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Ned Tijdschr Geneeskd ; 1652021 Oct 07.
Artigo em Holandês | MEDLINE | ID: mdl-34854629


The coronacrisis was a serious threat for health care and society. By its complexity and deep uncertainty the pandemic showed that patients, physicians and health care need more resilience and flexibility to manage similar future stressors. Moreover, the pandemic uncovered growing disparities in health among citizens, the close links between health care and other societal domains and the fact that we still have only limited power to manage complex new challenges for our global health. We have to adopt another way of managing health care and society to get grip on similar complex medical problems, which we will probably have to face in the future as well. Physicians cannot manage these by themselves. Governments also have to act to diminish social inequality, and create incentives for interdisciplinary collaboration, which together may make citizens and professionals experience coherent and resilient health care management.

Ned Tijdschr Geneeskd ; 1652021 Sep 16.
Artigo em Holandês | MEDLINE | ID: mdl-34854637


The negative OPERAM study results, which are in line with recent trials and reviews, warn against expecting positive patient related outcomes from single standardized medication reviews in all patients with polypharmacy admitted to hospital. The big underlying problem is the enormous heterogeneity of patients with polypharmacy. However, it remains possible that a personalized medication review in well selected vulnerable patients can have positive effects, especially if the review is integrated in a linked hospital and general practice medication policy. Thus, there also is sufficient evidence to stop conducting a one size fits all drug review randomized trials on polypharmacy, but we need pragmatic trials with smart selection of patient with polypharmacy-related health problems, whose personalized and transmural medication guidance may still contribute to positive outcomes of integrated care innovations, especially when the outcomes can be personalized as well.

Age Ageing ; 50(6): 1997-2003, 2021 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-34673884


BACKGROUND: Emergency physicians (EPs) provide care to older adults with complex health problems. Treating these patients is challenging for many EPs, which might originate from modest geriatric education. OBJECTIVE: Our aim was to assess EPs' self-perceived needs regarding geriatric emergency medicine (GEM) education, factors determining these needs and the utilization of this education. Our secondary aim was to assess emergency department (ED) managers' view and support for GEM education. METHODS: All EPs and ED managers in the Netherlands received a survey by e-mail. The questionnaires focused on EPs' needs in GEM education, EPs' utilization of GEM education and managerial support for GEM education. We used descriptive statistics to analyse needs, utilization of- and support for GEM education. Regression analyses were used to identify factors associated with EPs' need for GEM education. RESULTS: EPs reported to need better training in diagnosing, treating and communicating with older adults. Seventy percent of EPs reported no GEM education program in their hospital, and 83% reported no utilization of GEM education outside their hospital. EPs working in EDs with a possibility for geriatric consultation, and EPs aware of actual GEM education programs, had lower educational needs. Of responding managers, 86.2% reported the care for older adults as an important topic; lack of finances and time were obstacles to provide GEM education for EPs. CONCLUSION: EPs in the Netherlands feel insufficiently educated to treat older adults. ED managers largely recognize this educational challenge. This nationwide survey underlines the need to prioritize GEM education for EPs.

Medicina de Emergência , Geriatria , Médicos , Idoso , Serviço Hospitalar de Emergência , Humanos , Inquéritos e Questionários