What factors explain the differences in morbidity estimations among general practice registration networks in the Netherlands? A first analysis

BACKGROUND: Information on the incidence and prevalence of diseases is a core indicator for public health. There are several ways to estimate morbidity in a population (e.g., surveys, healthcare registers). In this paper, we focus on one particular source: general practice based registers. Dutch general practice is a potentially valid source because nearly all non-institutionalized inhabitants are registered with a general practitioner (GP), and the GP fulfils the role as "gatekeeper". However, there are some unexplained differences among morbidity estimations calculated from the data of various general practice registration networks (GPRNs). OBJECTIVE: To describe and categorize factors that may explain the differences in morbidity rates from different GPRNs, and to provide an overview of these factors in Dutch GPRNs. RESULTS: Four categories of factors are distinguished: "healthcare system", "methodological characteristics", "general practitioner", and "patient". The overview of 11 Dutch GPRNs reveals considerable differences in factors. CONCLUSION: Differences in morbidity estimation depend on factors in the four categories. Most attention is dedicated to the factors in the "methodology characteristics" category, mainly because these factors can be directly influenced by the GPR