| Research within this programme is focused on innovation and effect evaluation of (a) diagnos-tic decision-making and (b) therapeutic interventions in extramural and integrated health care. Both effectiveness and efficiency are studied. Complementary to original intervention studies, much work is being put into synthesis and the evaluation of completed studies (systematic reviews). The emphasis is on chronic diseases associated with a considerable burden of illness in the community. Diagnostic decision-making usually marks the first step in professio-nal care and is a key determinant of its effectiveness. Diagnostics are important for recognizing or excluding disease, for predicting clinical course and treatment effectiveness and for deciding on further diagnostic testing, treatment and referral. Within the unselected spectrum of morbidity presented in primary health care, differential diagnosis is essentially different from that in patients referred to secondary care. Also, co-morbidity is important in evaluating the validity of diagnostic testing, especially in the elderly. Moreover, the methodology of diagnostic research is far less developed than the methodology in therapeutic research, a fortiori in primary care. Therefore, diagnostic research in extramural and integrated care meets specific challenges. Meta-analyses and primary diagnostic studies are performed on current diagnostics and diagnostic strategies in various clinical fields. In addition, innovative (non-invasive) diagnostic technologies (such as ultra-sound measurements, uro-flow-metry and 24-hour measurement of bloodpressure) and computer assistance in diagnostic decision making are tested for their effectiveness and applicability in extramural and integrated care settings. The central object of the therapeutic intervention research is the innovation and evaluation of generalist-oriented extra-mural and integrated health care, including rehabilitation and home care. Effectiveness and cost-effectiveness of newly developed and already existing - but insuffi-ciently evaluated - interventions (gene-ral practice, physiotherapy and community nursing) are studied. Potential, limitations, and adverse effects of new (particularly non-invasive) technologies are investigated. Attention is paid to long term and adverse effects of chronic medication, with a specific interest in effects and feasibility of withdrawal or reduction of such medication. Furthermore, addressing co-morbidity is important in therapeutic decision-making and patient follow-up. Primary outcome variables concern health and well-being of patients, including quality of life and functional status. Emphasis is put on chronic diseases such as asthma, COPD, cardiovascular disease, musculoskeletal disorders, diabetes, and mental disorders, and to a lesser extent on minor ailments common in primary care. The research usually requires an experimental design with long-term follow-up. In addition to original studies with new data collections, making therapeutic systematic reviews a major field of interest. |
