1. Lex Goudswaard, GP, PhD Kees in ’t Veld, GP Saskia Mol, MD, PhD Netherlands College of GPs (NHG)

2. Guidelines...

3. Guidelines: indispensable for quality assurance / improvement, but...

4. Guidelines do not implement themselves! Kathleen Lohr

5. Close contact between ‘makers’ and ‘users’ is very helpful (if not necessary) for a successful guideline program! Jonathan Lomax

6. What’s old?50 GPs (randomly selected) are invited to comment upon the concept of the guideline

7. What’s new?50 GPs…involvement, from the start, of a staffmember with knowledge and experience in implementation

8. What’s new (2)?Discussion group at University Institute for Vocational Training: 6-8 GP trainers 1 GP trainee 3 staff NHG (chair)

9. MethodSpontaneous abortionProblem drinking Lower urinary tract symptoms Urinary tract infectionHeart failureOsteoporosis

10. Results (1) Proposed changes70Items changed 30(43%) Partially changed13(19%) Total43(61%)

11. Results (2) AlcoholDefinition: abuse, dependancy, problem drinking……problem drinkingMaking up the vitamin deficiency……in malnourished people

12. Results (3) LUTSReferral for further investigations and/or treatment linked to a life expectancy of 10 yrs……72 yrs, co-morbidityemphasis on shared decision making

13. Results (4) Spontaneous abortionNeutral stand on wait&see versus D&C……clear stand on the advantage of wait&see

15. Workshop

16. Workshop Keyfeatures clinical guideline UTI: 1.UTI without fever in healthy, non pregnant woman = uncomplicated 2.All other UTI are complicated

17. W orkshop 3.High risk patients: physical examination (abdomen, VE)! 4.A screening test of leucocyte enzymes can determine treatment

18. W orkshop 5.Treatment of choice: nitrofurantoin (5 day course) 6. Treatment complicated UTI: longer, with antibiotics effective against a wide range of bacteria

19. Thank you very much! P.O. Box 3231 3502 GE Utrecht the Netherlands +3130 288 17 00 c.intveld@nhg-nl.org