The experience of non-conveyance following emergency medical service triage from the perspective of patients and their relatives: A qualitative study.

BACKGROUND: As many as 25% of all Dutch ambulance emergency service assignments result in non-conveyance of the patient to the hospital. Little is known about how patients and their relatives experience being left at home by an ambulance nurse after an acute request for medical help. AIM: To gain insight into the experience of patients and their relatives with a high urgency request for ambulance assistance that results in non-conveyance, with the ultimate goal of offering adequate follow-up. METHOD: A qualitative design based on semi-structured interviews with fifteen patients and seven relatives, conducted between September and November 2018. RESULTS: Four themes emerged from the thematic analysis: Fear as the prominent emotion, four components of confidence in decision-making, different consequences and coping between patient and relative(s) over time and the perceived need for evaluation afterwards. CONCLUSION: The experience after non-conveyance has several phases in which fear, reassurance, confirmation (for relatives) and shame (for patients) follow each other throughout the care process. Complex interpersonal skills of ambulance nurses congruent with the concept of person-centred care can modulate this impact. These findings offer starting points for the optimisation of training programmes within the ambulance care sector.

Reconsideration of the scheme of the international classification of functioning, disability and health: incentives from the Netherlands for a global debate.

PURPOSE: The ICF (International Classification of Functioning, Disability and Health) framework (used worldwide to describe 'functioning' and 'disability'), including the ICF scheme (visualization of functioning as result of interaction with health condition and contextual factors), needs reconsideration. The purpose of this article is to discuss alternative ICF schemes. METHOD: Reconsideration of ICF via literature review and discussions with 23 Dutch ICF experts. Twenty-six experts were invited to rank the three resulting alternative schemes. RESULTS: The literature review provided five themes: 1) societal developments; 2) health and research influences; 3) conceptualization of health; 4) models/frameworks of health and disability; and 5) ICF-criticism (e.g. position of 'health condition' at the top and role of 'contextual factors'). Experts concluded that the ICF scheme gives the impression that the medical perspective is dominant instead of the biopsychosocial perspective. Three alternative ICF schemes were ranked by 16 (62%) experts, resulting in one preferred scheme. CONCLUSIONS: There is a need for a new ICF scheme, better reflecting the ICF framework, for further (inter)national consideration. These Dutch schemes should be reviewed on a global scale, to develop a scheme that is more consistent with current and foreseen developments and changing ideas on health. Implications for Rehabilitation We propose policy makers on community, regional and (inter)national level to consider the use of the alternative schemes of the International Classification of Functioning, Disability and Health within their plans to promote functioning and health of their citizens and researchers and teachers to incorporate the alternative schemes into their research and education to emphasize the biopsychosocial paradigm. We propose to set up an international Delphi procedure involving citizens (including patients), experts in healthcare, occupational care, research, education and policy, and planning to get consensus on an alternative scheme of the International Classification of Functioning, Disability and Health. We recommend to discuss the alternatives for the present scheme of the International Classification of Functioning, Disability and Health in the present update and revision process within the World Health Organization as a part of the discussion on the future of the International Classification of Functioning, Disability and Health framework (including ontology, title and relation with the International Classification of Diseases). We recommend to revise the definition of personal factors and to draft a list of personal factors that can be used in policy making, clinical practice, research, and education and to put effort in the revision of the present list of environmental factors to make it more useful in, e.g., occupational health care.

Fostering functioning of workers: A new challenge for prevention in occupational health.

Given large changes in working conditions and society, occupational health care has to prioritize its efforts towards fostering health and functioning of workers and as such promote work participation. This requires that more emphasis is given on the application of biopsychological models in the care of workers. Although a biopsychological approach is often mentioned as essential part of occupational health care, it's application is often hampered in practice, by practical barriers and lack of practical knowledge. This is illustrated by a study that uncovered facilitating and hindering factors in the implementation process of a preventive strategy, proven effective in reducing the risk of long term sickness absence. To facilitate the use of biopsychological models in occupational health care, it is shown that setting up a training curriculum is possible, based on the International Classification of Functioning, Disability and Health (ICF) grafted on available training in evidence based practice skills is possible. Furthermore, there is a need for elaboration of the personal factors relevant for workers and the relevant work-related environmental factors to support practical application of ICF in occupational health care. A paradigm shift in occupational health care can facilitate widespread implementation of the biopsychosocial approach in occupational health and may stimulate occupational health professionals to further integrate this approach in their daily practice.

Elaboration of the contextual factors of the ICF for Occupational Health Care.

BACKGROUND: Many work-related items are not included in the current classification of environmental factors from the International Classification of Functioning, Disability and Health (ICF). Furthermore, personal factors are not classified and the ICF only provides a very limited list of examples. These facts make the ICF less useful for occupational health care and for research in the field of occupation and health. OBJECTIVE: The objective of this discussion paper is to introduce an elaboration of contextual factors, focussing on factors that influence work participation. METHODS: During the last 12 years, we developed two concept lists from the bottom up. These lists are based on our experiences in teaching and research, suggestions from students and other researchers, and factors found in the literature. In the fall of 2015 a scoping literature review was done to check for missing factors in these two concept lists. RESULTS: An elaboration of contextual factors, consisting of a list of work-related environmental factors and a list of personal factors. CONCLUSIONS: Important contextual factors that influence work participation are identified. Researchers, teachers, students, occupational and insurance physicians, allied health care professionals, employers, employees, and policy makers are invited to use the elaboration and to make suggestions for improvement. The elaboration and the suggestions received can be used in the ICF revision process. The development of an ICF ontology must be given priority, to give room to this elaboration, which will increase the applicability of the ICF and enable mapping with other terminologies and classifications.

Experiences of occupational physicians with the implementation of indicated prevention for long term sickness absence.

BACKGROUND: Functioning including work participation, is an emerging challenge in occupational health. The prevention of long term sickness absence (LTSA) through a strategy involving screening and structured early consultation (preventive strategy) was proven effective and can address participation issues. Implementation of this strategy has proven difficult. OBJECTIVE: The aim of this study is to investigate the experiences of occupational physicians (OPs) delivering a structured early consultation to office workers, in order to enhance implementation of the strategy. METHODS: In this case study, a mixed method design was used. Interviews and surveys were conducted to obtain an in-depth picture of OPs experiences. RESULTS: Factors hindering implementation in relation to the OPs were difficulties in communicating the risk of future sick leave, prioritization of other tasks, maintaining a reactive approach due to work pressure, preference for prevention on the level of the work environment, privacy issues related to labeling workers to have mental or psychosocial issues, and the biomedical model being the mental model in use. CONCLUSIONS: Implementation of the preventive strategy seems to require a more profound focus on the biopsychosocial approach. Training of relevant skills is important to achieve a focus on prevention and fostering health over the lifespan.

Implementing the ICF in Occupational Health; building a curriculum as an exemplary case.

BACKGROUND: This paper addresses the need for a paradigm shift from post-diagnosis tertiary care towards maintenance and promotion of health across the lifespan, for healthcare in general and in occupational healthcare specifically. It is based on the assumption that the realization of this paradigm shift may be facilitated by teaching (future) occupational health professionals to use the International Classification of Functioning, Disability and Health (ICF). OBJECTIVE: Describing the development of a an ICF based occupational health curriculum. METHODS: Grafting a training trajectory in the ICF for educating the biopsychosocial health paradigm, onto a training trajectory in the Critical Appraisal of a Topic (CAT), a method for teaching evidence based practice skills. RESULTS: The development process of the training trajectories in the master program Work, Health, and Career at Maastricht University is described as an example of an intervention for shifting the paradigm in healthcare curricula. The expected results are a shift from the biomedical towards the biopsychosocial paradigm, a reductionist approach towards a more holistic view on cases, a reactive way of working towards a more proactive work style, and from using a merely quantifiable evidence base towards using a broad evidence base. CONCLUSIONS: Incorporating the biopsychosocial paradigm into the assessment and scientific reasoning skills of students is not only valuable in occupational healthcare but might be a valuable approach for all disciplines in healthcare for which contextual factors are important e.g. rehabilitation, psychiatry and nutritional science.

The applicability of the international classification of functioning, disability, and health to study lifestyle and quality of life of colorectal cancer survivors.

BACKGROUND: Well-designed studies on lifestyle and health-related quality of life (HRQoL) in colorectal cancer survivors based on a biopsychosocial instead of a traditional biomedical approach are warranted. We report on the applicability of the International Classification of Functioning, Disability, and Health (ICF) as useful biopsychosocial framework to improve research on how lifestyle influences colorectal cancer survivors' HRQoL, using the Energy for life after ColoRectal cancer (EnCoRe) study as an example. METHODS: The ICF was used to develop a conceptual model for studying lifestyle and colorectal cancer survivors' HRQoL, by identifying relevant factors from literature and mapping them within the ICF. Subsequently, this model was used for selection of measurement instruments and biomarkers. By linking meaningful concepts within selected measures to the ICF, we could assess the ICF coverage of our developed conceptual model. RESULTS: Within selected measures, 450 meaningful concepts were identified, of which 88% were linked to the ICF. The linking process resulted in 132 distinctive ICF categories assigned (38% within "Body Functions," 2% within "Body Structures," 46% within "Activities and Participation," and 14% within "Environmental Factors"). CONCLUSIONS: The selected EnCoRe study measures broadly cover ICF domains relevant to colorectal cancer survivors, stressing the relevance of using a biopsychosocial approach for studying this population's HRQoL. IMPACT: The developed conceptual model will guide data analyses and interpretation, and facilitate early transfer of results for development, evaluation, and implementation of personalized multidisciplinary lifestyle interventions. We recommend the ICF as an invaluable framework for improving the quality and scope of HRQoL studies.