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1.
BMC Fam Pract ; 19(1): 46, 2018 04 25.
Artigo em Inglês | MEDLINE | ID: mdl-29699492

RESUMO

BACKGROUND: General practice care plays a key role in keeping healthcare effective and cost-efficient. However, variation in the utilization rates of practices may reveal variation in practice performance. Our research goal is to investigate whether the socio-demographic profile of the patients' area of residence and practice organization characteristics influence the low or high utilization of general practice care. METHODS: Data on the utilization of general practice care were derived from the electronic health records of 232 general practices participating in the NIVEL Primary Care Database for the year 2013. Census data for the year 2013 were matched with the postal code of the patients. A small area estimation (SAE) technique was used to calculate the estimated utilization rate for general practice care per practice based on the socio-demographic profile of the patients' area of residence. Subsequently, the actual utilization rates were compared to the estimated rates per practice. Linear regression analysis was used to link the differences between the actual and estimated utilization rates to practice organization characteristics. RESULTS: The socio-demographic profile of the patients' area of residence accounted for 25.7% of the estimated utilization rates per practice. Practice organization characteristics accounted for 19.3% of the difference between the actual utilization rates and the estimated rates. Practices had higher utilization rates than estimated when a practice was a dual practice, when it employed female GPs, when it employed other healthcare providers and/or when it offered more services related to a disease management programme. CONCLUSION: We found that utilization rates of general practice care can be partially explained by the socio-demographic profile of the patients' area of residence, but also by practice organization characteristics. Insight into these factors provides both GPs and the other stakeholders involved in the organization of general practice care with information to help reflect on the utilization of care.


Assuntos
Medicina Geral/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Medicina Geral/organização & administração , Humanos , Lactente , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Países Baixos , Fatores Socioeconômicos , Adulto Jovem
2.
BMC Fam Pract ; 16: 96, 2015 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-26245953

RESUMO

BACKGROUND: General practitioners have an ideal position to motivate inactive patients to increase their physical activity. Most patients are able to exercise in regular local facilities outside the health care setting. The purpose of this study was to get insight into general practitioners perceptions and current practices regarding referral of patients to local exercise facilities. Furthermore, collaboration with exercise providers in the community was investigated, and motivators and barriers for referral. METHODS: A written questionnaire sent to a representative random sample of 800 Dutch general practitioners. Descriptive statistics and Chi(2) tests were used. RESULTS: All responding general practitioners (340) recommend their patients to take more exercise when necessary and 87 % say to refer patients sometimes. Limited motivation of the patient (44 %) and reduced health status (34 %) are the most mentioned barriers for advising patients to increase physical activity. When referred, most patients are send to a physical therapist (69 %) but also local exercise facilities were mentioned (54 %). The most important barrier for referring patients to local exercise activities are patients limited financial possibilities (46 %). Restricted knowledge of local exercise- or sport facilities was an additional barrier (19 %). There is little structural collaboration between general practitioners and exercise providers, but when collaboration exists general practitioners refer more often. Positive experiences of patients (67 %), affordable offers (59 %) and information of local exercise facilities (46 %) are seen as important promoting factors for referral. Although 32 % of the general practitioners think that good collaboration would be stimulating, regular meetings with sports and exercise providers were considered the least important for increasing referral (3 %). CONCLUSIONS: Dutch physicians have a positive attitude towards stimulating physical activity but referral to local exercise facilities is low. Referral is partly hindered by restricted knowledge of local exercise facilities. Although general practitioners think that collaboration is important for physical activity promotion, it should not cost them much extra time. A coordinator with knowledge of the local situation can facilitate contacts between GP practices and sports providers.


Assuntos
Atitude do Pessoal de Saúde , Comportamento Cooperativo , Exercício Físico , Academias de Ginástica , Medicina Geral/métodos , Promoção da Saúde/métodos , Relações Interprofissionais , Adulto , Idoso , Feminino , Medicina Geral/organização & administração , Promoção da Saúde/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Encaminhamento e Consulta , Esportes , Inquéritos e Questionários
3.
Diabet Med ; 31(7): 821-8, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24646343

RESUMO

AIMS: To investigate short- and long-term effects of real-time monitoring medication use combined with short message service (SMS) reminders for missed doses on refill adherence to oral anti-diabetic medication. METHODS: A randomized controlled trial with two intervention groups and one control group involving 161 participants with Type 2 diabetes with suboptimal adherence. For 6 months, participants in the SMS group (n = 56) were monitored and received SMS reminders if they missed their medication. Participants in the non-SMS group (n = 48) were only monitored. The control group (n = 57) was not exposed to any intervention. Primary outcome measure was refill adherence to oral anti-diabetic medication. Multi-level regression analyses were performed to examine intervention effects on adherence between and within groups after 1 and 2 years of follow-up. RESULTS: At baseline, mean refill adherence was comparable between the groups. After 1 year, adherence in the SMS group was significantly higher than in the control group (79.5% vs. 64.5%; P < 0.001) and showed a significant improvement from baseline (+16.3%; P < 0.001). Mean adherence in the non-SMS group reached 73.1% (+7.3%; P < 0.05), but did not differ from the control group (P = 0.06). After 2 years, the improved adherence in the SMS group persisted and remained significantly higher than in the control group (80.4% vs. 68.4%; P < .01), contrary to the non-SMS group whose adherence approached baseline level again (65.5%). CONCLUSIONS: This study shows the long-term effectiveness of real-time medication monitoring combined with SMS reminders in improving refill adherence. This new reminder system can strengthen the self-management of people with diabetes.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/psicologia , Adesão à Medicação/psicologia , Sistemas de Alerta , Autocuidado/psicologia , Envio de Mensagens de Texto , Administração Oral , Telefone Celular , Monitoramento de Medicamentos , Prática Clínica Baseada em Evidências , Feminino , Seguimentos , Hemoglobinas Glicadas/metabolismo , Humanos , Hipoglicemiantes/uso terapêutico , Masculino , Pessoa de Meia-Idade , Países Baixos , Sistemas de Alerta/tendências , Envio de Mensagens de Texto/tendências , Fatores de Tempo
4.
J Hum Nutr Diet ; 27(5): 426-33, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24205956

RESUMO

BACKGROUND: Greater insight into the effectiveness of usual dietetic care will contribute to the ongoing development of dietetic services. The present study examined the change in body mass index (BMI) in overweight patients after dietetic treatment in primary care, the sources of variability and factors associated with BMI change. METHODS: This population-based observational study was based on data from a Dutch registration network of dietitians in primary health care. Data were derived from electronic medical records concerning 3960 overweight adult patients (BMI ≥ 25 kg m⁻²) who received usual care from 32 registered dietitians between 2006 and 2012. Multilevel linear regression analyses were conducted. RESULTS: Patients' BMI significantly (P < 0.001) decreased by 0.94 kg m⁻² on average during treatment. An additional reduction of 0.8 kg m⁻² was observed in patients treated for longer than 6 months. BMI decreased by 0.06 kg m⁻² for each additional unit in initial BMI above 31.6. Most (97%) variability in BMI change was attributed to patients and 3% to dietitians. Part of the variance between patients (11%) and dietitians (30%) was explained by patient sociodemographic characteristics, nutrition-related health aspects, initial body weight and treatment duration. CONCLUSIONS: Dietetic treatment in primary care lowers BMI in overweight patients. Patients' change in BMI was rather similar between dietitians. Greater BMI reductions were observed in those with a high initial BMI and those treated for at least 6 months. Future research is necessary to study the long-term effects of weight loss after treatment by primary healthcare dietitians, especially because many patients drop out of treatment prematurely.


Assuntos
Dieta Redutora , Obesidade/dietoterapia , Sobrepeso/dietoterapia , Educação de Pacientes como Assunto , Adulto , Idoso , Índice de Massa Corporal , Registros Eletrônicos de Saúde , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Países Baixos , Nutricionistas , Pacientes Desistentes do Tratamento , Atenção Primária à Saúde , Fatores Socioeconômicos , Redução de Peso , Adulto Jovem
5.
Eur J Clin Pharmacol ; 69(8): 1599-606, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23588568

RESUMO

PURPOSE: Considerable variability in adherence over time exists. The aim of this study was to investigate to what extent deviations from the prescribed regimen in type 2 diabetes patients can be explained by characteristics of the individual 'medication intake moments' and the patient. METHODS: Medication intake of 104 non-adherent type 2 diabetes patients from 37 community pharmacies was electronically monitored for 6 months. The primary outcome measures were: (1) whether or not the intake occurred and (2) whether or not the intake occurred within the agreed-upon time period (correct timing). Multilevel logistic regression analyses were performed to account for the nested structure of the data. RESULTS: Medication intakes in the evening and during weekends and holidays were more likely to be incorrectly timed and also more likely to be completely missed. Irrespective of timing, most intakes occurred in the mornings of Monday through Thursday (96 %), and least intakes occurred on Saturday evening (82 %). Correctly timed intakes most often occurred on Monday and Tuesday mornings (61 %) in contrast to Sunday evenings (33 %). A patient's medication regimen was significantly associated with adherence. CONCLUSION: Based on our results, among patients who already have difficulties in taking their oral antidiabetic medication, interruptions in the daily routine negatively influence the intake of their medication. Professionals need to be aware of this variation in adherence within patients. As regular medication intake is important to maintain glycaemic control, healthcare professionals and patients should work together to find strategies that prevent deviations from the prescribed regimen at these problematic dosing times.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Monitoramento de Medicamentos/métodos , Hipoglicemiantes/uso terapêutico , Adesão à Medicação , Análise Multinível , Administração Oral , Equipamentos e Provisões Elétricas , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
6.
Osteoarthritis Cartilage ; 18(8): 1019-26, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20488250

RESUMO

OBJECTIVE: To determine if behavioral graded activity (BGA) results in better long-term effectiveness (5 years after inclusion) than usual exercise therapy (UC; usual care) in patients with osteoarthritis (OA) of the hip or knee. METHOD: Long-term follow-up study of a single blind cluster randomized trial comparing BGA and UC. One hundred and forty-nine patients out of the 200 included were followed until 60 months' follow-up. Primary outcome measures were pain, physical function, and patient global assessment. Furthermore, patient-oriented physical function, physical performance, health care utilization and the number of joint replacement surgeries were assessed. Assessments took place at 3, 9, 15 and 60 months' follow-up. Data were analyzed according to intent-to-treat principle. RESULTS: Both treatments showed beneficial within-groups effects in the long-term. In patients with knee OA no differences between treatments were found on the short-, mid-long and long-term. In patients with hip OA significant differences in favor of BGA were found at 3 months' (pain and physical performance) and 9 months' follow-up (pain, physical function, patients global assessment and patient-oriented physical function). Furthermore, UC resulted in patients with hip OA in more joint replacement surgeries compared to BGA (hazard ratio [HR], 2.87; 95% confidence interval [CI], 1.1; 7.3). CONCLUSION: No differences between treatment groups were found in the long-term on the primary outcome measures. Although more research is needed to confirm the study findings, the results indicate that BGA reduces the risk for joint replacement surgeries compared to UC in patients with hip OA, which probably can be explained by better outcome in favor of BGA in the short- and mid-long-term.


Assuntos
Terapia por Exercício/métodos , Osteoartrite do Quadril/terapia , Osteoartrite do Joelho/terapia , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Medição da Dor , Estatística como Assunto , Fatores de Tempo , Resultado do Tratamento
7.
Methods Inf Med ; 47(2): 98-106, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18338080

RESUMO

OBJECTIVES: In this study, we evaluated the internal validity of EPICON, an application for grouping ICPC-coded diagnoses from electronic medical records into episodes of care. These episodes are used to estimate morbidity rates in general practice. METHODS: Morbidity rates based on EPICON were compared to a gold standard; i.e. the rates from the second Dutch National Survey of General Practice. We calculated the deviation from the gold standard for 677 prevalence and 681 incidence rates, based on the full dataset. Additionally, we examined the effect of case-based reasoning within EPICON using a comparison to a simple, not case-based method (EPI-0). Finally, we used a split sample procedure to evaluate the performance of EPICON. RESULTS: Morbidity rates that are based on EPICON deviate only slightly from the gold standard and show no systematic bias. The effect of case-based reasoning within EPICON is evident. The addition of case-based reasoning to the grouping system reduced both systematic and random error. Although the morbidity rates that are based on the split sample procedure show no systematic bias, they do deviate more from the gold standard than morbidity rates for the full dataset. CONCLUSIONS: Results from this study indicate that the internal validity of EPICON is adequate. Assuming that the standard is gold, EPICON provides valid outcomes for this study population. EPICON seems useful for registries in general practice for the purpose of estimating morbidity rates.


Assuntos
Inteligência Artificial , Medicina de Família e Comunidade/estatística & dados numéricos , Sistemas Computadorizados de Registros Médicos/estatística & dados numéricos , Morbidade , Vigilância da População/métodos , Humanos , Incidência , Classificação Internacional de Doenças/estatística & dados numéricos , Países Baixos/epidemiologia , Prevalência , Reprodutibilidade dos Testes
8.
Eur J Gynaecol Oncol ; 27(1): 42-6, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16550967

RESUMO

OBJECTIVE: To investigate the six-month recommended follow-up after mass screening of Pap smears because of the absence of endocervical columnar cells (ECC-) or ECC+ smears with atypical squamous or glandular cells of undetermined origin (ASCUS/AGUS) or low-grade squamous or glandular intraepithelial lesions (LSIL/LGIL) in a Dutch mass screening cervical cancer programme. METHODS: Data were extracted from computerised medical records of national representative Dutch general practices. We have studied the attendance at and the outcome of the subsequent Pap smears after a 6-month recommendation. RESULTS: The six-month follow-up was linked to 8.7% of the Pap smears (n = 1,002); 77.6% were without endocervical columnar cells (ECC-). Clear differences were found between the follow-up of ECC+ and ECC- smears; after 36 weeks of follow-up of 43.5% the women had an ECC- smear and 66.9% had other conditions. For initial ECC- Pap smears, 84.1% had no abnormalities in the subsequent Pap smear; for initial ECC+ Pap smears, in about 64% of the cases no abnormalities were found (p < 0.0001). CONCLUSIONS: Repeating ECC- smears has a low follow-up rate but also lacks evidence-based necessity. However, for the other 6-month recommended Pap smears, one in five women had still not responded within one year, so improvement is necessary.


Assuntos
Colo do Útero/citologia , Programas de Rastreamento/normas , Teste de Papanicolaou , Displasia do Colo do Útero/patologia , Neoplasias do Colo do Útero/patologia , Esfregaço Vaginal/normas , Adulto , Idoso , Colo do Útero/patologia , Estudos de Coortes , Citodiagnóstico/métodos , Feminino , Seguimentos , Humanos , Programas de Rastreamento/tendências , Pessoa de Meia-Idade , Avaliação das Necessidades , Cooperação do Paciente/estatística & dados numéricos , Sistema de Registros , Medição de Risco , Sensibilidade e Especificidade , Fatores de Tempo , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Esfregaço Vaginal/tendências
9.
Ned Tijdschr Geneeskd ; 160: D983, 2016.
Artigo em Holandês | MEDLINE | ID: mdl-28074738

RESUMO

OBJECTIVE: The objective of this study was to examine mental health care provided by general practitioners and by mental health nurses working in general practices. DESIGN: Observational research. METHOD: We analysed how many consultations with patients with mental health problems were recorded in Dutch general practices in the period 2010-2014. General practices with and without a mental health nurse were compared, and we investigated which patients were mainly treated by mental health nurses. RESULTS: An increasing number of patients visited the GP for mental health problems in the period 2010-2014. GPs collaborating with a mental health nurse recorded a somewhat higher number of patients with mental health problems than GPs without a mental health nurse, but used as many consultations per patient. Mental health nurses mainly treat females, adult patients, and patients with common mental health problems. CONCLUSION: Mental health nurses do not take over care from GPs, but provide additional mental health care to patients with mental health problems. Collaborating with a mental health nurse might increase GPs' alertness to record mental health problems.


Assuntos
Medicina de Família e Comunidade/métodos , Medicina Geral/métodos , Clínicos Gerais/psicologia , Transtornos Mentais/enfermagem , Saúde Mental , Enfermagem Psiquiátrica , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos
10.
J Epidemiol Community Health ; 54(4): 306-13, 2000 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-10827914

RESUMO

OBJECTIVE: Many studies show the average health status in deprived areas to be poorer and the use of health care to be higher, but there is hardly any information on the impact of the geographical classification on the size of these differences. This study examines the impact of the geographical classification on the clustering of poor health per area and on the size of the differences in health by area deprivation. DESIGN: Data on self reported health regarding 5121 people were analysed using three classifications: neighbourhoods, postcode sectors and boroughs. Multilevel logistic models were used to determine the clustering of poor health per area and the size of the differences in health by area deprivation, without and subsequently with adjustment for individual socioeconomic status. SETTING: General population aged 16 years and over of Amsterdam, The Netherlands. MAIN OUTCOME MEASURES: Self rated health, mental symptoms (General Health Questionnaire, 12-item version), physical symptoms and long term functional limitations. MAIN RESULTS: The clustering of poor health is largest in neighbourhoods and smallest in postcode sectors. Health differences by area deprivation differ only slightly for the three geographical classifications, both with and without adjustment for individual socioeconomic status. CONCLUSIONS: In this study, the choice of the geographical classification affects the degree of clustering of poor health by area but it has hardly any impact on the size of health differences by area deprivation.


Assuntos
Nível de Saúde , Áreas de Pobreza , Pobreza/estatística & dados numéricos , Adolescente , Adulto , Idoso , Análise por Conglomerados , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Países Baixos , Fatores Socioeconômicos
11.
J Epidemiol Community Health ; 52(8): 487-93, 1998 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-9876359

RESUMO

STUDY OBJECTIVE: Urban-rural health differences are observed in many countries, even when socioeconomic and demographic characteristics are controlled for. People living in urban areas are often found to be less healthy. One of the possible causes for these differences is selective migration with respect to health or health risk factors. This hypothesis is hardly ever empirically tested. This paper tries to assess the existence of selective urban-rural migration. DESIGN: Health indicators and health risk factors were measured in a 1991 population sample. Moves were registered between 1991 and 1995. Using logistic regression analyses, comparisons were made between, firstly, urban to rural movers and rural to urban movers and secondly, between movers and stayers. SETTING: Region surrounding the city of Eindhoven in south eastern part of the Netherlands. SUBJECTS: Data were used of 15,895 respondents aged 20-74 in 1991. By 1995 613 subjects had moved from urban to rural and 191 subjects from rural to urban. MAIN RESULTS: Bivariate nor multivariate analyses show hardly and differences between movers into urban and movers into rural areas. Bivariate analyses on movers and stayers show that movers are healthier than stayers. However, when socioeconomic and demographic variables are controlled for, movers appear to be less healthy, with the exception of the younger age groups. CONCLUSIONS: Areas that attract many migrants from and lose few migrants to other degrees of urbanicity will in the long run obtain healthier populations, because of demographic and socioeconomic characteristics. However, if these characteristics are accounted for, the opposite is true, with the exception of younger age groups. In extreme cases this may cause spurious findings in cross sectional research into the relation between urbanicity and health. Absolute numbers of migrants need to be very high, however, to make this noticeable at the aggregate level.


Assuntos
Saúde da População Rural/estatística & dados numéricos , Migrantes , Saúde da População Urbana/estatística & dados numéricos , Adulto , Idoso , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Vigilância da População
12.
Br J Gen Pract ; 44(382): 205-10, 1994 May.
Artigo em Inglês | MEDLINE | ID: mdl-8204333

RESUMO

AIM: This study set out to examine the degree to which women choose to visit a woman doctor for women's health problems and the determinants of this choice. The differences between women and men doctors with regard to treating women's health problems were also studied. METHOD: Data from the Dutch national survey of general practice were used. All group practices with both women and men general practitioners were selected. Analyses were restricted to consultations among women aged 15-65 years about menstruation, the menopause, vaginal discharge, breast examination and cervical smear tests. RESULts. Given the size of their female practice population, women doctors saw considerably more women with women's health problems than did their male colleagues. Women were more likely to consult a woman general practitioner if she was more available (that is, working longer hours), and younger women were more likely than older women to choose women general practitioners. Sex differences in the treatment of women's health problems were small and mainly related to the verbal part of the consultation: counselling and providing information. The doctors' availability and their certainty about the working diagnosis explained differences in the verbal aspects of consultations. Women general practitioners had longer consultations than their male colleagues mainly because more health problems were presented per consultation. CONCLUSION: In order to increase the possibility of patients choosing women general practitioners, policy should be directed towards the education of more women general practitioners and women general practitioners should be encouraged to work more days a week.


Assuntos
Medicina de Família e Comunidade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Médicas/estatística & dados numéricos , Mulheres/psicologia , Adulto , Agendamento de Consultas , Feminino , Humanos , Países Baixos , Satisfação do Paciente , Relações Médico-Paciente , Encaminhamento e Consulta , Fatores Sexuais , Saúde da Mulher
13.
Health Policy ; 13(1): 55-64, 1989 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-10296155

RESUMO

Strengthening district-level primary health care systems has high priority in the WHO's 'Health for All' strategy. This article reviews governmental efforts to implement district health care systems in the Netherlands. Up to 1987, these activities corresponded to the WHO objectives, but their impact was limited. In 1987, government policy drifted away from these goals; the regulation of market forces and the increased influence of financing institutions have replaced planning by local government. Attempts to implement the district concept have, in fact, set primary health care planning back without offering the prospect of a leap forward.


Assuntos
Política de Saúde , Atenção Primária à Saúde , Regionalização da Saúde/organização & administração , Área Programática de Saúde , Países Baixos
14.
Health Policy ; 58(2): 99-119, 2001 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-11551661

RESUMO

UNLABELLED: An important aim of the government's quality policy is to stimulate quality management (QM) in health care organizations. The relationship between the government's quality policy and QM in health care organizations is unknown. This article explores that relationship by comparing two countries with different quality policies, The Netherlands and Finland. In The Netherlands QM is required by law and health care is organized at national level. In Finland, QM is not required by law and the responsibilities for organizing health care are delegated to the municipalities. The question is whether or not these differences in national policy are reflected in the extent and effectiveness of QM in health care organizations in the two countries. A cross sectional survey was conducted in late 1999. Data about QM in both countries were gathered by questionnaire. The subsectors involved were hospitals, care for the disabled and care for the elderly. A total of 1172 health care organizations participated in the study (response rate 64%). The results show that-in keeping with our hypothesis-slightly more QM-activities and more patient participation were found in Dutch health care organizations compared with the Finnish ones. However, contrary to our expectations, the Finnish organizations reported more perceived effects of their QM-activities. Further analyses showed that some QM-activities are more closely related to the effectiveness of QM than others. In particular, cyclic quality improvement procedures, human resource management and the flexible attitude of employees showed the strongest relationship with the perceived effects of QM. The difference between the national approach in The Netherlands and the decentralized approach in Finland did not, as we had assumed, result in more regional variation in QM in Finland. CONCLUSIONS: a government's quality policy may have some influence on the extent of QM in health care organizations. However, more QM-activities do not necessarily imply more effects. RECOMMENDATIONS: since QM-activities differ in the degree to which they bring about changes and improvements in care, it is recommended that policy makers promote those QM-activities, which are the most potent, in order to improve the quality of care.


Assuntos
Política de Saúde/legislação & jurisprudência , Gestão da Qualidade Total/legislação & jurisprudência , Idoso , Comparação Transcultural , Estudos Transversais , Finlândia , Pesquisas sobre Atenção à Saúde , Serviços de Saúde para Idosos/normas , Administração Hospitalar/normas , Humanos , Países Baixos , Participação do Paciente , Formulação de Políticas , Política , Reabilitação/normas , Inquéritos e Questionários , Gestão da Qualidade Total/organização & administração , Gestão da Qualidade Total/estatística & dados numéricos
15.
Health Policy ; 42(3): 255-67, 1997 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-10176304

RESUMO

The implementation of quality systems in Dutch health care was supervised by a national committee during 1990-1995. To monitor the progress of implementation a large survey was conducted in the beginning of 1995. The survey enclosed all subsectors in health care. A postal questionnaire--derived from the European Quality Award--was sent to 1594 health care institutions; the response was 74%. The results showed that in 13% of the institutions a coherent quality system had been implemented. These institutions reported, among other effects, an increase in staff effort and job satisfaction despite the increased workload; 59% of the institutions had implemented parts of a quality system. It appeared that management pay more attention to human resource management compared to documentation of the quality system. The medical staff pay relatively more attention to protocol development than to quality-assurance procedures. Patients were hardly involved in these quality activities. The research has shown that it is possible to monitor the progress of implementation of quality systems on a national level in all subsectors of health care. The results play an important role in the discussions and policy on quality assurance in health care.


Assuntos
Instalações de Saúde/normas , Programas Nacionais de Saúde/normas , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Coleta de Dados , Guias como Assunto , Humanos , Satisfação no Emprego , Países Baixos , Participação do Paciente , Gestão de Recursos Humanos , Formulação de Políticas , Inquéritos e Questionários
16.
Qual Health Care ; 10(4): 211-7, 2001 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11743149

RESUMO

BACKGROUND: The need for quality improvement and increasing concern about the costs and appropriateness of health care has led to the implementation of quality systems in healthcare organisations. In addition, nursing homes have made significant investments in their development. The effects of the implementation of quality systems on health related outcomes are not yet clear. OBJECTIVE: To examine evidence in the literature on whether quality systems have an impact on the care process and the satisfaction and health outcomes of long term care residents. METHODS: Review of the literature. RESULTS: The 21 empirical studies identified concerned quality system activities such as the implementation of guidelines; providing feedback on outcomes; assessment of the needs of residents by means of care planning, internal audits and tuition; and an ombudsman for residents. Only four articles described controlled studies. The selected articles were grouped according to five focal areas of quality. The opinion of residents was seldom used to evaluate the effectiveness of quality systems. The effects on care processes and the health outcomes of long term care residents were inconsistent, but there was some evidence from the controlled studies that specific training and guidelines can influence the outcomes at the patient level. CONCLUSIONS: The design of most of the studies meant that it was not possible to attribute the results entirely to the newly implemented quality system. As it is difficult in practice to design a randomised controlled study, future research into the effectiveness of quality systems should not only focus on selected correlates of quality, but should also include a qualitative and quantitative (multivariate and multilevel) approach. The methods used to measure quality need to be improved.


Assuntos
Assistência de Longa Duração/normas , Casas de Saúde/normas , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Idoso , Estudos de Avaliação como Assunto , Fidelidade a Diretrizes , Pesquisa sobre Serviços de Saúde , Humanos , Auditoria Administrativa , Auditoria Médica , Países Baixos , Casas de Saúde/organização & administração , Avaliação de Resultados em Cuidados de Saúde
17.
Health Place ; 5(1): 83-97, 1999 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-10670993

RESUMO

An increasing number of people are using alternative medical care. The literature suggests that there are important between place variations, however. This paper tries to assess the extent of these variations and mechanisms behind them for the utilization of homeopathy, paranormal healing and manual therapy. Are these variations a matter of level of supply, degree of urbanization, GP characteristics or simply a matter of composition of populations? Data are derived from the Dutch National Surgery of General Practice and analyzed using multilevel logistic regression models. Between place variation in utilization of homeopathy is mainly a matter of composition of populations with respect to health locus of control and religion. With respect to paranormal healing, it is exclusively a matter of religion. With respect to manual therapy, place variations are a matter of individual, GP, as well as area characteristics, but a relatively large amount remains unexplained.


Assuntos
Terapias Complementares/estatística & dados numéricos , Meio Social , Atitude do Pessoal de Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Países Baixos , Atenção Primária à Saúde/estatística & dados numéricos , Fatores Socioeconômicos
18.
Qual Manag Health Care ; 9(4): 63-76, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11499352

RESUMO

The aim of the study was to obtain more insight into the organizational and environmental determinants of the implementation of quality management in health care organizations. Primary survey data were collected in 1995 in a large nationwide study within 15 fields of health care and health care-related social services in The Netherlands. In general, there are more differences between health care organizations than between fields of health care. Environmental influence was found to be less important than was expected. Care-oriented organizations have a greater opportunity to involve their patients. It seems that apart from patients, the perceived pressure from other third parties has little influence on the implementation of quality management in health care organizations.


Assuntos
Administração de Serviços de Saúde/normas , Gestão da Qualidade Total/estatística & dados numéricos , Estudos Transversais , Tomada de Decisões Gerenciais , Fiscalização e Controle de Instalações , Pesquisas sobre Atenção à Saúde , Humanos , Modelos Estatísticos , Países Baixos , Meio Social , Inquéritos e Questionários , Gestão da Qualidade Total/organização & administração
19.
Tijdschr Gerontol Geriatr ; 26(2): 71-9, 1995 Apr.
Artigo em Holandês | MEDLINE | ID: mdl-7740603

RESUMO

Based on Dutch nationally representative data, this article reports on the number of psychological and social problems that residents of homes for the elderly (n = 2893) present to their general practitioner (GP). Furthermore, the number of encounters residents with psychological or social problems have with the general practice and the interventions which the GP applies are described. A comparison is made with elderly patients living independently (n = 28056). In a three-month period the GP found psychological problems in 33 per cent of the patients from homes for the elderly. For elderly patients living independently this was 17%. Controlling for background variables the patients from homes for the elderly still show considerably more psychological problems. Social problems are reported less frequently to GP's; 8% of patients from homes for the elderly and 5% of patients living independently report these problems. After controlling for background variables no statistically significant differences were found. The most frequently used intervention is the prescription of drugs. In both groups almost 80% of the respondents received drugs. Referral to mental health care is the least frequently used intervention. Many patients living in homes for the elderly have psychological or social problems. This implies a high workload for the GP. However, no evidence is found that GP's treat their patients in homes for the elderly differently from those living independently.


Assuntos
Transtornos Mentais/diagnóstico , Médicos de Família , Problemas Sociais , Idoso , Idoso de 80 Anos ou mais , Prescrições de Medicamentos , Feminino , Instituição de Longa Permanência para Idosos , Humanos , Estilo de Vida , Masculino , Transtornos Mentais/terapia , Assistência Individualizada de Saúde/estatística & dados numéricos , Papel do Médico
20.
Int J Integr Care ; 13: e055, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24399924

RESUMO

INTRODUCTION: In the Netherlands, bundled payments were introduced as part of a strategy to redesign chronic care delivery. Under this strategy new entities of health care providers in primary care are negotiating with health insurers about the price for a bundle of services for several chronic conditions. This study evaluates the level of involvement of primary health care dietitians in these entities and the experienced advantages and disadvantages. METHODS: In August 2011, a random sample of 800 Dutch dietitians were invited by email to complete an online questionnaire (net response rate 34%). RESULTS: Two-thirds participated in a diabetes disease management programme, mostly for diabetes care, financed by bundled payments (n=130). Positive experiences of working in these programmes were an increase in: multidisciplinary collaboration (68%), efficiency of health care (40%) and transparency of health care quality (25%). Negative aspects were an increase in administrative tasks (61%), absence of payment for patients with comorbidity (38%) and concerns about substitution of care (32%). DISCUSSION/CONCLUSION: Attention is needed for payment of patients with co- or multi-morbidity within the bundled fee. Substitution of dietary care by other disciplines needs to be further examined since it may negatively affect the quality of treatment. Task delegation and substitution of care may require other competencies from dietitians. Further development of coaching and negotiation skills may help dietitians prepare for the future.

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