30 Chapter 2 Table 2. Treatment of MRSA carriers. Frequency n/n (%) Estimated proportion of carriers in a GP practice that receive treatment * <20% 52/114 (46) 20–40% 8/114 (7) 40–60% 11/114 (10) 60–80% 12/114 (11) 80–100% 25/114 (22) Unknown 6/114 (5) Treatment by GP or referral to hospital Treatment by GP in all cases 12/114 (11) Referral to a hospital in all cases 40/114 (35) Treatment by GP in selected cases 32/114 (28) Uncomplicated carriership 23/32 (72) Patient preference for GP treatment 9/32 (28) Other 8/32 (25) None of the above 27/114 (24) Reasons not to refer to a hospital ** Unfamiliar with the existence of MRSA outpatient clinics 55/114 (48) Competent in self-performance 19/114 (17) Lack of recommendation in GP protocol 17/114 (15) Patients’ request not to be referred 13/114 (11) Costs for the patient *** 13/114 (11) Administrative burden of a referral 3/114 (3) Other **** 33/114 (29) Unknown 10/114 (9) Legend: * Estimation of the proportion of known MRSA carriers in the practice that are receiving eradication therapy or have received eradication treatment in the past. ** Multiple answers possible. *** In the Netherlands, the health insurance charges the patient an obligatory deductible excess for hospital care. **** Other reasons mentioned in free text were: consultation of specialist is sufficient, never considered, palliative settings, refusal of hospital, or not specified. GP = general practitioner. Two cases were presented in the questionnaire: case A was the description of a young patient with an uncomplicated carriership, and case B was a case of a complicated carriership (Box 1). Of the respondents, 40/114 (35%) were aware of the difference between ‘complicated’ versus ‘uncomplicated’ MRSA colonization. Respectively, 37 (33%) and 3 (3%) of the GPs would refrain from treatment in case A and B, 15 (13%) and 56 (49%) would refer the patient to a hospital for treatment, and 29 (25%) and 31 (27%) would first consult a specialist. Of the GPs that would initiate treatment in these cases themselves (17 in case A and 14 in case B), the treatment prescription was in accordance with the treatment guideline for 12/17 (71%) in case A (uncomplicated carriership) and for 8/14 (57%) in case B (complicated carriership). In both cases, four
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