{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T18:17:34Z","timestamp":1792433854602,"version":"4.5.0"},"reference-count":60,"publisher":"Royal College of General Practitioners","issue":"718","license":[{"start":{"date-parts":[[2019,2,12]],"date-time":"2019-02-12T00:00:00Z","timestamp":1549929600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Gen Pract"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Low-value pharmaceutical care exists in general practice. However, the extent among Dutch GPs remains unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To assess the prevalence of low-value pharmaceutical care among Dutch GPs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design and setting<\/jats:title><jats:p>Retrospective cohort study using data from patient records.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>The prevalence of three types of pharmaceutical care prescribed by GPs between 2016 and 2019 were examined: topical antibiotics for conjunctivitis, benzodiazepines for non-specific lower back pain, and chronic acid-reducing medication (ARM) prescriptions. Multilevel logistic regression analysis was performed to assess prescribing variation and the influence of patient characteristics on receiving a low-value prescription.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Large variation in prevalence as well as practice variation was observed among the types of low-value pharmaceutical GP care examined. Between 53% and 61% of patients received an inappropriate antibiotics prescription for conjunctivitis, around 3% of patients with lower back pain received an inappropriate benzodiazepine prescription, and 88% received an inappropriate chronic ARM prescription during the years examined. The odds of receiving an inappropriate antibiotic or benzodiazepine prescription increased with age (<jats:italic>P<\/jats:italic>&lt;0.001), but decreased for chronic inappropriate ARM prescriptions (<jats:italic>P<\/jats:italic>&lt;0.001). Sex affected only the odds of receiving a non-indicated chronic ARM, with males being at higher risk (<jats:italic>P<\/jats:italic>&lt;0.001). The odds of receiving an inappropriate ARM increased with increasing neighbourhood socioeconomic status (<jats:italic>P<\/jats:italic>&lt;0.05). Increasing practice size decreased the odds of inappropriate antibiotic and benzodiazepine prescriptions (<jats:italic>P<\/jats:italic>&lt;0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The results show that the prevalence of low-value pharmaceutical GP care varies among these three clinical problems. Significant variation in inappropriate prescribing exists between different types of pharmaceutical care \u2014 and GP practices.<\/jats:p><\/jats:sec>","DOI":"10.3399\/bjgp.2021.0625","type":"journal-article","created":{"date-parts":[[2022,2,10]],"date-time":"2022-02-10T18:05:11Z","timestamp":1644516311000},"page":"e369-e377","source":"Crossref","is-referenced-by-count":9,"title":["Low-value pharmaceutical care among Dutch GPs: a retrospective cohort study"],"prefix":"10.3399","volume":"72","author":[{"given":"Joris LJM","family":"M\u00fcskens","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone A","family":"van Dulmen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tjerk","family":"Wiersma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jako S","family":"Burgers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"Hek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gert P","family":"Westert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rudolf B","family":"Kool","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1987","published-online":{"date-parts":[[2022,2,10]]},"reference":[{"key":"2022051104050915000_72.718.e369.1","doi-asserted-by":"publisher","DOI":"10.1177\/1077558716656970"},{"key":"2022051104050915000_72.718.e369.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)32585-5"},{"key":"2022051104050915000_72.718.e369.3","unstructured":"Dutch College of General Physicians (2022) [NHG Standards]. [Article in Dutch]. https:\/\/richtlijnen.nhg.org (accessed 11 Mar 2022)."},{"issue":"2","key":"2022051104050915000_72.718.e369.4","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1093\/eurpub\/ckz245","article-title":"Assessing volume and variation of low-value care practices in the Netherlands","volume":"30","author":"Kool","year":"2020","journal-title":"Eur J Public Health"},{"key":"2022051104050915000_72.718.e369.5","unstructured":"Linden MVD Westert G Bakker D Schellevis F (2004) [Second national study regarding illness and actions within the general practitioner practice: diseases and medical conditions within the general population and general practice]. [Article in Dutch]. https:\/\/www.nivel.nl\/nl\/publicatie\/tweede-nationale-studie-naar-ziekten-en-verrichtingen-de-huisartspraktijk-klachten-en (accessed 11 Mar 2022)."},{"key":"2022051104050915000_72.718.e369.6","unstructured":"Volkers A van Dijk L Wolters I Bakker D (2009) [Formulary within general practice: use and adherence to advice]. [Article in Dutch]. https:\/\/www.nivel.nl\/nl\/publicatie\/formularia-de-huisartspraktijk-gebruik-en-het-opvolgen-van-adviezen (accessed 11 Mar 2022)."},{"issue":"4","key":"2022051104050915000_72.718.e369.7","first-page":"614","article-title":"Potentially inappropriate prescribing to older patients in primary care in the Netherlands: a retrospective longitudinal study","volume":"46","author":"Bruin-Huisman","year":"2017","journal-title":"Age Ageing"},{"issue":"1","key":"2022051104050915000_72.718.e369.8","doi-asserted-by":"crossref","first-page":"14086","DOI":"10.1038\/npjpcrm.2014.86","article-title":"Prevalence of inappropriate prescribing of inhaled corticosteroids for respiratory tract infections in the Netherlands: a retrospective cohort study","volume":"24","author":"Teichert","year":"2014","journal-title":"NPJ Prim Care Respir Med"},{"key":"2022051104050915000_72.718.e369.9","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-4-54"},{"issue":"8","key":"2022051104050915000_72.718.e369.10","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1016\/j.jacr.2018.12.015","article-title":"An evaluation of guideline-discordant ordering behavior for CT pulmonary angiography in the emergency department","volume":"16","author":"Simon","year":"2019","journal-title":"J Am Coll Radiol"},{"issue":"7","key":"2022051104050915000_72.718.e369.11","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1001\/jamainternmed.2014.1541","article-title":"Measuring low-value care in Medicare","volume":"174","author":"Schwartz","year":"2014","journal-title":"JAMA Intern Med"},{"issue":"1","key":"2022051104050915000_72.718.e369.12","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1186\/s12913-019-4277-9","article-title":"Measuring the frequency and variation of unnecessary care across Canada","volume":"19","author":"Bouck","year":"2019","journal-title":"BMC Health Serv Res"},{"key":"2022051104050915000_72.718.e369.13","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-014-3070-z"},{"issue":"7","key":"2022051104050915000_72.718.e369.14","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1001\/jamainternmed.2016.2086","article-title":"Comparison of low-value care in Medicaid vs commercially insured populations","volume":"176","author":"Charlesworth","year":"2016","journal-title":"JAMA Intern Med"},{"key":"2022051104050915000_72.718.e369.15","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2020-012576"},{"key":"2022051104050915000_72.718.e369.16","doi-asserted-by":"publisher","DOI":"10.9778\/cmajo.20160095"},{"key":"2022051104050915000_72.718.e369.17","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2017-006778"},{"key":"2022051104050915000_72.718.e369.18","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2019-010060"},{"issue":"457","key":"2022051104050915000_72.718.e369.19","first-page":"640","article-title":"Low back pain in general practice: reported management and reasons for not adhering to the guidelines in the Netherlands","volume":"50","author":"Schers","year":"2000","journal-title":"Br J Gen Pract"},{"key":"2022051104050915000_72.718.e369.20","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2296-8-54"},{"key":"2022051104050915000_72.718.e369.21","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2019-029760"},{"key":"2022051104050915000_72.718.e369.22","unstructured":"Nederlands Huisartsen Genootschap (2017) [NHG guideline: red eye and eye trauma]. [Article in Dutch]. https:\/\/richtlijnen.nhg.org\/standaarden\/rood-oog-en-oogtrauma (accessed 11 Mar 2022)."},{"key":"2022051104050915000_72.718.e369.23","unstructured":"Nederlands Huisartsen Genootschap (2017) [NHG guideline: non-specific lower back pain]. [Article in Dutch]. https:\/\/richtlijnen.nhg.org\/standaarden\/aspecifieke-lagerugpijn#volledige-tekst (accessed 11 Mar 2022)."},{"key":"2022051104050915000_72.718.e369.24","unstructured":"Nederlands Huisartsen Genootschap (2013) [NHG guideline: stomach complaints]. [Article in Dutch]. https:\/\/richtlijnen.nhg.org\/standaarden\/maagklachten (accessed 11 Mar 2022)."},{"issue":"8","key":"2022051104050915000_72.718.e369.25","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1016\/j.ophtha.2017.04.034","article-title":"Antibiotic prescription fills for acute conjunctivitis among enrollees in a large United States managed care network","volume":"124","author":"Shekhawat","year":"2017","journal-title":"Ophthalmology"},{"key":"2022051104050915000_72.718.e369.26"},{"issue":"10137","key":"2022051104050915000_72.718.e369.27","doi-asserted-by":"crossref","first-page":"2368","DOI":"10.1016\/S0140-6736(18)30489-6","article-title":"Prevention and treatment of low back pain: evidence, challenges, and promising directions","volume":"391","author":"Foster","year":"2018","journal-title":"Lancet"},{"issue":"2","key":"2022051104050915000_72.718.e369.28","doi-asserted-by":"crossref","first-page":"e2037328","DOI":"10.1001\/jamanetworkopen.2020.37328","article-title":"Trends in low-value health service use and spending in the US Medicare fee-for-service program, 2014\u20132018","volume":"4","author":"Mafi","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"2","key":"2022051104050915000_72.718.e369.29","doi-asserted-by":"crossref","first-page":"25","DOI":"10.7812\/TPP\/15-081","article-title":"Low back imaging when not indicated: a descriptive cross-system analysis","volume":"20","author":"Gold","year":"2016","journal-title":"Perm J"},{"issue":"7","key":"2022051104050915000_72.718.e369.30","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/j.pmrj.2013.12.015","article-title":"Trends in ambulatory physician opioid prescription in the United States, 1997\u20132009","volume":"6","author":"Jeffrey Kao","year":"2014","journal-title":"PM&R"},{"key":"2022051104050915000_72.718.e369.31","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g6380"},{"key":"2022051104050915000_72.718.e369.32","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-021-06909-3."},{"issue":"4","key":"2022051104050915000_72.718.e369.33","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1097\/SMJ.0b013e31828db01f","article-title":"Four-year trends of inappropriate proton pump inhibitor use after hospital discharge","volume":"106","author":"Leri","year":"2013","journal-title":"South Med J"},{"issue":"12","key":"2022051104050915000_72.718.e369.34","doi-asserted-by":"crossref","first-page":"2600","DOI":"10.1111\/jgs.16117","article-title":"Low-value proton pump inhibitor prescriptions among older adults at a large academic health system","volume":"67","author":"Mafi","year":"2019","journal-title":"J Am Geriatr Soc"},{"key":"2022051104050915000_72.718.e369.35","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2010.11.009"},{"key":"2022051104050915000_72.718.e369.36","doi-asserted-by":"publisher","DOI":"10.1002\/jhm.2330"},{"issue":"8","key":"2022051104050915000_72.718.e369.37","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1016\/j.dld.2020.05.005","article-title":"Appropriateness of proton pump inhibitors treatment in clinical practice: prospective evaluation in outpatients and perspective assessment of drug optimisation","volume":"52","author":"Giannini","year":"2020","journal-title":"Dig Liver Dis"},{"key":"2022051104050915000_72.718.e369.38","unstructured":"Hendriksen J Hooiveld M Nielen M Hek K (2021) [Methods used to determine descriptive statistics, Nivel Primary Care Database]. [Article in Dutch]. https:\/\/www.nivel.nl\/nl\/zorgregistraties-eerste-lijn\/methoden (accessed 11 Mar 2022)."},{"issue":"2","key":"2022051104050915000_72.718.e369.39","doi-asserted-by":"crossref","first-page":"98","DOI":"10.3414\/ME0471","article-title":"Estimating morbidity rates from electronic medical records in general practice. Evaluation of a grouping system","volume":"47","author":"Biermans","year":"2008","journal-title":"Methods Inf Med"},{"key":"2022051104050915000_72.718.e369.40","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2006.06.005"},{"key":"2022051104050915000_72.718.e369.41","unstructured":"Nivel zorgregistraties (2021) [Nivel Primary Care Database]. [Article in Dutch]. https:\/\/www.nivel.nl\/en\/nivel-zorgregistraties-eerste-lijn\/nivel-primary-care-database (accessed 11 Mar 2022)."},{"key":"2022051104050915000_72.718.e369.42","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2017-006678"},{"key":"2022051104050915000_72.718.e369.43","unstructured":"Snijders TAB Bosker RJ (2011) Multilevel analysis: an introduction to basic and advanced multilevel modeling (SAGE Publications, London)."},{"key":"2022051104050915000_72.718.e369.44","doi-asserted-by":"crossref","first-page":"231","DOI":"10.3389\/fpubh.2020.00231","article-title":"Socioeconomic status and access to healthcare: interrelated drivers for healthy aging","volume":"8","author":"McMaughan","year":"2020","journal-title":"Front Public Health"},{"issue":"3","key":"2022051104050915000_72.718.e369.45","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1177\/2150131917697439","article-title":"How socioeconomic status affects patient perceptions of health care: a qualitative study","volume":"8","author":"Arpey","year":"2017","journal-title":"J Prim Care Community Health"},{"key":"2022051104050915000_72.718.e369.46","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa044464"},{"issue":"1","key":"2022051104050915000_72.718.e369.47","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/S1068-8595(95)80012-3","article-title":"Gender, social roles and health care utilization","volume":"3","author":"David","year":"1995","journal-title":"Appl Behav Sci Rev"},{"issue":"2","key":"2022051104050915000_72.718.e369.48","first-page":"147","article-title":"Gender differences in the utilization of health care services","volume":"49","author":"Bertakis","year":"2000","journal-title":"J Fam Pract"},{"key":"2022051104050915000_72.718.e369.49","unstructured":"The Netherlands Institute for Social Research (2017) Statusscores 2017 (The Netherlands Institute for Social Research, The Hague)."},{"key":"2022051104050915000_72.718.e369.50","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.280318"},{"key":"2022051104050915000_72.718.e369.51","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/s12875-016-0460-9","article-title":"General practice variation when initiating long-term prescribing of proton pump inhibitors: a nationwide cohort study","volume":"17","author":"Haastrup","year":"2016","journal-title":"BMC Fam Pract"},{"key":"2022051104050915000_72.718.e369.52","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2009.12.005"},{"key":"2022051104050915000_72.718.e369.53","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2020.04.190310"},{"key":"2022051104050915000_72.718.e369.54","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2019.02.180111"},{"issue":"1","key":"2022051104050915000_72.718.e369.55","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1071\/HC20040","article-title":"Antibiotic prescribing patterns of general practice registrars for infective conjunctivitis: a cross-sectional analysis","volume":"13","author":"Cherry","year":"2021","journal-title":"J Prim Health Care"},{"issue":"1","key":"2022051104050915000_72.718.e369.56","doi-asserted-by":"crossref","first-page":"e187399","DOI":"10.1001\/jamanetworkopen.2018.7399","article-title":"Patterns in outpatient benzodiazepine prescribing in the United States","volume":"2","author":"Agarwal","year":"2019","journal-title":"JAMA Netw Open"},{"issue":"1","key":"2022051104050915000_72.718.e369.57","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1007\/s11606-019-05549-8","article-title":"Patterns of opioid and benzodiazepine use in opioid-na\u00efve patients with newly diagnosed low back and lower extremity pain","volume":"35","author":"Azad","year":"2020","journal-title":"J Gen Intern Med"},{"key":"2022051104050915000_72.718.e369.58","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.4151"},{"key":"2022051104050915000_72.718.e369.59","doi-asserted-by":"crossref","first-page":"7591045","DOI":"10.1155\/2019\/7591045","article-title":"Predictors of inappropriate proton pump inhibitors use in elderly patients","volume":"2019","author":"Voukelatou","year":"2019","journal-title":"Curr Gerontol Geriatr Res"},{"key":"2022051104050915000_72.718.e369.60","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-037019"}],"container-title":["British Journal of General Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.3399\/BJGP.2021.0625","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,26]],"date-time":"2023-01-26T14:52:47Z","timestamp":1674744767000},"score":1,"resource":{"primary":{"URL":"http:\/\/bjgp.org\/lookup\/doi\/10.3399\/BJGP.2021.0625"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,10]]},"references-count":60,"journal-issue":{"issue":"718","published-online":{"date-parts":[[2022,4,28]]},"published-print":{"date-parts":[[2022,5]]}},"alternative-id":["10.3399\/BJGP.2021.0625"],"URL":"https:\/\/doi.org\/10.3399\/bjgp.2021.0625","relation":{},"ISSN":["0960-1643","1478-5242"],"issn-type":[{"value":"0960-1643","type":"print"},{"value":"1478-5242","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,10]]}}}