHODS
Random sample of 103 general practices (161 family physicians) throughout The Netherlands with a total list of 335,000 patients.


RESULTS
MS patients had on average 5.7 encounters with general practice in 3 months compared to 2.3 in all other patients (P < 0.001). Home visits counted for 38.7% of all family physician's encounters in MS patients compared to 16.6% in all other patients (P < 0.01). The average encounter lasted 12.9 minutes per MS patient compared to 7.8 in all other patients (P < 0.01). Counselling by the family physician took place in all new patients and in 53% of known patients. Follow-up appointments were made with all new patients and 65.9% of all MS patients. Fifteen patients (12.7%) were newly referred to a specialist and 28 patients (24%) were still treated by specialists. No medication was prescribed to almost 40% of patients. Vitamin B, benzodiazepines, laxatives, antibiotics for treatment of urinary tract infections and muscle relaxants are the most frequently prescribed drugs. The average dose of vitamin B complex was 1.94 times the defined daily dose.


CONCLUSIONS
The family physician spends more time than average on MS patients, carries out more home visits and takes care of treatment of symptoms and complications of MS. Counselling and follow-up of patients takes an important place in family physician's management of MS. Vitamin B complex is being prescribed (too) frequently in a (too) high dose.
NIVEL, Dutch National Survey of General Practice, Utrecht, The Netherlands.
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Donker
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Foets
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Spreeuwenberg
D000328:Adult; D000368:Aged; D001071:Appointments and Schedules; D019090:Case Management; D015897:Comorbidity; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D009426:Netherlands / Q000453:epidemiology; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D012017:Referral and Consultation